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Multi–Detector Row CT Urography: Comparison of Strategies for Depicting the Normal Urinary Collecting System¹

¹ From the Department of Radiology, Division of Abdominal Imaging and Intervention, Brigham and Women’s Hospital, 75 Francis St, Boston, MA 02115 (J.D.M., M.J., K.H.Z., R.D.N., S.G.S.); Department of Diagnostic Radiology, Keio University School of Medicine, Tokyo, Japan (M.J.); and Department of Health Care Policy, Harvard Medical School, Boston, Mass (K.H.Z.). From the 2000 RSNA scientific assembly. Received September 14, 2001; revision requested November 12; final revision received April 26, 2002; accepted May 22. Address correspondence to S.G.S. (e-mail: sgsilverman@partners.org).

View larger version (155K): [in a new window]   Figure 1a. Selected transverse CT urographic images obtained with a multi-detector row CT scanner and supplemental infusion of normal saline show normal anatomy. Progressing from superior to inferior, the (a) renal pelves (arrows) and (b) upper (arrows), (c) lower (arrows), and (d) distal ureters (arrows) are all opacified.

View larger version (126K): [in a new window]   Figure 1b. Selected transverse CT urographic images obtained with a multi-detector row CT scanner and supplemental infusion of normal saline show normal anatomy. Progressing from superior to inferior, the (a) renal pelves (arrows) and (b) upper (arrows), (c) lower (arrows), and (d) distal ureters (arrows) are all opacified.

View larger version (144K): [in a new window]   Figure 1c. Selected transverse CT urographic images obtained with a multi-detector row CT scanner and supplemental infusion of normal saline show normal anatomy. Progressing from superior to inferior, the (a) renal pelves (arrows) and (b) upper (arrows), (c) lower (arrows), and (d) distal ureters (arrows) are all opacified.

View larger version (160K): [in a new window]   Figure 1d. Selected transverse CT urographic images obtained with a multi-detector row CT scanner and supplemental infusion of normal saline show normal anatomy. Progressing from superior to inferior, the (a) renal pelves (arrows) and (b) upper (arrows), (c) lower (arrows), and (d) distal ureters (arrows) are all opacified.

View larger version (130K): [in a new window]   Figure 2a. Selected coronal CT urographic images obtained with a multi-detector row CT scanner and supplemental infusion of normal saline show normal anatomy. Progressing from anterior to posterior, the upper (arrows in a and b), lower (arrowheads in b and c), and distal (arrows in c and d) ureters and lower-pole calyces (arrowheads in d) are all opacified.

View larger version (131K): [in a new window]   Figure 2b. Selected coronal CT urographic images obtained with a multi-detector row CT scanner and supplemental infusion of normal saline show normal anatomy. Progressing from anterior to posterior, the upper (arrows in a and b), lower (arrowheads in b and c), and distal (arrows in c and d) ureters and lower-pole calyces (arrowheads in d) are all opacified.

View larger version (133K): [in a new window]   Figure 2c. Selected coronal CT urographic images obtained with a multi-detector row CT scanner and supplemental infusion of normal saline show normal anatomy. Progressing from anterior to posterior, the upper (arrows in a and b), lower (arrowheads in b and c), and distal (arrows in c and d) ureters and lower-pole calyces (arrowheads in d) are all opacified.

View larger version (131K): [in a new window]   Figure 2d. Selected coronal CT urographic images obtained with a multi-detector row CT scanner and supplemental infusion of normal saline show normal anatomy. Progressing from anterior to posterior, the upper (arrows in a and b), lower (arrowheads in b and c), and distal (arrows in c and d) ureters and lower-pole calyces (arrowheads in d) are all opacified.

View larger version (125K): [in a new window]   Figure 3. CT urographic MIP image obtained with a multi-detector row CT scanner and supplemental infusion of normal saline shows normal anatomy and has been edited to remove some of the osseous structures. The urinary collecting systems and ureters are demonstrated.

View larger version (99K): [in a new window]   Figure 4a. CT urographic MIP images obtained with a multi-detector row CT scanner and supplemental infusion of normal saline demonstrate different opacification scores for the distal left ureter (arrow) in three patients: (a) score of 1, (b) score of 2, and (c) score of 3.

View larger version (99K): [in a new window]   Figure 4b. CT urographic MIP images obtained with a multi-detector row CT scanner and supplemental infusion of normal saline demonstrate different opacification scores for the distal left ureter (arrow) in three patients: (a) score of 1, (b) score of 2, and (c) score of 3.

View larger version (115K): [in a new window]   Figure 4c. CT urographic MIP images obtained with a multi-detector row CT scanner and supplemental infusion of normal saline demonstrate different opacification scores for the distal left ureter (arrow) in three patients: (a) score of 1, (b) score of 2, and (c) score of 3.

View larger version (66K): [in a new window]   Figure 5. Vertical bar graph compares CT urographic acquisition techniques and IVU. CT urography with supplemental saline depicted segments as well as IVU did in 11 of 12 segments and significantly better than IVU did in one of 12 segments (lower left ureter). Saline administration with prone and supine positioning significantly improved opacification of both distal ureters over that without saline administration and with prone positioning. No significant difference was identified between prone and supine positioning. Black bars = IVU, white bars = CT urography with patient supine and with saline administration, light gray bars = CT urography with patient prone and with saline administration, dark gray bars = CT urography with patient prone and no saline administration.

View larger version (33K): [in a new window]   Figure 6. Histogram shows percentages of segments with opacification greater than 50%, stratified according to technique. Overall, CT urography depicted good opacification in a high percentage of segments. When supplemental saline was administered, 94% of all segments achieved greater than 50% opacification. Black bar = CT urography with patient prone and no saline administration, white bar = CT urography with patient supine and with saline administration, light gray bar = CT urography with patient prone and with saline administration, dark gray bar = IVU.

View larger version (65K): [in a new window]   Figure 7. Vertical bar graph compares display methods for CT urography according to mean opacification scores. Combining transverse and coronal displays resulted in significantly improved opacification scores in the lower IRCS and upper ureter, as compared with those obtained with either display method alone. Black bar = MIP, white bar = coronal display, light gray bar = transverse display, dark gray bar = combined transverse and coronal displays, striped bar = combined transverse, coronal, and MIP displays.

View larger version (101K): [in a new window]   Figure 8a. Coronal and transverse CT urographic images obtained in three patients by using a multi-detector row CT scanner and supplemental infusion of normal saline. (a) Coronal images typically demonstrate longer segments of the upper and lower ureters than do transverse images, as these segments were usually positioned in a superoinferior axis (arrow). (b) Transverse images typically demonstrate longer segments of the distal ureters (arrowheads), as these segments are usually positioned on an anteroposterior axis. Because of anatomic variation, however, it is difficult to predict which plane will be best for a specific segment. (c) The distal ureter (arrowhead) is best seen in the coronal plane.

View larger version (105K): [in a new window]   Figure 8b. Coronal and transverse CT urographic images obtained in three patients by using a multi-detector row CT scanner and supplemental infusion of normal saline. (a) Coronal images typically demonstrate longer segments of the upper and lower ureters than do transverse images, as these segments were usually positioned in a superoinferior axis (arrow). (b) Transverse images typically demonstrate longer segments of the distal ureters (arrowheads), as these segments are usually positioned on an anteroposterior axis. Because of anatomic variation, however, it is difficult to predict which plane will be best for a specific segment. (c) The distal ureter (arrowhead) is best seen in the coronal plane.

View larger version (106K): [in a new window]   Figure 8c. Coronal and transverse CT urographic images obtained in three patients by using a multi-detector row CT scanner and supplemental infusion of normal saline. (a) Coronal images typically demonstrate longer segments of the upper and lower ureters than do transverse images, as these segments were usually positioned in a superoinferior axis (arrow). (b) Transverse images typically demonstrate longer segments of the distal ureters (arrowheads), as these segments are usually positioned on an anteroposterior axis. Because of anatomic variation, however, it is difficult to predict which plane will be best for a specific segment. (c) The distal ureter (arrowhead) is best seen in the coronal plane.

View larger version (59K): [in a new window]   Figure 9a. Coronal CT urographic images progress from posterior to anterior and demonstrate portions of (a) opacified (arrow) and (b) unopacified (arrow) upper ureter. Unopacified segments are best demonstrated when a long segment of the collecting systems or ureters is displayed in plane.

View larger version (57K): [in a new window]   Figure 9b. Coronal CT urographic images progress from posterior to anterior and demonstrate portions of (a) opacified (arrow) and (b) unopacified (arrow) upper ureter. Unopacified segments are best demonstrated when a long segment of the collecting systems or ureters is displayed in plane.