Department of Radiology, University of Pennsylvania, 3400 Spruce Street, 1 Silverstein, Philadelphia, PA, 19104, USA.
Abdom Radiol (NY). 2020 Mar;45(3):807-811. doi: 10.1007/s00261-019-02121-0.
Retrograde pyelography (RPG) is used in some centers to further evaluate patients with incompletely opacified segments on CT urography (CTU). This study intends to evaluate the utility of this imaging combination in terms of the yield of abnormal findings on the follow up RPG.
In this retrospective study, we searched the radiology database over a three-year period (11/1/2015-10/30/2018) for patients who had a CTU and then a diagnostic RPG within 180 days. Images and reports were reviewed from this period for patients who met the inclusion criteria.
292 patients underwent a CTU with follow up RPG over the search period. 131/292 RPGs (44.9%) were performed because the CTU described at least one incompletely opacified ureteral segment. Of the 148 ureters evaluated in these 131 patients, 4 ureters (2.7%) showed an abnormality on follow up retrograde pyelogram-two revealed a stricture at the unfilled segment, and two revealed contour irregularity in the distal ureter (biopsy showed urothelial cell carcinoma in these two).
There is a relatively low yield for detecting ureteral abnormalities when a retrograde pyelogram is performed after a CTU to evaluate an incompletely opacified ureteral segment-2.7% in our study, with only two of these incompletely opacified segments containing urothelial cancer (1.4%). In these two cases, a ureteral abnormality was visible on the CTU and RPG would seem to have a very low yield for follow up of unopacified ureteral segments if the ureters are otherwise normal-appearing on CTU and there is no hydronephrosis.
逆行肾盂造影术（RPG）在某些中心用于进一步评估 CT 尿路造影术（CTU）显示不完全显影的输尿管节段的患者。本研究旨在评估这种影像学联合应用在后续 RPG 异常发现的检出率方面的效用。
在这项回顾性研究中，我们在三年内（2015 年 11 月 1 日至 2018 年 10 月 30 日）搜索放射学数据库，寻找在 180 天内进行 CTU 检查后又进行诊断性 RPG 的患者。对符合纳入标准的患者进行回顾性分析。
在检索期间，292 例患者进行了 CTU 检查，随后进行了 RPG 检查。131/292 例（44.9%）进行 RPG 检查是因为 CTU 描述了至少一个不完全显影的输尿管节段。在这 131 例患者的 148 个输尿管中，4 个输尿管（2.7%）在随访逆行肾盂造影时显示异常——2 个显示未充盈段狭窄，2 个显示远端输尿管轮廓不规则（活检显示这两个输尿管均为尿路上皮癌）。
在 CTU 评估不完全显影的输尿管段后进行逆行肾盂造影时，检测输尿管异常的检出率相对较低——我们的研究中为 2.7%，其中只有 2 个不完全显影的输尿管节段含有尿路上皮癌（1.4%）。在这两种情况下，CTU 上可见输尿管异常，且如果 CTU 显示输尿管外观正常且无肾盂积水，则 RPG 对未显影输尿管节段的随访检出率似乎很低。
