title: Multidetector computerized tomography urography is more accurate than excretory urography for diagnosing transitional cell carcinoma of the upper urinary tract in adults with hematuria.
abstract: OBJECTIVE
  It is debatable whether traditionally used excretory urography or the recently introduced multidetector computerized tomography urography is more accurate for diagnosing upper urinary tract transitional cell carcinoma. We compared accuracy measures of both methods for diagnosing upper urinary tract transitional cell carcinoma in adult patients with hematuria.
  
  
  METHODS
  We retrospectively analyzed consecutive adult patients with hematuria undergoing excretory urography and multidetector computerized tomography urography before any surgery, intervention or treatment from April 2004 to December 2006 in our hospital. The presence of upper urinary tract transitional cell carcinoma on excretory urography and multidetector computerized tomography urography was reviewed independently by 2 uroradiologists who were blinded to clinical information and other imaging results. Final diagnosis of upper urinary tract transitional cell carcinoma was confirmed by histological results. Measures of the diagnostic accuracy of excretory urography and multidetector computerized tomography urography for upper urinary tract transitional cell carcinoma were calculated and compared with reference to the final diagnosis.
  
  
  RESULTS
  Of 34 men and 26 women with hematuria (mean age 60.73 +/- 12.95 years) 19 (31.7%) had a final diagnosis of 24 upper urinary tract transitional cell carcinomas. The sensitivity, specificity and accuracy of excretory urography were 0.750, 0.860 and 0.849, respectively. In contrast, the sensitivity, specificity and accuracy of multidetector computerized tomography urography were 0.958, 1.000 and 0.996, respectively. Overall the area under the receiver operating characteristic curve for multidetector computerized tomography urography was significantly larger than that for excretory urography (0.978 vs 0.815, p = 0.005).
  
  
  CONCLUSIONS
  Multidetector computerized tomography urography is more sensitive, specific and accurate than excretory urography in the diagnosis of upper urinary tract transitional cell carcinoma in adult patients with hematuria. Therefore, multidetector computerized tomography urography rather than excretory urography should be the first choice noninvasive imaging modality for diagnosing upper urinary tract transitional cell carcinoma.
authors.affiliation: Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan, Taiwan. lijenwang0918@gmail.com
authors.forename: Li-Jen
authors.initials: LJ
authors.lastname: Wang
authors.forename: Yon-Cheong
authors.initials: YC
authors.lastname: Wong
authors.forename: Chen-Chih
authors.initials: CC
authors.lastname: Huang
authors.forename: Cheng-Hsien
authors.initials: CH
authors.lastname: Wu
authors.forename: Sheng-Che
authors.initials: SC
authors.lastname: Hung
authors.forename: Huan-Wu
authors.initials: HW
authors.lastname: Chen
mesh_terms: D002295:Carcinoma, Transitional Cell / Q000150:complications / Q000000981:diagnostic imaging*; D005260:Female; D006417:Hematuria / Q000209:etiology; D006801:Humans; D007680:Kidney Neoplasms / Q000150:complications / Q000000981:diagnostic imaging*; D008297:Male; D008875:Middle Aged; D015203:Reproducibility of Results; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D014516:Ureteral Neoplasms / Q000150:complications / Q000000981:diagnostic imaging*; D014554:Urination; D014567:Urography / Q000379:methods