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Published online before print October 19, 2007, 10.1148/radiol.2452061060
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(Radiology 2007;245:798-805.)
© RSNA, 2007

Genitourinary Imaging

Hematuria: Portal Venous Phase Multi–Detector Row CT of the Bladder—A Prospective Study1

Sung Bin Park, MD, Jeong Kon Kim, MD, Hyun Joo Lee, MD, Hyuck Jae Choi, MD, and Kyoung-Sik Cho, MD

1 From the Department of Radiology, Asan Medical Center, University of Ulsan, 388-1 Poongnap-dong, Songpa-gu, Seoul 138-736, South Korea (S.B.P., J.K.K., H.J.L., K.S.C.); and Department of Radiology, National Cancer Center, Goyang, South Korea (H.J.C.). Received June 18, 2006; revision requested August 21; revision received November 7; accepted December 18; final version accepted April 9, 2007. Address correspondence to J.K.K. (e-mail: rialto{at}amc.seoul.kr).

Purpose: To prospectively determine the accuracy of portal venous phase helical multi–detector row computed tomography (CT) for bladder lesion evaluation in patients with hematuria by using cystoscopy as the reference standard.

Materials and Methods: The study was approved by the institutional review board for human investigation, and informed consent was obtained from all patients. This study included 118 patients (91 male, 27 female; age range, 15–87 years; mean age ± standard deviation, 62 years ± 14) who underwent portal venous phase multi–detector row CT (scanning delay, 70 seconds; section thickness, 2 mm) and conventional cystoscopy because of painless gross hematuria or recurrent microscopic hematuria. Two reviewers with different experience levels independently evaluated the bladder for lesions at CT in a prospective fashion. The {kappa} statistic was used to determine the per lesion and per patient agreement between the two reviewers and between the CT and cystoscopic findings. The sensitivity and specificity of multi–detector row CT for bladder lesion detection were analyzed for numbers of lesions and for numbers of patients.

Results: Multi–detector row CT showed excellent per lesion ({kappa} = 0.839) and per patient ({kappa} = 0.881) agreement between the two reviewers. Respective per lesion and per patient agreement between the CT and cystoscopic findings was also excellent in the first ({kappa} = 0.866 and {kappa} = 0.881) and second ({kappa} = 0.802 and {kappa} = 0.863) reviewers. The sensitivity and specificity of multi–detector row CT were 89%–92% and 88%–97%, respectively, in the per lesion analysis and 95% and 91%–93%, respectively, in the per patient analysis for both reviewers. All statistical parameters of diagnostic accuracy were similar between the two reviewers (P > .05).

Conclusion: Portal venous phase multi–detector row CT can provide high accuracy and reader agreement for bladder lesion detection in patients with painless gross hematuria and recurrent microscopic hematuria; these results indicate that multi–detector row CT can be used as the initial bladder examination in such patients.

© RSNA, 2007




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