title: Significance of upper urinary tract urothelial thickening and filling defect seen on MDCT urography in patients with a history of urothelial neoplasms.
abstract: OBJECTIVE
  The purpose of this article is to assess the ability of CT urography to depict urothelial tumors in the upper renal collecting systems, compared with ureteroscopy and pathologic analysis, and to describe the relative implication of the radiologic signs of urothelial thickening and endoluminal filling defects.
  
  
  METHODS
  We conducted a retrospective study to evaluate 326 consecutive CT urography examinations (using the split-bolus technique) performed at our institution between February 2006 and May 2009 in 188 patients (145 men and 43 women; median age, 65.5 years; range, 32.4-90.2 years) undergoing surveillance because of a history of urothelial tumor. Initial CT urography reports from multiple board-certified body imaging radiologists were reviewed for upper tract lesions and were classified by radiologic sign (filling defect or urothelial wall thickening) and lesion location (pelvicalyceal or ureteral) by one of the authors. The reference standard for comparison was pathologic analysis or visualization of tumor on ureteroscopy. Sensitivity and positive predictive values (PPVs) were calculated for upper tract tumors.
  
  
  RESULTS
  Thirty-eight lesions were reported on initial CT urography examinations, 24 of which were subsequently confirmed to be tumors (PPV, 63.2%). Urothelial thickening was reported in 14 lesions, nine of which were tumors (PPV, 64%). Endoluminal filling defects were seen in 24 lesions, 15 of which were tumors (PPV, 62.5%). When stratified by location, urothelial thickening was more predictive of tumor in the pelvicalyceal system (PPV, 87.5% [7/8]) than in the ureter (PPV, 33.3% [2/6]). In contrast, filling defects were more predictive in the ureter (PPV, 87.5% [7/8]) than in the pelvicalyceal system (PPV, 50% [8/16]). CT urography failed to depict four tumors.
  
  
  CONCLUSIONS
  Our data confirm that CT urography has utility in the surveillance of upper tract tumors. Urothelial thickening is an important radiologic sign of tumor, especially in the pelvicalyceal system.
authors.affiliation: Department of Radiology, The University of Texas M. D. Anderson Cancer Center, Houston, TX 77030-4009, USA.
authors.forename: Alan D
authors.initials: AD
authors.lastname: Xu
authors.forename: Chaan S
authors.initials: CS
authors.lastname: Ng
authors.forename: Ashish
authors.initials: A
authors.lastname: Kamat
authors.forename: H Barton
authors.initials: HB
authors.lastname: Grossman
authors.forename: Colin
authors.initials: C
authors.lastname: Dinney
authors.forename: Carl M
authors.initials: CM
authors.lastname: Sandler
mesh_terms: D000369:Aged, 80 and over; D002295:Carcinoma, Transitional Cell / Q000000981:diagnostic imaging*; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology*; D007682:Kidney Pelvis / Q000000981:diagnostic imaging / Q000473:pathology; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D014516:Ureteral Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology*; D014567:Urography / Q000379:methods; D019459:Urothelium / Q000000981:diagnostic imaging / Q000473:pathology