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Incidental Extraurinary Findings at MDCT Urography in Patients with Hematuria: Prevalence and Impact on Imaging Costs

¹ Division of Abdominal Imaging and Intervention, Department of Radiology, Brigham & Women's Hospital, Harvard Medical School, 75 Francis St., Boston, MA 02115.

OBJECTIVE. We determined the prevalence of incidental extraurinary findings at MDCT urography in patients with hematuria and evaluated their impact on subsequent imaging costs.

MATERIALS AND METHODS. Three hundred forty-four consecutive patients with hematuria were evaluated with MDCT urography. Incidental extraurinary findings were classified into three categories according to their clinical significance (high, moderate, and low). Medical records were reviewed, and the cost of additional imaging examinations was calculated using 2002 Medicare reimbursements.

RESULTS. Extraurinary findings were detected in 259 patients (75.3%). Of these, 62 patients (18.0%) had highly clinically significant findings, including three cancers. Only 20 (32.3%) of the 62 patients with highly clinically significant findings underwent additional imaging for findings of high clinical significance; 10 (16.1%) were followed clinically, and 32 (51.6%) were not evaluated. The most prevalent highly clinically significant findings were pulmonary nodules and lymphadenopathy. Of the 344 patients studied, 116 (33.7%) had findings in which the highest level of clinical significance was moderate; 81 (23.5%) had findings of only low clinical significance. Nine patients (2.6%) underwent additional imaging for findings of moderate or low clinical significance. Overall, 29 patients (8.4%) underwent further imaging at a cost of $14,231 (average of $41.37 per patient).

CONCLUSION. Although incidental extraurinary findings were common at MDCT urography, only a small percentage of patients were imaged further. MDCT urography, when used to evaluate patients with hematuria, detects extraurinary disease without a substantial increase in per-patient imaging costs.

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