Seminars in Ultrasound, CT and MRI
Volume 30, Issue 4 , Pages 258-270 , August 2009

The Role of Imaging in the Investigation of Painless Hematuria in Adults

  • Kevin N. O'Regan, MB, MRCPI, FFR(RCSI)

      Affiliations

    • Department of Radiology, Cork University Hospital, Cork, Ireland
    • University College Cork, Cork, Ireland
    • ,
  • Owen J. O'Connor, MD, MRCSI, FFR(RCSI)

      Affiliations

    • Department of Radiology, Cork University Hospital, Cork, Ireland
    • ,
  • Patrick McLoughlin, MB, BCh, BAO

      Affiliations

    • Department of Radiology, Cork University Hospital, Cork, Ireland
    • ,
  • Michael M. Maher, MD, FRCSI, FFR(RCSI), FRCR

      Affiliations

    • Department of Radiology, Cork University Hospital, Cork, Ireland
    • University College Cork, Cork, Ireland
    • Corresponding Author InformationAddress reprint requests to Michael M. Maher, MD, FRCSI, FFR(RCSI), FRCR, Department of Radiology, Cork University Hospital, Wilton, Cork, Ireland

References 

  1. Silverman S, Leyendecker J, Amis S. What is the current role of CT urography and MR urography in the evaluation of the urinary tract?. Radiology. 2009;250:309–323
  2. Grossfield GD, Litwin MS, Wolf JS, et al. Evaluation of asymptomatic microscopic hematuria in adults: The American Urological Association best practice policy II (Patient evaluation, cytology, voided markers, imaging, cystoscopy, nephrology evaluation and follow-up). Urology. 2001;57:604–610
  3. Grossfeld GD, Carroll PR. Evaluation of asymptomatic microscopic hematuria. Urol Clin North Am. 1998;25:661–676
  4. Rose B, Fletcher R. Evaluation of hematuria in adults: UpToDate, Version 16.3, Updated. June 2008;Accessed February 25, 2009
  5. Rodgers M, Nixon J, Hempel S, et al. Diagnostic tests and algorithms used in the investigation of haematuria: Systematic reviews and economic evaluation. Health Technol Assess. 2006;10:iii–ivxi-259
  6. Feldstein MS, Hentz JG, Gillett MD, et al. Should the upper tracts be imaged for microscopic hematuria?. Br J Urol. 2005;96:612–617
  7. Ritchie CD, Bevan EA, Collier SJ. Importance of occult hematuria found at screening. Br Med J Clin Res Ed. 1986;292:681–683
  8. Bjerklund Johansen TE. Diagnosis and imaging in urinary tract infections. Curr Opin Urol. 2002;12:39–43
  9. Belldegrun A, Dekernion JB. Renal Tumours. In:  Walsh PC,  Retik AB,  Vaughan DE, et al. editor. Campbell's Urology. Philadelphia, PA: WB Saunders Co; 1998;p. 2283–2326
  10. Dunnick RN, Sandler CM, Newhouse JH, et al. Nephrocalcinosis and nephrolithiasis. In: Textbook of Uroradiology. (ed 3). Philadelphia, PA: Lippincott Williams & Wilkins; 2001;p. 178–194
  11. McInnis MD, Newhouse IJ, von Duvillard SP, et al. The effect of exercise intensity on hematuria in healthy male runners. Eur J Appl Physiol Occup Physiol. 1998;79:99–105
  12. Edwards TJ, Dickinson AJ, Natale S, et al. A prospective analysis of the diagnostic yield resulting from the attendance of 4020 patients at a protocol-driven haematuria clinic. BJU Int. 2006;97:301–305discussion, 305
  13. Grossfeld GD, Litwin MS, Wolf JS, et al. Evaluation of asymptomatic microscopic hematuria in adults: The American Urological Association best practice policy—Part I: Definition, detection, prevalence, and etiology. Urology. 2001;57:599–603
  14. Scottish Intercollegiate Guidelines Network. Investigation of asymptomatic microscopic haematuria in adults. http://www.sign.ac.uk1997;
  15. Van der Molen AJ, Cowan NC, Mueller-Lisse UG, et al. Urography Working Group of the European Society of Urogenital Radiology (ESUR) CT urography: Definition, indications and techniques (A guideline for clinical practice). Eur Radiol. 2008;18:4–17
  16. O'Keeffe S, McNally S, Keogan M. Investigating painless haematuria. BMJ. 2008;337:a260
  17. Choyke P, Bluth E, Bush W, et al. Am College Radiol ACR Appropriateness Criteria: Hematuria. October, 2008;version. Available at: http://www.acr.org. Accessed February 26, 2009
  18. Choyke P. Radiologic evaluation of hematuria: Guidelines from the American College of Radiology's appropriateness criteria. Am Fam Physician. 2008;78:347–352
  19. Vrtiska TJ. Quantitation of stone burden: Imaging advances. Urol Res. 2005;33:398–402
  20. Ege G, Akman H, Kuzucu K, et al. Can computed tomography scout radiography replace plain film in the evaluation of patients with acute urinary tract colic?. Acta Radiol. 2004;45:469–473
  21. Caoli EM, Cohan RH, Korobkin M, et al. Urinary tract abnormalities: Initial experience with multi-detector row CT urography. Radiology. 2002;222:353–360
  22. Fielding JR, Silverman SG, Rubbing GD. Helical CT of the urinary tract. AJR Am J Roentgenol. 1999;172:1199–1206
  23. Smith RC, Verga M, McCarthy S, et al. Diagnosis of acute flank pain: Value of unenhanced helical CT. AJR Am J Roentgenol. 1996;166:97–101
  24. Chen MY, Zagoria RJ. Can noncontrast helical computed tomography replace intravenous urography for evaluation of patients with acute urinary tract colic?. J Emerg Med. 1999;17:299–303
  25. Niall O, Russell J, MacGregor R, et al. A comparison of noncontrast computerized tomography with excretory urography in the assessment of acute flank pain. J Urol. 1999;161:534–537
  26. Eikefjord EN, Thorsen F, Rorvik J. Comparison of effective radiation doses in patients undergoing unenhanced MDCT and excretory urography for acute flank pain. AJR Am J Roentgenol. 2007;188:934–939
  27. Wall BF, Hart D. Revised radiation doses for typical X-ray examinations (Report on a recent review of doses to patients from medical X-ray examinations in the UK by NRPB. National Radiological Protection Board). Br J Radiol. 1997;70:437–439
  28. Kluner C, Hein PA, Gralla O, et al. Does ultra-low-dose CT with a radiation dose equivalent to that of KUB suffice to detect renal and ureteral calculi?. J Comput Assist Tomogr. 2006;30:44–50
  29. Katz SI, Saluja S, Brink JA, et al. Radiation dose associated with unenhanced CT for suspected renal colic: Impact of repetitive studies. AJR Am J Roentgenol. 2006;186:1120–1124
  30. Dalla Palma L. What is left of i.v. urography?. Eur Radiol. 2001;11:931–939
  31. Tiselius HG, Alken P, Buck C, et al. Guidelines on urolithiasis. Update 2008;Available at: http://www.uroweb.org/nc/professional-resources
  32. Worster A, Preyra I, Weaver B, et al. The accuracy of noncontrast helical computed tomography versus intravenous pyelography in the diagnosis of suspected acute urolithiasis: A meta-analysis. Ann Emerg Med. 2002;40:280–286
  33. Shine S. Urinary calculus: Ivu v CT renal stone? (A critically appraised topic). Abdom Imaging. 2008;33:41–43
  34. Warshauer DM, McCarthy SM, Street L, et al. Detection of renal masses: Sensitivities and specificities of excretory urography/linear tomography, US, and CT. Radiology. 1988;169:363–365
  35. Dyer R, Chen M, Zagoria R. Intravenous urography: Technique and interpretation. Radiographics. 2001;21:799–824
  36. Wong-You-Cheong JJ, Wagner BJ, Davis CJ. Transitional cell carcinoma of the urinary tract: Radiologic-pathologic correlation. Radiographics. 1998;18:123–142
  37. Brennan RE, Pollack HM. Nonvisualized (“phantom”) renal calyx: Causes and radiological approach to diagnosis. Urol Radiol. 1979;1:17–23
  38. Batata MA, Whitmore WF, Hilaris BS, et al. Primary carcinoma of the ureter: A prognostic study. Cancer. 1975;35:1626–1632
  39. Caoili EM, Cohan RH, Inampudi P, et al. Urography of upper tract urothelial neoplasms. AJR Am J Roentgenol. 2005;184:1873–1881
  40. Tsili AC, Efremidis SC, Kalef-Ezra J, et al. Multi-detector row CT urography on a 16-row CT scanner in the evaluation of urothelial tumors. Eur Radiol. 2007;17:1046–1054
  41. Nawfel RD, Judy PF, Schleipman AR, et al. Patient radiation dose at CT urography and conventional urography. Radiology. 2004;232:126–132
  42. Yakoumakis E, Tsalafoutas IA, Nikolaou D, et al. Differences in effective dose estimation from dose are product and entrance surface dose measurements in intravenous urography. Br J Radiol. 2001;74:727–734
  43. Fowler KA, Lochen JA, Duchesne JH, et al. US for detecting renal calculi with nonenhanced CT as a reference standard. Radiology. 2002;222:109–114
  44. Jamis-Dow CA, Choyke PL, Jennings SB, et al. (< or = 3-cm) renal masses: Detection with CT v US and pathologic correlation. Radiology. 1996;198:785–788
  45. Thurston W, Wilson SR. The urinary tract. In:  Thurston W,  Wilson SR,  Wilson SR editor. Diagnostic Ultrasound. (ed 3). St. Louis, MO: Elsevier Mosby; 2005;p. 321–393
  46. Browne RF, Meehan CP, Colville J, et al. Transitional cell carcinoma of the upper urinary tract: Spectrum of imaging findings. Radiographics. 2005;25:1609–1627
  47. Nolte-Ernsting C, Cowan N. Understanding multislice CT urography techniques: Many roads lead to Rome. Eur Radiol. 2006;16:2670–2686
  48. Maher MM, Kalra MK, Rizzo S, et al. Urography in imaging of the urinary tract in patients with hematuria. Kor J Radiol. 2004;5:1–10
  49. Kalra MK, Maher MM, Sahani DV, et al. Current status of multidetector computed tomography urography in imaging of the urinary tract. Curr Probl Diagn Radiol. 2002;31:210–221
  50. Caoili EM, Inampudi P, Cohan RH, et al. Optimization of multi-detector row CT urography: Effect of compression, saline administration, and prolongation of acquisition delay. Radiology. 2005;235:116–123
  51. Noroozian M, Cohan RH, Caoili EM, et al. Multislice CT urography: State of the art. Br J Radiol. 2004;77:S74–S86
  52. Chow LC, Kwan SW, Olcott EW, et al. Split-Bolus MDCT urography with synchronous nephrographic and excretory phase enhancement. AJR Am J Roentgenol. 2007;184:131–138
  53. Chai RY, Jhaveri K, Saini S, et al. Comprehensive evaluation of patients with haematuria on multi-slice computed tomography scanner: Protocol design and preliminary observations. Australas Radiol. 2001;45:536–538
  54. Kawamoto S, Horton KM, Fishman EK. Opacification of the collecting system and ureters on excretory-phase CT using oral water as contrast medium. AJR Am J Roentgenol. 2006;186:136–140
  55. McTavish J, Jinzaki M, Zou K, et al. Multi-Detector row CT urography: Comparison of strategies for depicting the normal urinary collecting system. Radiology. 2002;225:783–790
  56. Sanyal R, Deshmukh A, Sheorain V, et al. Urography: A comparison of strategies of upper urinary tract opacification. Eur Radiol 17. 2007;1262–1266
  57. Chow LC, Sommer FG. Multidetector CT: Urography with abdominal compression and three-dimensional reconstruction. AJR Am J Roentgenol. 2001;177:849–855
  58. Heneghan JP, Kim DH, Leder RA, et al. Compression CT urography: A comparison with IVU in the opacification of the collecting system and ureters. J Comput Assist Tomogr. 2001;25:343–347
  59. McNicholas MMJ, Raptopoulos VD, Schwartz RK, et al. Excretory phase CT urography for opacification of the urinary collecting system. AJR Am J Roentgenol. 1998;170:1261–1267
  60. Nolte-Ernsting C, Wildberger J, Borchers H, et al. Multislice CT urography after diuretic injection: Initial results. Rofo. 2001;173:176–180
  61. Silverman S, Akbar S, Mortele K, et al. Multidetector-row CT urography: Comparison of furosemide and saline as adjuncts to contrast medium for depicting the normal urinary collecting system. Radiology. 2006;240:749–755
  62. O'Connor O, McSweeney S, Maher M. Imaging of hematuria. Radiol Clin North Am. 2008;46:113–132
  63. Kalra MK, Maher MM, D'Souza RV, et al. Detection of urinary tract stones at low dose ct with z-axis automatic tube current modulation: Phantom and clinical studies. Radiology. 2005;235:523–529
  64. Sheth S, Scatarige JC, Horton KM, et al. Current concepts in the diagnosis and management of renal cell carcinoma: Role of multidetector CT and three-dimensional CT. Radiographics. 2001;21:S237–S254
  65. Silverman SG, Lee BY, Seltzer SE, et al. Small (< or = 3 cm) renal masses: Correlation of spiral CT features and pathologic findings. AJR Am J Roentgenol. 1994;163:597–605
  66. Kocakoc E, Bhatt S, Dogra VS. Renal multidetector row CT. Radiol Clin North Am. 2005;43:1021–1047
  67. Zagoria RJ. Imaging of small renal masses: A medical success story. AJR Am J Roentgenol. 2000;175:945–955
  68. Gray Sears CL, Ward JF, Sears ST, et al. Prospective comparison of computerized tomography and excretory urography in the initial evaluation of asymptomatic microhematuria. J Urol. 2002;168:2457
  69. Cowan N, Turney V, Taylor N, et al. Urography for diagnosing upper tract urothelial tumor. BJU Int. 2007;99:1363–1370
  70. Sadow CA, Silverman SG, O'Leary MP, et al. Bladder cancer detection with CT urography in an Academic Medical Center. Radiology. 2008;249:195–202
  71. Turney BW, Willatt JMC, Nixon D, et al. Computed tomography for diagnosing bladder cancer. BJU Int. 2006;98:345–348
  72. Leyendecker J, Barnes C, Zagoria R. MR urography: Techniques and clinical applications. Radiographics. 2008;28:23–48
  73. Roy C, Saussine C, Guth S, et al. MR urography in the evaluation of urinary tract obstruction. Abdom Imaging. 1998;167:1497–1502
  74. Nolte-Ernsting CCA, Staatz G, Tacke J, et al. MR urography today. Abdom Imaging. 2003;28:191–209
  75. Ergen FB, Hussain HK, Carlos RC, et al. 3D excretory MR urography: Improved image quality with intravenous saline and diuretic administration. J Magn Reson Imaging. 2007;25:783–789
  76. Sudah M, Vanninen R, Partanen K, et al. MR urography in evaluation of acute flank pain: T2 weighted sequences and gadolinium-enhanced three-dimensional FLASH compared with urography. AJR Am J Roentgenol. 2001;176:105–112
  77. Shokeir AA, El-Diasty T, Eassa W, et al. Diagnosis of ureteral obstruction in patients with compromised renal function: The role of noninvasive imaging. J Urol. 2004;171:2303–2306
  78. Riccabona M. Pediatric MRU: Its potential and its role in the diagnostic work-up of upper urinary tract dilatation in infants and children. World J Urol. 2004;22:79–87

PII: S0887-2171(09)00024-9

doi: 10.1053/j.sult.2009.03.006

Seminars in Ultrasound, CT and MRI
Volume 30, Issue 4 , Pages 258-270 , August 2009

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