Contrast enhancement in bladder tumors examined with CT urography using traditional scan phases

Bladder assessment in an early contrast-enhancing computed tomography urography (CTU) phase requires that bladder tumors be enhanced using contrast material.

To investigate the enhancement pattern in bladder tumors using a CTU protocol where the scan is enhancement triggered.

Fifty patients diagnosed with bladder cancer were examined during the unenhanced (UP), corticomedullary (CMP), and excretory phases (EP). Twenty-one patients, all aged 50 years or older, were also examined during the nephrographic phase (NP). A ROI placed in the aorta was used to start the scan during the CMP when the attenuation reached 200 Hounsfield units (HU). The NP and EP were started with a 40 s and 300 s delay, respectively, after the CMP was finished. Attenuation and size measurements were made in the axial plane.

Mean contrast enhancement of bladder tumors was 37, 25, and 17 HU in the CMP, NP, and EP, respectively. The differences in contrast enhancement were significant across all three phases. Eighty-eight percent of patients showed the highest contrast enhancement in the CMP. In 96% of the cases, contrast enhancement >20 HU was seen. The mean value of the shortest dimension of the bladder tumors was 22 ± 12 mm.

The contrast enhancement is significantly higher in the CMP than in the NP and EP, suggesting that the CMP is preferable when assessing the bladder in the early contrast enhancing phase.