Indications For Mdctu

Due to the radiation intensive nature of MDCTU (see section "Radiation"), some investigators (12) have suggested that this study be performed only on patients who are preidentified by subspecialists (such as urologists) as being at a high risk for having urinary tract pathology, especially transitional cell carcinoma. When these restrictions are enforced, MDCTU is generally performed on patients more than 40 years of age and patients with at least one of the following: a history of transitional cell carcinoma (and who are therefore likely to have recurrences or meta-chronous tumors), positive urine cytology, previous equivocal imaging studies (18), and persistent symptoms (e.g., ongoing hematuria). In this setting, there are some patients who might not qualify for MDCTU and who might still be referred to EU or standard abdominal and pelvic CT examinations instead. In contrast, others suggest performing MDCTU as a screening test on any patient who presents with hematuria (10,13,14). According to these authors, MDCTU is already in a position to replace EU completely. Regardless of the differing recommendations as to when MDCTU should be performed, all investigators are extremely enthusiastic about its potential. Even those advocating limited use have stated that with a few additional radiation-restricting modifications in CT hardware and changes in CT technique, MDCTU is poised to make EU obsolete in the very near future (12).

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