The best way to achive urinary distention for CT/MRI urography?

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Permalink Reply by Phil Haslam on April 29, 2008 at 4:04am

Hi Gipo, I use 20mg IV frusemide and do 7min scan. Not convinced by the split bolus technique as yet. I find i can see most TCC etc with 70second post contrast scan on background of well distended PC system, ie tumour enhanced on background of non opacified urine. When we have a decent scanner i may pursue the split bolus technique some more. Currently using 4 slice! Phil

Permalink Reply by Giuseppe Pelle on April 29, 2008 at 7:36am

Hi Phil, i'm agree with you about your protocol.
Here we don't use diuretcs and we are not also convinced by the split bolus technique.
To achive a better distention of the collecting system we use a particular protocol (THIS ONLY MY EXPERIENCE)
In my personal experience i found the oral Hydratation a key point for this pourpose.
These are the principal steps of the protocol:
- 1) when the patient arrives ask him/her to drink 0.5 0r 1 L of water.
-2) When a moderate stimulus for urination is felt ask to the patient to come in the CT unit ad perform the scan without contrast media (abdomen and pelvis).Then inject the contrast media ( 140-150 ml, iomeron 350, 3 ml/sec) obtainig a nefrographic phase (70-80 delay) (optional arterial phase with bolus tracking technique).
-3) Then ask the patien to leave the CT unit and perform another patient.
-4) Rescan the patient after 15-20 minutes for the urographic phase . the scan parameters are very important (we use the minum dertector collimation 0.75 x 64, 1 mm slice reconstructed and a recon increment of 0.5 mm.).



In my experience with this protocol, compared with the standard urographic delay of 10 minutes (without Hydratation), i observed a wider caliber of the entire collecting system and almost the absence of peristaltic obscured segments of the ureter (in patients without obstraction). I have read in some textbook (i'll find it for reference!!!) that during the first part of urine excretion peristaltic waves are predominant but when a sufficent time laps the peristaltic waves become sparse and the urine flow moves to the bladder according to the Hydrostatics gradients.
BY GIPO

Permalink Reply by shubra on May 8, 2008 at 8:31am

hi here also we say patient to drink water n we wait till the bladder is filled but only30% of patient are able to drink lots of water or there bladder is filled so for the rest we have to switchon for diuretics and i find it the best way for doing ct

Permalink Reply by Giuseppe Pelle on May 8, 2008 at 2:58pm

In my experince 0,5 l of water is usually sufficent for the pourpose. I'm agree to your argumentation but i'm disagree on the 30%.......The compliance is better achived by spend time to explain and justify the contribute of oral idratation..........When oral idratation is not applicable the ev. idratation and duretics are necessary.


Shubra you are welcome in thi group.
I would like to invite you to share with us your experience, cases and ideas for new discussion.

GIPO