Imaging of Hematuria

Abstract

Conventional radiography has no role in the detection of renal or urothelial carcinoma. Low-dose CT offers much greater sensitivities for the detection of urinary tract calculi than radiography at doses equivalent to conventional radiography. Ultrasound alone is insufficient for imaging of hematuria. Using ultrasound alone, it is often difficult to differentiate renal transitional cell carcinoma from other causes of filling defects of the renal collecting system such as blood clots, sloughed papillae, or fungus balls. The prominence of the role of excretory urography in the evaluation of patients with hematuria has diminished, and MDCT urography is now preferred to excretory urography in most cases.

Ultrasound Doppler renal resistive index

“…After initial enthusiasm in the early 1990s, several clinical trials [34] considerably reduced the expectations regarding the usefulness of Doppler-derived indices in this area as results showed that most patients with partial obstruction had normal RRIs [35]. These findings, together with the progressive acceptance of unenhanced CT as the gold standard for identifying ureteral calculi [36], have led to a decrease in interest over the usefulness of this parameter, except perhaps with regard to specific clinical conditions, such as the evaluation of the pregnant patient. More recently, several studies have addressed the potential clinical use of contrast-enhanced ultrasound in different vascular fields, although specific application for this method remains a matter of debate.…”

Multi-detector CT urography: effect of oral hydration and contrast medium volume on renal parenchymal enhancement and urinary tract opacification—a quantitative and qualitative analysis

“…Multi-detector CT urography has become the gold standard in the evaluation of patients with refractory, otherwise asymptomatic haematuria [15,17,18]. Several imaging approaches have been used to optimise image quality, and hence, improve diagnostic accuracy [2-5, 7, 8, 10, 11, 13, 16].…”

MDCT Evaluation of Ureteral Tumors: Advantages of 3D Reconstruction and Volume Visualization

“…Gross or microscopic hematuria is the most common presenting symptom in patients with urothelial malignancies of the renal pelvis or ureter and is present in over 75% of patients. As a result, any patient who presents with hematuria should undergo imaging of their upper tracts (typically with CT urography), as well as evaluation of the bladder with conventional cystoscopy (particularly in patients older than 40 years) [1,8].…”