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Trial Lecture – time and place
See Trial Lecture.
Adjudication committee
- First opponent: Professor II Erik Skaaheim Haug, University of Bergen
- Second opponent: Senior Consultant Fredrik Jäderling, Karolinska Institutet, Sweden
- Third member and chair of the evaluation committee: Professor II Mona-Elisabeth Rootwelt-Revheim, University of Oslo
Chair of the Defence
Professor Emeritus Jarl Jakobsen, University of Oslo
Principal Supervisor
Researcher Erik Rud, Oslo University Hospital
Summary
Painless visible hematuria (VH) is a key symptom of urothelial carcinoma (UC) but may also indicate renal cell carcinoma (RCC) or urinary stone disease.
There are no uniform guidelines for patients with painless VH. However, current recommendations suggest unenhanced computed tomography (CT) for diagnosing urinary stones and two to three contrast-enhanced CT phases for diagnosing UC and RCC. As a result, patients with painless VH usually undergo a comprehensive multiphase CT as a precaution.
Although some studies suggest that single nephrographic phase (NP) CT may be sufficient, they are retrospective or performed in mixed or highly selected patient populations.
No previous CT studies have focused exclusively on patients with painless VH.
This thesis presents the very first prospective comparison of multiphase (i.e. four-phase) and single NP CT in patients with painless VH, aiming to determine whether single NP CT is sufficient. Blinded, randomized radiologists (both specialists and generalists) assessed each CT scan for UC, RCC, and urinary stones.
The results showed that the diagnostic accuracy of single NP was no worse than that of four-phase CT in detecting UC, with no added value from additional imaging phases. Likewise, single NP performed equally well as four-phase CT in detecting and excluding RCC. It was also highly effective in detecting bladder and ureteral stones, though it missed some small kidney stones that did not require treatment. Findings were consistent regardless of the radiologist’s specialization.
Radiation exposure with single NP was nearly 60% lower than with four-phase CT.
Altogether, single NP CT is sufficient in detecting UC, RCC, and urinary stones in patients with painless VH. This is significant for patient care, as it reduces radiation exposure and healthcare costs while maintaining diagnostic accuracy.
Additional information
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