MDCT Urography for Detecting Recurrence After Transurethral Resection of Bladder Cancer: Comparison of Nephrographic Phase With Pyelographic Phase
- 김진영; 김시형; 이희정; 김미정; 김영환
- Alternative Author(s)
- Kim, Jin Young; Kim, See Hyung; Lee, Hee Jung; Kim, Mi Jeong; Kim, Young Hwan
- Publication Year
- OBJECTIVE. The purpose of this study was to prospectively compare nephrographic
phase MDCT urography performed with oral hydration and a diuretic with standard
pyelographic phase MDCT in the detection of recurrence after transurethral resection.
SUBJECTS AND METHODS. The study included 140 MDCT urographic examinations
of 121 patients (87 men, 34 women; age range, 46–88 years) at risk of urinary tract cancer
recurrence. Acquisition was performed 60 seconds (nephrographic phase) and 420 seconds
(pyelographic phase) after contrast injection. Two radiologists independently recorded
the presence of recurrent lesions in each phase. The reference standard was histologic findings
and prospective clinical decision. Distention and opacification were compared for each radiologist
in each segment in each phase by kappa statistic and Spearman rank coefficient. Generalized
estimating equations for logistic regression analysis were used to compare performance
for each radiologist and phase and were adjusted for possibility within patient correlation.
RESULTS. Urinary tract distention was rated significantly better at the pyelographic
phase for all segments (p < 0.001). The degree of opacification provided by each radiologist
for the same segment showed high correlation. There were 59 bladder recurrences in 38
patients and 19 upper tract recurrences in 13 patients. For recurrence detection in the bladder,
the overall accuracy was significantly higher for the nephrographic phase than the pyelographic
phase (91.7% [354/386] vs 83.2% [321/386], p = 0.038). For recurrence detection in
the upper tract, the overall accuracy was significantly higher in the nephrographic phase than
in the pyelographic phase (86.7% [260/300] vs 80% [240/300], p = 0.028).
CONCLUSION. Use of nephrographic phase MDCT urography is associated with a higher
rate of detection of urinary tract recurrence than is pyelographic phase MDCT, which suggests
the value of this technique for evaluating the urinary tract after transurethral resection.
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