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Hematuria Evaluation With MDCT Urography: Is a Contrast-Enhanced Phase Needed When Calculi Are Detected in the Unenhanced Phase?
MedLine Citation:
PMID:  21701000     Owner:  NLM     Status:  In-Data-Review    
Abstract/OtherAbstract:
OBJECTIVE: The purpose of this study was to assess the added utility of the contrast-enhanced phase of MDCT urography (MDCTU) when urinary tract calculi are detected in the preliminary unenhanced phase.
MATERIALS AND METHODS: A computer search of CT reports with the term "hematuria" yielded the records of 1209 patients who had undergone MDCTU. The reports of 286 MDCTU examinations in which urinary tract calculi were detected were identified, and two blinded abdominal radiologists reviewed the images to find a second source of hematuria. The unenhanced images were reviewed first, and the findings were compared with those on the subsequent contrast-enhanced images. The aggregate findings of the 286 examinations in which calculi were present were compared with those of the 923 examinations in which calculi were absent. The follow-up diagnosis was based on histopathologic findings, findings at urologic procedures, or the imaging diagnosis.
RESULTS: In 119 of the 1209 patients (10%), 127 lesions other than urinary tract calculi were identified as possible sources of hematuria. Eighty-two lesions were diagnosed in 77 patients (6%) at follow-up evaluation. A second source of hematuria was found in 19 of the 286 examinations (7%) with calculi compared with 58 of the 923 examinations (6%) without calculi (p = 0.828), and contrast was needed to make a specific diagnosis in 16 of the 19 examinations (84%).
CONCLUSION: When urinary tract calculi are identified at MDCTU, the rate of detection of other potential causes of hematuria is not different from that in MDCTU examinations without calculi. The contrast-enhanced portion of the MDCTU examination is needed even if calculi are seen because important pathologic changes are diagnosed only after the contrast-enhanced phase.
Authors:
Julie H Song; Michael D Beland; William W Mayo-Smith
Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  AJR. American journal of roentgenology     Volume:  197     ISSN:  1546-3141     ISO Abbreviation:  AJR Am J Roentgenol     Publication Date:  2011 Jul 
Date Detail:
Created Date:  2011-06-24     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  7708173     Medline TA:  AJR Am J Roentgenol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  W84-9     Citation Subset:  AIM; IM    
Affiliation:
Department of Diagnostic Imaging, Rhode Island Hospital-Warren Alpert Medical School of Brown University, 593 Eddy St, Providence, RI 02903.
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