CT UROGRAM C+
(last updated 09/15/2025, last reviewed 09/15/2025)
INDICATION: Transitional cell carcinoma, Urothelial Neoplasm, Hematuria
SERIES
- 3mm Axial pre
- 1mm Axial urogram
- 3mm Coronal (pre, urogram)
- 3mm Sagittal (pre, urogram)
- Coronal and Sagittal thick slab 3 cm urogram
- Coronal 3D urogram
SINGLE COLLIMATION WIDTH: 0.625 mm
SLICE THICKNESS: 3 mm
KERNAL: std soft tissue
SFOV: large
COVERAGE: Precontrast – diaphragm -> pubic symphysis / ischial tuberosities
Postcontrast – diaphragm -> pubic symphysis / ischial tuberosities
ACQUISITION: craniocaudal
IV CONTRAST: yes
INJECTION RATE: 3 to 4 mL/sec
SCAN DELAY: 35 mL Isovue + 100 mL saline
~wait 7 min~
90 mL Isovue 300 + 30 mL saline – 80 to 90 sec
repeat if needed for segmental ureter visualization
IV CONTRAST DOSE: 35 mL, followed by 90 mL split bolus
ORAL CONTRAST: water
POSTPROCESSING: 3 mm coronal, 3 mm sagittal precontrast and postcontrast, Coronal and Sagittal slab postcontrast, Coronal 3D postcontrast
NOTES: No positive oral contrast. May use water as oral contrast. Just prior to scanning the patient, give 1-2 cups of water in order to distend the stomach.
Split bolus technique: The patient is given 35 mL of intravenous contrast and 100 mL saline after the non-contrast exam, but prior to the imaging of the mixed nephrographic/exretory (“Urogram”) phase. This is to allow contrast to progress into the collecting system and provide excretory phase images, “CT Urogram”. Seven minutes after the administration of the 35 mL of intravenous contrast, the patient is given 90 mL of intravenous contrast. The postcontrast phase is then obtained. Right before setting up for the contrast-enhanced scan, have the patient lie prone for 30 seconds and then set up for the scan with the patient lying supine. This maneuver will help empty the contrast from the renal pelvis to the ureters.
Postcontrast phase reformats:
CT Urogram– Thin sagittal and coronal (3mm x 3mm) of the entire data set, and thick slab (3cm x 3mm) coronal and sagittal MPR reconstruction should be performed of the opacified renal pelvis, ureters, and bladder. 3D of the collecting system can be performed, as needed or requested.
Optional: Coronal/ oblique coronal thick volume slabs (1cm x 3mm) MPRs thru both kidneys and renals veins should be performed. The plane best depicting the mass and its relationship to the vessels and collecting system is chosen. The oblique coronal plane parallel to the renal vein and renal hila is often the best obliquity. These reconstructions can be helpful for localization of upper and lower pole masses and staging (ie. renal vein and IVC involvement). Curved reformatted MPRs may be helpful. Shaded surface and volume-rendered or MIP 3D displays during the parenchymal phase may be helpful for exophytic lesions, but the coronal/ oblique coronal thin slice and thick volume slab MPRs thru both kidneys and renal veins are often more helpful in the staging of the renal cancer.
Occasionally, an arterial phase will be requested to evaluate the renal arteries and their relationship to a renal mass or UPJ obstruction. (see CTA-Renal mass or CTA-Renal mass-Urogram protocols)