From the Research
Yes, a CT abdomen and pelvis with contrast is an appropriate imaging study for evaluating painless hematuria, particularly in adults. This imaging modality should be considered after initial workup including urinalysis, urine culture, and possibly cystoscopy depending on risk factors. The typical protocol involves intravenous contrast administration with imaging during the nephrographic and excretory phases to evaluate both the renal parenchyma and collecting systems. CT with contrast offers excellent sensitivity for detecting urinary tract malignancies, stones, and renal masses that may cause hematuria, as supported by a study published in 2019 1.
Some key points to consider when using CT with contrast for evaluating painless hematuria include:
- The ability to identify tumors as small as 5mm in the kidneys, ureters, and bladder
- Providing information about the surrounding structures
- Differentiating vascular lesions from other abnormalities
- Improving visualization of the urinary tract
In patients with contraindications to contrast, such as significant renal impairment or severe contrast allergy, alternative imaging like non-contrast CT, MRI urogram, or ultrasound may be considered, though these may have lower sensitivity for certain conditions, as noted in a study from 2003 2. Radiation exposure is a consideration, particularly in younger patients, but the benefit of detecting significant pathology typically outweighs this risk in adults with unexplained hematuria, as discussed in a study from 2015 3.
It's also worth noting that CT urography with a low dose of contrast medium and radiation is a useful diagnostic imaging test for investigating patients with hematuria, as found in a study from 2015 3. Additionally, a study from 2005 4 compared intravenous pyelography and combined unenhanced and excretory phase multidetector-row CT, and found that MDCT performed better regarding image quality, subjective diagnostic certainty, and diagnostic results with respect to stone detection.