Urothelial-phase thin-section MDCT of the bladder in patients with hematuria: added value of multiplanar reformatted ima

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KIDNEYS, URETERS, BLADDER, RETROPERITONEUM

Urothelial‑phase thin‑section MDCT of the bladder in patients with hematuria: added value of multiplanar reformatted images Byoung Hee Han1 · Sung Bin Park2   · In Ho Chang3 · Byung Hoon Chi3 · Hyun Jeong Park2 · Eun Sun Lee2 Received: 14 June 2020 / Revised: 4 October 2020 / Accepted: 10 October 2020 © Springer Science+Business Media, LLC, part of Springer Nature 2020

Abstract Purpose  To evaluate the diagnostic performance of MDCT with axial images and multiplanar reformatted (MPR) images from the urothelial phase of the bladder in patients with hematuria using cystoscopy as the reference standard. Materials and methods  Our IRB for human investigation approved this study, and informed consent was waived. We included 192 patients (121 men, 71 women; age range 17–90 years; mean age ± SD: 60 ± 14 years) who underwent contrast-enhanced MDCT (scan delay: 70 s; section thickness: 2 mm) and conventional cystoscopy examination for painless gross hematuria or recurrent microscopic hematuria. Two radiologists in consensus interpreted the images for the presence or absence of bladder lesions. Using the kappa statistic, the patient-based agreement was determined between the CT and cystoscopic findings. We compared the diagnostic performance of axial images to those with coronal and sagittal reformations to detect bladder lesions. Results  MDCT showed excellent agreement between cystoscopy–axial scans (κ = 0.896) and axial with reformatted images (κ = 0.948). The sensitivity, specificity, and accuracy of MDCT were 94%, 96%, and 95% in the axial scans and 98%, 97%, and 97% in the axial with reformatted images, respectively. All statistical parameters of diagnostic performance were similar between the axial and the reformatted images (p > .05). Conclusion  Axial MDCT imaging demonstrates high diagnostic performance in detecting bladder lesions, but additional reformatted images can improve diagnostic accuracy. Keywords  Urinary bladder neoplasms · Cystoscopy · Multidetector computed tomography · Hematuria · Early detection of cancer

Introduction Urinary bladder tumors are the most common types of tumors detected in patients with gross hematuria [1]. Bladder lesions account for approximately 20% of hematuria [2, 3]. Thus, an accurate evaluation of the bladder is important in hematuria patients with negative upper urinary tract findings [4]. Cystoscopy remains the reference standard to * Sung Bin Park [email protected] 1



Department of Radiology, Gangneung Asan Hospital, College of Medicine, University of Ulsan, Gangneung, Korea

2



Department of Radiology, Chung‑Ang University Hospital, Chung-Ang University College of Medicine, 102, Heukseok‑ro, Dongjak‑gu, Seoul 06973, Republic of Korea

3

Department of Urology, Chung‑Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea



detect bladder lesions. However, cystoscopy, an invasive procedure, may be uncomfortable for some patients [5, 6]. Contraindications for conventional cystoscopy include acute