Genitourinar y Imaging Original Research

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Diagnostic Yield of CT Urography

in the Evaluation of Young Adults
With Hematuria
1 OBJECTIVE. CT urography is increasingly used as the initial imaging test in patients with
R. Peter Lokken
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Cheryl A. Sadow hematuria. The aim of our study was to determine the yield of CT urography in young adults with
Stuart G. Silverman hematuria to see whether single phase unenhanced CT would have been sufficient.
MATERIALS AND METHODS. We reviewed medical records of consecutive patients
undergoing CT urography between March 2000 and July 2009 at our tertiary medical cen-ter.
Of 5400 CT urograms performed, 375 (6.9%) in 359 patients aged 40 years or younger with
hematuria were included in the study. Urographic findings were tabulated according to their
clinical significance. CT images were reviewed to see whether contrast-enhanced im-ages
were necessary for diagnosis.
RESULTS. A clinically significant source was found in 83 of 375 examinations (22.1%),
including 42 of 142 (29.6%) for gross hematuria, 29 of 181 (16.0%) for microscopic
hematu-ria, and 12 of 52 (23.1%) for hematuria of unspecified subtype. The most common
clinically significant findings were renal or ureteral calculi (n = 73 [75.3%]); four
malignancies were also detected. Ninety-two (94.8%) of 97 clinically significant findings
were evident on unen-hanced images. All significant findings that required contrast-
enhanced images for diagnosis occurred in patients with predisposing medical conditions.
CONCLUSION. A clinically significant source of hematuria was detected in 22.1% of
CT urograms of young adults. However, an unenhanced CT alone may be sufficient in pa-
tients without additional predisposing medical conditions, thereby reducing radiation dose in
this radiosensitive population.

ematuria is a common urologic H finding in

Keywords: CT urography, gross hematuria, hematuria,
microscopic hematuria, upper urinary tract
DOI:10.2214/AJR.11.7296
Received May 30, 2011; accepted after
revision July 21, 2011.
1 Urologic Association and American College of
All authors: Department of Radiology, Division
of Abdominal Imaging and Intervention,
Brigham and Womens Hospital, 75 Francis St,
Boston, MA 02115. Address correspondence to
R. P. Lokken (rlokken@partners.org).
AJR 2012; 198:609615
0361803X/12/1983609
American Roentgen Ray Society
young adults, reported in 0.338.7% of adults in
popula-tion-based studies [13]. Gross
hematuria has a relatively high predictive
value for malignancy and therefore warrants
a thorough urologic evaluation [4, 5].
Asymptomatic microscopic hematuria rarely
signals a life-threatening condition and is
most often a benign incidental finding [68].
The appropriate strategy for imaging young
adults with microscopic hematuria has there-
fore been controversial.
Current guidelines from the American
Radiology recommend upper urinary tract
imaging of adults with excretory urography or
CT urography [9, 10]. However, many studies
have found few clinically signifi-cant upper
urinary tract findings in patients aged 40 years
and younger [1114], leading some to question
the need to image all young
adults with microscopic hematuria [3]. The
increasing use of CT urography as the initial
imaging test raises additional concerns
about radiation exposure to this
radiosensitive pop-ulation [1517].
We therefore examined the diagnostic
yield of CT urography in young adults eval-
uated for hematuria at our institution to de-
termine whether the increased radiation dose
compared with excretory urography or a sin-
gle phase unenhanced CT is indicated.
Materials and Methods
This retrospective single-center cohort study
was HIPAA-compliant. Institutional review board
approval was obtained before initiation of the
study, with waiver of informed consent for review
of medical records.
We retrospectively reviewed medical records of
all patients who underwent CT urography at our
tertiary academic medical center between March
2000 and July 2009 to identify examinations

AJR:198, March 2012 609

 Lokken et al.

TABLE 1: Sources of Hematuria Identified in 375 CT Urograms Performed in Patients Aged 40 Years or Younger
No. of Positive Findings, by Type of Hematuria
Findings Evident on Unenhanced
Category, Diagnosis Gross Microscopic Unspecified Images, No./Total (%)
Life threatening
Lymphoma 0 0 1 0/1 (0.0)
Metastatic testicular cancer 1 0 0 1/1 (100.0)
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Metastatic Ewing sarcoma 1 0 0 1/1 (100.0)

Renal mass 1 0 0 1/1 (100.0)
Renal laceration 1 0 0 1/1 (100.0)
Total 4 0 1 4/5 (80.0)
Significant, requiring treatment
Renal calculus 29 18 10 57/57 (100.0)
Ureteral calculus 9 5 2 16/16 (100.0)
Ureteropelvic junction obstruction 2 1 0 3/3 (100.0)
Bacterial cystitis 1 0 0 0/1 (0.0)
Colovesical fistula 1 0 0 1/1 (100.0)
Medullary nephrocalcinosis 0 2 0 2/2 (100.0)
Hemorrhagic cystitis 1 0 0 1/1 (100.0)
Pyelonephritis 0 1 0 0/1 (0.0)
Ureteral transection 0 1 0 1/1 (100.0)
Total 43 28 12 81/83 (97.6)
Significant, requiring observation
Atrophic kidney 1 3 0 4/4 (100.0)
Neurogenic bladder 2 0 0 1/2 (50.0)
Benign prostatic hyperplasia 0 0 1 1/1 (100.0)
Interstitial cystitis 0 1 0 1/1 (100.0)
Papillary necrosis 0 1 0 0/1 (0.0)
Total 3 5 1 7/9 (77.8)
Insignificant
Renal cyst (Bosniak category I or II) 23 24 7 37/54 (68.5)
Duplicated collecting system 4 1 1 3/6 (50.0)
Renal parenchymal scarring 3 3 0 4/6 (66.7)
Calyceal diverticulum 0 1 1 1/2 (50.0)
Total 30 29 9 45/68 (66.2)

performed on patients 40 years of age or younger for We reviewed imaging reports of included studies, who was blinded to the imaging report and to
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the primary indication of hematuria. On the basis of
information available in the medical record,
hematuria was classified as microscopic, gross, or
unspecified subtype. A total of 5400 CT urographic
examinations were performed during this period,
including 829 examinations (15.4%) in patients 40
years or younger. Of these, 375 examinations in 359
patients were performed for the primary indication of
hematuria, including gross (n = 142), microscopic (n
= 181), and hematuria of unspecified subtype (n =
52). The patient population included 150 male and
209 female patients (age range, 16 40 years; mean
SD, 32.7 6.0 years).
rendered by 14 abdominal radiologists with 125
years of experience interpreting CT examinations, to
evaluate whether a potential source of hematuria was
detected. Follow-up examinations and clinical data in
the medical record were reviewed to determine
whether these findings were true- or false-positives.
True-positive findings were tabulated according to
their clinical significance as specified by the
American Urologic Association Best Practice Policy
Guidelines [8].
Imaging studies with true- and false-positive
findings were reviewed by a radiologist with 9
years of experience interpreting CT urography
whether the study contained a true- or false-
positive finding. The reviewer first attempted to
identify sources of hematuria by examining axial
unenhanced phase images alone. If the reviewer
identified a potential abnormality on unenhanced
images but requested contrast-enhanced phases
for further characterization, the finding was also
tabulated as visible on unenhanced images. If no
finding was detected, the reviewer then evaluated
the contrast-enhanced images. If findings were
detected only on contrast-enhanced images, they
were tabulated as requiring contrast-enhanced
images for detection. If the reviewer did not

610 AJR:198, March 2012

 CT Urography to Evaluate Hematuria in Young Adults

0.8751.25 pitch, 120 kVp, and 155280 mA) and a

synchronous nephrographic and excretory phase scan
(0.61.0 mm collimation, 0.651.00 pitch, 120 kVp,
and 160180 mA) of the abdomen and pelvis that
followed an initial dose of contrast medium, a 6-
minute delay, a second dose of contrast medium, and
imaging acquisition at 100 seconds after the second
dose of contrast [19]. During the period when the
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split-bolus scans were performed, protocols varied

slightly using different combinations of contrast
medium dosing with either 150 mL total of
iopromide 300 or 120 mL of iopromide 370.

Results
A B
We identified 165 findings associated with
Fig. 140-year-old man who had episode of painless gross hematuria. hematuria in 132 (35.2%) of the 375 CT uro-
A, Axial nephrographic phase image of CT urogram shows heterogeneously enhancing 6.4-cm right
upper pole renal mass (arrow) suspicious for renal cell carcinoma.
grams; of these findings, 97 (58.8%) findings
B, Renal mass was evident on unenhanced image. Patient was lost to follow-up before in 83 examinations (22.1%) were clinically
pathologic specimen was obtained. significant (Table 1). The yield of CT urog-
raphy for clinically significant findings was
29.6% (42/142 CT urograms) for patients with
gross hematuria, 16.0% (29/181) for mi-
croscopic hematuria, and 23.1% (12/52) for
hematuria of unspecified subtype.
Four of five life-threatening findings were
tumors; the other was a renal laceration in a
patient who had sustained a biking accident.
Four of the life-threatening findings, including
metastatic testicular cancer, metastatic Ewing
sarcoma, a probable renal cell carcinoma (Fig.
1), and the renal laceration, were evident on
unenhanced images. A hypoenhancing renal
A B mass suspicious for tumor involvement in a
patient with non-Hodgkin lymphoma and new
Fig. 223-year-old woman with non -Hodgkin lymphoma who developed hematuria and
abdominal pain while undergoing chemotherapy. CT urogram was performed, and oral contrast onset of hematuria required contrast-enhanced
agent was administered for concurrent cancer staging. images for detection (Fig. 2).
A, Axial nephrographic phase image shows hypoenhancing 3.4-cm right renal mass (arrow) There were 83 findings in 72 studies that
suspicious for tumor.
B, Renal mass was not detected on unenhanced image. were significant and required treatment; 81
(97.6%) of these findings were detectable on
unenhanced images. The majority of these
detect the finding on any images, the study was Before January 2004, patients were scanned by findings were renal (n = 49 [59.0%]) or ure-
then shown to an adjudicator with 25 years of using a three-scan CT protocol, including an teral (n = 15 [18.1%]) calculi, all of which
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experience interpreting CT examinations, who
determined whether the finding was present on
unenhanced or contrast-enhanced images.
CT urography was performed with 4-, 16-, 64-,
or 128-MDCT scanners (Somatom Volume Zoom,
Somatom Sensation 16, Somatom Sensation 64,
and Definition AS 128, all from Siemens
Healthcare; and Aquilion 64 and Aquilion 320,
both from Toshiba). Patients were asked to void
immediately before the examination and to drink
900 mL of water. Examinations were
supplemented with either 250 mL of IV saline
after instillation of 10 mg of IV furosemide
(Lasix, Abbott Laboratories) administered 23
minutes before contrast medium, or both [18].
Patients were scanned in the supine position.
unenhanced scan (0.62.5 mm collimation, 0.875
1.25 pitch, 120 kVp, and 155280 mA) of the
abdomen and pelvis, a nephrographic phase scan of
the kidneys (0.62.5 mm collimation, 0.8751.25
pitch, 120 kVp, and 155280 mA) 100 seconds after
IV contrast administration of 100 mL of iopromide
(Ultravist 300, Berlex Laboratories) at 3 mL/s, and an
excretory phase scan of the abdomen and pelvis (0.6
1.0 mm collimation, 0.651.00 pitch, 120 kVp, and
160180 mA) 15 minutes after contrast injection
[18]. Excretory phase scans were reconstructed at
3-to 5-mm-thick sections in the axial plane and 3-
mm-thick sections in the coronal plane.
Beginning January 2004, patients were scanned by
using a two-scan split-bolus protocol, including an
unenhanced scan (0.62.5 mm collimation,
were evident on unenhanced images. One
ureteral calculus was detected by the blind-
ed reviewer on unenhanced images as either
a ureteral calculus or phlebolith; the diag-
nosis of ureteral calculus was confirmed on
contrast-enhanced images. One 1-mm re-nal
calculus and one 2-mm ureteral calculus
were not detected on either unenhanced or
contrast-enhanced images by the blinded re-
viewer but were detected by the adjudicator
on unenhanced images.
Two findings that were significant and re-
quired treatment were detected on contrast-
enhanced images only. One was bacterial
cystitis in a patient with recurrent microscop-ic
hematuria and urinary urgency. Concur-

AJR:198, March 2012 611

 Lokken et al.
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A B C
Fig. 340-year-old woman with multiple sclerosis, recurrent urinary tract infections, and neurogenic bladder evaluated for microscopic hematuria.
A and B, Coronal (A) and axial (B) images from excretory phase CT urogram show clubbed calyces (arrows) and sloughed papillae (arrowheads),
consistent with severe papillary necrosis.
C, Axial unenhanced phase image was insufficient to make diagnosis.

A B C
Fig. 433-year-old woman with gross hematuria.
A and B, Axial (A) and sagittal (B) images from excretory phase of CT urogram show focal thickening (arrow, A) of anterior bladder wall at midline that
was considered suspicious for urothelial neoplasm. In retrospect, sagittal image (B) shows that area of thickening (arrowhead) is on serosal surface
and is contiguous with median umbilical ligament, finding typical of urachal insertion.
C, Finding was not evident on unenhanced image. Cystoscopy was deferred, and patient has had no genitourinary problems with 2 years of clinical follow-up.

rent urinalysis and urine culture revealed 50 There were nine findings in nine studies images that was not apparent on unenhanced
100 WBCs per high-power field and more than that were significant and required observa- images when the bladder was underdistend-
100,000 colonies of Escherichia coli. The tion, including four atrophic kidneys, two ed. The patient had a history of spinal cord
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second finding was heterogeneously di-
minished enhancement of the right kidney,
which was suspicious for early or resolving
pyelonephritis in a patient with flank pain. The
patient had a history of obstructive urop-athy
secondary to stone disease previously treated
with temporary ureteral stent place-ment.
Urinalysis revealed 50100 WBCs, 2+
leukocyte esterase, and 4+ bacteria.
neurogenic bladders, and one each of benign
prostatic hyperplasia, interstitial cystitis, and
papillary necrosis. Of these findings, seven
(77.8%) were detected on unenhanced im-
ages. One of two neurogenic bladders and
papillary necrosis (Fig. 3) required contrast-
enhanced images for detection. The patient
with neurogenic bladder had a thickened and
trabeculated bladder wall on excretory phase
injury at the T2 level sustained during a mo-
tor vehicle collision in childhood. The pa-
tient with papillary necrosis had a history of
multiple sclerosis, neurogenic bladder, and
recurrent urinary tract infections.
There were 68 findings in 66 studies that
were clinically insignificant. The majori-ty
were benign renal cortical cysts (n = 54
[81.8%]). Forty-five (66.2%) of the insignifi-

612 AJR:198, March 2012

 CT Urography to Evaluate Hematuria in Young Adults
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A B
Fig. 523-year-old man with multiple episodes of gross hematuria after long-distance running.
A and B, Axial (A) and sagittal (B) images from excretory phase CT urogram show focal thickening (arrows) of anterior bladder wall that was
considered suspicious for urothelial neoplasm.
C, Finding was not evident on unenhanced image. Cystoscopy and bladder wall biopsies obtained in region of CT abnormality showed benign urothelium.
cant findings were detected on unenhanced
images alone. Seventeen benign cortical
cysts, two patients with renal scarring, three
duplicated renal collecting systems, and one
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calyceal diverticulum required contrast-en-
hanced images for diagnosis.
Twelve genitourinary findings described in
the radiology reports were found to be false-
positive on clinical and radiologic follow-up.
Suspected urothelial neoplasms of the blad-der
(n = 5) were followed by either negative
cystoscopy (n = 2) or negative cystoscopy and
biopsy (n = 1) of the area of CT abnormal-ity.
Cystoscopy was deferred in two of the pa-
tients. One of these patients had a history of
ketamine use at the time of the CT urogram.
The patient had an unenhanced CT scan 8
years later for recurrent hematuria, revealing
cystitis that was clinically attributed to contin-
ued ketamine use. The second patient had no
genitourinary problems after 2 years of clini-
cal follow-up. In retrospect, the CT finding in
this patient was typical of an urachal inser-tion
(Fig. 4). All suspected urothelial lesions of the
ureter (n = 2) were followed by nega-tive
ureteroscopy and retrograde pyelography (n =
1) or retrograde pyelography alone (n = 1).
Four of the five suspected bladder lesions
(80%) and two of the suspected ureteral le-
sions (100%) were visible only on the con-
trast-enhanced images (Fig. 5).
Several additional false-positive findings
were visible on contrast-enhanced images only.
An indeterminate solid-appearing renal lesion
measuring 1.0 cm with equivocal enhancement
was interpreted as a possible renal cell carcino-
ma and remained stable in appearance on CT
scans obtained up to 7 years after initial detec-
tion. Bilateral foci of renal cortical low atten-
AJR:198, March 2012
uation and hypoenhancement were reported as
suspicious for pyelonephritis in a patient with
bilateral cortical scarring and history of reflux
nephropathy. The patient had no clinical symp-
toms of pyelonephritis, and the findings were
more clearly shown to be blunted renal calyces
on a follow-up abdominal CT. A fluid-attenu-
ating focus within the prostate was reported as
suspicious for prostatic abscess. A prostate ul-
trasound was recommended but deferred be-
cause of lack of clinical symptoms.
Two additional false-positive findings were
detected with unenhanced images. In one pa-tient,
the right ureter took a reverse-J configura-tion
thought to be suggestive of ureteral reflux. A
99m
subsequent Tc mercaptoacetyltriglycine renal
scintigram showed no associated abnor-mality.
One finding of suspected retroperitone-al fibrosis
was stable on follow-up with two ad-ditional CT
urograms obtained over the next 9 months and
was later determined to represent tortuous
retroperitoneal vessels.
Three of the 375 CT urograms (0.8%) were
associated with adverse events. One patient
had a severe contrast material reaction that re-
quired treatment with 0.3 mg of subcutaneous
epinephrine and subsequent monitoring in the
emergency department. One patient had a de-
layed contrast material reaction of facial swell-
ing that was treated in the emergency depart-
ment. One patient became anxious during IV
catheter placement and experienced a presyn-
copal episode; after clinical evaluation in the
radiology department, the patient was treated
with lorazepam.
Discussion
Current best practice guidelines from the
American Urologic Association for the
C
evaluation of adults with hematuria were
published in 2001 and recommend initial
upper urinary tract imaging with either ex-
cretory urography or CT urography, in ad-
dition to cystoscopy of the urinary bladder
and urine cytology [9]. Several studies have
since shown increased detection of urinary
calculi, renal masses, renal and perirenal in-
fections, and unsuspected extraurinary dis-
ease with CT urography compared with ex-
cretory urography [2023]. CT urography is
currently recommended over excretory
urog-raphy by the American College of
Radiolo-gy in the evaluation of hematuria
[10] and is now used more often than
excretory urogra-phy by most
uroradiologists [15].
The recommendation that young adults
with microscopic hematuria be evaluated
with upper urinary tract imaging is support-
ed by studies that discovered life-
threatening lesions on imaging [2427].
However, sev-eral large studies have found
few clinical-ly significant lesions on
imaging of young adults with hematuria. In
a retrospective study of 1000 Israeli Air
Force personnel with asymptomatic
microscopic hematuria on routine annual
screening, Froom et al.
[3] detected malignancies in 0.1% of sub-
jects, leading the authors to conclude that
asymptomatic microscopic hematuria may
not warrant urologic investigation in
patients younger than 40 years. Of 100
prospectively studied men aged 1640 years
with micro-scopic hematuria, two
significant upper uri-nary tract lesions were
detected on excreto-ry urography, including
one ureteral calculus and one duplex right
renal collecting system
[28]. Khadra et al. [13] prospectively stud-
ied 277 patients aged 40 years and younger
613

who were referred to a hematuria clinic with
either gross or microscopic hematuria. Al-
though seven cases of bladder cancer were
detected with cystoscopy, no upper urinary
tract malignancies were found on ultrasound
or excretory urography [13]. A prospective
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study of 292 patients referred for asymptom-
atic microscopic hematuria with 13 years of
follow-up found no malignancies in patients
younger than 50 years on initial evaluation
[14]. The sensitivity of these studies may
have been limited by evaluation of patients
with excretory urography or ultrasound in-
stead of CT. In addition, the diagnostic yield
may have been further limited in several
studies by the use of a screened sample of
the general population instead of a referred
population [29]. Several of these studies re-
ported only malignant lesions instead of all
findings likely to affect patient management.
In the present study, CT urography yield-
ed a clinically significant diagnosis in 22.1%
of young adult patients with gross or micro-
scopic hematuria. The majority (75.3%) of
clinically significant findings were renal or
ureteral calculi. However, we also detected
malignancies in four patients. All tumors
were renal or perirenal masses, with no con-
firmed urothelial lesions detected.
CT urography also resulted in adverse
outcomes for several patients in the form of
false-positive findings and contrast agent
reactions. The majority (n = 7 [58.3%]) of the
12 false-positive findings were suspect-ed
urothelial lesions of the ureters or uri-nary
bladder, with no true-positive urotheli-al
lesions detected. Workup of false-positive
findings resulted in seven unnecessary CT
studies, one ureteroscopy, one bladder biop-sy,
two retrograde pyelograms, one cystosco-
py that would otherwise have been deferred,
99m
and one Tc mercaptoacetyltriglycine
renal scintigram. The ureteroscopy was
compli-cated by ureteral injury, resulting in
tempo-rary ureteral stent placement, three
visits to the emergency department, and one
hospital admission. In addition, three
patients (0.8%) experienced adverse contrast
material reac-tions, of which two required
treatment in the emergency department.
The majority of findings in our study, in-
cluding 92 (94.8%) of the 97 clinically signif-
icant findings, were evident on unenhanced
images. The five important lesions that were
missed on unenhanced images included lym-
phomatous involvement of the kidney, pyelo-
nephritis, bacterial cystitis, neurogenic blad-
der, and papillary necrosis. However, all five
614
Lokken et al.
patients with important findings missed on
unenhanced images had significant predis-
posing medical histories for urologic dis-ease,
including prior malignancy, multiple sclerosis,
spinal cord injury, history of re-current urinary
tract infections, or pyuria. Clinically
insignificant findings, most often renal cortical
cysts of Bosniak category I or II, more often
required contrast-enhanced phase images for
detection (n = 23/68 lesions [33.8%]).
However, these findings affected neither
treatment nor prognosis and arguably did not
require detection. In addition, many of these
findings may have been coinciden-tal rather
than causative of hematuria, as has been long
stressed in the literature [30].
Our findings support current guidelines that
recommend imaging of the upper uri-nary tract
of young patients with gross or microscopic
hematuria but raise questions as to whether CT
urography is the optimal modality for imaging
evaluation. Given the high prevalence of
urinary tract calculi and the detection of
several renal and perirenal masses, our data
support the use of CT over excretory
urography [23, 31]. However, our findings
suggest that the majority of young adults with
hematuria could be optimally evaluated with a
single phase unenhanced CT, reserving CT
urography for patients with significant
predisposing conditions for uro-logic disease in
addition to hematuria. This imaging strategy
would have allowed detec-tion of all clinically
significant urologic le-sions in our cohort and
may have reduced de-tection of false-positive
findings by 75.0%.
The increasing use of CT urography as the
initial imaging test raises concerns about ra-
diation exposure. It has been estimated that
0.4% of all cancers in the United States may be
attributable to radiation from CT stud-ies, with
the lifetime attributable risk of can-cer death
increasing in patients younger than 40 years
[17]. The mean effective dose of CT urography
of 14.8 mSv leads to approximate-ly 1.5 times
the radiation risk from excretory urography; in
addition, when a two-scan split-bolus CT
urography protocol with dose modu-lation is
used, the mean effective dose of CT urography
is twice that of a single phase CT
[16]. Given the relatively high radiation dose
of multiphase CT urography, an alternative
imaging strategy that includes unenhanced CT
for the majority of patients would substantial-
ly reduce radiation exposure to this radiosen-
sitive population. Several findings detected on
unenhanced images in our study, such as sus-
pected ureteral transection and a renal mass,
would have prompted additional contrast-en-
hanced imaging for further characterization;
however, the majority of patients in our cohort
would have been spared the additional radia-
tion dose associated with CT urography.
Our findings should be interpreted in the
context of our study design and patient popu-
lation. Clinical information, including labora-
tory studies of patients referred to our hospi-tal
from outside institutions, was not always
available in the electronic medical record for
confirmation. Because our patient population
included a high proportion of patients who
were referred to urologists, our recommenda-
tions should be applied with caution to young
adult patients with hematuria evaluated in the
primary care setting, who may have a lower
pretest probability of significant urologic dis-
ease [29]. The European Society of Urogeni-tal
Radiology recommends ultrasound as the
primary imaging test in patients younger than
40 years with either microscopic or gross he-
maturia [32]. It is possible that our cohort in-
cluded patients who were prescreened with
ultrasound, which may further reduce the
findings missed by using unenhanced CT
alone. Finally, only axial unenhanced images
were available for evaluation by our blinded
reviewer. Because of the lack of sagittal and
coronal reformations, which are customar-ily
included in single phase unenhanced CT
studies of the urinary tract at many institu-
tions, we may have underestimated the diag-
nostic yield of unenhanced images for uro-
logic findings.
In conclusion, the yield of CT urography
for significant urologic disease was 22.1%
in young adults imaged for hematuria. How-
ever, a single phase unenhanced CT may be
sufficient for the majority of these patients
without additional predisposing medical
con-ditions. These data will help determine
the appropriate indications for CT urography
in patients with hematuria.
Acknowledgment
We thank Jorge Fuentes Orrego for his
contribution to data acquisition.
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