title: Diagnostic performance of ultrasound for macroscopic hematuria in the era of multidetector computed tomography urography.
abstract: OBJECTIVE
  The objective of this study was to evaluate the diagnostic performance of ultrasound for detecting urinary tract neoplasm in the setting of macroscopic hematuria by using multidetector computed tomography urography (MDCTU) and cystoscopy as the reference standard.
  
  
  METHODS
  This retrospective study was approved by our institutional review board. Patients with macroscopic hematuria who were investigated with an abdominal or renal ultrasound, an MDCTU, and a cystoscopy between January 2007 and December 2009, were eligible (95 patients). Exclusion criteria were time interval >12 months between index and reference tests or the absence of histopathologic proof of malignancy. Ultrasound results of the remaining 86 patients were collected and compared with the reference standard test, which was the combination of MDCTU for the assessment of upper urinary tract and cystoscopy for assessment of the lower urinary tract. The final diagnosis of neoplasm was based on pathologic findings.
  
  
  RESULTS
  Urinary tract neoplasm was diagnosed in 20% of the patients (17/86). Sensitivity, specificity, positive and negative predictive values, and positive and negative likelihood ratios of ultrasound for detecting urinary tract neoplasms were 35.3% (6/17), 89.9% (62/69), 46.2% (6/13), 84.9% (62/73), 3.48 (95% confidence interval, 1.34-9.02), and 0.72 (95% confidence interval, 0.5-1.3), respectively.
  
  
  CONCLUSIONS
  Sensitivity of ultrasound for the evaluation of macroscopic hematuria in the era of MDCTU is lower than expected. Results of our study suggest that patients with macroscopic hematuria should undergo MDCTU as first-line imaging modality, with little added benefit from ultrasound.
authors: Department of Radiology, Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, Québec, Canada.
authors: Julien
authors: J
authors: Rhéaume-Lanoie
authors: Department of Radiology, Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, Québec, Canada.
authors: Luigi
authors: L
authors: Lepanto
authors: Department of Urology, Centre Hospitalier Universitaire de Québec, Quebec, Québec, Canada.
authors: Vincent
authors: V
authors: Fradet
authors: Department of Radiology, Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, Québec, Canada.
authors: Jean-Sébastien
authors: JS
authors: Billiard
authors: Department of Radiology, Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, Québec, Canada. Electronic address: Duotango@gmail.com.
authors: An
authors: A
authors: Tang
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003287:Contrast Media; D003558:Cystoscopy; D005260:Female; D006417:Hematuria / Q000000981:diagnostic imaging*; D006801:Humans; D007472:Iohexol; D008297:Male; D008875:Middle Aged; D061330:Multidetector Computed Tomography; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed / Q000379:methods; D014463:Ultrasonography; D014567:Urography / Q000379:methods; D014571:Urologic Neoplasms / Q000000981:diagnostic imaging*
chemical_list: D003287:Contrast Media; D007472:Iohexol
keywords: Macroscopic hematuria; Multidetector computed tomography urography; Transitional cell carcinoma; Ultrasound; Urinary tract neoplasm