CTU and MRU are of greater usefulness because they allow for the comprehensive evaluation of the genitourinary tract, as well as the assessment of retroperitoneal and pelvic lymph nodes (see CTU and MRU sections). CT Pelvis Without IV Contrast There is no relevant literature to support the use of CT pelvis without IV contrast (separate from CTU protocol) in the pretreatment staging of UTUC. Imaging of the entire abdomen and pelvis would be indicated. CTU Without and With IV Contrast The European Association of Urology guidelines [31] recommendations specific to UTUC indicate that CTU is generally the most accurate and preferred modality for diagnosis and staging, both local and distant. This is supported by several studies concluding that CT, particularly CTU, is the most used imaging modality worldwide for the diagnosis and staging of urothelial malignancies [2], and CTU is the favored modality used for localizing, locoregional staging, and detecting distant metastases in UC [34]. The American Urology Association has recently published guidelines for UTUC separate to bladder cancer [19]. CTU is also essential to evaluate for synchronous UTUC or bladder UC. Approximately two-thirds of UTUCs present as high-grade invasive disease at the time of diagnosis, and multifocal disease has been reported in approximately 25% to 30% of UTUC [7,8]. A meta-analysis and systematic review of CTU for UTUC reported a pooled sensitivity of 96% (95% CI, 88%-100%) and a Pretreatment Staging of Urothelial Cancer specificity of 99% (95% CI, 98%-100%) for identifying UC [113]. In a recent review by Mirmomen et al [35], CTU demonstrated a 91% diagnostic accuracy in detecting UCs, but it may miss very small or flat lesions that are more easily detected by direct visualization [23]. In recent years, CTU has largely replaced IVU for evaluating the renal collecting systems and ureters [37,38].
Pretreatment Staging of Urothelial Cancer. CTU and MRU are of greater usefulness because they allow for the comprehensive evaluation of the genitourinary tract, as well as the assessment of retroperitoneal and pelvic lymph nodes (see CTU and MRU sections). CT Pelvis Without IV Contrast There is no relevant literature to support the use of CT pelvis without IV contrast (separate from CTU protocol) in the pretreatment staging of UTUC. Imaging of the entire abdomen and pelvis would be indicated. CTU Without and With IV Contrast The European Association of Urology guidelines [31] recommendations specific to UTUC indicate that CTU is generally the most accurate and preferred modality for diagnosis and staging, both local and distant. This is supported by several studies concluding that CT, particularly CTU, is the most used imaging modality worldwide for the diagnosis and staging of urothelial malignancies [2], and CTU is the favored modality used for localizing, locoregional staging, and detecting distant metastases in UC [34]. The American Urology Association has recently published guidelines for UTUC separate to bladder cancer [19]. CTU is also essential to evaluate for synchronous UTUC or bladder UC. Approximately two-thirds of UTUCs present as high-grade invasive disease at the time of diagnosis, and multifocal disease has been reported in approximately 25% to 30% of UTUC [7,8]. A meta-analysis and systematic review of CTU for UTUC reported a pooled sensitivity of 96% (95% CI, 88%-100%) and a Pretreatment Staging of Urothelial Cancer specificity of 99% (95% CI, 98%-100%) for identifying UC [113]. In a recent review by Mirmomen et al [35], CTU demonstrated a 91% diagnostic accuracy in detecting UCs, but it may miss very small or flat lesions that are more easily detected by direct visualization [23]. In recent years, CTU has largely replaced IVU for evaluating the renal collecting systems and ureters [37,38].