Hematuria evaluation with MDCT urography: is a contrast-enhanced phase needed when calculi are detected in the

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Point-of-Care Kidney and Genitourinary Ultrasound in Adults: Image Acquisition
03:19

Point-of-Care Kidney and Genitourinary Ultrasound in Adults: Image Acquisition

Published on: June 21, 2024

Julie H Song1, Michael D Beland, William W Mayo-Smith

  • 1Department of Diagnostic Imaging, Rhode Island Hospital-Warren Alpert Medical School of Brown University, Providence, 02903, USA. jsong2@lifespan.org

AJR. American Journal of Roentgenology
|June 25, 2011
PubMed

Insights

The contrast-enhanced phase of multi-detector CT urography (MDCTU) is crucial for diagnosing hematuria, even when urinary tract calculi are present. This phase helps identify other potential causes of bleeding not visible on unenhanced scans.

Area of Science:

  • Radiology
  • Urology
  • Medical Imaging

Background:

  • Hematuria is a common clinical presentation.
  • Multi-detector CT urography (MDCTU) is frequently used for hematuria evaluation.
  • The role of the contrast-enhanced phase in MDCTU when calculi are present requires further clarification.

Purpose of the Study:

  • To determine the added diagnostic value of the contrast-enhanced phase of MDCTU when urinary tract calculi are identified in the unenhanced phase.
  • To assess if the detection rate of alternative hematuria sources differs between MDCTU with and without calculi.

Main Methods:

  • Retrospective review of 1209 MDCTU reports for patients presenting with hematuria.
  • Identification of 286 examinations with detected urinary tract calculi.
  • Blinded review by two abdominal radiologists to identify a second source of hematuria, comparing unenhanced and contrast-enhanced phases.
  • Follow-up diagnosis based on histopathology, urologic procedures, or imaging.

Main Results:

  • In 10% of patients, lesions other than calculi were identified as potential hematuria sources.
  • A second source of hematuria was found in 7% of examinations with calculi versus 6% without (p=0.828).
  • Contrast enhancement was necessary for a specific diagnosis in 84% of examinations where a second source was identified.

Conclusions:

  • The detection rate of other potential hematuria causes is similar whether or not urinary tract calculi are present.
  • The contrast-enhanced phase of MDCTU is essential, even with visible calculi, as it aids in diagnosing significant pathologic changes.
  • Contrast-enhanced MDCTU is valuable for comprehensive hematuria evaluation, regardless of initial calculus findings.
Abstract

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