Performance of diffusion-weighted MRI post-CT urography for the diagnosis of upper tract urothelial carcinoma

Comparison with selective urine cytology sampling

Hirotaka Akita, Eiji Kikuchi, Nozomi Hayakawa, Shuji Mikami, Hiroaki Sugiura, Mototsugu Oya, Masahiro Jinzaki

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2 Citations (Scopus)

Abstract

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.

Original languageEnglish
Pages (from-to)208-215
Number of pages8
JournalClinical Imaging
Volume52
DOIs
Publication statusPublished - 2018 Nov 1

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Diffusion Magnetic Resonance Imaging
Urography
Cell Biology
Urine
Carcinoma

Keywords

  • CT urography
  • Diffusion-weighted MRI
  • Selective urine cytology sampling
  • Upper tract urothelial carcinoma

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging

Cite this

@article{d7306f8c3fc048438d2178c901d3bda1,
title = "Performance of diffusion-weighted MRI post-CT urography for the diagnosis of upper tract urothelial carcinoma: Comparison with selective urine cytology sampling",
abstract = "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.",
keywords = "CT urography, Diffusion-weighted MRI, Selective urine cytology sampling, Upper tract urothelial carcinoma",
author = "Hirotaka Akita and Eiji Kikuchi and Nozomi Hayakawa and Shuji Mikami and Hiroaki Sugiura and Mototsugu Oya and Masahiro Jinzaki",
year = "2018",
month = "11",
day = "1",
doi = "10.1016/j.clinimag.2018.08.012",
language = "English",
volume = "52",
pages = "208--215",
journal = "Clinical Imaging",
issn = "0899-7071",
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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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SN - 0899-7071

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