Can Intravenous Urography be Replaced by CT Urography? Our Experience in the Evaluation for Hematuria

This study was conducted for comparing the diagnostic rate of CT and IVU for hematuria and establishing a proper diagnostic protocol During the year of 2004, total 32 patients presented with hematuria received both IVU and CT examination. The CT examination included three phase axial scan: noncontrast (phase I), 90 seconds (phase II) and 180 seconds (phase III) after contrast administration and coronal reconstruction for phase I and III images. The diagnosis of both imaging studies were compared with the final diagnosis. The two examinations were compared by the results of diagnostic accuracy for different diseases. The most common cause of hematuria is stone, while malignancy is the most common cause in patients more than 50 years old, especially urothelial cell carcinoma (UCC). The diagnostic accuracy for hematuria is 84.3% in CT and 31.3% in IVU. Although suspicious abnormal f indings in IVU were recognized in most patients (25/28, 89.3%), they were usually inadequate for making accurate diagnosis and further examinations were thus acquired. The diagnostic rate of CT for stone, renal parenchymal lesion and other intraabdominal pathology is higher than IVU. For the diagnosis of UCC, CT could yield better diagnostic rate as compared with IVU because of its ability to detect wall thickness, adjacent fat infiltration, and contrast enhancement, although IVU yielded better imaging resolution. In the protocol for CT, we found that diagnosis could be obtained in phase I and phase II imaging in most cases. CT has higher diagnostic rate for hematuria as compared with IVU and could be the one-stop examination for patient with hematuria. CTU should be under consideration to have CTU as the first line diagnostic tool, although more delicate cost-effectiveness evaluation is needed for the conclusion.