Mustafa ÖZDEMİR, Aysel TÜRKVATAN CANSEVER, Fatma Ayça EDİS ÖZDEMİR, Muharrem TOLA, Onur TUTAR

Hematürili hastaların değerlendirilmesinde bilgisayarlı tomografik ürografinin yeri

AmaAmaç: Bu çalışmanın amacı hematüri yakınması ile gelen olgularda bilgisayarlı tomografik (BT) ürografi sonuçlarının değerlendirilmesi ve hematürinin nedeninin saptanmasında BT ürografinin etkinliğinin araştırılmasıdır. Gereç ve Yöntem: Ocak 2007 ile Mayıs 2008 tarihleri arasında makroskopik veya mikroskopik hematürisi bulunan ve kliniğimizde BT ürografi çekilen, yaşları 20 ile 90 ( ortalama 50,5) arasında değişen 59 olgunun (27 kadın, 32 erkek) görüntüleri retrospektif olarak tarandı. Olguların tümünün incelenmesinde 16-dedektörlü çok kesitli BT cihazı ile aynı inceleme protokolü (prekontrast, nefrografik faz, pyelografik faz ) kullanıldı. Alınan ham görüntülerden multiplanar reformat, maksimum intensity projection ve volum rendering teknikleri kullanılarak iki ve üç boyutlu görüntüler oluşturuldu. Bulgular: Hematürisi bulunan toplam 59 olgunun 6’sında (%10,2) BT ürografi ile hematüriye neden olabilecek herhangi bir bulgu saptanmamıştır. Geriye kalan 53 olguda BT ürografi ile saptanan hematüri nedenleri; taş (n=25), renal hücreli karsinom (n=3), Bosniak kategori 4 renal kist (n=1), renal papiller nekroz (n=1), üreteropelvik bileşke darlığı (n=2), pelvikaliksiyel yapılarda basıya neden olan multiple renal kist (n=8), pelvikaliksiyel yapılarda bası ve dilatasyona neden olan multiple intrarenal lenfadenopati (n=1), üretelyal tümör (n=1) ve mesane anormallikleri (n=11) şeklindeydi. Ayrıca 52 olgunun 41’inde (%79) ekstraüriner bulgu mevcuttu. Sonuç: BT ürografi hematürili olguların tek bir incelemede kapsamlı olarak değerlendirilebilmesine olanak tanımaktadır. Bu nedenle hematürili olgularda BT ürografi daha kapsamlı bilgi vermesi açısından giderek artan bir kullanım alanına sahip olup bu hastalarda herhangibir kontrendikasyon yoksa ilk tetkik olarak kullanılabilir.

Anahtar Kelimeler:

Hematüri, bilgisayarlı tomografi, ürografi

The importance of computerized tomographic urography in evaluation of the patients with hematuria

ObjObjective: The aim of this study is to evaluate the results of computerized tomographic (CT) urography in cases with hematuria complaints and to investigate the efficacy of CT urography in detecting the cause of hematuria. Material and Method: We retrospectively screened 59 patients (27 female, 32 male) aged between 20 and 90 (mean 50.5) who had macroscopic or microscopic hematuria between January 2007 and May 2008 and underwent CT urography in our clinic. All of the cases were examined using the same examination protocol (pre-contrast, nephrographic phase, pyelographic phase) with a 16-detector multislice CT device. Two-and three-dimensional images were generated using basal images from multiplanar reformat, maximum intensity projection and volume rendering techniques. Findings: In 6 out of 59 patients (10.2%) with hematuria, no findings were found with CT urography. Causes of hematuria detected by CT urography in the remaining 53 cases; renal cell carcinoma (n = 3), Bosniak category 4 renal cyst (n = 1), renal papillary necrosis (n = 1), ureteropelvic junction obstruction (n = 2), pelvicaliceal multiple renal cysts (n = 8), multiple intrarenal lymphadenopathy (n = 1), ureteral tumor (n = 1) and bladder abnormalities (n = 11) causing pneumatic and dilatation of the pelvicalyceal structures. In addition, 41 of 52 (79%) cases had extraurinar findings. Conclusion: CT urography allows comprehensive evaluation of hematuria in a single examination. For this reason, CT urography can be used as an initial examination if there is no contraindication in any of these patients.

Keywords:

Hematuria, computerized tomograpy, urography,

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