Multidetector computed tomography virtual cystoscopy: an effective diagnostic tool in patients with hematuria

Urology. 2012 Feb;79(2):270-6. doi: 10.1016/j.urology.2011.10.011.

Abstract

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.

Publication types

  • Validation Study

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • 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
  • Middle Aged
  • Neoplasm Metastasis / diagnostic imaging
  • Neoplasms / diagnostic imaging
  • 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
  • User-Computer Interface