Faculty Collaboration Database

Multidetector computerized tomography urography as the primary imaging modality for detecting urinary tract neoplasms in patients with asymptomatic hematuria. J Urol 2008 Mar;179(3):862-7; discussion 867

Date

01/29/2008

Pubmed ID

18221955

DOI

10.1016/j.juro.2007.10.061

Scopus ID

2-s2.0-39149098795 (requires institutional sign-in at Scopus site)   84 Citations

Abstract

PURPOSE: We determined whether multidetector computerized tomography urography is sensitive and specific for detecting urinary tract neoplasms when used as the primary imaging modality for evaluating patients with hematuria.

MATERIALS AND METHODS: A retrospective review was performed of the radiological, urological and pathological records of 468 patients without a history of urinary neoplasms who presented with hematuria. All patients underwent multidetector computerized tomography urography and complete urological evaluation, including cystoscopy. Laboratory urinalysis and cytology were done in 350 and 318 of the 468 patients, respectively. Multivariate logistic regression analysis was performed using the variables multidetector computerized tomography urography diagnosis, worst urine cytology, number of red blood cells per high power field, gross hematuria, age and gender to predict urinary tract neoplasm.

RESULTS: A total of 50 urinary neoplasms were diagnosed in 468 patients. Multidetector computerized tomography urography detected 32 of 50 neoplasms for a sensitivity of 64%, specificity of 98%, positive predictive value of 76% and negative predictive value of 96%. There were 10 false-positive and 18 false-negative multidetector computerized tomography urography studies. Multivariate logistic regression showed that abnormal multidetector computerized tomography urography findings, ie neoplasm (p <0.0001), and suspicious or positive urine cytology (p = 0.0009) were significant. Patients with an abnormal multidetector computerized tomography urography diagnosis and suspicious or positive urine cytology had 44 and 47 times greater odds, respectively, of having urinary neoplasms compared to the odds in those with normal examinations.

CONCLUSIONS: Multidetector computerized tomography urography is relatively sensitive and highly specific for detecting urinary neoplasms. It may serve as the primary imaging modality to evaluate patients with hematuria. Multidetector computerized tomography urography does not eliminate the role of cystoscopy in the evaluation of hematuria.

Author List

Sudakoff GS, Dunn DP, Guralnick ML, Hellman RS, Eastwood D, See WA

Author

Michael Guralnick MD Professor in the Urologic Surgery department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Adult
Aged
Aged, 80 and over
Female
Hematuria
Humans
Male
Middle Aged
Retrospective Studies
Sensitivity and Specificity
Tomography, X-Ray Computed
Urography
Urologic Neoplasms