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Computed tomography urography in macroscopic hematuria : a retrospective study with implications for standard care pathway

Jendeberg, Johan ; Björkman, Alma ; Dahlman, P. ; Eklöf, Hampus ; Eriksson, Elisabeth LU ; Hellström, Mikael LU orcid ; Holst, Susanna LU ; Karalli, Amar ; Leonhardt, Henrik and Magnusson, Anders LU , et al. (2025) In Acta Radiologica 67(2).
Abstract

Background: Standardized care pathway (SCP) for macrohematuria (patients aged ≥50 years) in Sweden includes four-phase computed tomography urography (CTU) before cystoscopy, but targeted SCP lead time for CTU (6 days)/treatment is fulfilled in <25% of patients. Purpose: To retrospectively analyze the incidence of CTU-diagnosed upper urinary tract (UUT), kidney and bladder tumors, calculi, radiation dose, and its implications for SCP. Material and Methods: A total of 4491 consecutive CTU reports on macrohematuria indication were reviewed, mainly during 2022 (86.6%) from nine radiology units: four regions, three university hospitals, and two private units. Tumor findings were verified via biopsy/cytology reports, CTU characteristics,... (More)

Background: Standardized care pathway (SCP) for macrohematuria (patients aged ≥50 years) in Sweden includes four-phase computed tomography urography (CTU) before cystoscopy, but targeted SCP lead time for CTU (6 days)/treatment is fulfilled in <25% of patients. Purpose: To retrospectively analyze the incidence of CTU-diagnosed upper urinary tract (UUT), kidney and bladder tumors, calculi, radiation dose, and its implications for SCP. Material and Methods: A total of 4491 consecutive CTU reports on macrohematuria indication were reviewed, mainly during 2022 (86.6%) from nine radiology units: four regions, three university hospitals, and two private units. Tumor findings were verified via biopsy/cytology reports, CTU characteristics, and follow-up. Effective patient radiation doses were calculated. Results: In patients aged ≥50 years (n = 3915) the incidence of UUT/kidney/bladder tumors was 0.9%/1.0%/6.9%, respectively, and of calyceal, pelvic, ureteral, and bladder calculi was 13%, 2.0%, 2.7%, and 2.2%, respectively. Median effective dose was 12.9 mSv (range=10–22 mSv) in the six radiology units using four-phase CTU in 87%–100% of the examinations and 9–12 mSv in the three units using four-phase in 3%–53%. Conclusion: The limited incidence of UUT and kidney tumors diagnosed at CTU for macrohematuria necessitates a multidisciplinary discussion on how to improve SCP lead times for the vast majority with urothelial tumors, i.e. bladder tumors. Alternative diagnostic pathways such as cystoscopy and clinical risk evaluation before CTU should be contemplated. Additionally, there is a need to optimize radiation dose by reducing the number of CTU phases on one hand and without losing significant diagnostic accuracy on the other hand.

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organization
publishing date
type
Contribution to journal
publication status
in press
subject
keywords
Computed tomography, hematuria, lead time, radiation dose, standardized care pathway, urography, urothelial cancer (urinary tract tumors)
in
Acta Radiologica
volume
67
issue
2
publisher
SAGE Publications
external identifiers
  • scopus:105025158973
  • pmid:41411174
ISSN
0284-1851
DOI
10.1177/02841851251387444
language
English
LU publication?
yes
additional info
Publisher Copyright: © The Foundation Acta Radiologica 2025
id
f8ecf12d-7232-4e47-83bc-d628f6a00f4f
date added to LUP
2026-02-26 16:04:07
date last changed
2026-02-26 16:04:38
@article{f8ecf12d-7232-4e47-83bc-d628f6a00f4f,
  abstract     = {{<p>Background: Standardized care pathway (SCP) for macrohematuria (patients aged ≥50 years) in Sweden includes four-phase computed tomography urography (CTU) before cystoscopy, but targeted SCP lead time for CTU (6 days)/treatment is fulfilled in &lt;25% of patients. Purpose: To retrospectively analyze the incidence of CTU-diagnosed upper urinary tract (UUT), kidney and bladder tumors, calculi, radiation dose, and its implications for SCP. Material and Methods: A total of 4491 consecutive CTU reports on macrohematuria indication were reviewed, mainly during 2022 (86.6%) from nine radiology units: four regions, three university hospitals, and two private units. Tumor findings were verified via biopsy/cytology reports, CTU characteristics, and follow-up. Effective patient radiation doses were calculated. Results: In patients aged ≥50 years (n = 3915) the incidence of UUT/kidney/bladder tumors was 0.9%/1.0%/6.9%, respectively, and of calyceal, pelvic, ureteral, and bladder calculi was 13%, 2.0%, 2.7%, and 2.2%, respectively. Median effective dose was 12.9 mSv (range=10–22 mSv) in the six radiology units using four-phase CTU in 87%–100% of the examinations and 9–12 mSv in the three units using four-phase in 3%–53%. Conclusion: The limited incidence of UUT and kidney tumors diagnosed at CTU for macrohematuria necessitates a multidisciplinary discussion on how to improve SCP lead times for the vast majority with urothelial tumors, i.e. bladder tumors. Alternative diagnostic pathways such as cystoscopy and clinical risk evaluation before CTU should be contemplated. Additionally, there is a need to optimize radiation dose by reducing the number of CTU phases on one hand and without losing significant diagnostic accuracy on the other hand.</p>}},
  author       = {{Jendeberg, Johan and Björkman, Alma and Dahlman, P. and Eklöf, Hampus and Eriksson, Elisabeth and Hellström, Mikael and Holst, Susanna and Karalli, Amar and Leonhardt, Henrik and Magnusson, Anders and Meurling, Edward and Papatziamos Hjelle, Christian and Sjögren, Adam and Tila, Rodica and Wallström, Jonas and Öman, Jenny and Nyman, Ulf}},
  issn         = {{0284-1851}},
  keywords     = {{Computed tomography; hematuria; lead time; radiation dose; standardized care pathway; urography; urothelial cancer (urinary tract tumors)}},
  language     = {{eng}},
  month        = {{12}},
  number       = {{2}},
  publisher    = {{SAGE Publications}},
  series       = {{Acta Radiologica}},
  title        = {{Computed tomography urography in macroscopic hematuria : a retrospective study with implications for standard care pathway}},
  url          = {{http://dx.doi.org/10.1177/02841851251387444}},
  doi          = {{10.1177/02841851251387444}},
  volume       = {{67}},
  year         = {{2025}},
}