RadteraCT Urogram (Hematuria; Multiphase)
CT+ ContrastAbdomen & Pelvis
Indications
- Gross or microscopic hematuria evaluation (especially with risk factors for urothelial malignancy)
- Suspected urothelial / upper tract neoplasm
- Surveillance of known urothelial carcinoma
- Evaluation of urinary tract anatomy, congenital anomalies, hydronephrosis, urinary obstruction
Patient prep
- Screen eGFR/contrast allergy; premedicate if indicated
- Hydration improves collecting system distension and opacification; some sites give oral water and/or IV saline
- Consider low-dose IV furosemide or compression to improve distension (site-dependent)
- IV access 18-20 G; supine, arms up; void before excretory phase per protocol
Contrast
Agentiodinated (e.g. iohexol 350 or iopamidol 370)
RouteIV
Dose≈100-125 mL at 2.5-3 mL/s with saline flush
TimingMultiphase: non-contrast, nephrographic ~90-100 s, excretory/delayed ~8-15 min; SPLIT-BOLUS option (e.g. ~50 mL, then remainder ~8-10 min later, single combined nephrographic+excretory scan ~55-100 s after second injection) reduces phases/dose
Technique
- Supine, arms up; coverage kidneys through bladder base (abdomen/pelvis)
- Classic triple-phase: (1) non-contrast for stones/baseline density, (2) nephrographic for renal parenchyma/masses, (3) excretory for urothelium/collecting system; corticomedullary phase optional
- Split-bolus technique combines nephrographic + excretory into one acquisition to cut dose
- 120 kV; mAs per scanner with AEC; iterative reconstruction; thin 1.25-2 mm source
- Coronal and sagittal reformats, thin-slab MIP and 3D for collecting system/ureters
Series / Sequences
| # | Series / Sequence | Plane | Thickness | Notes |
|---|---|---|---|---|
| 1 | Non-contrast axial | axial | 3-5 mm (thin source 1.25-2 mm) | Stones, baseline attenuation of masses |
| 2 | Nephrographic axial | axial | 3 mm (thin 1.25-2 mm) | ~90-100 s; renal masses, parenchyma |
| 3 | Excretory axial | axial | 2-3 mm | ~8-15 min delay; opacified urothelium/ureters, filling defects |
| 4 | Coronal MIP / 3D urogram | coronal | thin-slab MIP | Collecting system, ureters, bladder map |
Key points
- CT urography is first-line for gross hematuria and high-risk microhematuria (ACR Appropriateness Criteria)
- Excretory phase is essential to evaluate urothelium for upper-tract urothelial carcinoma — distend and opacify the entire collecting system; prone/delayed imaging or repositioning helps fill dependent ureteric segments
- Split-bolus protocols reduce radiation by combining nephrographic and excretory phases; balance against image quality
- Look for enhancing urothelial filling defects, stones, masses; compare non-contrast vs nephrographic HU for renal masses
References
• ACR–SAR–SPR Practice Parameter for the Performance of CT Urography
• ACR Appropriateness Criteria: Hematuria
• Radiopaedia: CT urogram / split-bolus technique link
• RadioGraphics: CT Urography — Principles and Pitfalls
• ACR Appropriateness Criteria: Hematuria
• Radiopaedia: CT urogram / split-bolus technique link
• RadioGraphics: CT Urography — Principles and Pitfalls
Source: Researched — verify against your institution
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Reference template — verify and adapt to your scanner, vendor and institution before clinical use. Not a substitute for clinical judgment.