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The purpose of this study is to determine the role of computed tomography (CT) on the decision to administer blood transfusions in patients with abdominopelvic hemorrhage (trauma, surgery, invasive procedure, and spontaneous) and to determine the clinical parameters most likely to influence the decision to administer blood transfusions in patients with spontaneous abdominopelvic hemorrhage. In this IRB approved and HIPPA compliant study, retrospective analysis was performed on 298 patients undergoing abdominal and pelvic CT for suspected abdominopelvic hemorrhage and the CT reports and electronic medical records were reviewed. Odds ratios and 95% CI were calculated to compare the odds of abdominopelvic hemorrhage and transfusion for categorical and continuous predictors. The presence of abdominopelvic hemorrhage by CT was significantly associated with blood transfusions for trauma patients (p-value <0.0001) only. 106 patients with suspected spontaneous abdominopelvic hemorrhage had the lowest CT positivity rate (n = 23, 21.7%) but the highest blood transfusion rate (n = 62, 58.5%) compared to the patients with abdominopelvic hemorrhage from known preceding causes. In patients with spontaneous abdominopelvic hemorrhage, low hemoglobin and hematocrit levels immediately prior to obtaining the CT study were more predictive for receiving a blood transfusion (p-value <0.0001) than the presence of hemorrhage by CT. CT positivity is strongly correlated with the decision to administer blood transfusions for patients with abdominopelvic hemorrhage from trauma, indicating that CT studies play a significant role in determining the clinical management of trauma patients. For patients with spontaneous abdominopelvic hemorrhage, the decision to transfuse depends not on the CT study but on the patient's hemoglobin and hematocrit levels. CT studies should therefore not be performed for the sole purpose of determining the need for blood transfusion in patients with spontaneous abdominopelvic hemorrhage.

Purpose: To determine whether focal peripheral zone enhancement on routine venous-phase CT is predictive of higher-grade (Gleason 4 + 3 and higher) prostate cancer., Materials and Methods: IRB approval was obtained and informed consent waived for this HIPAA-compliant retrospective study. Forty-three patients with higher-grade prostate cancer (≥Gleason 4 + 3) and 96 with histology-confirmed lower-grade (≤Gleason 3 + 4 [n = 47]) or absent (n = 49) prostate cancer imaged with venous-phase CT comprised the study population. CT images were reviewed by ten blinded radiologists (5 attendings, 5 residents) who scored peripheral zone enhancement on a scale of 1 (benign) to 5 (malignant). Mass-like peripheral zone enhancement was considered malignant. Likelihood ratios (LR) and specificities were calculated. Multivariate conditional logistic regression analyses were conducted., Results: Scores of "5" were strongly predictive of higher-grade prostate cancer (pooled LR+ 9.6 [95% CI 5.8-15.8]) with rare false positives (pooled specificity: 0.98 [942/960, 95% CI 0.98-0.99]; all 10 readers had specificity ≥95%). Attending scores of "5" were more predictive than resident scores of "5" (LR+: 14.7 [95% CI 5.8-37.2] vs. 7.6 [95% CI 4.2-13.7]) with similar specificity (0.99 [475/480, 95% CI 0.98-1.00] vs. 0.97 [467/480, 95% CI 0.96-0.99]). Significant predictors of an assigned score of "5" included presence of a peripheral zone mass (p < 0.0001), larger size (p < 0.0001), and less reader experience (p = 0.0008). Significant predictors of higher-grade prostate cancer included presence of a peripheral zone mass (p = 0.0002) and larger size (p < 0.0001)., Conclusion: Focal mass-like peripheral zone enhancement on routine venous-phase CT is specific and predictive of higher-grade (Gleason 4 + 3 and higher) prostate cancer.

Purpose: To determine whether the frequency of intra-observer measurement discrepancies ≥5 mm for solid renal masses varies by renal mass characteristics and CT contrast phase., Materials and Methods: This HIPAA-compliant retrospective study was approved by our IRB. We selected single CT images performed during the nephrographic phase (NP) of renal enhancement in 97 patients, each with a single solid renal mass. Mass location, margin, heterogeneity, and growth pattern were assessed. Six readers measured each mass on two occasions >3 weeks apart. Readers also measured the masses on images in 50 patients who had corticomedullary phase (CMP) images obtained during the same study. Results were assessed using Chi-square/Fisher's exact and Wilcoxon Signed Rank tests, and logistic regression analyses., Results: For NP to NP comparisons, intra-reader measurement differences ≥5 mm were seen for 3.7% (17/463) of masses <4 cm, but increased to 16.8% (20/119) for masses >4 cm (p < 0.0001). Masses with poorly defined margins (15.9% [22/138] vs. 3.4% [15/444] for well-defined margins, p < 0.0001) and heterogeneity (15.3% [22/144], vs. 5.0% [14/282] for minimally heterogeneous, vs. 0.6% [1/156] for homogeneous, p < 0.0001), were more frequently associated with measurement differences ≥5 mm. Differences ≥5 mm were more frequent when only CMP images were utilized (14% [42/299]), or when CMP images were compared with NP images (26% [77/299])., Conclusions: A ≥5 mm intra-reader variation in measured size of solid renal masses <4 cm is uncommon for NP to NP comparisons. Variation increases when masses are ≥4 cm, poorly defined, or heterogeneous; or when CMP images are utilized.

Background: The purpose of our study was to determine the sensitivity of 16-row multi-detector computed tomography urography (CTU) axial, coronal reformatted, and curved-planar reformatted image-types for upper tract urothelial neoplasm detection., Methods: Twenty-one CTU examinations were identified that contained one or more pathology-proven upper tract urothelial neoplasms during our study period. Two readers independently reviewed 1.25 and 2.5 mm axial, coronal reformatted, and curved-planar reformatted excretory phase CTU images. Each reader then documented the location and appearance of lesions suspicious for upper tract urothelial neoplasm. These results were correlated with relevant endoscopic/surgical procedure notes as well as pathology results., Results: Reader #1 detected 72%, 63%, 75%, and 72% of the known 32 upper tract urothelial neoplasms using 1.25 mm axial, 2.5 mm axial, coronal reformatted, and curved-planar reformatted image-types, respectively. Reader #2 detected 72% of the known neoplasms using each of the four image-types. No significant difference in sensitivity between image-types was identified. After combining the results for all four image-types, readers #1 and #2 had overall sensitivities of 94% and 91%., Conclusions: Axial, coronal reformatted, and curved-planar reformatted image-types have similar sensitivities for the detection of upper tract urothelial neoplasm in 16-row multi-detector CTU. Reviewing multiple image-types increases the sensitivity of urothelial lesion detection.

The aim was to develop clinical guidelines for multidetector computed tomography urography (CTU) by a group of experts from the European Society of Urogenital Radiology (ESUR). Peer-reviewed papers and reviews were systematically scrutinized. A summary document was produced and discussed at the ESUR 2006 and ECR 2007 meetings with the goal to reach consensus. True evidence-based guidelines could not be formulated, but expert guidelines on indications and CTU examination technique were produced. CTU is justified as a first-line test for patients with macroscopic haematuria, at high-risk for urothelial cancer. Otherwise, CTU may be used as a problem-solving examination. A differential approach using a one-, two- or three-phase protocol is proposed, whereby the clinical indication and the patient population will determine which CTU protocol is employed. Either a combined nephrographic-excretory phase following a split-bolus intravenous injection of contrast medium, or separate nephrographic and excretory phases following a single-bolus injection can be used. Lower dose (CTDIvol 5-6 mGy) is used for benign conditions and normal dose (CTDIvol 9-12 mGy) for potential malignant disease. A low-dose (CTDIvol 2-3 mGy) unenhanced series can be added on indication. The expert-based CTU guidelines provide recommendations to optimize techniques and to unify the radiologist's approach to CTU.

Multi-detector computed tomography urography (CTU) is a robust imaging modality for evaluation of the kidneys and urinary tract. When compared to excretory urography (EU), CTU's superior contrast resolution appears to more effectively detect and characterize numerous benign and malignant conditions involving the kidneys, upper urinary tracts, and urinary bladder. While the concept of CTU has been utilized for nearly a decade, there is still no universally accepted technique. In fact, numerous articles evaluating various CTU techniques and associated ancillary maneuvers have been recently described in the literature. This review will discuss various indications, specific techniques, image reconstruction/reformatting, detection of pathology, and pitfalls related to CTU.

The authors present 14 cases from the film interpretation session of the 11th annual meeting of the European Society of Urogenital Radiology presented in September, 2004. The cases demonstrate the imaging findings, differential diagnoses, and clinical relevance of a wide variety of genitourinary tract diseases. The cases include examples of benign and malignant urinary tract neoplasms, inflammatory processes, vascular diseases, traumatic injuries, and congenital anomalies.

Twelve patients presented for percutaneous catheter drainage of 13 postoperative pelvic lymphoceles. Six patients with 7 lymphoceles were treated with povidone-iodine sclerosis prior to catheter removal. Only 1 lymphocele (which continued to drain large amounts of fluid during and after the sclerosis procedure) recurred. Six patients with 6 lymphoceles had their percutaneous catheters removed without sclerosis. Fluid collections recurred in 3 instances, necessitating repeat percutaneous drainage (2 patients) or surgery (1 patient). Percutaneous therapy is the treatment of choice for patients with postoperative lymphoceles. Povidone-iodine sclerosis is often effective in preventing reaccumulation of fluid once the lymphocele cavity is collapsed.