title: Comparison of computed tomographic urography, magnetic resonance urography and the combination of diffusion weighted imaging in diagnosis of upper urinary tract cancer.
abstract: OBJECTIVE
  To evaluate the performance of computed tomographic urography (CTU), static-fluid magnetic resonance urography (static-fluid MRU) and combinations of CTU, static-fluid MRU and diffusion weighted imaging (DWI) in the diagnosis of upper urinary tract cancer.
  
  
  METHODS
  Between January 2010 and June 2011, patients with suspected UUT cancer underwent CTU, static-fluid MRU and DWI (b=1000s/mm(2)) within a 1-week period. The diagnostic performances of CTU, static-fluid MRU and combinations of CTU, static-fluid MRU and DWI for upper urinary tract cancer were prospectively evaluated. The ureteroscopic and histopathologic findings were compared with the imaging findings.
  
  
  RESULTS
  Compared to static-fluid MRU alone (sensitivity: 76/75%, reader 1/reader 2), combining DWI with MRI can increase the sensitivity (sensitivity: 84/84%, p=0.031/p=0.016) of upper urinary tract cancer diagnosis. CTU had greater sensitivity (95/94%) and accuracy (92/91%) than both static-fluid MRU (sensitivity: p<0.001/p<0.001 and accuracy: 83/81%, p=0.001/p<0.001) and static-fluid MRU with DWI (sensitivity: p=0.023/p=0.039 and accuracy: 87/85%, p=0.042/p=0.049) for the diagnosis of upper urinary tract cancers. Compared with CTU alone, CTU with DWI did not significantly increase sensitivity, specificity or accuracy. However, the diagnostic confidence was improved when the combined technique was used (p=0.031/p=0.024). Moreover, there was no significant change in sensitivity, specificity, accuracy or diagnostic confidence when static-fluid MRU was used in combination with CTU and DWI.
  
  
  CONCLUSIONS
  Although there is a potential role for static-fluid MRU and static-fluid MRU with DWI in urinary tract imaging, CTU is still the better choice for the diagnosis of upper urinary tract cancer. Combining DWI with CTU can help improve confidence in upper urinary tract cancer diagnoses.
authors.affiliation: Department of Radiology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, No. 1630, Dongfang Road, Pudong, Shanghai 200120, PR China.
authors.forename: Guang-Yu
authors.initials: GY
authors.lastname: Wu
authors.affiliation: Department of Radiology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, No. 1630, Dongfang Road, Pudong, Shanghai 200120, PR China.
authors.forename: Qing
authors.initials: Q
authors.lastname: Lu
authors.affiliation: Department of Radiology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, No. 1630, Dongfang Road, Pudong, Shanghai 200120, PR China.
authors.forename: Lian-Ming
authors.initials: LM
authors.lastname: Wu
authors.affiliation: Department of Urinary Surgery, Renji Hospital, Shanghai Jiao Tong University School of Medicine, No. 1630, Dongfang Road, Pudong, Shanghai 200120, PR China.
authors.forename: Jin
authors.initials: J
authors.lastname: Zhang
authors.affiliation: Department of Radiology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, No. 1630, Dongfang Road, Pudong, Shanghai 200120, PR China.
authors.forename: Xiao-Xi
authors.initials: XX
authors.lastname: Chen
authors.affiliation: Department of Radiology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, No. 1630, Dongfang Road, Pudong, Shanghai 200120, PR China. Electronic address: renjixujr@163.com.
authors.forename: Jian-Rong
authors.initials: JR
authors.lastname: Xu
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D038524:Diffusion Magnetic Resonance Imaging / Q000379:methods*; D005260:Female; D006801:Humans; D007089:Image Enhancement / Q000379:methods*; D007680:Kidney Neoplasms / Q000175:diagnosis*; D008297:Male; D008875:Middle Aged; D064847:Multimodal Imaging / Q000379:methods*; D015588:Observer Variation; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D014516:Ureteral Neoplasms / Q000175:diagnosis*; D014567:Urography / Q000379:methods*
keywords: Computed tomographic urography; Diagnostic confidence; Diffusion-weighted imaging; Magnetic resonance urography; Upper urinary tract cancer