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Virtual Ureteroscopy of Upper Tract Urothelial Tumors

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Urothelial Malignancies of the Upper Urinary Tract

Abstract

Imaging plays a crucial role in the evaluation of urinary tract pathology. Technologic advancements in computing and imaging technology have revolutionized the role in which radiology plays in the workup of patients with hematuria. CT and MR have replaced conventional intravenous pyelography (IVP) in the imaging workup for abnormalities of the urinary collecting system. Both methods have their relative advantages and disadvantages, however both can elegantly and noninvasively diagnose disease with high sensitivity and specificity. Emerging techniques, such as ‘Virtual’ Ureteroscopy with both CT and MR are going to play an expanding part in the workup of neoplastic urinary tract pathology. Utilizing dedicated 3D software, virtual ureteroscopy makes it possible to manipulate the imaging dataset obtained from CT or MR to allow for intraluminal visualization of renal collecting system, ureters, and bladder. This can provide a noninvasive way to diagnose even small lesions of the urinary tract, or offer a road map for treatment or interventions.

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References

  1. Cauberg ECC, Nio CY, de la Rosette JM, Laguna MP, de Reijke TM. Computed tomography-urography for upper urinary tract imaging: is it required for all patients who present with hematuria? J Endourol. 2011;25(11):1733–40.

    Article  PubMed  Google Scholar 

  2. Cowan N. CT Urography for hematuria. Nat Rev Urol. 2012;9:218–26.

    Article  CAS  PubMed  Google Scholar 

  3. Chandarana H, Taouli B. Diffusion and perfusion imaging of the liver. Eur J Radiol. 2010;76(3):348–58.

    Article  PubMed  Google Scholar 

  4. Raman SP, Horton KM, Fishman EK. MDCT Evaluation of ureteral tumors: advantages of 3D reconstruction and volume visualization. Am J Roentgenol. 2013;201(6):1239–47. doi:10.2214/AJR.13.10880.

    Article  Google Scholar 

  5. Rouprêt M, Babjuk M, Compérat E, et al. European guidelines on upper tract urothelial carcinomas: 2013 update. Eur Urol. 2013;63(6):1059–71. doi:10.1016/j.eururo.2013.03.032.

    Article  PubMed  Google Scholar 

  6. Lee KS, Zeikus E, DeWolf WC, Rofsky NM, Pedrosa I. MR urography versus retrograde pyelography/ureteroscopy for the exclusion of upper urinary tract malignancy. Clin Radiol. 2010;65(3):185–92. doi:10.1016/j.crad.2009.11.003.

    Article  PubMed  CAS  Google Scholar 

  7. Lucca I, Leow JJ, Shariat SF, Chang SL. Diagnosis and management of upper tract urothelial carcinoma. Hematol Oncol Clin North Am. 2015;29(2):271–88. doi:10.1016/j.hoc.2014.10.003.

    Article  PubMed  Google Scholar 

  8. Latchamsetty KC, Porter CR. Treatment of upper tract urothelial carcinoma: a review of surgical and adjuvant therapy. Rev Urol. 2006. 8(2):61–70. http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1578534&tool=pmcentrez&rendertype=abstract.

  9. Razavi SA, Sadigh G, Kelly AM, Cronin P. comparative effectiveness of imaging modalities for the diagnosis of upper and lower urinary tract malignancy: a critically appraised topic. Acad Radiol. 2012;19(9):1134–40. doi:10.1016/j.acra.2012.05.004.

    Article  PubMed  Google Scholar 

  10. Silverman SG, Leyendecker JR, Amis ES. What is the current role of CT urography and MR urography in the evaluation of the urinary tract? Radiology. 2009;250(2):309–23. doi:10.1148/radiol.2502080534.

    Article  PubMed  Google Scholar 

  11. Mullen KM, Sahni VA, Sadow CA, Silverman SG. Yield of urinary tract cancer diagnosis with repeat CT urography in patients with hematuria. Am J Roentgenol. 2015;204(2):318–23. doi:10.2214/AJR.14.12825.

    Article  Google Scholar 

  12. O’Connor OJ, McSweeney SE, Maher MM. Imaging of hematuria. Radiol Clin North Am. 2008;46(1):113–32. doi:10.1016/j.rcl.2008.01.007.

    Article  PubMed  Google Scholar 

  13. Anderson EM, Murphy R, Rennie TM, Cowan NC. Multidetector computed tomography urography (MDCTU) for diagnosing urothelial malignancy. Clin Radiol. 2007;62(4):324–32. doi:10.1016/j.crad.2006.10.008.

    Article  PubMed  CAS  Google Scholar 

  14. Takeuchi M, Konrad AJ, Kawashima A, Boorjian SA, Takahashi N. CT urography for diagnosis of upper urinary tract urothelial carcinoma: are both nephrographic and excretory phases necessary? Am J Roentgenol. 2015;205(3):W320–7. doi:10.2214/AJR.14.14075.

    Article  PubMed  Google Scholar 

  15. Davenport MS, Khalatbari S, Cohan RH, Dillman JR, Myles JD, Ellis JH. Contrast material-induced nephrotoxicity and intravenous low-osmolality iodinated contrast material: risk stratification by using estimated glomerular filtration rate. Radiology. 2013;268(3):719–28. doi:10.1148/radiol.13122276.

    Article  PubMed  Google Scholar 

  16. Chlapoutakis K, Theocharopoulos N, Yarmenitis S, Damilakis J. Performance of computed tomographic urography in diagnosis of upper urinary tract urothelial carcinoma, in patients presenting with hematuria: systematic review and meta-analysis. Eur J Radiol. 2010;73(2):334–8. doi:10.1016/j.ejrad.2008.10.026.

    Article  PubMed  Google Scholar 

  17. Chow LC, Kwan SW, Olcott EW, Sommer G. Split-bolus MDCT urography with synchronous nephrographic and excretory phase enhancement. Am J Roentgenol. 2007;189(2):314–22. doi:10.2214/AJR.07.2288.

    Article  Google Scholar 

  18. Browne RFJ, Meehan CP, Colville J, Power R, Torreggiani WC. Transitional cell carcinoma of the upper urinary tract: spectrum of imaging findings. Radiographics. 2005;25(6):1609–27. doi:10.1148/rg.256045517.

    Article  PubMed  Google Scholar 

  19. Raman SP, Horton KM, Fishman EK. Transitional cell carcinoma of the upper urinary tract: optimizing image interpretation with 3D reconstructions. Abdom Imaging. 2012;37(6):1129–40. doi:10.1007/s00261-011-9838-2.

    Article  PubMed  Google Scholar 

  20. Yuh BI, Cohan RH. Different phases of renal enhancement: role in detecting and characterizing renal masses during helical CT. 1999;(Sept):747–55.

    Google Scholar 

  21. Xu AD, Ng CS, Kamat A, Grossman HB, Dinney C, Sandler CM. Significance of upper urinary tract urothelial thickening and filling defect seen on MDCT urography in patients with a history of urothelial neoplasms. Am J Roentgenol. 2010;195(4):959–65. doi:10.2214/AJR.09.4177.

    Article  Google Scholar 

  22. Dillman JR, Caoili EM, Cohan RH, et al. Comparison of urinary tract distension and opacification using single-bolus 3-phase vs split-bolus 2-phase multidetector row CT urography. J Comput Assist Tomogr. 2007;31(5):750–7. doi:10.1097/RCT.0b013e318033df36.

    Article  PubMed  Google Scholar 

  23. Hwang I, Cho JY, Kim SY, et al. Low tube voltage computed tomography urography using low-concentration contrast media: comparison of image quality in conventional computed tomography urography. Eur J Radiol. 2015;. doi:10.1016/j.ejrad.2015.09.010.

    Article  PubMed  Google Scholar 

  24. O’Connor OJ, McLaughlin P, Maher MM. MR urography. Am J Roentgenol. 2010;195(3):W201–6. doi:10.2214/AJR.09.4176.

    Article  Google Scholar 

  25. Ergen FB, Hussain HK, Carlos RC, et al. 3D excretory MR urography: improved image quality with intravenous saline and diuretic administration. J Magn Reson Imaging. 2007;25(4):783–9. doi:10.1002/jmri.20875.

    Article  PubMed  Google Scholar 

  26. Maheshwari E, O’Malley ME, Ghai S, Staunton M, Massey C. Split-bolus MDCT urography: upper tract opacification and performance for upper tract tumors in patients with hematuria. Am J Roentgenol. 2010;194(2):453–8. doi:10.2214/AJR.09.3228.

    Article  Google Scholar 

  27. Van Der Molen AJ, Cowan NC, Mueller-Lisse UG, Nolte-Ernsting CCA, Takahashi S, Cohan RH. CT urography: definition, indications and techniques. A guideline for clinical practice. Eur Radiol. 2008;18(1):4–17. doi:10.1007/s00330-007-0792-x.

    Article  Google Scholar 

  28. Kekelidze M, Dwarkasing RS, Dijkshoorn ML, Sikorska K, Verhagen PCMS, Krestin GP. Kidney and urinary tract imaging: triple-bolus multidetector CT urography as a one-stop shop-protocol design, opacification, and image quality analysis. Radiology. 2010;255(2):508–16. doi:10.1590/S1677-55382010000400019.

    Article  PubMed  Google Scholar 

  29. Davenport MS, Cohan RH, Ellis JH. Contrast media controversies in 2015: imaging patients with renal impairment or risk of contrast reaction. Am J Roentgenol. 2015;(June):1–8. doi:10.2214/AJR.14.14259.

    Article  PubMed  Google Scholar 

  30. Beckett KR, Moriarity AK, Langer JM. Safe use of contrast media: what the radiologist needs to know. RadioGraphics. 2015;35(3):1738–50.

    Article  PubMed  Google Scholar 

  31. Katayama H, Yamaguchi K, Kozuka T, Takahima T, Seez P, Matsuura K. adverse nonionic reactions contrast to ionic media the japanese on the safety of contrast. Radiology. 1990;1775:621–8.

    Article  Google Scholar 

  32. Ramamurthy NK, Moosavi B, McInnes MDF, Flood TA, Schieda N. Multiparametric MRI of solid renal masses: pearls and pitfalls. Clin Radiol. 2015;70(3):304–16. doi:10.1016/j.crad.2014.10.006.

    Article  PubMed  CAS  Google Scholar 

  33. Dickerson EC, Dillman JR, Smith EA, DiPietro MA, Lebowitz RL, Darge K. Pediatric MR urography: indications, techniques, and approach to review. RadioGraphics. 2015;35(4):1208–30. doi:10.1148/rg.2015140223.

    Article  PubMed  Google Scholar 

  34. Fishman EK, Ney DR, Heath DG, Corl FM, Horton KM, Johnson PT. Volume rendering versus maximum intensity projection in CT angiography: what works best, when, and why. Radiographics. 2006;26(3):905–22. doi:10.1148/rg.263055186.

    Article  PubMed  Google Scholar 

  35. Neri E, Boraschi P, Caramella D, et al. MR virtual endoscopy of the upper urinary tract. Am J Roentgenol. 2000;175(6):1697–702. http://www.scopus.com/inward/record.url?eid=2-s2.0-0033654115&partnerID=40&md5=4d77f6f06410ff7c0c330b19b3dfd232.

    Article  CAS  PubMed  Google Scholar 

  36. Mueller-Lisse UG, Mueller-Lisse UL, Hinterberger J, Schneede P, Meindl T, Reiser MF. Multidetector-row computed tomography (MDCT) in patients with a history of previous urothelial cancer or painless macroscopic haematuria. Eur Radiol. 2007;17(11):2794–803. doi:10.1007/s00330-007-0609-y.

    Article  PubMed  Google Scholar 

  37. Bokacheva L, Rusinek H, Zhang J, Lee V. Assessment of renal function with dynamic contrast-enhanced mr imaging. Magn Reson Imaging Clin N Am. 2008;16(4):597–611.

    Article  PubMed  PubMed Central  Google Scholar 

  38. Takeuchi M, Matsuzaki K, Kubo H, Nishitani H. High- b -value diffusion-weighted magnetic resonance imaging of pancreatic cancer and mass-forming chronic pancreatitis: preliminary results. Acta Radiol. 2008;49(4):383–6. doi:10.1080/02841850801895381.

    Article  PubMed  CAS  Google Scholar 

  39. Chahal R, Taylor K, Eardley I, Lloyd SN, Spencer JA. Patients at high risk for upper tract urothelial cancer: evaluation of hydronephrosis using high resolution magnetic resonance urography. J Urol. 2005;174(2):478–82. doi:10.1097/01.ju.0000165169.94286.3d.

    Article  PubMed  CAS  Google Scholar 

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Correspondence to Anthony Gilet .

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Video 5.1

Right ureteral ‘fly-through’ of a volume rendered CT virtual ureteroscopy. A 0.5 mm lesion is demonstrated along the right anterolateral wall of the distal ureter (end of video, page 221 of 225). The green 3-D orientation box in the lower left hand of the screen as well as a cross-referenced line with the axial acquired imaged (not shown) provides a roadmap for the clinician (WMV 1239 kb)

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Tong, A., Gilet, A. (2018). Virtual Ureteroscopy of Upper Tract Urothelial Tumors. In: Eshghi, M. (eds) Urothelial Malignancies of the Upper Urinary Tract. Springer, Cham. https://doi.org/10.1007/978-3-319-51263-1_5

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  • DOI: https://doi.org/10.1007/978-3-319-51263-1_5

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