Urology Book

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Helical CT Urogram

Aka: Helical CT Urogram, CT Urogram, CT Urography, Multidetector CT Urography
  1. Indications
    1. Hematuria evaluation (preferred imaging study)
  2. Contraindications
    1. Pregnancy
  3. Protocol
    1. Step 1: Patients given water (distends urinary tract)
    2. Step 2: Noncontrast helical CT of Kidneys (identifies renal stones)
    3. Step 3: Inject iodinated contrast
    4. Step 4: Nephrogenic phase - Obtain immediate high resolution (1-2 mm sections)
    5. Step 5: Delayed images - Obtain high resolution images, 5-10 minutes later
      1. Follows injected contrast as it is excreted from the Kidneys
  4. Efficacy
    1. Hematuria evaluation
      1. Preferred over other imaging modalities
      2. Gray Sears (2002) J Urol 168:2457-60 [PubMed]
    2. Nephrolithiasis evaluation
      1. Noncontrast CT is preferred for evaluation of typical Renal Colic
      2. Sensitivity: 95 to 100%
      3. Specificity: 94 to 96%
      4. Originally replaced intravenous pyelogram (IVP) in Nephrolithiasis evaluation
      5. Worster (2002) Ann Emerg Med 40:280-6 [PubMed]
  5. Findings
    1. Renal and ureter morphology
    2. Urinary tract fistula
    3. Ureteral obstructive mass
    4. Nephrolithiasis and Ureteral Stone localization (non-contrast CT preferred)
    5. Solid Renal Masses
    6. Renal Infarct
    7. Pyelonephritis
  6. References
    1. Broder (2022) Crit Dec Emerg Med 36(5): 20-1

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