Preoperative 3D and 4D-CT imaging using 640-Multislice CT (640-MSCT) in diagnosis of female urethral diverticulum

Abstract

ObjectiveTo determine the sensitivity and specificity of 640-Multislice CT (640-MSCT) in diagnosing the female UD.Materials and methodsWe investigated 16 patients with symptomatic UDs preoperatively in our hospital from August 2010 to March 2016. The patients’ average age was 38.8 years. All patients were performed 640-MSCT of pelvis; then, 3D and 4D images were reconstructed preoperatively.ResultsIn 3D and 4D-CT images, out of 16 patients, thirteen patients had one ostium, two had 2 ostia and one had 3 ostia. Out of those thirteen patients, eight patients’ ostia were located at 5 o’clock and five patients’ at 7 o’clock. Patients with 2 ostia location were at 5 and 6 o’clock and 5 and 7 o’clock, respectively. Patients with 3 ostia location were at 5, 6 and 7 o’clock. The mean distance from the bladder neck to the ostia was 22.5 mm. The shape of UD was out-pouching in 11 patients (68.8%), U-shaped in four patients (25.0%) and circumferential in 1 patient (6.2%). The CT findings were confirmed by surgical findings.Conclusions640-MSCT is a useful tool in identifying UD’s shape and ostium (including number, location) before operation. Preoperative 640-MSCT should be an adaptable modality for clinically suspected UD patients.Advances in knowledgeSeveral imaging methods have been used to diagnose female UD. 640-MSCT may be more suitable to diagnose it for its higher sensitivity and specificity in diagnosis of female UD, especially in identifying UD’s shape and number and location of ostium.

Diagnostic tools for female urethral diverticulum: Current perspectives

“…43 In 2017, Zhao et al published data on the use of the 640-Multislice CT (640-MSCT), with 3D and 4D reconstruction, to ascertain the existence of the UDs and to figure out their locations, sizes, ostia and shapes in 16 female patients. 44 Using new-generation 640-MSCT, images of a contrast agent-filled urethra during patient voiding were obtained in approximately 5 seconds, providing more detailed urethral structure, which made it possible to identify the UD ostia easily and clearly; also, the high resolution of the system made it feasible to detect the small amount of contrasts passing through the ostia, even the narrow ones. Finally, with the help of post processing techniques, authors reformatted 3D and 4D images, and all patients were diagnosed accurately pre-operation, with a positive predictive values of 100% in diagnosis of female UD.…”

“…Finally, with the help of post processing techniques, authors reformatted 3D and 4D images, and all patients were diagnosed accurately pre-operation, with a positive predictive values of 100% in diagnosis of female UD. 44 Highly interesting was the recent rare case of a large UD complicating pregnancy in third trimester, influencing the mode of delivery, performed by cesarean section. 45 In fact, the diagnosis and management of UD in pregnancy are challenging because of the rare nature of the condition, the varied presentations and the possibility of misdiagnosis, often related to absence of pelvic examination during second and third trimester.…”