Diagnostic Yield of CT Urography in the Evaluation of Young Adults With Hematuria

OBJECTIVE. CT urography is increasingly used as the initial imaging test in patients with hematuria. The aim of our study was to determine the yield of CT urography in young adults with hematuria to see whether single phase unenhanced CT would have been sufficient. MATERIALS AND METHODS. We reviewed medical records of consecutive patients undergoing CT urography between March 2000 and July 2009 at our tertiary medical center. Of 5400 CT urograms performed, 375 (6.9%) in 359 patients aged 40 years or younger with hematuria were included in the study. Urographic findings were tabulated according to their clinical significance. CT images were reviewed to see whether contrast-enhanced images were necessary for diagnosis. RESULTS. A clinically significant source was found in 83 of 375 examinations (22.1%), including 42 of 142 (29.6%) for gross hematuria, 29 of 181 (16.0%) for microscopic hematuria, and 12 of 52 (23.1%) for hematuria of unspecified subtype. The most common clinically significant findings were renal or ureteral calculi (n = 73 [75.3%]); four malignancies were also detected. Ninety-two (94.8%) of 97 clinically significant findings were evident on unenhanced images. All significant findings that required contrast-enhanced images for diagnosis occurred in patients with predisposing medical conditions. CONCLUSION. A clinically significant source of hematuria was detected in 22.1% of CT urograms of young adults. However, an unenhanced CT alone may be sufficient in patients without additional predisposing medical conditions, thereby reducing radiation dose in this radiosensitive population.