Computed tomography for visible haematuria – a single nephrographic phase is sufficient for detecting renal cell carcinoma

Kristina Flor Galtung; Peter Mæhre Lauritzen; Gunnar Sandbæk; Dag Bay; Erica Ponzi; Eduard Baco; Nigel Christopher Cowan; Anca Mihaela Naas; Erik Rud

doi:10.2340/sju.v59.18467

Authors

Kristina Flor Galtung Department of Radiology, Oslo University Hospital, Oslo, Norway; Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Norway
Peter Mæhre Lauritzen Department of Radiology, Oslo University Hospital, Oslo, Norway; Department of Life Sciences and Health, Faculty of Health Science, Oslo Metropolitan University, Oslo, Norway
Gunnar Sandbæk Department of Radiology, Oslo University Hospital, Oslo, Norway; Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Norway
Dag Bay Department of Radiology, Oslo University Hospital, Oslo, Norway
Erica Ponzi Department of Research Support for Clinical Trials, Clinical Trial Unit, Oslo University Hospital, Oslo, Norway; Oslo Center for Biostatistics and Epidemiology (OCBE), Department of Biostatistics, University of Oslo, Oslo, Norway
Eduard Baco Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Norway; Department of Urology, Oslo University Hospital, Oslo, Norway.
Nigel Christopher Cowan Department of Radiology, Portsmouth Hospitals University NHS Trust, UK
Anca Mihaela Naas Department of Pathology, Oslo University Hospital, Oslo, Norway
Erik Rud Department of Radiology, Oslo University Hospital, Oslo, Norway

DOI:

https://doi.org/10.2340/sju.v59.18467

Keywords:

Hematuria, Multidetector Computed Tomography, Prospective Study, Renal Cell Carcinoma

Abstract

Objectives: No previous studies have compared two computed tomography (CT) protocols in patients presenting with visible haematuria, and most patients undergo a multiphase CT in order to detect upper tract malignancies. We aimed to prospectively compare the diagnostic performance of single- and four-phase CT for detecting renal cell carcinoma (RCC) in patients with visible haematuria.

Materials & methods: ‘A Prospective Trial for Examining Hematuria using Computed Tomography’ (PROTEHCT) was a single-centre prospective paired diagnostic study in patients referred for CT due to painless visible haematuria between September 2019 and June 2021. All patients underwent four-phase CT (control) from which a single nephrographic phase dual energy CT (experimental) was extracted. Both were independently assessed for RCC by randomised radiologists. Histologically verified RCC defined a positive reference standard. Follow-up ascertainment of RCC diagnosis was completed in May 2022. Descriptive statistics were used to calculate the accuracies. Inter-reader agreement was assessed by kappa statistics.

Results: A total of 308 patients (median age, 68 years [interquartile range 53–77, range 18–96], 250 males) were included for analysis. RCC was diagnosed in seven (2.3%) patients during a median follow-up time of 19 months (interquartile range: 15–25). For the control and experimental CT, sensitivity was 100% versus 100%, specificity was 97% versus 98% and accuracy 97% versus 97%. The positive predictive value was 44% versus 50%, and the negative predictive value was 100% versus 100%. The agreement between the control and experimental CT was 98% (k = 0.79).

Conclusion: A single nephrographic phase dual energy CT is sufficient for detecting RCC in patients with visible haematuria.

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