Abstract
Purpose
This study sought to assess the diagnostic accuracy of 64-slice computed tomography urography (CTU) in evaluation of the urinary tract.
Materials and methods
A total of 322 CTU procedures were carried out in 317 consecutive patients (mean age 64.4 years). The findings were compared with previous and subsequent patient workup considering both laboratory and imaging studies, such as urine cytology, abdominal ultrasound and CT, cystoscopy, retrograde pyelography, surgery and pathology.
Results
Out of 322 CTU examinations, 169 showed significant urinary tract changes, whereas 153 revealed no urinary disease, in good agreement with the follow-up. In particular, in bladder evaluation, for which we have a direct comparison with cystoscopy in 125 patients, we calculated a CTU sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and diagnostic accuracy of 85%, 94%, 92%, 89% and 90%, respectively.
Conclusions
CTU was accurate for urinary tract evaluation, but it cannot replace cystoscopy in patients in whom a malignant bladder disease is suspected.
Riassunto
Obiettivo
Scopo del nostro lavoro è stato valutare l’accuratezza diagnostica dell’uro-tomografia computerizzata (TC) eseguita con apparecchiatura a 64 strati nella valutazione delle patologie della via escretrice.
Materiali e metodi
Sono stati effettuati 322 esami uro-TC su 317 pazienti consecutivi (età media 64,6 anni). L’esito è stato confrontato con il precedente e successivo iter diagnostico seguito dal paziente, tenendo in considerazione sia gli esami laboratoristici e strumentali, quali citologia urinaria, ecografia e TC addominale, cistoscopia, cistouretrografia retrograda, sia gli eventuali interventi chirurgici con relativa diagnosi istologica.
Risultati
Tra le 322 uro-TC eseguite, 169 hanno individuato significative alterazioni a carico dell’apparato urinario e 153 non hanno evidenziato aspetti di rilievo, con buona concordanza al follow-up. In particolare a livello vescicale, ove possediamo in 125 pazienti un riscontro diretto dei reperti mediante cistoscopia, abbiamo rilevato un valore di sensibilità dell’85%, una specificità del 94%, un valore predittivo positivo del 92%, un valore predittivo negativo dell’89%, per una accuratezza diagnostica del 90%.
Conclusioni
L’uro-TC si è dimostrata un esame accurato per lo studio della via escretrice, ma non può sostituirsi all’esecuzione di un esame cistoscopico nello studio dei pazienti con sospetta patologia neoplastica vescicale.
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Martingano, P., Stacul, F., Cavallaro, M. et al. 64-Slice CT urography: 30 months of clinical experience. Radiol med 115, 920–935 (2010). https://doi.org/10.1007/s11547-010-0567-3
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DOI: https://doi.org/10.1007/s11547-010-0567-3