Julie H. Song MD, Presenter: Nothing to Disclose

Michael David Beland MD, Abstract Co-Author: Nothing to Disclose

William W. Mayo-Smith MD, Abstract Co-Author: Research support, Covidien AG Research support, Bracco Group

To determine the added benefits of the contrast-enhanced phase of MDCTU when a urinary tract calculus is detected on the preliminary un-enhanced phase

This study was IRB approved and HIPAA compliant. A computer search of abdominal CT reports using the term “hematuria” identified 1221 MDCTU performed from March 2004 to September 2008. From the reports, 289 (24%) exams with urinary tract calculi were identified and these exams were reviewed by 2 abdominal radiologists in a blinded fashion to determine a second source of hematuria. First, the un-enhanced images were reviewed then the findings were compared with the subsequent contrast enhanced images. The aggregate findings in the 289 exams with calculi were then compared to the 932 exams without calculi. The follow-up diagnosis was established by histopathology, findings at urologic procedures, or imaging diagnosis.

One hundred twenty-eight lesions were identified as possible sources of hematuria other than urinary tract calculi in 121 of 1221 MDCTU (10%). There were 83 lesions diagnosed at 80 (6.6%) MDCTU: 29 masses of kidney; 4 masses, 2 strictures and 1 inflammation of ureter; 41 masses and 5 inflammation of bladder; and 1 pelvic mass. Of the 289 exams with calculi, 19 (6.6%) had a second source for hematuria compared to 61 (6.5%) exams in the group without calculi (p=0.986), and contrast was required to make the specific diagnosis in 16 (84%) of the 19 exams.

When a urinary tract calculus is identified at MDCTU, the detection of other potential causes of hematuria is not different from that of exams without calculus. The majority of significant pathology is only diagnosed after the contrast-enhanced phase.

When a urinary tract calculus is detected at MDCTU for hematuria, contrast-enhanced phase is still required for the complete evaluation of urinary tract.

Song, J, Beland, M, Mayo-Smith, W, Is Contrast Required for Hematuria Evaluation When a Calculus Is Detected on the Unenhanced Phase of MDCT Urography?.  Radiological Society of North America 2009 Scientific Assembly and Annual Meeting, November 29 - December 4, 2009 ,Chicago IL. http://archive.rsna.org/2009/8004662.html