RSNA News - April 2005

RSNA Research Scholar Sets New Standard of GU Care

My mentors … have taught me that to be the best clinician, the best doctor, the best radiologist you can possibly be means that you are always asking research questions and using your research to be a better clinician.
—Elaine Caoili, M.D.

Elaine Caoili, M.D. University of Michigan Health Systems

Nothing can strike fear in a patient faster than discovering blood in their urine. Termed hematuria, it is one of the most common reasons for a visit to the urologist. It can signal a problem as benign as a bladder infection to an illness as deadly as cancer.

Historically, a workup for hematuria has involved subjecting patients to a series of costly and time-consuming imaging tests with varying degrees of success. These tests would include plain film radiography, ultrasound, CT and excretory urography (EU), which until recently was considered by many urologists to be the gold standard. But while EU proved useful in evaluating for renal and ureteral stones, it provided a cursory examination of the renal parenchyma and bladder.

In recent years, radiologists have sought a more comprehensive screening test for urinary tract disease. Significant progress has been made by Elaine Caoili, M.D., an assistant professor of radiology, Richard H. Cohan, M.D., a professor of radiology, and a team of radiologists and urologists at the University of Michigan Health Systems, who have developed an innovative examination for early detection of renal and urothelial disease—multidetector CT urography (MDCTU).

"Our research was aimed at refining MDCTU to make it a better and more comprehensive exam for detecting urothelial cancer and other urinary tract abnormalities," she said.

Armed with an Agfa Corporation/RSNA Research Scholar grant in 2001, Dr. Caoili set her sights on defining and implementing new CT technology that enables radiologists to generate high-resolution images of the entire renal collecting system in a single helical run. MDCTU lends itself to the creation of detailed 3D urograms which, when combined with axial data, provide a comprehensive examination of the entire genitourinary tract.

"Dr. Caoili has developed a technique which has combined the qualities of CT and EU in a way that exceeds the value of either test alone," said N. Reed Dunnick, M.D., Fred Jenner Hodges Professor and chair of the Department of Radiology at the University of Michigan.

Dr. Caoili's research successfully undertook three objectives:

1. Compare MDCTU to EU in the evaluation of patients with hematuria.
2. Establish optimal techniques for the MDCTU.
3. Compare MDCTU to CT scout radiographs to determine the best CT method for displaying the collecting system anatomy.

The goal was to improve the ability of CT to detect urothelial abnormalities yet provide patients with a single comprehensive examination.

"Urologists cannot evaluate the ureters as easily as they can the bladder with endoscopy and so we knew that MDCTU could play a critical role in detecting abnormalities in the renal collecting system and ureters," said Dr. Caoili. "This technology allows us to view the whole urinary tract system non-invasively, and we have been able to improve the exam to such a degree that we can detect tumors smaller than five millimeters in size. It's really quite remarkable given that these tumors are not easily detected by other exams."

Her preliminary findings were presented at several RSNA annual meetings.

"MDCTU has made EU obsolete. Not only can small lesions be detected, but MDCTU provides a valuable roadmap to guide surgical intervention," said Dr. Dunnick.

Dr. Caoili is excited by the explosive growth and potential for MDCTU and plans to continue her work in this area. Currently she is developing different imaging algorithms that will further refine the MDCTU technique by reducing the number of images needed for each exam. She is also looking into computer-aided detection in an effort to find subtle tumors.

"My research efforts have been highly rewarding and have taught me important lessons," said Dr. Caoili, who credits the RSNA Research Scholar grant with helping her to become a better researcher by allowing her to pursue work on MDCTU while also obtaining a master's degree in statistical analysis and clinical research.

She dreams of being a leader in the field as a clinician, researcher and educator. Although it is still relatively early in her career, Dr. Caoili's work has shown great promise as proven by her numerous honors, including the New Investigator Award from the American Institute of Ultrasound in Medicine.

"My mentors, particularly Richard Cohan, have taught me that to be the best clinician, the best doctor, the best radiologist you can possibly be means that you are always asking research questions and using your research to be a better clinician," she said.

Dr. Caoili received her undergraduate and medical degrees from the University of Michigan in Ann Arbor where she joined the staff in 1999. She completed an internship in internal medicine at the University of Pennsylvania and her radiology residency at the University of California, San Francisco. She also completed an abdominal imaging fellowship at Duke University Medical Center.