You have accessJournal of UrologyImaging/Radiology: Uroradiology1 Apr 20112217 REDUCING RADIATION EXPOSURE WHEN IMAGING PATIENTS WITH HEMATURIA Tyler Neitlich, Neelima Reddy, Alan Nieder, and Jeffrey Neitlich Tyler NeitlichTyler Neitlich Carmel, CA More articles by this author , Neelima ReddyNeelima Reddy Miami Beach, FL More articles by this author , Alan NiederAlan Nieder Miami Beach, FL More articles by this author , and Jeffrey NeitlichJeffrey Neitlich Miami Beach, FL More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.02.2457AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES CT Urography is now the standard for imaging the Genitourinary (GU) tract. Most protocols utilize either a dual or triple phase approach, including a noncontrast (NC) study and at least one contrast enhanced study. Each phase exposes the patient to a full CT dose of radiation. This study evaluated the efficacy of the NC scan in improving the diagnostic accuracy of CT Urography. METHODS A retrospective analysis of 297 CT Urograms ordered for hematuria over a three year period was performed. The imaging studies consisted of a NC scan, followed by 50 cc of nonionic contrast, hydration with saline, and a single 20 mg dose of furosemide. After a 20 minute delay, CT was performed with a bolus injection of an additional 100 cc nonionic contrast. Three blinded GU radiologists interpreted independently the noncontrast, contrast and combined studies. The studies were graded for the presence of calculi, benign or suspicious masses, inflammation and obstruction. RESULTS 155 renal, 3 ureteral and 10 bladder calculi were seen on the initial NC study. 98 renal, 3 ureteral and 8 bladder calculi were seen on the contrast study. All calculi not identified on the contrast study were less than 2 mm. 182 renal masses were seen on the contrast study, of which 167 were cysts (simple or hemorrhagic), 6 were angiomyolipomas, 3 were suspicious for neoplasm and 6 were indeterminate due to density. Only 147 of the renal lesions (81%) were seen on the NC study. The NC exam missed 15 cysts, 1 angiomyolipoma, 3 indeterminate lesions and 1 suspicious lesion. The remaining findings matched the contrast study. The combined exam was able to characterize 5 of the 6 indeterminate lesions as benign hemorrhagic cysts based on lack of enhancement with contrast. The contrast study detected 4 suspicious ureteral lesions and 23 suspicious bladder lesions. The NC study only identified 1 of 4 (25%) of the ureteral lesions and 2 of 23 (9%) of the bladder lesions. CONCLUSIONS The NC portion of CT Urography is not routinely necessary for the evaluation of hematuria. The contrast phase is not useful for the diagnosis of calculi. The only time the NC scan was useful was in detecting punctate intrarenal or bladder calculi, and (combined with contrast) in helping to characterize indeterminate, dense renal lesions as hemorrhagic cysts. From this perspective, 292 of our 297 patients could have had their radiation dose reduced by 50% with no loss in diagnostic accuracy. The remaining 5 could have returned for a renal ultrasound, or within 24 hours for a NC exam to diagnose benign hemorrhagic cyst. This approach minimizes the expense and radiation exposure of imaging patients with hematuria. © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 185Issue 4SApril 2011Page: e890 Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.MetricsAuthor Information Tyler Neitlich Carmel, CA More articles by this author Neelima Reddy Miami Beach, FL More articles by this author Alan Nieder Miami Beach, FL More articles by this author Jeffrey Neitlich Miami Beach, FL More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...