Indication for CT urography in hematuria
- Male sex
- Age, especially being older than 60 years
- Pelvic radiation
In Swedish practice, the protocol is determined by age:
- In patients under 40 years, generally:
- Low-radiation-dose of urinary system, without IV contrast
- Normal-radiation-dose with split bolus IV contrast, 7.5 minutes and 90 seconds before image acquisition.
- In patients over 40 years, or younger if suspicion of cancer is high:
- Low-radiation-dose of whole abdomen, without IV contrast
- Normal-radiation-dose of whole abdomen 20 seconds after bolus tracking, for visualization of renal cortex.
- Normal-radiation-dose of upper abdomen 40 seconds after the previous, for visualization of all renal parenchyma.
- Normal-radiation-dose of urinary system 7.5 minutes after IV contrast, for renal pelvises and ureters.
Regardless of age, 1 liter water is given orally 1 hours before the CT, as well as avoiding urination during 1 hour before, in order to increase renal filtration and distend the bladder. If the images show insufficient contrast filling in the renal pelvices and ureters, an additional image is taken after 5 minutes, possibly with the patient lying on the stomach to make gravity help fill the ureters.
If patient has flank pain, a CT of kidney stone disease (without IV contrast) should be done instead.
- CT without contrast: Look for:
If found, see CT of kidney stone disease.
- CTs with contrast: Tumors within the kidney, ureters or bladder.
- Signs of bladder tumor:
- Bladder wall thickening, which may indicate a bladder tumor, especially when nodular or irregular. Look both at images 40 seconds after IV contrast and with contrast-containing bladder lumen, since that contrast may both demarcate a tumor as well as obscure one by beam-hardening artifacts. In suspected bladder tumor, see CT of urinary bladder tumors
- Lymph nodes. Enlarged lymph nodes may be metastases. Generalized lymphadenopathy may indicate lymphoma, and in such cases tumors in the urinary system may be lymphomas as well.
- For a full list of contributors, see article Radlines:Authorship for details. . Creators of images are attributed at the image description pages, seen by clicking on the images. See