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Strategy for optimizing bladder opacification on CT urogram?
Hi all,
What strategy have you found to be best for maximizing bladder opacification on a CT urogram? Our ureteral opacification is pretty good, but the bladder always has a contrast-urine level where the contrast pools dependently and the anterior bladder is unopacified.
Thanks!
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17 Replies
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We used to have them get up and walk around.
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Back in the old “we don’t care about radiation” days, one of our places used to do 4 sets of cuts through the bladder…. supine, both obliques, and prone
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Your job as a radiologist is to evaluate for a source of bleeding above the bladder
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We tried rolling the patient on the CT table right before the delayed scans and it works except the techs dont like to do it and forget.Minor point, but the images of the delayed study are not linked to the prior series because of differences in positioning after rolling.
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We just live with it.
Obviously, it’s the anterior bladder we are dealing with in this circumstance.
I have found that most bladder masses show nicely on the early series as enhancing soft tissue. Rarely do I see a mass only demonstrated as a filling defect on late imaging.
For bladder integrity, would do a CT cystogram, which opacifies fine.
And as implied above, cystoscopy is standard for most urologists in the work up. They can do it in about 60 seconds in the office. Those superficial mucosal lesions will be occult by CT no matter what. They want to know what’s going on above that.
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On similar theme, do you all code these as CT Urograms… and if so, do you or techs do 3D recons of collecting system/ureters? And therefore do you charge for 3D recons on independent workstation?
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we have the technologists put their hands on the patient’s hips and ‘jiggle’ the pelvis a little to help aggitate the bladder contrast.
Takes 5 seconds.
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Can have patient roll over on the CT table to
mix the contrast in the bladder.-
All of my negative CT Urograms get this in the impression (especially when ordered by Non urologists): “No discrete upper tract lesions seen to explain patient’s hematuria. Recommend Urologic referral for cystoscopy to complete this hematuria workup”
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Quote from FlyNavy
All of my negative CT Urograms get this in the impression (especially when ordered by Non urologists): “No discrete upper tract lesions seen to explain patient’s hematuria. Recommend Urologic referral for cystoscopy to complete this hematuria workup”
When we do stop doing everyone’s job though? They should know the workup they are ordering
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Wait 10 min and and then scan but that may not be feasible depending on throughput.
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Urogram should only be ordered by urology. No need to tell them we don’t adequately asses the bladder.
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Perfect world everyone we get to see a urologist Many times lower level providers are doing this work up And that number may increase in the future. Many times a radiologist is the only doctor in the whole chain of care ..
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CT urogram is not for the bladder it is for the upper tract. Even if there is something weird looking in the bladder on the delayed images, I would be careful about borderline calls since the contrast isnt entering the bladder in any kind of standardized way, its just pouring in there according to the patients excretion. I look hard at the 100 second post contrast images to make sure I dont miss an enhancing lesion. But there is so much mixing on the delay that I dont want I draw any firm conclusions.
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Quote from Megaliver
CT urogram is not for the bladder it is for the upper tract. Even if there is something weird looking in the bladder on the delayed images, I would be careful about borderline calls since the contrast isnt entering the bladder in any kind of standardized way, its just pouring in there according to the patients excretion. I look hard at the 100 second post contrast images to make sure I dont miss an enhancing lesion. But there is so much mixing on the delay that I dont want I draw any firm conclusions.
I look hard at the 100 second post contrast images to make sure I dont miss an enhancing lesion.
^^^yes.
youll be surprised how many lesions are evident. -
So you are imaging kidneys through bladder three times: non con, 100 sec, and delayed?
Most places Ive seen do a noncontrast from kidneys through bladder (stones), venous phase through just kidneys (renal masses), and then excretory phase through both kidneys and bladder (collecting system, ureters, bladder lesions).
Interesting to see the different protocols.
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Quote from irfellowship
So you are imaging kidneys through bladder three times: non con, 100 sec, and delayed?
Most places Ive seen do a noncontrast from kidneys through bladder (stones), venous phase through just kidneys (renal masses), and then excretory phase through both kidneys and bladder (collecting system, ureters, bladder lesions).
Interesting to see the different protocols.
If I were to bag a phase through the bladder, it would be the noncon. You can still figure out distal stones on the early enhanced images, no excreted contrast. Bladder lesions enhance, so the early enhanced phase thru the bladder is really helpful.
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