Is CT scanning necessary for interstitial cystitis?
MD.,PhD. Hana Yoon (1), MD.,PhD. Kwang Hyun Kim (1), Gil Do Jung (2)
(1) Ewha Womans University, Seoul, South Korea, (2) Ewha Womans University Seoul Hospital, Seoul, South Korea
Radiologic imaging studies has been known to have limitation in diagnosis of interstitial cystitis (IC) except severe cases such as significant bladder contracture and related upper tract changes. Major role of contrast-enhanced bladder CT scan in current clinical practice for diagnosing IC is ruling out potential malignancy or other possible causes of pelvic or bladder pain. However, destructed urothelial barrier function and chronic inflammatory reactions of IC bladder would result in bladder and surrounding tissue changes which might visible in contrast-enhanced CT.In this study, we aimed to investigate the correlation between cystoscopic and CT findings of the ulcer type IC bladder.
Twenty IC patients who had been had cystoscopy and fulguration under general anesthesia with pre-operative abdomino-pelvic dynamic CT (with contrast enhancement) were retrospectively reviewed. As the control group, 11 age-matched asymptomatic microscopic hematuria patients without any urological history including urinary tract infection were selected. Cystoscopic findings including Hunner’s lesions, and CT findings including bladder wall thickness were evaluated and analyzed to find their correlations.
Fourteen out of 20 IC patients showed bladder wall thickening in dynamic CT. On the other hand, control group did not show any abnormal finding either in the bladder dynamic CT nor cystoscopy.In IC group, all 14 patients with bladder wall thickening compared with control group had Hunner’s lesion and 75% of them had correlation between their bladder lesions and bladder wall thickenings of the dynamic CT (Mann-Whitney test, p=0.002).Severities and numbers of the bladder lesions such as Hunner’s lesion, glomerulation, or mucosal cracks/denudations showed significant correlations with CT findings of the bladder (Mann-Whitney test, p<0.001).
Pathologic changes of the bladder tissue in IC are also reflected in dynamic abdomino-pelvic CT in accordance with disease severities. Advanced IC can be detected even with the dynamic CT of the bladder. Dynamic CT scanning would be helpful not only for screening of other diseases but also predict the presence of ulcers or pathologic changes related with IC progression.