Raphaële Renard-Penna1,2, Laurence Rocher3,4,5, Catherine Roy6, Marc André7, Marie-France Bellin3,4,5, Isabelle Boulay8, David Eiss9,10, Nicolas Girouin11, Nicolas Grenier12,13, Olivier Hélénon9,10, Jean-François Lapray14, Arnaud Lefèvre15,16, Xavier Matillon17,18,19, Jean-Michel Ménager20, Ingrid Millet21,22, Sébastien Ronze23, Thomas Sanzalone24, Jean Tourniaire25, Serge Brunelle26, Olivier Rouvière18,27. 1. Academic Department of Radiology, Hôpital Pitié-Salpêtrière and Hôpital Tenon, Assistance Publique-Hôpitaux de Paris, Paris, France. raphaele.renardpenna@psl.aphp.fr. 2. Sorbonne Universités, GRC no 5, ONCOTYPE-URO, Paris, France. raphaele.renardpenna@psl.aphp.fr. 3. Department of Diagnostic and Interventional Radiology, Assistance Publique-Hôpitaux de Paris, Groupe Hospitalier Paris Sud, Le Kremlin Bicêtre, France. 4. Université Paris Sud, Le Kremlin Bicêtre, France. 5. IR4M, UMR 8081, Service hospitalier Joliot Curie, Orsay, France. 6. Department of Radiology B, CHU de Strasbourg, Nouvel Hôpital Civil, Strasbourg, France. 7. Department of Radiology, Hôpital Européen, Marseille, France. 8. Department of Radiology, Fondation Hôpital Saint Joseph, Paris, France. 9. Department of Adult Radiology, Assistance Publique-Hôpitaux de Paris, Hôpital Necker-Enfants Malades, Paris, France. 10. Paris Descartes University, Sorbonne Paris Cité, Paris, France. 11. Norimagerie, Caluire et Cuire, France. 12. Department of Diagnostic and Interventional Adult Imaging, CHU de Bordeaux, Bordeaux, France. 13. Université de Bordeaux, Bordeaux, France. 14. Centre d'Imagerie Créqui, Lyon, France. 15. Centre d'Imagerie Médicale Tourville, Paris, France. 16. Department of Radiology, American Hospital of Paris, Neuilly, France. 17. Department of Urology and Transplantation, Hospices Civils de Lyon, Lyon, France. 18. Faculté de médecine Lyon Est, Université de Lyon, Université Lyon 1, Lyon, France. 19. CarMeN Laboratory, INSERM U1060, Lyon, France. 20. Centre d'Imagerie des Gratte-Ciel, Villeurbanne, France. 21. Department of Radiology, Hôpital Lapeyronie, Montpellier, France. 22. Université de Montpellier, Montpellier, France. 23. Imagerie médicale Val d'Ouest Charcot (IMVOC), Ecully, France. 24. Department of Radiology, Centre Hospitalier de Valence, Valence, France. 25. Department of Radiology, Clinique Rhône Durance, Avignon, France. 26. Department of Radiology, Institut Paoli-Calmettes, Marseille, France. 27. Department of Urinary and Vascular Imaging, Hôpital Edouard Herriot, Hospices Civils de Lyon, 5 Place d'Arsonval, 69 347, Lyon, France.
Abstract
OBJECTIVES: To develop technical guidelines for computed tomography urography. METHODS: The French Society of Genitourinary Imaging organised a Delphi consensus conference with a two-round Delphi survey followed by a face-to-face meeting. Consensus was strictly defined using a priori criteria. RESULTS: Forty-two expert uro-radiologists completed both survey rounds with no attrition between the rounds. Ninety-six (70%) of the initial 138 statements of the questionnaire achieved final consensus. An intravenous injection of 20 mg of furosemide before iodinated contrast medium injection was judged mandatory. Improving the quality of excretory phase imaging through oral or intravenous hydration of the patient or through the use of an abdominal compression device was not deemed necessary. The patient should be imaged in the supine position and placed in the prone position only at the radiologist's request. The choice between single-bolus and split-bolus protocols depends on the context, but split-bolus protocols should be favoured whenever possible to decrease patient irradiation. Repeated single-slice test acquisitions should not be performed to decide of the timing of excretory phase imaging; instead, excretory phase imaging should be performed 7 min after the injection of the contrast medium. The optimal combination of unenhanced, corticomedullary phase and nephrographic phase imaging depends on the context; suggestions of protocols are provided for eight different clinical situations. CONCLUSION: This expert-based consensus conference provides recommendations to standardise the imaging protocol for computed tomography urography. KEY POINTS: • To improve excretory phase imaging, an intravenous injection of furosemide should be performed before the injection of iodinated contrast medium. • Systematic oral or intravenous hydration is not necessary to improve excretory phase imaging. • The choice between single-bolus and split-bolus protocols depends on the context, but split-bolus protocols should be favoured whenever possible to decrease patient irradiation.
OBJECTIVES: To develop technical guidelines for computed tomography urography. METHODS: The French Society of Genitourinary Imaging organised a Delphi consensus conference with a two-round Delphi survey followed by a face-to-face meeting. Consensus was strictly defined using a priori criteria. RESULTS: Forty-two expert uro-radiologists completed both survey rounds with no attrition between the rounds. Ninety-six (70%) of the initial 138 statements of the questionnaire achieved final consensus. An intravenous injection of 20 mg of furosemide before iodinated contrast medium injection was judged mandatory. Improving the quality of excretory phase imaging through oral or intravenous hydration of the patient or through the use of an abdominal compression device was not deemed necessary. The patient should be imaged in the supine position and placed in the prone position only at the radiologist's request. The choice between single-bolus and split-bolus protocols depends on the context, but split-bolus protocols should be favoured whenever possible to decrease patient irradiation. Repeated single-slice test acquisitions should not be performed to decide of the timing of excretory phase imaging; instead, excretory phase imaging should be performed 7 min after the injection of the contrast medium. The optimal combination of unenhanced, corticomedullary phase and nephrographic phase imaging depends on the context; suggestions of protocols are provided for eight different clinical situations. CONCLUSION: This expert-based consensus conference provides recommendations to standardise the imaging protocol for computed tomography urography. KEY POINTS: • To improve excretory phase imaging, an intravenous injection of furosemide should be performed before the injection of iodinated contrast medium. • Systematic oral or intravenous hydration is not necessary to improve excretory phase imaging. • The choice between single-bolus and split-bolus protocols depends on the context, but split-bolus protocols should be favoured whenever possible to decrease patient irradiation.
Authors: Xiaopan Xu; Huanjun Wang; Yan Guo; Xi Zhang; Baojuan Li; Peng Du; Yang Liu; Hongbing Lu Journal: Front Oncol Date: 2021-07-15 Impact factor: 6.244