From the Department of Radiology, Mayo Clinic, 200 1st St SW, Rochester, MN 55905 (H.N., H.T., N.T.); and Departments of Radiology (C.V.W., A.K.) and Laboratory Medicine and Pathology (M.L.S.), Mayo Clinic, Scottsdale, Ariz.
Radiographics. 2024 Nov;44(11):e240056. doi: 10.1148/rg.240056.
Upper tract urothelial carcinoma (UTUC) originates in the renal pelvis or ureters and typically affects elderly patients, with its incidence increasing over the past few decades. UTUC is a distinct clinical entity with more aggressive clinical behavior than that of lower tract urothelial carcinoma. Due to the significant challenge of acquiring an adequate tissue sample for biopsy, comprehensive risk stratification is required for treatment planning, including radical nephroureterectomy and kidney-sparing management. Imaging plays an important integrated role in risk assessment along with endoscopy and pathologic examination. Lifelong surveillance is required after treatment due to the high incidence of recurrent and metachronous tumors. Lynch syndrome is a frequently unrecognized genetic disorder associated with UTUC that warrants specific attention in patient management. UTUC may manifest with diverse imaging findings, including filling defects, wall thickening, and mass-forming lesions. CT urography is the preferred modality for diagnosis and staging or restaging of UTUC, with numerous technical variations. Efforts have been made to optimize image quality and radiation exposure. Due to its poor sensitivity for small lesions, use of MR urography is limited to special clinical scenarios (eg, when patients have contraindications to iodinated contrast agents). Fluorine 18 fluorodeoxyglucose PET helps to detect metastatic lesions. Image-guided biopsy may be considered for uncertain lesions. Radiologists need to be familiar with the imaging findings and their differential diagnoses. RSNA, 2024 Supplemental material is available for this article.
上尿路尿路上皮癌（UTUC）起源于肾盂或输尿管，通常影响老年患者，其发病率在过去几十年中有所增加。UTUC 是一种独特的临床实体，其临床行为比下尿路尿路上皮癌更为激进。由于获得足够的活检组织样本具有很大的挑战性，因此需要进行全面的风险分层，以制定治疗计划，包括根治性肾输尿管切除术和保肾管理。成像在风险评估中与内窥镜检查和病理检查一起发挥着重要的综合作用。由于复发性和异时性肿瘤的发生率较高，治疗后需要终身监测。林奇综合征是一种与 UTUC 相关的常被忽视的遗传疾病，在患者管理中需要特别注意。UTUC 可能表现为多种影像学表现，包括充盈缺损、壁增厚和肿块形成病变。CT 尿路造影是诊断和分期或重新分期 UTUC 的首选方式，有多种技术变化。已经努力优化图像质量和辐射暴露。由于其对小病变的敏感性较差，磁共振尿路造影的应用仅限于特殊临床情况（例如，当患者对碘造影剂有禁忌症时）。氟 18 氟代脱氧葡萄糖 PET 有助于检测转移性病变。对于不确定的病变，可以考虑进行影像引导活检。放射科医生需要熟悉影像学表现及其鉴别诊断。RSNA，2024 补充材料可用于本文。
