Imaging findings of urinary tuberculosis on computerized tomography versus excretory urography: through 46 confirmed cases
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Abstract
Background: Imaging findings of urinary tuberculosis (TB) on excretory urography (IVP) and CT have been reported to be nonspecific although CT may provide detailed informations. We performed a retrospective study of patients with proven urinary TB to compare imaging findings on IVP and CT and to make a systemic approach to imaging analysis of urinary TB.
Methods: Urinary TB was diagnosed in 46 patients who had IVP and CT examinations prior to definitive diagnosis and treatment. They were 30 females and 16 males with a mean age of 43.6 ys. We assessed the presence and frequency of urinary tract calcifications, autonephrectomy, renal parenchymal masses, renal parenchymal scarring, moth-eaten calices, amputated infundibulum, renal parenchymal cavities, hydrocalycosis, hydronephrosis, hydroureter and thick urinary tract walls.
Results: CT was most sensitive in detecting any renal parenchyma cavities (p=0.01), hydronephrois (p=0.0005), ureteral stricture (p=0.03) and walls thickening of the renal pelvis / ureter (p< 0.0001). Four imaging patterns were noted in 20 IVPs (43%) and 34 CTs (74%) with multiple findings. They were hydrocalycosis, hydronephrosis or hydroureter du to multiple stricture sites, ureteral stricture with thick wall, autonephrectomy combined with at least 1 other type of imaging finding and thick wall of renal pelvis or ureters and bladder with at least 1 other type of imaging finding.
Conclusions: Renal parenchymal cavities, hydronephrosis, ureteral stricture and thickened urinary tract walls were significantly more common on CT than on IVP. Multiple findings on CT were more common and very useful for TB diagnosis. Thus, we recommend CT as the standard exam in patients with suspicion of urinary TB.
Methods: Urinary TB was diagnosed in 46 patients who had IVP and CT examinations prior to definitive diagnosis and treatment. They were 30 females and 16 males with a mean age of 43.6 ys. We assessed the presence and frequency of urinary tract calcifications, autonephrectomy, renal parenchymal masses, renal parenchymal scarring, moth-eaten calices, amputated infundibulum, renal parenchymal cavities, hydrocalycosis, hydronephrosis, hydroureter and thick urinary tract walls.
Results: CT was most sensitive in detecting any renal parenchyma cavities (p=0.01), hydronephrois (p=0.0005), ureteral stricture (p=0.03) and walls thickening of the renal pelvis / ureter (p< 0.0001). Four imaging patterns were noted in 20 IVPs (43%) and 34 CTs (74%) with multiple findings. They were hydrocalycosis, hydronephrosis or hydroureter du to multiple stricture sites, ureteral stricture with thick wall, autonephrectomy combined with at least 1 other type of imaging finding and thick wall of renal pelvis or ureters and bladder with at least 1 other type of imaging finding.
Conclusions: Renal parenchymal cavities, hydronephrosis, ureteral stricture and thickened urinary tract walls were significantly more common on CT than on IVP. Multiple findings on CT were more common and very useful for TB diagnosis. Thus, we recommend CT as the standard exam in patients with suspicion of urinary TB.
Keywords:
kidney, urinary tract, tuberculosis, medical imaging.##plugins.themes.academic_pro.article.details##
References
- Kouni Chahed M, Bellali H, Dhouibi S, Ben Alaya N, Zouari B. Tuberculosis control programme in Tunisia: efficacy assessment. Sante. 2010;20:87-92.
- Burrill J, Williams CJ, Bain G, Conder G, Hine AL, Misra RR. Tuberculosis: a radiologic review. Radiographics. 2007;27:1255-73
- Bouraoui S, Haouet S, Mekni A, et al. Extrapulmonary tuberculosis in Tunisia. Report of 830 cases. Experience of the Anatomic Pathology Laboratory of the Rabta Hospital. Tunis Med. 2003;81:529-34.
- Engin G, Acuna B, Acuna G, Tunaci M. Imaging of extrapulmonary tuberculosis. Radiographics. 2000;20:471-88.
- Harisinghani MG, McLoud TC, Shepard JA, Ko JP, Shroff MM, Mueller PR. Tuberculosis from head to toe. Radiographics. 2000;20:449-70
- Gibson MS, Puckett ML, Shelly ME. Renal tuberculosis. Radiographics. 2004;24:251-6.
- Kenney PJ. Imaging of chronic renal infections. AJR Am J Roentgenol. 1990;155:485-94.
- Wang LJ, Wong YC, Chen CJ, Lim KE. CT features of genitourinary tuberculosis. J Comput Assist Tomogr. 1997;21:254-8
- Tonkin AK, Witten DM. Genitourinary tuberculosis. Semin Roentgenol 1979;14:305-18
- Goldman SM, Fishman EK, Hartman DS, Kim YC, Siegelman SS. Computed tomography of renal tuberculosis and its pathological correlates. J Comput Assist Tomogr. 1985;9:771¬ 6.
- . Premkumar A, Lattimer J, Newhouse JH. CT and sonography of advanced urinary tract tuberculosis. AJR Am J Roentgenol. 1987;148:65-9
- Wang LJ, Wu CF, Wong YC, Chuang CK, Chu SH, Chen CJ. Imaging findings of urinary tuberculosis on excretory urography and computerized tomography. J Urol. 2003;169:524¬8.
- Leder RA, Low VH. Tuberculosis of the abdomen. Radiol Clin North Am. 1995;33:691¬705
- Kawashima A, Sandler CM, Ernst RD, Goldman SM, Raval B, Fishman EK. Renal inflammatory disease: the current role of CT. Crit Rev Diagn Imaging. 1997;38:369-415
- Kaplan DM, Rosenfield AT, Smith RC. Advances in the imaging of renal infection. Helical CT and modern coordinated imaging. Infect Dis Clin North Am. 1997;11:681¬ 705
- Stacul F, Rossi A, Cova MA. CT urography: the end of IVU? Radiol Med. 2008;113:658¬ 69.