All Articles

Identifying Underlying Causes of Hematuria

CT urography offers significant advantages over IVP

Jared Allen, MD

Jared Allen, MD

Imaging plays a crucial role in the investigation of the underlying causes of hematuria, and until recently the primary approach has been IV pyelography (IVP).

In a review of imaging modalities for patients with hematuria in AJR, O’Connor et al, noted that multiphase CT urography offers significant advantages over IVP in sensitivity and specificity, 3D rendering and global evaluation of the entire kidney and collection system, as well as discovery of alternate causes. The major drawback, however, has been the increased radiation dose needed for the examination, but the report concluded that low-dose CT may overcome this drawback.

SMIL provides optimized protocols for patients allowing for dose-saving measures while maximizing the benefits of CT urography, says Jared Allen, MD, PhD, a radiologist at Scottsdale Medical Imaging (SMIL).

“Individuals with hematuria and a history of a known cancer or risk factors for urinary tract cancer, particularly smokers, should be scanned,” Allen says. “In general, for any presentation of unexplained hematuria that is not associated with a known pattern of kidney disease, CT urography is the preferred imaging examination.”

Allen says that SMIL’s dose-saving measures include a hematuria protocol that reduces the number of scans for younger patients, as well as physician monitoring to eliminate unnecessary delayed phases that can accompany multi-phase CT scans.

“For our CT urogram, we do a non-contrast phase using a lower dose,” Allen says. “This is followed by a spilt contrast dose that allows for simultaneous evaluation of both the nephrographic phase, that shows us the outer tissue of the kidney, and the excretory phase, highlighting the entire collecting system.”

Allen adds that CT urography often catches alternate causes of hematuria. “We can see alternative diagnoses with CT that would never be picked up with conventional IV pyelography,” Allen says. •

O’Conner Owen, Fitzgerald Edward, Maher Michael. Imaging of hematuria. AJR. 2010;195:263-267.

We would like to thank you for your review and support of The SMIL Radiology Report by sponsoring your 2018 membership to the Phoenix Fine Dining Group. Your membership invites you to experience the exceptional food and distinctive personality of 30 top-tier Valley restaurants all at great savings; restaurants such as Talavera, Bistro 24, T Cook's and Roka Akor.

To receive your 2018 membership card please complete the form below. You will receive your card by mail - please allow 4 to 6 weeks (your information will not be published or shared with any other organization).

To learn more about Phoenix Fine Dining Group and Preferred Restaurants visit

    Name (required)

    Title (required)

    Speciality (required)

    Name of your practice (required)

    Address (required)

    City, State, Zip (required)


    Please rate how useful this article was to you


    What topics would you like to see covered in upcoming
    editions of the SMIL Radiology Report? (required)

    Other comments suggestions you would like to share with the SMIL Radiology Report team?