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.

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In patients with malignant astrocytomas or metastatic brain disease treated with high-dose radiotherapy, conventional imaging methods may not adequately distinguish recurrent tumor from radiation change. We used a fast spoiled gradient refocusing technique in the open-configuration intraoperative MR system to assess the rate of regional enhancement of the treated tumor bed and to localize specific sites for pathologic sampling to determine whether gadolinium uptake correlated with histologic data. Twenty-four patients were studied. Fourteen of 15 patients with areas of early enhancement had recurrent tumor present in histologic samples, and 8 of the remaining 9 patients had only reactive changes. Dynamic MRI was predictive of recurrent tumor (P < .0005, Fisher exact test and P < .002, Student t test). We conclude that dynamic MRI in the open-bore magnet is a promising method for localizing potential sites of active tumor growth in patients treated for malignant astrocytomas and metastatic brain lesions.

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