Diagnosis of bladder tumours in patients with macroscopic haematuria: a prospective comparison of split-bolus computed tomography urography, magnetic resonance urography and flexible cystoscopy.

OBJECTIVE: The aim of this study was to compare split-bolus computed tomography urography (CTU), magnetic resonance urography (MRU) and flexible cystoscopy in patients with macroscopic haematuria regarding the diagnosis of bladder tumours. MATERIALS AND METHODS: In this prospective study, 150 patients underwent CTU, MRU and flexible cystoscopy. Two uroradiologists individually reviewed the images without any clinical information, using a questionnaire. Patient records and pathology reports were also reviewed. RESULTS: At flexible cystoscopy, MRU and CTU, 32, 19 and 15 bladder lesions were identified, respectively. Histopathology showed that 13 of the 29 biopsied lesions were transitional cell carcinomas. Compared with the histopathology, the sensitivity and specificity for detection of tumours by CTU and MRU were 61.5% and 94.9%, and 79.9% and 93.4%, respectively. False-positive detection of bladder tumours, compared with histopathology, was reported in seven CTUs and nine MRUs, whereas the number of false-negative findings was five for CTUs and three for MRUs. CONCLUSIONS: Split-bolus CTU or MRU cannot replace cystoscopy in cases of macroscopic haematuria. MRU has a higher sensitivity than split-bolus CTU, and is a potential alternative to flexible cystoscopy. Patients with a low risk of bladder cancer may forgo flexible cystoscopy if a bladder tumour is identified by either CTU or MRU, and proceed straight to transuretheral resection of the bladder.

CT urography and hematuria: a retrospective analysis of 771 patients undergoing CT urography over a 1-year period.

BACKGROUND: Computed tomography (CT) urography is now used in the work-up of patients with hematuria. The dose of contrast medium and radiation varies considerably between the different CT protocols. PURPOSE: To study the disease prevalence in a consecutive group of patients with hematuria undergoing CT urography with a low dose of contrast medium and radiation. MATERIAL AND METHODS: From 1 April 2007 to 31 March 2008, using the Radiological Information System (RIS) as well as electronic patient records, demographic data, reason for referral, and diagnosis were obtained for all patients undergoing CT urography due to hematuria. The patients were followed for 3 years. RESULTS: A total of 771 patients had hematuria diagnosed at the time of referral. In 137 patients (18%), a tumor and / or a complex cyst was found in the urinary tract (renal, ureteral, or bladder), in 68 (9%) a calculi, in 118 (15%) other disease (i.e. infection or anomaly) was found. No abnormalities were found at CT urography in 455 (58%) of the patients with hematuria. Lesions were found more frequently in patients with visible hematuria than in patients with non-visible hematuria (48% vs. 29%). No malignant tumor or complex cyst was found in the kidneys or the ureters in patients with nonvisible hematuria. CONCLUSION: CT urography with its low dose of contrast medium and radiation is a useful diagnostic imaging test for investigating patients with hematuria.

Bone bruise in the acutely injured knee.

We used MRI to study the lesions in a consecutive group of 64 patients with an acute trauma of the knee and normal plain radiography during the winter season. Bone bruise was present in 35 of the patients, and these were referred to subsequent MRI 4 and 12 months later. After 4 months bone bruise was still present in 69% of the patients and after 12 months in 12%. Soft tissue lesions, for example, lesion in the meniscus, ACL rupture, or MCL lesion was present in 94% of the patients with bone bruise. Interobserver agreement varied from good to excellent. Soft tissue lesions are found in almost all patients with bone bruise, and these generally resolve 4-12 months after the injury. In the patients with no bone bruise the number of ligament injuries was lower.