Abstract：
OBJECTIVE: To assess the proportion of upper tract urothelial carcinomas (UTUC) that are evident without the excretory phase at CT urography (CTU), and the proportion of potentially avoidable radiation.
METHODS: UTUCs diagnosed between January 2008-December 2017 were retrospectively identified from a population-based cancer registry. For each patient, US, non-urographic CT, and MRI exams were assessed for a primary mass and secondary imaging findings (hydronephrosis, urinary tract thickening, luminal distention, fat stranding, and lymphadenopathy/metastatic disease). CTUs were assessed for primary and secondary findings, and whether the tumor was evident as a filling defect on excretory phase. The dose-length product (DLP) of potentially avoidable excretory phases was calculated as a fraction of total DLP.
RESULTS: 288 patients (mean age, 72±11 years, 165 males) and 545 imaging examinations were included. Of 192 patients imaged with 370 non-urographic CTs, a primary mass was evident in 154 (80.2%), secondary findings were evident in 172 (89.6%), and primary or secondary findings were evident in 179 (93.2%). Of 175 CTUs, primary and secondary findings were evident in 157 (89.7%) and 166 (94.9%) examinations, respectively, and primary or secondary findings were evident in 170/175 (97.1%). 131/175 (74.9%) UTUCs were evident as a filling defect, including the 5/175 (2.9%) UTUCs without primary or secondary findings. Of 144 CTUs with available DLP data, the proportion of potentially avoidable radiation was 103.7/235.8 (44.0%) Gy⋅cm.
CONCLUSIONS: In our population, almost all UTUCs were evident via primary or secondary imaging findings without requiring the excretory phase. These results support streamlining protocols and pathways.
METHODS: UTUCs diagnosed between January 2008-December 2017 were retrospectively identified from a population-based cancer registry. For each patient, US, non-urographic CT, and MRI exams were assessed for a primary mass and secondary imaging findings (hydronephrosis, urinary tract thickening, luminal distention, fat stranding, and lymphadenopathy/metastatic disease). CTUs were assessed for primary and secondary findings, and whether the tumor was evident as a filling defect on excretory phase. The dose-length product (DLP) of potentially avoidable excretory phases was calculated as a fraction of total DLP.
RESULTS: 288 patients (mean age, 72±11 years, 165 males) and 545 imaging examinations were included. Of 192 patients imaged with 370 non-urographic CTs, a primary mass was evident in 154 (80.2%), secondary findings were evident in 172 (89.6%), and primary or secondary findings were evident in 179 (93.2%). Of 175 CTUs, primary and secondary findings were evident in 157 (89.7%) and 166 (94.9%) examinations, respectively, and primary or secondary findings were evident in 170/175 (97.1%). 131/175 (74.9%) UTUCs were evident as a filling defect, including the 5/175 (2.9%) UTUCs without primary or secondary findings. Of 144 CTUs with available DLP data, the proportion of potentially avoidable radiation was 103.7/235.8 (44.0%) Gy⋅cm.
CONCLUSIONS: In our population, almost all UTUCs were evident via primary or secondary imaging findings without requiring the excretory phase. These results support streamlining protocols and pathways.
摘要：
目的：为了评估上尿路上皮癌（UTUC）的比例，在CT尿路造影（CTU）时没有排泄期，以及潜在可避免辐射的比例。
方法：在2008年1月至2017年12月之间诊断的UTUCs从基于人群的癌症登记处进行回顾性鉴定。对于每个病人来说,US,非尿路CT,和MRI检查评估原发性肿块和继发性影像学发现(肾积水，尿路增厚,管腔扩张,脂肪绞合，和淋巴结病/转移性疾病）。评估CTU的主要和次要发现，以及肿瘤在排泄期是否明显为充盈缺损。潜在可避免的排泄相的剂量长度乘积（DLP）计算为总DLP的分数。
结果：288例患者（平均年龄，72±11岁,包括165名男性）和545项影像学检查。在192例患者中，有370例非尿路造影CT，原发性肿块明显出现在154例(80.2%)，次要发现在172人中很明显(89.6%)，主要或次要发现在179例(93.2%)中明显。175个CTU中,主要和次要发现在157（89.7％）和166（94.9％）检查中很明显，分别,主要或次要发现在170/175(97.1%)中明显。131/175(74.9%)UTUC明显为填充缺陷，包括没有主要或次要发现的5/175（2.9％）UTUC。在144个具有可用DLP数据的CTU中，潜在可避免辐射的比例为103.7/235.8(44.0%)Gy·cm。
结论：在我们的人群中，几乎所有UTUCs均通过原发性或继发性影像学表现明显,无需排泄期.这些结果支持简化协议和途径。
方法：在2008年1月至2017年12月之间诊断的UTUCs从基于人群的癌症登记处进行回顾性鉴定。对于每个病人来说,US,非尿路CT,和MRI检查评估原发性肿块和继发性影像学发现(肾积水，尿路增厚,管腔扩张,脂肪绞合，和淋巴结病/转移性疾病）。评估CTU的主要和次要发现，以及肿瘤在排泄期是否明显为充盈缺损。潜在可避免的排泄相的剂量长度乘积（DLP）计算为总DLP的分数。
结果：288例患者（平均年龄，72±11岁,包括165名男性）和545项影像学检查。在192例患者中，有370例非尿路造影CT，原发性肿块明显出现在154例(80.2%)，次要发现在172人中很明显(89.6%)，主要或次要发现在179例(93.2%)中明显。175个CTU中,主要和次要发现在157（89.7％）和166（94.9％）检查中很明显，分别,主要或次要发现在170/175(97.1%)中明显。131/175(74.9%)UTUC明显为填充缺陷，包括没有主要或次要发现的5/175（2.9％）UTUC。在144个具有可用DLP数据的CTU中，潜在可避免辐射的比例为103.7/235.8(44.0%)Gy·cm。
结论：在我们的人群中，几乎所有UTUCs均通过原发性或继发性影像学表现明显,无需排泄期.这些结果支持简化协议和途径。
