Schulz G B, Gresser E K, Casuscelli J, Strittmatter F, Tritschler S, Karl A, Stief C G, Nörenberg D
Urologische Klinik und Poliklinik, Klinikum der Universität München, Campus Großhadern, Marchioninistr. 15, 81377, München, Deutschland.
Klinik und Poliklinik für Radiologie, Klinikum der Universität München, Campus Großhadern, München, Deutschland.
Urologe A. 2019 Jan;58(1):5-13. doi: 10.1007/s00120-018-0828-7.
Staging of bladder cancer, hematuria as well as the evaluation of unclear findings of the kidneys and ureters are the most frequent indications for imaging of the upper urinary tract (UUT). Endourological assessment of the UUT is much more invasive compared to imaging of the bladder, raising the question of the optimal imaging technique. Several technical improvements regarding computed tomography (CT) as well as magnetic resonance imaging (MRI) were implemented in recent years.
To compare the efficacy and limitations of the most important imaging techniques regarding the UUT.
Systematic review of the literature and current German, European, and American guidelines regarding bladder cancer, urothelial carcinoma of the UUT and hematuria.
The CT-based urography has superseded excretory urography and is the first choice for imaging of the UUT. In case of contraindications, MRI is a feasible alternative. In all cases, a urography phase is indispensable.
Imaging of the UUT has to be used in a reasonable combination together with endourological methods and cytology. Optical coherence tomography, confocal laser endomicroscopy and scientific innovations such as radiomics might improve UUT imaging and differential diagnosis of UUT lesions in the future.
膀胱癌分期、血尿以及对肾脏和输尿管不明病变的评估是上尿路（UUT）成像最常见的指征。与膀胱成像相比，UUT的腔内泌尿外科评估侵入性更强，这就引发了关于最佳成像技术的问题。近年来，计算机断层扫描（CT）和磁共振成像（MRI）在技术上有了多项改进。
比较UUT最重要成像技术的有效性和局限性。
对关于膀胱癌、UUT尿路上皮癌和血尿的文献以及当前德国、欧洲和美国的指南进行系统综述。
基于CT的尿路造影已取代排泄性尿路造影，是UUT成像的首选。如有禁忌证，MRI是一种可行的替代方法。在所有情况下，尿路造影期都是必不可少的。
UUT成像必须与腔内泌尿外科方法和细胞学合理结合使用。光学相干断层扫描、共聚焦激光内镜显微镜以及诸如放射组学等科学创新未来可能会改善UUT成像和UUT病变的鉴别诊断。
