Role of Multidetector Computed Tomography (MDCT) in Detection and Characterization of Ureteral Lesions,
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- Category: Vol. 84, June 2016
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Role of Multidetector Computed Tomography (MDCT) in Detection and Characterization of Ureteral Lesions, TAMER W. KASSEM, MOHAMED F. OSMAN and MAGED A. HAWANA
Abstract
Background: The ureters may be affected by a variety of congenital, traumatic, inflammatory, neoplastic and extrinsic disorders. Congenital anomalies of the ureters include complete and partial duplication, ectopic ureteral insertion, and ure-teroceles. Transitional Cell Carcinoma (TCC) is the most common malignant tumor of the ureter. Traumatic injury to the ureter is most frequently iatrogenic, but it may result from blunt or penetrating traumatic injuries. Extrinsic involve-ment of the ureter can result from a seemingly endless variety of pathologic processes that cause obstruction by direct invasion, pressure, or constriction. The differential diagnosis of ureteral obstruction include intra luminal (calculi, blood clots, papillary necrosis with sloughed papilla), intramural (tumour, infection diseases, post-surgery/instrumentation trauma, lesions after radiotherapy, ureterocele, megaureter) and extrinsic abnormalities (retroperitoneal fibrosis, invasion or compression by extrinsic malignancy, lymphadenopathy, inflammatory diseases).
CT scanning plays a major role in imaging the ureter involving the confirmation or further characterization of causes of obstruction or deviation of the ureter by tumor masses or vascular abnormalities. Detection of urothelial carcinoma is arguably the primary role of CT urography, whether in patients with hematuria or those with a history of urothelial tumors of the bladder requiring surveillance of the upper tracts.
Objective: The purpose of this study is to evaluate the role of Multidetector Computed Tomography (MDCT) in detection and characterization of the different ureteral lesions.
Patients and Methods: This study was conducted on 52 patients over a period of 18 months from February 2014 to August 2015 referred from Urology Department of Kasr El-Aini Hospital. Patients were adequately prepared and MDCT Urography was performed consisting of three imaging phases: Unenhanced, nephrographic and excretory phases. Images were processed and finally the CT findings were correlated with surgical and pathologic findings.
Results: Fifty two patients having different ureteral lesions were examined by MDCT, 34.6% (n=18) of cases showed ureteric stones, 17.3% (n=9) of cases had post bilharzial sequelae, 17.3% (n=9) of cases had ureteric strictures (four cases secondary to inflammation, three cases secondary to radiation therapy and two cases secondary to hysterectomy), 11.5% (n=6) of cases had traumatic injuries to the ureter, 7.6 (n=4) of cases had retroperitoneal fibrosis causing ureteric obstruction, 7.6% (n=4) of cases had TCC of the ureter, 1.9% (n=1) of cases had uretrocele and 1.9% (n=1) of cases had ureteric intra luminal blood clots.
Conclusion: MDCT is an excellent imaging modality in evaluating ureteral lesions and can clearly show the relationship between the ureter and the surrounding structures. Multiplanar (MP) and three-dimensional volume rendering (3D VR) technologies are particularly useful in diagnosing ureteral lesions and their complications. MDCT Urography is now described as a comprehensive test, which can be performed as a substitute "one stop" imaging test for a number of imaging studies, thereby saving time, hospital visits and cost, and potentially shortening the duration of diagnostic evaluation for urinary tract pathology.