Transitional cell carcinoma of the upper urinary tract: optimizing image interpretation with 3D reconstructions

Area of Science:

• Radiology
• Urologic Oncology

Background:

• Transitional cell carcinoma (TCC) is a significant malignancy affecting the upper urinary tract.
• Conventional imaging methods have limitations in fully characterizing TCC, especially subtle lesions.

Purpose of the Study:

• To review the pathophysiology of transitional cell carcinoma (TCC).
• To discuss computed tomography urography (CTU) protocols and 3D reconstruction techniques.
• To emphasize the importance of 3D reconstructions for accurate TCC interpretation.

Main Methods:

• Review of CT urography (CTU) protocols for upper urinary tract evaluation.
• Analysis of different 3D reconstruction techniques: maximum intensity projection, volume rendering, and virtual ureteroscopy.
• Presentation of clinical cases illustrating the utility of 3D reconstructions.

Main Results:

• CTU has largely superseded conventional intravenous pyelography for upper urinary tract TCC assessment.
• Standard axial and multiplanar images effectively detect larger TCC lesions.
• 3D reconstructions are essential for visualizing subtle TCC lesions, particularly at the infundibulum-calyx junction and within the ureters.

Conclusions:

• 3D reconstructions are indispensable for comprehensive interpretation of CTU in upper urinary tract TCC.
• Each 3D technique (MIP, VR, virtual ureteroscopy) offers unique advantages but also has potential pitfalls.
• Accurate diagnosis and staging of TCC are improved by judicious use of 3D CTU techniques.