CT abdomen and pelvis without and with IV contrast is defined as any protocol not specifically tailored for evaluation of the upper and lower urinary tracts and without both the precontrast and excretory phases. There is no relevant literature regarding the use of CT with IV contrast or CT without IV contrast in the evaluation of gross hematuria. CTU CTU The usefulness of CTU in the evaluation of gross hematuria has been mixed [11,13,20-23]. In one study of 150 patients, the sensitivity and specificity of CTU for the detection of bladder malignancy was 61.5% and 94.9% using cystoscopy as the reference standard [21]. However, in another study of 435 patients, CTU performed comparably to cystoscopy for the detection of bladder malignancy with sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of 87%, 99%, 91%, and 98%, compared with 87%, 100%, 98%, and 98%, respectively, for cystoscopy [22]. The recent DETECT (Detecting Bladder Cancer Using the UroMark Test) 1 study recommends CTU for gross hematuria because of an upper tract tumor rate of 0.8% [18]. MRU There is no relevant literature regarding the use of MRU in patients with gross hematuria. Direct comparison of MRI and CTU sensitivity for evaluation of urothelial lesions in gross hematuria is not available in the literature. MRI Abdomen and Pelvis For the purposes of this document, we make a distinction between MRU and MRI abdomen and pelvis without and with IV contrast. MRI abdomen and pelvis without and with IV contrast is defined as any protocol not specifically tailored for evaluation of the upper and lower urinary tracts, without both the precontrast and excretory phases, and without heavily T2-weighted images of the urinary tract. MRI without contrast may be helpful for the evaluation of gross hematuria. In one study of 130 patients, MRI had a sensitivity of 98.5% and PPV of 100% for determining the cause of gross hematuria, using cystoscopy and histopathology as the reference standards [24].
Hematuria. CT abdomen and pelvis without and with IV contrast is defined as any protocol not specifically tailored for evaluation of the upper and lower urinary tracts and without both the precontrast and excretory phases. There is no relevant literature regarding the use of CT with IV contrast or CT without IV contrast in the evaluation of gross hematuria. CTU CTU The usefulness of CTU in the evaluation of gross hematuria has been mixed [11,13,20-23]. In one study of 150 patients, the sensitivity and specificity of CTU for the detection of bladder malignancy was 61.5% and 94.9% using cystoscopy as the reference standard [21]. However, in another study of 435 patients, CTU performed comparably to cystoscopy for the detection of bladder malignancy with sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of 87%, 99%, 91%, and 98%, compared with 87%, 100%, 98%, and 98%, respectively, for cystoscopy [22]. The recent DETECT (Detecting Bladder Cancer Using the UroMark Test) 1 study recommends CTU for gross hematuria because of an upper tract tumor rate of 0.8% [18]. MRU There is no relevant literature regarding the use of MRU in patients with gross hematuria. Direct comparison of MRI and CTU sensitivity for evaluation of urothelial lesions in gross hematuria is not available in the literature. MRI Abdomen and Pelvis For the purposes of this document, we make a distinction between MRU and MRI abdomen and pelvis without and with IV contrast. MRI abdomen and pelvis without and with IV contrast is defined as any protocol not specifically tailored for evaluation of the upper and lower urinary tracts, without both the precontrast and excretory phases, and without heavily T2-weighted images of the urinary tract. MRI without contrast may be helpful for the evaluation of gross hematuria. In one study of 130 patients, MRI had a sensitivity of 98.5% and PPV of 100% for determining the cause of gross hematuria, using cystoscopy and histopathology as the reference standards [24].