title: Diagnosis of bladder tumours in patients with macroscopic haematuria: a prospective comparison of split-bolus computed tomography urography, magnetic resonance urography and flexible cystoscopy.
abstract: OBJECTIVE
  The aim of this study was to compare split-bolus computed tomography urography (CTU), magnetic resonance urography (MRU) and flexible cystoscopy in patients with macroscopic haematuria regarding the diagnosis of bladder tumours.
  
  
  METHODS
  In this prospective study, 150 patients underwent CTU, MRU and flexible cystoscopy. Two uroradiologists individually reviewed the images without any clinical information, using a questionnaire. Patient records and pathology reports were also reviewed.
  
  
  RESULTS
  At flexible cystoscopy, MRU and CTU, 32, 19 and 15 bladder lesions were identified, respectively. Histopathology showed that 13 of the 29 biopsied lesions were transitional cell carcinomas. Compared with the histopathology, the sensitivity and specificity for detection of tumours by CTU and MRU were 61.5% and 94.9%, and 79.9% and 93.4%, respectively. False-positive detection of bladder tumours, compared with histopathology, was reported in seven CTUs and nine MRUs, whereas the number of false-negative findings was five for CTUs and three for MRUs.
  
  
  CONCLUSIONS
  Split-bolus CTU or MRU cannot replace cystoscopy in cases of macroscopic haematuria. MRU has a higher sensitivity than split-bolus CTU, and is a potential alternative to flexible cystoscopy. Patients with a low risk of bladder cancer may forgo flexible cystoscopy if a bladder tumour is identified by either CTU or MRU, and proceed straight to transuretheral resection of the bladder.
authors.affiliation: Departments of Diagnostic Radiology.
authors.forename: Karen L
authors.initials: KL
authors.lastname: Gandrup
authors.forename: Vibeke B
authors.initials: VB
authors.lastname: Løgager
authors.forename: Thomas
authors.initials: T
authors.lastname: Bretlau
authors.forename: Jørgen
authors.initials: J
authors.lastname: Nordling
authors.forename: Henrik S
authors.initials: HS
authors.lastname: Thomsen
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001706:Biopsy; D002295:Carcinoma, Transitional Cell / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000473:pathology; D003558:Cystoscopy / Q000379:methods*; D003951:Diagnostic Errors / Q000706:statistics & numerical data; D005260:Female; D006417:Hematuria / Q000175:diagnosis* / Q000209:etiology; D006801:Humans; D015994:Incidence; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed / Q000379:methods*; D001743:Urinary Bladder / Q000473:pathology; D001749:Urinary Bladder Neoplasms / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000473:pathology; D014567:Urography / Q000379:methods*
keywords: Computed tomography; diagnostic imaging; haematuria; magnetic resonance imaging; urography.