title: Multidetector-row computed tomography (MDCT) in patients with a history of previous urothelial cancer or painless macroscopic haematuria.
abstract: The sensitivity and specificity of MDCT for depiction and localization of urothelial carcinoma (UC) was determined retrospectively. Axial and coronal four-row MDCT of the urinary tract (unenhanced, contrast-enhanced nephrographic, CT urography) was independently reviewed for UC by a radiologist (R1) and a urologist (R2), without other patient information, in 27 patients (22 male, five female; age, 72 +/- 11 years) with previous UC and/or painless macroscopic haematuria. Urinary tract segments included bladder, right and left upper, middle, and lower caliceal groups, renal pelvis, uretero-pelvic junction, upper, middle, and lower ureter. MDCT findings were corroborated by surgery, other invasive procedures, and 1-year follow-up, including MDCT, intravenous urography, and cystoscopy. Receiver-operating characteristic analysis was undertaken and the the area under the curve (AUC) calculated. Eighteen of 27 patients had evidence of UC (pTa, n = 3; pT1-pT3, n = 15; TNM 2002). Tumor was correctly located by both R1 and R2 in 17 patients (sensitivity, 94%; 95% confidence interval, 84-100%) and ruled out in seven (specificity, 78%; 95% confidence interval, 51-100%), with complete agreement. Each detected ten of 11 upper urinary tracts affected by UC. For 35 urinary tract segments with UC and 308 without, the AUC was 0.910 +/- 0.035 (R1) and 0.74 +/- 0.055 (R2), z = 2.4772, Bonferroni-corrected P = 0.022. MDCT depicts urinary tracts affected by UC with high sensitivity and substantial agreement between readers with different training.
authors.affiliation: Department of Clinical Radiology, University of Munich, Ziemssenstrasse 1, 80336, Muenchen, Germany. Ullrich.Mueller-Lisse@med.uni-muenchen.de
authors.forename: Ullrich G
authors.initials: UG
authors.lastname: Mueller-Lisse
authors.forename: Ulrike L
authors.initials: UL
authors.lastname: Mueller-Lisse
authors.forename: Josef
authors.initials: J
authors.lastname: Hinterberger
authors.forename: Peter
authors.initials: P
authors.lastname: Schneede
authors.forename: Thomas
authors.initials: T
authors.lastname: Meindl
authors.forename: Maximilian F
authors.initials: MF
authors.lastname: Reiser
mesh_terms: D000368:Aged; D019540:Area Under Curve; D002277:Carcinoma / Q000150:complications* / Q000473:pathology*; D005260:Female; D006417:Hematuria / Q000150:complications* / Q000175:diagnosis / Q000473:pathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012372:ROC Curve; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed / Q000379:methods*; D001743:Urinary Bladder / Q000473:pathology; D014551:Urinary Tract / Q000473:pathology; D014571:Urologic Neoplasms / Q000150:complications* / Q000175:diagnosis / Q000473:pathology*; D019459:Urothelium / Q000473:pathology*