Diagnostic Values of Urothelial Carcinomas: Single-bolus Versus Split-bolus Computed Tomography Urography

  • End date
    Jul 31, 2021
  • participants needed
  • sponsor
    Chang Gung Memorial Hospital
Updated on 23 January 2021


Single-bolus computed tomography urography (CTU)is a recently developed one-stop imaging examination for diagnosis of urinary tract diseases, including urinary malignancies. However, single-bolus CTU uses two post- contrast phases (i.e.: nephrographic and excretory phases) for diagnosis of urinary tract diseases. A further-developed split-bolus CTU uses solitary post-contrast phase containing mixed information of nephrographic and excretory phases for diagnosis of urinary tract disease; however, whether split-bolus CTU has similar high diagnostic values for urinary malignancies remains unaddressed. Thus, the aim of this study is to compare the diagnostic performance between single-bolus and split-bolus CTU for diagnosing urinary malignancies. This study will enroll 352 patients from two hospitals if they fit the including criteria including aged > 40 years old, presenting with gross hematuria or having urinary malignancies histories, normal renal function (i.e.: estimated glomerular filtration rate > 60 mL/min/1.73 m2, no allergic history to iodinated contrast medium and no pregnancy). All enrolled patients will be randomized to undergo split-bolus and single-bolus CTU in 1: 1 manner. Two radiologists will read CTU images independently using a standardized recording sheet with Likert scales 1-5 representing higher probabilities of presence of urinary malignancies for larger number). The diagnostic values of split-bolus and single-bolus CTU will analyzed using reference standards by final diagnoses of urinary malignancies (i.e.: presence of urinary malignancies based on histological examinations of cytology examinations, biopsies or surgical specimens). The diagnostic performance of split-bolus CTU and single- bolus CTU for urinary malignancies will be compared using areas under receiver operating curve (ROC) to determine whether there is presence of significant difference .


This study will enroll 352 patients. The calculation of sample size is according to the following equation:

n2=(Z+Z/2)^2/(-||)^2 [p1(1-p1)/k+p1(1-p2)]

=0.05, =0.2, =0.05, p1=0.96, p2=0.80 Then, the number of each arm patient should be 141 patients. However, if 20 % of the enrolled patients by fitting inclusion criteria are excluded by fitting exclusion criteria, the number of each arem should be 176 patients. Thus, this study plans to enroll 352 patients (for two arms). The enrolled patients are randomized to two groups (using single-bolus CTU versus using split-bolus CTU) using permuted block method.

Condition Transitional cell carcinoma, Urothelial Carcinoma
Treatment Urinary malignancy
Clinical Study IdentifierNCT04113603
SponsorChang Gung Memorial Hospital
Last Modified on23 January 2021


Yes No Not Sure

Inclusion Criteria

Is your age greater than or equal to 40 yrs?
Gender: Male or Female
Do you have any of these conditions: Urothelial Carcinoma or Transitional cell carcinoma?
Fitting all of the followings
age 40 years old
presenting with gross hematuria or having a history of urothelial carcinomas
normal renal function (i.e.: estimated glomerular filtration rate 60 mL/min/1.73 m2)
no allergy history of iodinated contrast medium

Exclusion Criteria

Fitting any of the followings
pregnant or lactating woman
withdrawal of informed consent
no completion of CTU study
no established final diagnosis or follow up duration less than 6 months
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