RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES KARNATAKA, BENGALURU.

ANNEXURE – 2

PROFORMA FOR REGISTRATION OF TOPIC FOR DISSERTATION

1 / Name of the candidate
and address / DR USHANANDHINI G
ROOM NO11 PG LADIES HOSTEL
VICTORIA HOSPITAL
BMC&RI
2. / Name of the Institution / BANGALORE MEDICAL COLLEGE AND RESEARCH INSTITUTE, BENGALURU.
3. / Course of study and subject / M.D. in RADIODIAGNOSIS.
4. / Date of Admission to the course / 31.05.2011.
5. / Title of topic / CT UROGRAPHY IN EVALUATIONOF PATIENTS WITH MACROSCOPICHEMATURIA.
6. / Brief Resume of the intended work:
6.1. Need for study:
Hematuria is one of the most common manifestations of urinary tract.Hematuriacan originate from any site along the urinary tract and has a wide range of causes includingcalculi,neoplasm,infection,trauma, medications, coagulopathy and renal parenchymal diseases.1
The concept of CTUrography(CTU) is more appropriate as both the renal parenchyma and urotheliumcan be evaluated with one relatively non invasive comprehensive examination2.The rationale for CT urography is that patients with haematuria can be fully investigated by a single imaging technique with a high degree of sensitivity and specificity3.It is especially suitable for patients presenting with hematuria where the urinary tract must be assessed for stone disease and neoplasms of the kidney and /or urothelium4.
CT urography combines the benefits of excretory urography with those of cross sectional imaging into a single study which depicts the renal parenchyma,collecting system and ureters.This technique is based onthe acquisition of non enhanced and enhanced CT scans of the abdomen and pelvis,including the essential acquisition of thin section helical CT scans of the urinary tract during the excretory phase of enhancement.Multiplanar 2 dimensional and 3dimensional reformation images are produced from axial source images during the excretory phase5. CT urography offers several advantages for imaging of the urinary tract: single breath-hold coverage of the entire urinary tract with absence of respiratory mis-registration, rapid imaging with optimum contrast medium opacification and reduced partial volume effect as appropriate slices can be selected from the volumetric data6.
6.2. Review of Literature:
A study was done by Song JH et al, to assess the utility of contrast enhanced CTU in patients with urinary calculi.It was found out that contrast enhanced phase was necessary in 84% of examinations tomake out the specific diagnosis of hematuria because important pathologic changes are seen onlyafter contrast enhanced phase1.
Cowan et al performed CT urography in 106 patients with painless hematuria and it yielded a sensitivity of 97% and specificity of 93% in detecting upper urinary tract urothelial tumours .The study validated the use of CTU in detecting upper urinary tract urothelial tumours2.
In a pilot study conducted by Jinzaki M et al,contrast enhanced CT was performed in 59 patients with bladder tumours. CT with MultiPlanar Reformation depicted bladder tumours with a sensitivity of 90% and no false positive findings .Therefore it was concluded that contrast enhanced MDCT shows specificity for the detection of bladder tumours4.
Another study by McTavish JD et al in 51 patients with hematuria /suspected renal mass underwent several protocols for depiction of the urinary collecting system and found out that CT urography with supplemental saline infusion reliably delineates the opacified urinary collecting system7.
In a study by Chow LC et al,500patients (327 patients with painless hematuria) underwent CTurography for urinary tract abnormalities and the it was concluded that CTurography detected all proven cases of renal cell carcinoma yielding high sensitivity and specificity8.
In retrospective study by Maheswari et al 200 patients underwent CT urography and a sensitivity,specificity and accuracy of 100%,99%,99% respectively was obtained for upper urinary tract cancers9.
6.3.Aims and Objectives of the Study:
1.The study is an attempt to define the accuracy of CT urography in evaluation of patients with macroscopic hematuria
2.Tostudy the most common etiology of macroscopic hematuria
7. / Materials and Methods:
7.1. Source of data:
Fifty patients with history of macroscopic hematuria, between 18-75 years of age will besubjected to study which includes out patients, inpatients,referral patients of Bangalore medical college and research institute namely Victoria hospital, Bowring and Lady Curzon hospital,Vanivilas hospital and Institute of NephroUrology.
7.2. Method of collection of data :
a)Study design :prospective study
b)Study Place : Department of radio diagnosis, BMCRI
c)Study duration : Nov 2011 to May 2013
d)Sample Size : 50
e) Inclusion criteria:
  1. Patients presenting with macroscopic hematuria
f)Exclusion Criteria:
  1. Patients below 18 and above 75 years of age.
  2. Pregnant and lactating patient
  3. Severe renal failure
  4. Cardiac failure
  5. Multiple myeloma
  6. Previous allergic reaction to contrast media
  7. Patientswith non urologic causes of hematuria
g)Methodology:
The patients will undergo a 3 phase CT examination after obtaining informed consent in written form.First phase is theinitial non-contrast phase.Second phase is the nephrographic phase, which will be acquired following a delay of 90- 100 seconds after administration of 120 ml of intravenous iodinated contrast, to evaluate the renal parenchyma.Followed by the pyelographic phase which will be taken 5 -10 minutes followingadministration, to evaluate the urothelium from the pelvicaliceal system to the bladder.
This will be performed with a Multidetector row CT scanner (somatom emotion 6) CT scans will be obtained from the kidneys to the bladder with the following technique: a collimator of 5 mm, a pitch of 1.5/2, and with 20 mAs. Images will be reconstructed at a thickness of 2.5 mm.Three-dimensional (3D) reconstructions of the non enhanced,nephrogenic phase and excretory phase will beperformed.The follow up diagnosis will be established on the basis of histopatholigic findings or the findings at a urologic procedure(cystoscopy, ureteroscopyand retrograde pyelography) wherever possible.
Statistical analysis:
Sensitivity, Specificity, Positive predictive value, Negative predictive value, Chi square test and Other appropriate statistical methods as applicable.
7.3. Does the study require any investigation or interventions to be conducted in patients or animals? If so describe briefly.
The study requires a three phase CT examination following an administration intravenous iodinated contrast.
7.4. Has ethical clearance been obtained from your institution in case of 7.3
8. / List of references:
  1. Song JH ,Beland MD, Mayo-Smith WW.Hematuria evaluation with MDCT urography.AJR 2011 ;197:W84-W89
  2. Cowan NC, TurneyBW ,Taylor NJ, McCarthy CL, Crew JP ,Multi Detector CT urpgraphy for diagnosing upper urinary tract urothelialtumour.BJU international2006;99:1363-1370
  3. Grainger RG, Allison DJ,AamA,Dixon:Text book of radiology.5th edition vol 1.Churchill Livingstone;1863-1883
  4. JinzakiM,TanimotoA,ShinmotoH,HoriguchiY,SatoK,KuribayashiS,Silverman SG Detection of bladder tumours with MDCTU .AJR 2007; 188:913-918
  5. HaagaJR,DograVS,ForstingM,Gilkeson RC, Kwon H,CT and MRI of the whole body.5th edition vol 2.John F kennedy;1863-1952.
  6. Maher MM et al,Urinary Tract Imaging with Multidetector CT Urography in Patients with Hematuria. Korean Journal of Radiology 5(1), March 2004.
  7. McTavish JD, JinzakiM ,Zon KH, Nawfel RD, Silverman SG,Multidetector row CT urography :comparison of strategies for depiction of urinary collecting system. RSNA 2002:225:783-790
  8. Chow LC, Kwan SW,Olcott EW, Sommer G split bolus MDCTU with synchronous nephrographic and excretory phase enhancement.AJR 2007;314-322
  9. MaheswariE,O’malley ME, Ghai S, Staunton M,Massey C,Slit Bolus MDCTU :Upper tract opacification and performance for upper tract tumours in patients with hematuria.AJR2010;194:453-458

9. / Signature of the Candidate
10. / Remarks of the guide / Hematuria is a common cause encountered in the routine practice due to various etiological factors like renal parenchymal disease, infection, calculi, neoplasm.
CT urography is helpful in evaluating renal parenchyma in one relatively non invasivecomprehensive examination.
CT urography combines the benefits of excretory urography and cross sectional imaging in one study delineating the collecting systems and ureters.
CT urography also offers several advantages in imaging the urinary tract in a single breath hold coverage. Not many studies have been conducted with this technique in the recent past .Hence I recommend this study.
11. / Name & Designation of
(in block letters)
11.1. Guide / DR.B.R.NAGARAJ
PROFESSOR AND HEAD
DEPARTMENT OF RADIODIAGNOSIS,
VICTORIA HOSPITAL,
BMCRI, BENGALURU.
11.2. Signature
11.3. Co guide / ----
11.4. Signature / -----
11.5 Head of the Department / DR.H.SATISHCHANDRA
PROFESSOR AND HEAD
DEPARTMENT OF RADIODIAGNOSIS
BMCRI, BANGALORE
11.6. Signature
12. / 12.1. Remarks of the Chairman &
Principal
12.2. Signature