Computed tomography for visible haematuria - a single nephrographic phase is sufficient for detecting renal cell carcinoma

Scand J Urol. 2024 Jan 16:59:10-18. doi: 10.2340/sju.v59.18467.


Objectives: No previous studies have compared two computed tomography (CT) protocols in patients presenting with visible haematuria, and most patients undergo a multiphase CT in order to detect upper tract malignancies. We aimed to prospectively compare the diagnostic performance of single- and four-phase CT for detecting renal cell carcinoma (RCC) in patients with visible haematuria.

Materials & methods: 'A Prospective Trial for Examining Hematuria using Computed Tomography' (PROTEHCT) was a single-centre prospective paired diagnostic study in patients referred for CT due to painless visible haematuria between September 2019 and June 2021. All patients underwent four-phase CT (control) from which a single nephrographic phase dual energy CT (experimental) was extracted. Both were independently assessed for RCC by randomised radiologists. Histologically verified RCC defined a positive reference standard. Follow-up ascertainment of RCC diagnosis was completed in May 2022. Descriptive statistics were used to calculate the accuracies. Inter-reader agreement was assessed by kappa statistics.

Results: A total of 308 patients (median age, 68 years [interquartile range 53-77, range 18-96], 250 males) were included for analysis. RCC was diagnosed in seven (2.3%) patients during a median follow-up time of 19 months (interquartile range: 15-25). For the control and experimental CT, sensitivity was 100% versus 100%, specificity was 97% versus 98% and accuracy 97% versus 97%. The positive predictive value was 44% versus 50%, and the negative predictive value was 100% versus 100%. The agreement between the control and experimental CT was 98% (k = 0.79).

Conclusion: A single nephrographic phase dual energy CT is sufficient for detecting RCC in patients with visible haematuria.

MeSH terms

  • Aged
  • Carcinoma, Renal Cell* / diagnostic imaging
  • Carcinoma, Renal Cell* / pathology
  • Hematuria / etiology
  • Humans
  • Kidney Neoplasms* / diagnostic imaging
  • Kidney Neoplasms* / pathology
  • Male
  • Prospective Studies
  • Sensitivity and Specificity
  • Tomography, X-Ray Computed / methods