Multidetector Computed Tomography Virtual Cystoscopy: An Effective Diagnostic Tool in Patients With Hematuria

• Published in: Urology (Ridgewood, N.J.) Vol. 79; no. 2; pp. 270 - 276
• Main Authors: Kuehhas, Franklin Emmanuel, Weibl, Peter, Tosev, Georgi, Schatzl, Georg, Heinz-Peer, Gertraud
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.02.2012; Elsevier
• Subjects: Adult; Aged; Aged, 80 and over; Biological and medical sciences; Carcinoma in Situ - complications; Carcinoma in Situ - diagnostic imaging; Carcinoma, Transitional Cell - complications; Carcinoma, Transitional Cell - diagnostic imaging; Cystoscopy; Diagnostic Techniques, Urological; Diverticulum - complications; Diverticulum - diagnostic imaging; Endometriosis - complications; Endometriosis - diagnostic imaging; Female; Hematuria - etiology; Humans; Imaging, Three-Dimensional; Male; Medical sciences; Middle Aged; Neoplasm Metastasis - diagnostic imaging; Neoplasms - diagnostic imaging; Nephrology. Urinary tract diseases; Sensitivity and Specificity; Tomography, Spiral Computed - methods; Urinary Bladder Diseases - complications; Urinary Bladder Diseases - diagnostic imaging; Urinary Bladder Neoplasms - complications; Urinary Bladder Neoplasms - diagnostic imaging; Urinary system involvement in other diseases. Miscellaneous; Urinary tract. Prostate gland; Urology; User-Computer Interface; Human; Nephrology; Urinary system disease; Radiodiagnosis; Hematuria; Cystoscopy; Hemorrhage; Virtual endoscopy; Urology; Efficiency; Medical imagery; Computerized axial tomography; Diagnosis
• ISSN: 0090-4295; 1527-9995
• DOI: 10.1016/j.urology.2011.10.011

Objective To evaluate the efficacy and the potential use of multidetector computed tomography virtual cystoscopy (MDCT-VC) in patients with gross hematuria. Methods A total of 32 patients underwent MDCT-VC, cystoscopy, and a cytologic examination. The slice thickness of MDCT was 1 mm. Bladder distension was done with room air. The data were converted into 3-dimensional virtual reconstructive models. The data sets were reviewed independently by 2 experienced radiologists. Tumors confined to the mucosa, infiltrating the muscularis, and transmural tumors were distinguished. Results VC showed a sensitivity and specificity of 100%. The radiologic accuracy regarding T stage correlated in 87.5%. MDCT-VC identified 21 bladder lesions suspicious for bladder cancer in 18 patients. The histologic results showed 22 patients with bladder lesions, 18 were diagnosed with transitional cell carcinoma of the bladder, 3 had bladder endometriosis, and 1 had an infiltrating colon cancer. Four patients had concomitant carcinoma in situ lesions, which were not seen completely with MDCT-VC. However, cytology was positive in those cases. Ten patients did not have any tumor signs on VC and the subsequent conventional cystoscopy did not bring any change to the initial tumor-free diagnosis of VC. Conclusion MDCT-VC combined with urine cytology is a good alternative to conventional cystoscopy for patients with painless gross hematuria. It should be used as a decision-making aid to identify patients who will benefit from additional cystoscopic examination. Future developments should focus on the visibility of sessile and carcinoma in situ lesions.