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Single-phase DECT with VNCT compared with three-phase CTU in patients with haematuria

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Abstract

Objective

To retrospectively evaluate the diagnostic performance of single-phase dual-energy CT (DECT) with virtual non-contrast CT (VNCT) compared with three-phase CT urography (CTU) in patients with haematuria.

Methods

A total of 296 patients underwent three-phase CTU (NCT at 120 kVp; nephrographic phase and excretory phase DECTs at 140 kVp and 80 kVp) owing to haematuria. Diagnostic performances of CT scans were compared for detecting urothelial tumours and urinary stones. Dose-length product (DLP) was compared in relation to single-phase DECT and three-phase CTU Dose-length product (DLP) was compared in relation to single-phase DECT and three-phase CTU.

Results

Sensitivity and specificity for tumour were 95 % (19/20) and 98.9 % (273/276) on CTU, 95 % (19/20) and 98.2 % (271/276) on nephrographic phase DECT, and 90 % (18/20) and 98.2 % (271/276) on excretory phase DECT (P > 0.1). Of the 148 stones detected on NCT, 108 (73 %) and 100 (67.6 %) were detected on nephrographic phase and excretory phase VNCTs, respectively. The mean size of stones undetected on nephrographic and excretory VNCTs was measured as 1.5 ± 0.5 mm and 1.6 ± 0.6 mm, respectively. The mean DLPs of three-phase CTU, nephrographic phase DECT and excretory phase DECT were 1076 ± 248 mGy · cm, 410 ± 98 mGy · cm, and 360 ± 87 mGy · cm, respectively (P < 0.001).

Conclusions

Single-phase DECT has a potential to replace three-phase CTU for detecting tumours with a lower radiation dose.

Key Points

• Single-phase DECT with virtual NCT may replace three-phase CTU for detecting tumours.

• Virtual NCT cannot replace NCT for detecting small urinary stones.

• Single-phase DECT may reduce the radiation dose by 62–67 % compared to three-phase CTU.

• Nephrographic phase DECT is superior to excretory phase DECT for assessing haematuria.

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Abbreviations

DECT:

dual-energy CT

VNCT:

virtual non-contrast CT

NCT:

non-contrast CT

CTU:

CT urography

DLP:

dose-length product

References

  1. Davis R, Jones JS, Barocas DA et al (2012) Diagnosis, evaluation and follow-up of asymptomatic microhematuria (AMH) in adults: AUA guideline. J Urol 188:2473–2481

    Article  PubMed  Google Scholar 

  2. Silverman SG, Leyendecker JR, Amis ES Jr (2009) What is the current role of CT urography and MR urography in the evaluation of the urinary tract? Radiology 250:309–323

    Article  PubMed  Google Scholar 

  3. O'Connor OJ, Maher MM (2010) CT urography. AJR Am J Roentgenol 195:W320–W324

    Article  PubMed  Google Scholar 

  4. Wolin EA, Hartman DS, Olson JR (2013) Nephrographic and pyelographic analysis of CT urography: principles, patterns, and pathophysiology. AJR Am J Roentgenol 200:1210–1214

    Article  PubMed  Google Scholar 

  5. Wolin EA, Hartman DS, Olson JR (2013) Nephrographic and pyelographic analysis of CT urography: differential diagnosis. AJR Am J Roentgenol 200:1197–1203

    Article  PubMed  Google Scholar 

  6. Van Der Molen AJ, Cowan NC, Mueller-Lisse UG, Nolte-Ernsting CC, Takahashi S, Cohan RH (2008) CT urography: definition, indications and techniques. A guideline for clinical practice. Eur Radiol 18:4–17

    Article  Google Scholar 

  7. Jinzaki M, Matsumoto K, Kikuchi E et al (2011) Comparison of CT urography and excretory urography in the detection and localization of urothelial carcinoma of the upper urinary tract. AJR Am J Roentgenol 196:1102–1109

    Article  PubMed  Google Scholar 

  8. Wang LJ, Wong YC, Huang CC, Wu CH, Hung SC, Chen HW (2010) Multidetector computerized tomography urography is more accurate than excretory urography for diagnosing transitional cell carcinoma of the upper urinary tract in adults with hematuria. J Urol 183:48–55

    Article  PubMed  Google Scholar 

  9. Shinagare AB, Sahni VA, Sadow CA, Erturk SM, Silverman SG (2011) Feasibility of low-tube-voltage excretory phase images during CT urography: assessment using a dual-energy CT scanner. AJR Am J Roentgenol 197:1146–1151

    Article  PubMed  Google Scholar 

  10. Dahlman P, van der Molen AJ, Magnusson M, Magnusson A (2012) How much dose can be saved in three-phase CT urography? A combination of normal-dose corticomedullary phase with low-dose unenhanced and excretory phases. AJR Am J Roentgenol 199:852–860

    Article  PubMed  Google Scholar 

  11. Hack K, Pinto PA, Gollub MJ (2012) Targeted delayed scanning at CT urography: a worthwhile use of radiation? Radiology 265:143–150

    Article  PubMed  Google Scholar 

  12. Mangold S, Thomas C, Fenchel M et al (2012) Virtual nonenhanced dual-energy CT urography with tin-filter technology: determinants of detection of urinary calculi in the renal collecting system. Radiology 264:119–125

    Article  PubMed  Google Scholar 

  13. Sahni VA, Shinagare AB, Silverman SG (2013) Virtual unenhanced CT images acquired from dual-energy CT urography: accuracy of attenuation values and variation with contrast material phase. Clin Radiol 68:264–271

    Article  CAS  PubMed  Google Scholar 

  14. Moon JW, Park BK, Kim CK, Park SY (2012) Evaluation of virtual unenhanced CT obtained from dual-energy CT urography for detecting urinary stones. Br J Radiol 85:e176–e181

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  15. Metser U, Goldstein MA, Chawla TP, Fleshner NE, Jacks LM, O'Malley ME (2012) Detection of urothelial tumors: comparison of urothelial phase with excretory phase CT urography--a prospective study. Radiology 264:110–118

    Article  PubMed  Google Scholar 

  16. Kupershmidt M, Margolis M, Jang HJ, Massey C, Metser U (2011) Evaluation of upper urinary tract tumors with portal venous phase MDCT: a case-control study. AJR Am J Roentgenol 197:424–428

    Article  PubMed  Google Scholar 

  17. Helenius M, Dahlman P, Magnusson M, Lonnemark M, Magnusson A (2014) Contrast enhancement in bladder tumors examined with CT urography using traditional scan phases. Acta Radiol 55:1129–1136

    Article  PubMed  Google Scholar 

  18. Kim JY, Kim SH, Lee HJ, Kim MJ, Kim YH, Cho SH (2014) MDCT Urography for detecting recurrence after transurethral resection of bladder cancer: comparison of nephrographic phase with pyelographic phase. AJR Am J Roentgenol 203:1021–1027

    Article  PubMed  Google Scholar 

  19. Huda W, Ogden KM, Khorasani MR (2008) Converting dose-length product to effective dose at CT. Radiology 248:995–1003

    Article  PubMed  PubMed Central  Google Scholar 

  20. Bland JM, Altman DG (1995) Multiple significance tests: the Bonferroni method. BMJ 310:170

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  21. Nolte-Ernsting C, Cowan N (2006) Understanding multislice CT urography techniques: many roads lead to Rome. Eur Radiol 16:2670–2686

    Article  PubMed  Google Scholar 

  22. Kim S, Wang LL, Heiken JP, Siegel CL, Hildebolt CF, Bae KT (2008) Opacification of urinary bladder and ureter at CT urography: effect of a log-rolling procedure and postvoiding residual bladder urine volume. Radiology 247:747–753

    Article  PubMed  Google Scholar 

  23. Graser A, Johnson TR, Chandarana H, Macari M (2009) Dual energy CT: preliminary observations and potential clinical applications in the abdomen. Eur Radiol 19:13–23

    Article  PubMed  Google Scholar 

  24. Graser A, Johnson TR, Hecht EM et al (2009) Dual-energy CT in patients suspected of having renal masses: can virtual nonenhanced images replace true nonenhanced images? Radiology 252:433–440

    Article  PubMed  Google Scholar 

  25. Graser A, Becker CR, Staehler M et al (2010) Single-phase dual-energy CT allows for characterization of renal masses as benign or malignant. Invest Radiol 45:399–405

    PubMed  Google Scholar 

  26. Takeuchi M, Kawai T, Ito M et al (2012) Split-bolus CT-urography using dual-energy CT: feasibility, image quality and dose reduction. Eur J Radiol 81:3160–3165

    Article  PubMed  Google Scholar 

  27. Takahashi N, Hartman RP, Vrtiska TJ et al (2008) Dual-energy CT iodine-subtraction virtual unenhanced technique to detect urinary stones in an iodine-filled collecting system: a phantom study. AJR Am J Roentgenol 190:1169–1173

    Article  PubMed  PubMed Central  Google Scholar 

  28. Botsikas D, Hansen C, Stefanelli S, Becker CD, Montet X (2014) Urinary stone detection and characterisation with dual-energy CT urography after furosemide intravenous injection: preliminary results. Eur Radiol 24:709–714

    Article  PubMed  Google Scholar 

  29. Lokken RP, Sadow CA, Silverman SG (2012) Diagnostic yield of CT urography in the evaluation of young adults with hematuria. AJR Am J Roentgenol 198:609–615

    Article  PubMed  Google Scholar 

  30. Lisanti CJ, Toffoli TJ, Stringer MT, DeWitt RM, Schwope RB (2014) CT evaluation of the upper urinary tract in adults younger than 50 years with asymptomatic microscopic hematuria: is IV contrast enhancement needed? AJR Am J Roentgenol 203:615–619

    Article  PubMed  Google Scholar 

  31. Helenius M, Dahlman P, Lonnemark M, Brekkan E, Wernroth L, Magnusson A (2015) Comparison of post contrast CT urography phases in bladder cancer detection. Eur Radiol

  32. Hansen C, Becker CD, Montet X, Botsikas D (2014) Diagnosis of urothelial tumors with a dedicated dual-source dual-energy MDCT protocol: preliminary results. AJR Am J Roentgenol 202:W357–W364

    Article  PubMed  Google Scholar 

  33. Ascenti G, Mileto A, Gaeta M, Blandino A, Mazziotti S, Scribano E (2013) Single-phase dual-energy CT urography in the evaluation of haematuria. Clin Radiol 68:e87–e94

    Article  CAS  PubMed  Google Scholar 

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Acknowledgments

The scientific guarantor of this publication is Dr. Won Jae Lee. The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article. The authors state that this work has not received any funding. We have consulted an expert in statistics and biometry, Keumhee Cho, PhD, for the preparation of our manuscript; her institution is Samsung Medical Center, Biostatistics & Clinical Epidemiology Center. Institutional Review Board approval was obtained. Written informed consent was waived by the Institutional Review Board. Approval from the institutional animal care committee was not required because our research was a human study. Our study included 143 patients, which Moon et al. already evaluated in their paper entitled "Evaluation of virtual unenhanced CT obtained from dual-energy CT urography for detecting urinary stones" published on British Journal of Radiology 2012;85(1014):e176–181. Methodology: retrospective, case control, performed at one institution.

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Authors and Affiliations

  1. Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Ilwon-dong, Kangnam-ku, Seoul, 135-710, Republic of Korea

    Jung Jae Park, Byung Kwan Park & Chan Kyo Kim

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  1. Jung Jae Park
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  2. Byung Kwan Park
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Correspondence to Byung Kwan Park.

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Park, J.J., Park, B.K. & Kim, C.K. Single-phase DECT with VNCT compared with three-phase CTU in patients with haematuria. Eur Radiol 26, 3550–3557 (2016). https://doi.org/10.1007/s00330-016-4206-9

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  • DOI: https://doi.org/10.1007/s00330-016-4206-9

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