In hematüria patients bladder of examination with ct cystography and positive virtual cystoscopy

The most common malignancy of urinary tract is bladder cancer. More than half of the collecting system tumors are located in urinary bladder and most of these patients suffer from microscopic or macroscopic hematuria. 80 ? 90 % of these masses are macroscopically polipoid lesions and more than 90 % of them are transitional cell carcinomas on pathological examination. Conventional cystoscopy is a minimally invasive procedure and is the gold standard diagnostic tool in the evaluation of bladder cancers. On the other hand, the procedure is not so comfortable for the patients, and sometimes general anesthesia is needed, so related complication risk may increase. In addition; various clinical conditions such as bacteriuria, acute cystitis, urethritis, prostatitis, obstructive prostatic hypertrophy, urethra rupture or stenosis may preclude conventional cystoscopy. These factors reveal the necessity for a non-invasive alternative imaging modality which should be as sensitive as gold standard tool. Developments of helical CT technology introduced three dimensional (3D) imaging of urinary bladder, as in colon and tracheo-bronchial system. The 3D virtual CT cystoscopy was first presented at 1996 and the technique depends on 3D reconstruction of transverse thin sections obtained by helical CT scanners. Comparison of the results of virtual CT cystoscopy to the conventional cystoscopy is the subject of various recent papers. In this trial; the patients who admitted to the Urology clinic of our hospital with hematuria complaint between June 2005 ? June 2007 were examined. Not only the bladder cancers, but the other bladder pathologies such as diverticulae and trabeculation were also evaluated. Fifty-one patients with either microscopic or macroscopic hematuria were enrolled in this prospective study. Bladder scans were obtained with patients on supine position with following parameters: Slice thickness: 3 mm, 120 kV, 250 mAs, and pitch: 2. The volumetric data was reconstructed at 1 mm intervals and transferred to the work station. 3D endoluminal images of bladder were produced with the help of Navigator 2.06 software. The threshold values were manually adjusted according to the opacification level of bladder. These transverse sections and the virtual cystoscopic images were prospectively evaluated. The patients were then examined cystoscopically within 1 month of initial CT scans. Both examinations were compared to each other. According to these comparisons; the sensitivity, specifity, positive and negative predictive value of transverse and reformatted CT images to detect polipoid and plaque-like masses were 100 %, 94 %, 97 % and 100 %, respectively. When all the bladder lesions such as masses, diverticulae etc? were considered, the same figures were as following: sensitivity: 92 %, specifity: 96 %, positive predictive value: 95 % and negative predictive value: 92 %. Similar figures were revealed in comparison of virtual CT cystoscopy results to the conventional cystoscopy findings: sensitivity: 100 %, specifity: 94 %, positive predictive value: 97 % and negative predictive value: 100 % for mass detection; sensitivity: 92 %, specifity: 96 %, positive predictive value: 95 % and negative predictive value: 92 % for bladder pathology detection. Neither transverse and reformatted images nor virtual CT cystoscopy could detect the 2 of 4 lesions smaller than or equal to 5 mm. These two lesions were 2 mm and 3 mm on conventional cystoscopy. All lesions over 5 mm were detected by CT. In conclusion; beneath several handicaps such as the difficulty to show the fine mucosal detail and the impossibility to obtain pathological specimens, as all the mass lesions over 5 mm can successfully detected, virtual CT cystoscopy can be a proper alternative to conventional cystoscopy especially in selected patients who cannot be examined cystoscopically. The evaluation of transverse and reformatted images besides the virtual cystoscopic images can raise the success of the examination and the possible extra-vesical invasion and lymph node involvement may be detected.