Improved detection of renal pathologic features on multiphasic helical CT compared with IVU in patients presenting with microscopic hematuria.
OBJECTIVE
To examine the virtues of multiphasic helical computed tomography (CT) in the diagnosis of upper urinary tract lesions refractory to identification by intravenous urography (IVU).


METHODS
A total of 86 patients (59 men and 27 women), 27 to 88 years old, with microscopic hematuria and negative IVU findings were examined with multiphasic helical CT consisting of a pre-enhancement, late arterial-early cortical-medullary, nephrographic, and excretory phase helical CT of the kidneys, using 3 to 5-mm collimation and 7.5-mm/s table feed.


RESULTS
The multiphasic helical CT was conclusive in 84 lesions. Twenty-five cases of early papillary and medullary necrosis, 7 of 8 inflammatory lesions, 3 caliceal diverticula, 1 lupus nephritis, 26 small calculi, 2 medullary sponge kidney, 5 vascular anomalies, and 3 infarcts presented with characteristic manifestations on CT but lacked findings on IVU. Similarly 8 of 9 small malignant neoplasms, 2 small benign neoplasms, and 2 small cysts produced no detectable findings on IVU but were readily diagnosed on helical CT.


CONCLUSIONS
Characteristic findings, particularly on late arterial, early corticomedullary, parenchymal, and excretory phase helical CT make possible the diagnosis of early inflammatory disease, small masses and neoplastic lesions, and vascular abnormalities. Limited resolution (needed to identify small calculi) and the lack of ability to capture phases significantly reduce the diagnostic ability of IVU.
Lang
Erich K
EK
Department of Radiology, Tulane University Health Sciences Center, New Orleans, Louisiana70112-2699, USA.
Macchia
Richard J
RJ
Thomas
Raju
R
Watson
Richard A
RA
Marberger
Michael
M
Lechner
Gerhard
G
Gayle
Brian
B
Richter
Frank
F
D000328:Adult; D000368:Aged; D005069:Evaluation Studies as Topic; D005260:Female; D006417:Hematuria / Q000000981:diagnostic imaging*; D006801:Humans; D007668:Kidney / Q000000981:diagnostic imaging*; D007669:Kidney Calculi / Q000000981:diagnostic imaging; D007674:Kidney Diseases / Q000000981:diagnostic imaging*; D007680:Kidney Neoplasms / Q000000981:diagnostic imaging; D008297:Male; D008875:Middle Aged; D011856:Radiographic Image Enhancement; D012189:Retrospective Studies; D036542:Tomography, Spiral Computed / Q000379:methods*; D014554:Urination; D014567:Urography / Q000379:methods*