Imaging of Upper Tract Transitional Cell Carcinoma

Abstract

While bladder and kidney cancer are the 6th and 9th most common malignancies, transitional cell carcinoma of the pelvis and ureters is much less common. It accounts for only 2–6 % of all transitional cell carcinomas, the majority of which occur in the bladder, and accounts for only 10 % of all renal tumors [1]. Upper tract transitional cell carcinoma (UTTCC) is three times more common in men than in women and the incidence increases with age with the highest prevalence in the fifth to seventh decades of life [1]. Patients with UTTCC have a variable and nonspecific presentation, hematuria being the most common presenting symptom. Unfortunately, hematuria may also be secondary to more common etiologies including renal calculi, urinary tract infection, genital infection and benign prostatic hypertrophy. In some cases, patients with UTTCC may also present with symptoms of urinary obstruction or may present with symptoms of metastatic disease. While UTTCC can be diagnosed with retrograde uretopyelography or ureteroscopy, both of these exams are invasive and require general anesthesia. Noninvasive imaging, therefore, plays a major role in the diagnosis, work up and follow up of UTTCC. Historically, intravenous pyelography was the imaging gold standard for the detection of UTTCC. However, with advancements in imaging technology, this has fallen out of favor. Today, computed tomography (CT) and magnetic resonance imaging (MR) urography are the mainstays of evaluating patients for UTTCC. This chapter will review the current radiologic imaging modalities and techniques used to evaluate for UTTCC and will explore the strengths and weakness of each. Understanding the utility and limitations of the different imaging techniques is important and should lead to improved patient care and outcomes with earlier diagnosis.