Spiral computed tomography (CT) is the state of the art today in imaging many features of the genitourinary tract. The use of dual-phase CT imaging improves our ability to detect and stage a wide range of pathologies. However, imaging in the arterial phase has several potential pitfalls that can result in either overcalling or undercalling genitourinary pathology. This paper reviews some of the common pitfalls and presents strategies on how to avoid them.
Helical CT is commonly used for evaluation of a multitude of conditions in the abdomen and pelvis, including those involving the genitourinary (GU) tract (1). Like the parenchymal organs of the upper abdomen, the GU tract is subject to potential pitfalls if arterial-phase imaging alone is used for diagnosis (2-7). Most of these pitfalls reflect temporal phenomena of early enhancement that are easily appreciated and pose minimal diagnostic challenge or significance. However, some can mask significant pathology or produce a false-positive diagnosis if not recognized. This essay illustrates some of the more common enhancement-related pitfalls or arterial-phase scanning involving the kidney, collecting system, bladder, and uterus.