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{"title":"Imaging of Upper Tract Urothelial Carcinoma.","authors":"Hirotsugu Nakai, Hiroaki Takahashi, Clinton V Wellnitz, Melissa L Stanton, Naoki Takahashi, Akira Kawashima","doi":"10.1148/rg.240056","DOIUrl":null,"url":null,"abstract":"<p><p>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. <sup>©</sup>RSNA, 2024 Supplemental material is available for this article.</p>","PeriodicalId":54512,"journal":{"name":"Radiographics","volume":null,"pages":null},"PeriodicalIF":5.2000,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Radiographics","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1148/rg.240056","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING","Score":null,"Total":0}
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Abstract
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.
上尿路上皮癌的成像。
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不断上升。UTUC是一种独特的临床实体,其临床表现比下尿路上皮癌更具侵袭性。由于获取足够的组织样本进行活检是一项巨大的挑战,因此在制定治疗计划(包括根治性肾切除术和保肾治疗)时需要进行全面的风险分层。成像与内镜检查和病理检查在风险评估中发挥着重要的综合作用。由于复发和转移性肿瘤的发病率很高,因此治疗后需要进行终身监测。林奇综合征(Lynch Syndrome)是一种与UTUC相关的遗传性疾病,但经常未被发现,因此在患者管理中需要特别注意。UTUC可能表现为不同的影像学结果,包括充盈缺损、管壁增厚和肿块形成病变。CT 尿路造影是 UTUC 诊断、分期或重新分期的首选方式,但技术上存在许多差异。人们一直在努力优化图像质量和辐射暴露。由于磁共振尿路造影对小病灶的敏感性较差,因此仅限于特殊的临床情况(如患者对碘化造影剂有禁忌症)。18 氟脱氧葡萄糖 PET 有助于检测转移性病灶。对于不确定的病灶,可考虑在图像引导下进行活检。放射医师需要熟悉成像结果及其鉴别诊断。©RSNA,2024 本文有补充材料。
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