TY - JOUR
T1 - Performance of diffusion-weighted MRI post-CT urography for the diagnosis of upper tract urothelial carcinoma
T2 - Comparison with selective urine cytology sampling
AU - Akita, Hirotaka
AU - Kikuchi, Eiji
AU - Hayakawa, Nozomi
AU - Mikami, Shuji
AU - Sugiura, Hiroaki
AU - Oya, Mototsugu
AU - Jinzaki, Masahiro
PY - 2018/11/1
Y1 - 2018/11/1
N2 - Objectives: To evaluate the usefulness of adding diffusion-weighted MRI (DW-MRI) to CT urography (CTU) for diagnosing upper tract urothelial carcinoma (UTUC). Materials and methods: We retrospectively evaluated 102 high-risk patients with UTUC who underwent both CTU and DW-MRI. The diagnostic performance of CTU and DW-MRI was evaluated in all the patients. Then, the diagnostic performance of DW-MRI in the patients with positive CTU findings was assessed based on the types of CTU findings (mass formation, wall thickening, and small filling defects). The diagnostic performance of DW-MRI and selective urine cytology sampling in these patients was also compared. Results: The sensitivity of DW-MRI (92%) was less than that of CTU (98%) (P = 0.25), since DW-MRI could not detect any small papillary tumors. The specificity of DW-MRI (91%) was greater than that of CTU (78%) (P = 0.065), since DW-MRI could discriminate some benign conditions from UTUC. Among the 59 positive CTU lesions, DW-MRI correctly diagnosed all 41 mass-forming lesions and improved the accuracy from 36% using CTU alone to 79% for 14 wall-thickening lesions but could not add any additional information for 4 small filling-defect lesions. Among the 44 patients with positive CTU findings who underwent selective urine cytology sampling, the sensitivity of DW-MRI (95%) was significantly greater than that of selective urine cytology sampling (56%) (P < 0.001). Conclusions: The addition of DW-MRI would be useful for both mass-forming and wall-thickening lesions. DW-MRI has the potential to reduce the frequency of selective urine cytology sampling for such lesions.
AB - Objectives: To evaluate the usefulness of adding diffusion-weighted MRI (DW-MRI) to CT urography (CTU) for diagnosing upper tract urothelial carcinoma (UTUC). Materials and methods: We retrospectively evaluated 102 high-risk patients with UTUC who underwent both CTU and DW-MRI. The diagnostic performance of CTU and DW-MRI was evaluated in all the patients. Then, the diagnostic performance of DW-MRI in the patients with positive CTU findings was assessed based on the types of CTU findings (mass formation, wall thickening, and small filling defects). The diagnostic performance of DW-MRI and selective urine cytology sampling in these patients was also compared. Results: The sensitivity of DW-MRI (92%) was less than that of CTU (98%) (P = 0.25), since DW-MRI could not detect any small papillary tumors. The specificity of DW-MRI (91%) was greater than that of CTU (78%) (P = 0.065), since DW-MRI could discriminate some benign conditions from UTUC. Among the 59 positive CTU lesions, DW-MRI correctly diagnosed all 41 mass-forming lesions and improved the accuracy from 36% using CTU alone to 79% for 14 wall-thickening lesions but could not add any additional information for 4 small filling-defect lesions. Among the 44 patients with positive CTU findings who underwent selective urine cytology sampling, the sensitivity of DW-MRI (95%) was significantly greater than that of selective urine cytology sampling (56%) (P < 0.001). Conclusions: The addition of DW-MRI would be useful for both mass-forming and wall-thickening lesions. DW-MRI has the potential to reduce the frequency of selective urine cytology sampling for such lesions.
KW - CT urography
KW - Diffusion-weighted MRI
KW - Selective urine cytology sampling
KW - Upper tract urothelial carcinoma
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U2 - 10.1016/j.clinimag.2018.08.012
DO - 10.1016/j.clinimag.2018.08.012
M3 - Article
C2 - 30125847
AN - SCOPUS:85051677856
SN - 0899-7071
VL - 52
SP - 208
EP - 215
JO - Clinical Imaging
JF - Clinical Imaging
ER -