title: Bladder cancer detection in patients with gross haematuria: Computed tomography urography with enhancement-triggered scan versus flexible cystoscopy.
abstract: OBJECTIVE
  Computed tomography urography (CTU) can be used to direct further investigation of patients if the bladder tumour detection rate is high. The aim of this study was to compare a CTU protocol including an enhancement-triggered scan and flexible cystoscopy for detecting bladder tumours.
  
  
  METHODS
  Patients with gross haematuria undergoing CTU during 2005-2008 were included. For patients younger than 50 years the CTU protocol included unenhanced, enhancement-triggered corticomedullary, and excretory phases. Patients older than 50 years followed the same protocol plus a nephrographic phase. The entire urinary tract was examined in all phases.
  
  
  RESULTS
  Of 435 patients, 55 patients were diagnosed with bladder tumour. CTU detected bladder tumour in 48 patients (87%). Five CTU examination reports were false positive. With CTU, sensitivity for finding bladder tumour was 0.87, specificity 0.99, positive predictive value (PPV) 0.91 and negative predictive value (NPV) 0.98. Cystoscopy detected bladder tumour in 48 patients (87%) and had one false-positive finding, resulting in sensitivity of 0.87, specificity 1.0, PPV 0.98 and NPV 0.98.
  
  
  CONCLUSIONS
  The detection rate of bladder tumours for the CTU protocol including an enhancement-triggered scan was high and comparable to flexible cystoscopy. Hence, this protocol could be used to assess the bladder as the primary investigation and direct further investigation of the patient.
authors: a 1 Department of Radiology, Oncology and Radiation Science, Section of Radiology, Uppsala University Hospital , Uppsala, Sweden.
authors: Malin
authors: M
authors: Helenius
authors: b 2 Department of Surgical Sciences, Section of Urology, Uppsala University Hospital , Uppsala, Sweden.
authors: Einar
authors: E
authors: Brekkan
authors: a 1 Department of Radiology, Oncology and Radiation Science, Section of Radiology, Uppsala University Hospital , Uppsala, Sweden.
authors: Pär
authors: P
authors: Dahlman
authors: a 1 Department of Radiology, Oncology and Radiation Science, Section of Radiology, Uppsala University Hospital , Uppsala, Sweden.
authors: Maria
authors: M
authors: Lönnemark
authors: a 1 Department of Radiology, Oncology and Radiation Science, Section of Radiology, Uppsala University Hospital , Uppsala, Sweden.
authors: Anders
authors: A
authors: Magnusson
mesh_terms: D000328:Adult; D000368:Aged; D003558:Cystoscopy / Q000379:methods*; D005189:False Positive Reactions; D005260:Female; D006417:Hematuria; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed / Q000379:methods*; D001749:Urinary Bladder Neoplasms / Q000175:diagnosis*; D014567:Urography / Q000379:methods*
keywords: Cystoscopy; haematuria; multidetector computed tomography; urinary bladder neoplasms; urography