Multi–Detector Row CT Urography in the Evaluation of Hematuria

Abstract

Hematuria can be well evaluated with a comprehensive contrast material-enhanced multi-detector row computed tomography (CT) protocol that combines unenhanced, nephrographic-phase, and excretory-phase imaging. Unenhanced images are obtained from the kidneys to the bladder and allow optimal detection of renal calculi, a common cause of hematuria. Renal parenchymal abnormalities, particularly masses, are best visualized on nephrographic-phase images, which also provide excellent evaluation of the other abdominal organs. Thin-section delayed images obtained from the kidneys to the bladder demonstrate the urinary tract distended with contrast material and are useful in detecting urothelial disease. Intravenous urography, ultrasonography, CT, retrograde ureterography and pyelography, cystoscopy, and ureteroscopy can all be used to evaluate patients with hematuria. In the past, a combination of several of these examinations was necessary to fully evaluate these patients. Now, however, this CT protocol may permit evaluation of hematuria patients with a single comprehensive examination, although more experience and data are needed to determine its efficacy in this setting.

Prospective evaluation of interobserver diagnostic agreement for focal urinary bladder wall abnormalities detected by ultrasound

“…Although CT urography is nowadays considered as the most appropriate [25] and the most clinically effective imaging method in the evaluation of patients with hematuria [13,14,26], yield and clinical effectiveness of US should not be disregarded in the evaluation of the urinary bladder. Our experience indicated that US has a good sensitivity and overall accuracy for cystoscopy-proved FBWA even when different but dedicated operators perform sonographic exploration of the bladder.…”

When the non-contrast-enhanced phase is unnecessary in abdominal computed tomography scans? A retrospective analysis of 244 cases

“…Exclusion criteria were patients younger than 18 years, with indication for non-contrastenhanced abdominal CT scans, or with contraindication for utilization of iodinated contrast agents. Patients whose indication for the scan was investigation of hematuria were also excluded, considering the well established theoretical groundings in literature advocating the need for non-contrastenhanced phase in such cases (11,12) .…”

Acute Flank Pain: Multi-detector Computed Tomographic Evaluation in the Emergency Room

“…MDCT without contrast helps evaluate nephrolithiasis which is one of the main reasons of hematuria and allows imaging from the kidney to the bladder (3).…”

“…Delayed thin slice images from the kidneys to the bladder reveal contrast distended urinary system and are used to detect uroepithelial diseases (3). Pyelographic phase images are obtained 5-15 min after contrast administration and are used to evaluate uroepithelium.…”