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  • Review Article
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CT urography for hematuria

Nature Reviews Urology volume 9, pages 218–226 (2012)Cite this article

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Abstract

Hematuria can signify serious disease such as bladder cancer, upper urinary tract urothelial cell carcinoma (UUT-UCC), renal cell cancer or urinary tract stones. CT urography is a rapidly evolving technique made possible by recent advances in CT technology. CT urography is defined as CT examination of the kidneys, ureters and bladder with at least one series of images acquired during the excretory phase after intravenous contrast administration. The reasoning for using CT urography to investigate hematuria is based on its high diagnostic accuracy for urothelial cell carcinoma (UCC) and favorable comparison with other imaging techniques. The optimum diagnostic imaging strategy for patients with hematuria at high-risk for UCC involves the use of CT urography as a replacement for other imaging tests (ultrasonography, intravenous urography, or retrograde ureteropyelography) and as a triage test for cystoscopy, resulting in earlier diagnosis and improved prognosis of bladder cancer, UUT-UCC, renal cell cancer and stones. Current problems with CT urography for investigating hematuria might be solved with a formative educational program simulating clinical reporting to reduce reader error, and a new technique for image-guided biopsy of UUT-UCC detected by CT urography for histopathological confirmation of diagnosis and elimination of false-positive results. CT urography is recommended as the initial imaging test for hematuria in patients at high-risk for UCC.

Key Points

  • Hematuria can signify serious disease such as bladder cancer, upper urinary tract urothelial cell cancer (UUT-UCC), renal cell cancer or urinary tract stones

  • Patients with hematuria can be divided into low-risk and high-risk groups for UUT-UCC based on risk factors such as patient age, visible hematuria, occupational exposure to toxins and other factors

  • CT urography is defined as CT examination of the kidneys, ureters and bladder with at least one series of images acquired during the excretory phase following intravenous contrast administration

  • Reasoning for the use of CT urography to investigate hematuria is based on its high diagnostic accuracy for UUT-UCC and favorable comparisons with other imaging techniques

  • CT urography is recommended as the initial imaging investigation for patients over 40 years old presenting with hematuria (UTI excluded), specifically those at high risk of urothelial cell carcinoma (UCC)

  • The optimum diagnostic imaging strategy for patients at high risk of UCC is to use CT urography as a replacement test for conventional upper tract imaging techniques and as a triage test for cystoscopy

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Figure 1: Imaging and biopsy of a large renal pelvic UUT-UCC.
Figure 2: Imaging and biopsy of urothelial cell carcinoma.
Figure 3: A summary of diagnostic strategies for investigating hematuria.

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Author information

Authors and Affiliations

  1. The Manor Hospital, Beech Road, OX3 7RP, Oxford, UK

    Nigel C. Cowan

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Supplementary information

Supplementary Text

CT urography single bolus protocol for hematuria (DOC 25 kb)

Supplementary Table 1

CT urography single bolus protocol for hematuria GE LightSpeed VCT 64 (DOC 37 kb)

Supplementary Table 2

CT urography single bolus protocol for hematuria Siemens SOMATOM Sensation 16 (DOC 41 kb)

Supplementary Table 3

CT urography acquisition and reconstruction parameters for GE X4 - 16 CT machines. (DOC 84 kb)

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Cowan, N. CT urography for hematuria. Nat Rev Urol 9, 218–226 (2012). https://doi.org/10.1038/nrurol.2012.32

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