Multidetector computed tomography virtual cystoscopy: an effective diagnostic tool in patients with hematuria.
OBJECTIVE
To evaluate the efficacy and the potential use of multidetector computed tomography virtual cystoscopy (MDCT-VC) in patients with gross hematuria.


METHODS
A total of 32 patients underwent MDCT-VC, cystoscopy, and a cytologic examination. The slice thickness of MDCT was 1 mm. Bladder distension was done with room air. The data were converted into 3-dimensional virtual reconstructive models. The data sets were reviewed independently by 2 experienced radiologists. Tumors confined to the mucosa, infiltrating the muscularis, and transmural tumors were distinguished.


RESULTS
VC showed a sensitivity and specificity of 100%. The radiologic accuracy regarding T stage correlated in 87.5%. MDCT-VC identified 21 bladder lesions suspicious for bladder cancer in 18 patients. The histologic results showed 22 patients with bladder lesions, 18 were diagnosed with transitional cell carcinoma of the bladder, 3 had bladder endometriosis, and 1 had an infiltrating colon cancer. Four patients had concomitant carcinoma in situ lesions, which were not seen completely with MDCT-VC. However, cytology was positive in those cases. Ten patients did not have any tumor signs on VC and the subsequent conventional cystoscopy did not bring any change to the initial tumor-free diagnosis of VC.


CONCLUSIONS
MDCT-VC combined with urine cytology is a good alternative to conventional cystoscopy for patients with painless gross hematuria. It should be used as a decision-making aid to identify patients who will benefit from additional cystoscopic examination. Future developments should focus on the visibility of sessile and carcinoma in situ lesions.
Department of Urology, Medical University of Vienna, Vienna, Austria. fkuehhas@hotmail.com
Franklin Emmanuel
FE
Kuehhas
Peter
P
Weibl
Georgi
G
Tosev
Georg
G
Schatzl
Gertraud
G
Heinz-Peer
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002278:Carcinoma in Situ / Q000150:complications / Q000000981:diagnostic imaging; D002295:Carcinoma, Transitional Cell / Q000150:complications / Q000000981:diagnostic imaging; D003558:Cystoscopy; D003950:Diagnostic Techniques, Urological; D004240:Diverticulum / Q000150:complications / Q000000981:diagnostic imaging; D004715:Endometriosis / Q000150:complications / Q000000981:diagnostic imaging; D005260:Female; D006417:Hematuria / Q000209:etiology*; D006801:Humans; D021621:Imaging, Three-Dimensional; D008297:Male; D008875:Middle Aged; D009362:Neoplasm Metastasis / Q000000981:diagnostic imaging; D009369:Neoplasms / Q000000981:diagnostic imaging; D012680:Sensitivity and Specificity; D036542:Tomography, Spiral Computed / Q000379:methods*; D001745:Urinary Bladder Diseases / Q000150:complications / Q000000981:diagnostic imaging*; D001749:Urinary Bladder Neoplasms / Q000150:complications / Q000000981:diagnostic imaging; D014584:User-Computer Interface