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Genitourinary ❯ Hematuria

ProblemEvaluation of hematuria
ProtocolThe key to the renal CT protocol is the use of a multiphase acquisition including non contrast , arterial, venous and delayed phase imaging. Depending on the patient age how far we scan in each phase thru the abdomen will vary. For example on patient over 40 we will scan thru the pelvis  (bladder) on arterial phase but if under 40 we will only scan till the iliac crest. Review of images in axial, multiplanar and ideally 3D imaging is critical.
Pearls1.    The specific protocols will vary based on patient age and whether the question is macroscopic or microscopic hematuria
2.     The evaluation of the kidney and urinary tract is also a bit age related as for example bladder cancer is more common in a 70 year old male compared to a 35 year old male
3.    Post processing with MIP imaging is valuable for looking at the renal pelvis and calyceas as well as the ureter
4.    Renal tumors range from hypervascular to hypovascular lesions. Hypervascular lesions (over 110HU) are typically clear cell renal cell carcinoma and those under 90HU are typically papillary renal cell carcinomas. Other hypovascular tumors include lymphoma.
5.    The Bosniak classification is useful for management of cystic renal lesions
6.    Delayed phase imaging is critical for the diagnosis of transitional cell carcinoma (TCC) as well as papillary necrosis.
7.    Delayed phase imaging may be the best phase for detection of acute pyelonephritis while the arterial phas may be the best phase for detecting certain hypervascular tumors
8.    Arterial phase is best for visualization of the renal arteries and venous phase is best for visualization of the renal vein (renal vein thrombosis)

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