MRU may be performed for nodal, synchronous bladder, and metastatic staging. The main benefit of MRU over CTU includes inherent higher contrast resolution [62]. In addition, when the entire upper tract is not visualized or degraded by motion artifact, MRU sequences can be repeated multiple times without fear of added radiation risk. Inherent higher contrast resolution of MRU is particularly beneficial for small tumor detection. Radiography Chest All patients with UTUC need pulmonary evaluation [31]. The chest radiograph is an effective and low-morbidity screen [74]. Patients with UTUC who have abnormal chest radiograph findings or are at high risk should undergo chest CT, consistent with other guidelines [31,32]. Radiography Intravenous Urography The widespread use of CTU and emerging use of MRU have essentially replaced IVU for evaluation of the urothelium in the renal collecting systems and ureters. Sensitivity of excretory urography to detect upper urinary tract lesions is reportedly 50% to 70% [37]. However, a study comparing the accuracy of detection and localization of upper urinary tract UC with CTU versus excretory urography favored CTU with per-patient sensitivity, specificity, and overall accuracy rates of 93.5%, 94.8%, and 94.2%, respectively, compared with 80.4%, 81.0%, and 80.8%, respectively, for excretory urography [37]. Pretreatment Staging of Urothelial Cancer US Kidneys and Bladder Retroperitoneal Limited literature is available to support the use of US kidney and bladder retroperitoneal in the evaluation of UTUC. Due to limited sensitivity, a negative US kidney and bladder retroperitoneal study should not be considered adequate, and further imaging studies would be required for pretreatment staging. Likewise, a positive US kidney and bladder retroperitoneal study would also need follow-up evaluation for more complete staging.
Pretreatment Staging of Urothelial Cancer. MRU may be performed for nodal, synchronous bladder, and metastatic staging. The main benefit of MRU over CTU includes inherent higher contrast resolution [62]. In addition, when the entire upper tract is not visualized or degraded by motion artifact, MRU sequences can be repeated multiple times without fear of added radiation risk. Inherent higher contrast resolution of MRU is particularly beneficial for small tumor detection. Radiography Chest All patients with UTUC need pulmonary evaluation [31]. The chest radiograph is an effective and low-morbidity screen [74]. Patients with UTUC who have abnormal chest radiograph findings or are at high risk should undergo chest CT, consistent with other guidelines [31,32]. Radiography Intravenous Urography The widespread use of CTU and emerging use of MRU have essentially replaced IVU for evaluation of the urothelium in the renal collecting systems and ureters. Sensitivity of excretory urography to detect upper urinary tract lesions is reportedly 50% to 70% [37]. However, a study comparing the accuracy of detection and localization of upper urinary tract UC with CTU versus excretory urography favored CTU with per-patient sensitivity, specificity, and overall accuracy rates of 93.5%, 94.8%, and 94.2%, respectively, compared with 80.4%, 81.0%, and 80.8%, respectively, for excretory urography [37]. Pretreatment Staging of Urothelial Cancer US Kidneys and Bladder Retroperitoneal Limited literature is available to support the use of US kidney and bladder retroperitoneal in the evaluation of UTUC. Due to limited sensitivity, a negative US kidney and bladder retroperitoneal study should not be considered adequate, and further imaging studies would be required for pretreatment staging. Likewise, a positive US kidney and bladder retroperitoneal study would also need follow-up evaluation for more complete staging.