Small (<2-cm) upper-tract urothelial carcinoma: evaluation with gadolinium-enhanced three-dimensional spoiled gradient-recalled echo MR urography.
OBJECTIVE
To retrospectively evaluate the detection of small (<2-cm) urothelial tumors by using gadolinium-enhanced three-dimensional (3D) spoiled gradient-recalled echo (GRE) magnetic resonance (MR) urography.


METHODS
This HIPAA-compliant study received institutional review board approval. All patients included had previously consented to the use of their medical records for research purposes. Eleven of 110 patients (10 men, one woman; mean age, 73.5 years) who underwent MR urography were ultimately identified to have 23 upper-tract urothelial carcinomas smaller than 2 cm or carcinoma in situ. Breath-hold coronal T2-weighted single-shot fast spin-echo and breath-hold coronal 3D T1-weighted spoiled GRE images with fat suppression during nephrographic and excretory phases after intravenous injection of gadolinium-based contrast material were obtained in all patients with a 1.5-T imager. Two radiologists reviewed the MR images in consensus for the presence of tumors. Lesion detectability was compared between each sequence by using the McNemar test.


RESULTS
Of 23 tumors, 17 (74%) were detected by using at least one sequence, eight (35%) were detected with T2-weighted imaging, 15 (65%) were detected on nephrographic phase images, and 15 (65%) were detected on excretory phase images. Two lesions each were detected only on either nephrographic or excretory phase images. Detectability was significantly higher on nephrographic and excretory phase images compared with T2-weighted images (P < .05).


CONCLUSIONS
Gadolinium-enhanced 3D spoiled GRE MR urography helped detect 74% of small urothelial carcinomas. Nephrographic and excretory phase images are essential for helping detect small urothelial carcinomas.
Takahashi
Naoki
N
Department of Radiology, Mayo Clinic, 200 First St SW, Rochester, MN 55905, USA.
Kawashima
Akira
A
Glockner
James F
JF
Hartman
Robert P
RP
Leibovich
Bradley C
BC
Brau
Anja C S
AC
Beatty
Philip J
PJ
King
Bernard F
BF
D000368:Aged; D000704:Analysis of Variance; D003287:Contrast Media; D005260:Female; D019786:Gadolinium DTPA; D006801:Humans; D021621:Imaging, Three-Dimensional; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D012189:Retrospective Studies; D018709:Statistics, Nonparametric; D001749:Urinary Bladder Neoplasms / Q000175:diagnosis* / Q000473:pathology
D003287:Contrast Media; D019786:Gadolinium DTPA