MDCT urography of upper tract urothelial neoplasms

OBJECTIVE: The purpose of our study was to review the MDCT urography appearance of pathologically proven transitional cell carcinomas of the renal collecting system and ureter and to correlate the MDCT urography findings with pathology findings. MATERIALS AND METHODS: Of 370 MDCT urography examinations performed over an 18-month period, 18 patients were diagnosed with 27 renal collecting system or ureteral urothelial neoplasms at endoscopic biopsy (n = 8) or surgery (n = 19). Initial MDCT reports were reviewed to determine the sensitivity of original reviewers in detecting these neoplasms. Two radiologists also retrospectively reviewed these scans and characterized the CT appearance of the neoplasms on both axial CT and 3D reformatted images. Findings at retrospective review were correlated with pathology results to determine whether any CT features could be used to predict tumor grade. RESULTS: Eighteen of 27 neoplasms were prospectively identified on MDCT urography, and an additional six neoplasms were detected on retrospective review. Three ureteral neoplasms could not be visualized. The 24 retrospectively detected neoplasms had three distinct MDCT appearances: circumferential urothelial wall thickening (n = 14), small masses (> 5 mm in maximal diameter) (n = 5), and large masses (> 5 mm in maximal diameter) (n = 5). All detected lesions could be seen on axial excretory phase images provided wide window settings were reviewed; however, only six were detected on 3D reconstructions. MDCT urography appearance did not correlate with tumor grade. CONCLUSION: MDCT urography is a promising technique for detecting upper urinary tract neoplasms. The static 3D reconstructions used in this study are insufficient for visualization. Axial image review remains essential for tumor identification.     

肾移植术后尿路上皮肿瘤的临床特点及诊疗经验

 目的 总结肾移植术后尿路上皮肿瘤的临床特点及诊治体会。方法 回顾性分析清华大学第一附属医院和解放军总医院第三医学中心2004-07至2017-12收治的31例肾移植术后尿路上皮肿瘤患者的临床资料。结果 31例肾移植术后尿路上皮肿瘤患者中,男10例,女21例,15例为输尿管肿瘤,7例为膀胱肿瘤,3例膀胱肿瘤同时合并输尿管肿瘤,5例肾盂肿瘤,1例移植肾肾盂癌。患者均接受手术治疗,其中17例患者术后肿瘤复发而再次接受手术治疗。随访期内6例因肿瘤复发死亡,1例因肠梗阻伴脓毒症死亡。结论 肾移植受者更易发生肿瘤,应早期诊断并根据肿瘤特点尽早采取积极的手术治疗措施。     

Evaluation of renal urothelial carcinoma by contrast-enhanced ultrasonography

Purpose

To observe ultrasonographic features of urothelial carcinoma in renal pelvis and evaluate contrast-enhanced ultrasound (CEUS) in diagnosis.

Materials and methods

Fifty-two patients with urothelial carcinoma underwent preoperative conventional US, colour Doppler flow imaging (CDFI) and CEUS.

Results

Of 52 total lesions, 41 (78.8%) could be clearly identified by US, and 49 (94.2%) were enhanced by CEUS. Among US-imaged lesions, 39 (95.1%) were solid tumours, and two (4.9%) were mixed solid-cystic; 25 (61.0%) were isoechoic, 11 (26.8%) hypoechoic, and five (12.2%) hyperechoic. Analysis of tumour blood flow by CDFI characterised 17 avascular lesions (41.5% of total), 16 hypovascular (39.0%), and 8 hypervascular (19.5%). The resistance index ranged from 0.65 to 0.88 (mean of 0.71). Enhancement was seen in 49 lesions after injection of SonoVue. A slow enhancement pattern was observed in 36 lesions (73.5%) relative to renal cortex, and 13/49 (26.5%) showed simultaneous enhancement. At peak enhancement, 38 lesions (77.6%) were hypo-enhanced, six (12.2%) iso-enhanced, and five (10.2%) hyper-enhanced. There were 12 lesions with intertumoural necrosis or haemorrhage (24.5%) that were heterogeneously enhanced, and 37 (75.5%) were homogeneously enhanced. A fast washout pattern was observed in 46 lesions (93.9%), synchronous washout in two (4.08%), and slow washout in one (2.04%).

Conclusions

Slow-in, fast-out, and hypo-enhancement properties are associated with renal urothelial carcinoma and may thus have diagnostic value. We found that CEUS is able to identify tumours that are ambiguous by conventional US, and it thus significantly improves the confidence of diagnosis.     

High-grade urothelial carcinoma of the prostate on FDG PET-CT

We report the PET-CT appearance of a high-grade prostatic urothelial carcinoma in a 68-year-old man with a long history of urothelial carcinoma. The patient was initially diagnosed with urothelial carcinoma in the left ureter, status postleft nephrourethrectomy. He was subsequently, 11 years later, diagnosed with low-grade urothelial carcinoma involving the bladder for which he received monthly Bacillus Calmette-Guerin treatment. Three months after the diagnosis of the bladder tumor, he was found to have biopsy-proven high-grade urothelial carcinoma of the prostate for which he was referred to have a PET-CT scan to evaluate for distant metastasis.     

MR urography for suspected upper tract urothelial carcinoma

The key components of the MR urography protocol for suspected upper tract urothelial carcinoma are coronal T2-weighted hydrographic sequences without contrast agent and coronal gadolinium-enhanced T1-weighted 3D-spoiled gradient-recalled echo in nephrographic and pyelographic phases. Upper tract urothelial carcinomas can be categorized into papillary tumor, flat tumor, and infiltrative tumor based on the growth pattern and extent. Papillary lesions appear as small filling defects of soft tissue signal on T2-weighted hydrographic and T1-weighted pyelographic phase images. On nephrographic phase images, the lesions show homogeneous enhancement. A flat tumor appears as a segmental area of diffuse thickening and enhancement of the urinary tract wall on nephrographic phase images. Infiltrative tumor often appears as a large heterogeneously enhancing mass. MR urography is a promising alternative for CT urography in the evaluation of upper tract urothelial carcinoma, especially when the patient has a contraindication to iodinated contrast material.     

Imaging of urothelial cancers: what the urologist needs to know

OBJECTIVE: Imaging is vital in the diagnosis, staging, and surveillance of urothelial carcinomas. In this review, we discuss what treating urologists need to know from radiologists to optimally identify disease, plan surgery, determine prognosis, and identify patients in need of multimodal or alternative treatment strategies. We identify key points that a radiologist should convey to the treating urologist, in writing, in order to be an active partner in the formulation of an effective course of care. CONCLUSION: Because imaging plays a crucial role in the diagnosis, staging, and surveillance of patients with tumors of the urinary tract, it is imperative that radiologists provide information about the anatomic features related to the primary tumor, the surrounding anatomy, and involvement or lack of involvement of known potential landing sites for metastases. A good understanding of the imaging features that affect management of the disease and a good relationship between the radiologist and the urologist are vital to the care of patients with urothelial cancers.     

人精氨酸/丝氨酸丰富剪接因子1在膀胱尿路上皮癌中表达及临床意义

目的探讨人精氨酸/丝氨酸丰富剪接因子1(SRSF1)在膀胱尿路上皮细胞癌的表达及其临床意义。方法应用免疫组化方法检测41例膀胱尿路上皮癌及10例正常膀胱尿路上皮中SRSF1的表达情况。结合临床资料以及分析SRSF1与病理分期,组织学分级和复发转移情况的关系。结果 SRSF1在膀胱尿路上皮细胞癌的阳性表达率为83(34/41),而对照组的阳性率为10.0%(1/10),两组间比较差异有统计学意义(P<0.01)。SRSF1的阳性表达与膀胱尿路上皮癌的初发和复发、是否转移显著相关(P<0.05);但在病理分期,组织学分级和肿瘤数量无显著差异。结论 SRSF1在膀胱尿路上皮细胞癌的表达明显上调,并且与膀胱尿路上皮癌的复发及转移密切相关,SRSF1可能通过与肿瘤基因相互作用,调控细胞周期及凋亡等多途径,参与肿瘤的发生及发展。SRSF1可用于膀胱上皮细胞癌早期诊断和复发、转移的一项重要指标。     

Computed tomography in urothelial tumors of renal pelvis and related filling defects

Our study includes 12 patients. Of these, six had transitional cell carcinoma, three patients with stones and three patients with blood clots. With the use of computed tomography we were able to arrive at a reasonable staging and diagnosis of the filling defects. Computed tomography is not sufficiently sensitive to recognize microscopic invasion. Reactive fibrosis and postobstructive inflammatory changes can mimic tumor invasion on computed tomography, and in such cases staging will not be accurate.     

低度恶性潜能乳头状尿路上皮肿瘤二例

世界卫生组织/国际泌尿病理学2004年分类[WHO(2004)/ISUP]中对尿路上皮肿瘤分级标准化进行了有益的尝试.在乳头状膀胱肿瘤分类中,新加入了"具有低度恶性潜能乳头状尿路上皮肿瘤(papillary urothelial neoplasms of low malignant potential,PUNLMP)"条目.膀胱PUNLMP发生率为3/10万,大约5%的PUNLMP发生于上尿路5%,非常罕见,笔者结合文献对我院诊治的输尿管末端和膀胱PUNLMP各1例报告如下.     

Multidetector computed tomography urography (MDCTU) for diagnosing urothelial malignancy

Multidetector computed tomography (MDCT) is well established for the detection of stones and renal masses, but more recently MDCT urography (MDCTU) is becoming widely used for examination of the entire urinary tract aimed specifically for diagnosing urothelial lesions. Evidence is rapidly accumulating to support the use of MDCTU in this manner. Familiarity with the MDCTU signs of urothelial malignancy is a prerequisite for optimum radiological practice. This article provides a review of the appearances of transitional cell cancer in the upper urinary tract and bladder.     

Multistep phase difference phase contrast imaging

A new technique for multistep phase-contrast image processing is presented. The N-step method consists of simply forming the linear average of the N — 1 adjacent phase-difference signals. It has similar noise reduction properties as other multistep techniques, but the simplicity of the noise variance of the N-step technique allows intuitive insight into phase-difference phase-contrast processing and noise reduction, which can aid in the design of efficient and improved phase-contrast imaging sequences. As well, the computational simplicity of the N-step phase-difference technique compared with any other known multistep technique is advantageous. Like other multistep techniques, it has far more efficient noise reduction properties than simple two-step, multiple average phase-contrast imaging, even when normalized for total scan time. A three-step phase-difference velocity image has 50% less variance than an image acquired with two steps and two scans averaged but is obtained in 25% less scan time. Given its advantages, it should now be the chosen technique for increasing velocity-to-noise and contrast-to-noise ratios in all phase-difference phase-contrast clinical applications.     

胰岛素样生长因子受体2在膀胱尿路上皮癌组织中表达及其临床意义

目的探讨胰岛素样生长因子受体2(IGF2R)在膀胱尿路上皮癌组织中的表达及其临床意义。方法选取中国医科大学肿瘤医院自2010年5月至2017年5月确诊膀胱尿路上皮癌患者135例为研究对象。应用实时荧光定量聚合酶链式反应检测15例膀胱尿路上皮癌组织及癌旁正常膀胱黏膜组织中IGF2R的mRNA表达水平。采用免疫组化法检测120例膀胱尿路上皮癌组织中IGF2R的蛋白表达水平。分析IGF2R的表达水平与膀胱癌临床病理特征及预后的相关性。结果 IGF2R在膀胱尿路上皮癌组织中的表达,显著低于癌旁正常膀胱黏膜组织,差异有统计学意义(P<0.05)。单因素分析显示,IGF2R低表达、临床分期、肿瘤分期、淋巴结转移与膀胱癌患者的死亡风险密切相关(P<0.05)。多因素分析显示,IGF2R低表达、临床分期、淋巴结转移为膀胱癌患者总存活期的独立预测因素(P<0.05)。Kaplan-Meier生存曲线表明,IGF2R低表达患者的5年存活率明显低于高表达患者(P<0.05)。结论 IGF2R在膀胱尿路上皮癌组织中低表达,且为膀胱尿路上皮癌患者不良预后的独立预测因素。检测IGF2R的表达对膀胱癌患者生存预后的预测具有重要参考价值。     

Multiparametric magnetic resonance imaging of plasmacytoid urothelial carcinoma with histopathological correlation: A case report

Plasmacytoid urothelial carcinomas of the bladder are rare, aggressive variants with a poor prognosis. Few reports have described the correlation of histopathological features with multiparametric magnetic resonance imaging findings in the local staging of plasmacytoid urothelial carcinoma. An 82-year-old woman with hematuria was referred to our hospital. Magnetic resonance imaging showed diffuse bladder wall thickening, with different signal intensities in the 2 layers—inner and outer. This case suggests that the presence of diffuse bladder wall thickening and varying signal intensities in the 2 layers could aid in the local staging of plasmacytoid urothelial carcinoma. A thickened bladder wall with restricted diffusion suggests tumor invasion, indicating that the tumor can invade the organ in contact with the thickened bladder wall.