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Imaging protocols for CT urography: results of a consensus conference from the French Society of Genitourinary
Raphaële Renard-Penna1,2, Laurence Rocher3,4,5, Catherine Roy6
1Academic Department of Radiology, Hôpital Pitié-Salpêtrière and Hôpital Tenon, Assistance Publique-Hôpitaux de Paris, Paris, France. raphaele.renardpenna@psl.aphp.fr.
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.