European Radiology

, Volume 20, Issue 9, pp 2146–2152 | Cite as

Multi-detector CT urography: effect of oral hydration and contrast medium volume on renal parenchymal enhancement and urinary tract opacification—a quantitative and qualitative analysis

  • Dieter H. SzolarEmail author
  • Manfred Tillich
  • Klaus W. Preidler



To assess the effect of oral hydration and contrast-medium volume on renal enhancement and urinary tract opacification in multi-detector CT urography.


A total of 192 patients were assigned to different protocols with varying doses of contrast agent with and without oral hydration. The attenuation was measured in the renal parenchyma in the unenhanced, nephrographic and excretory phase, and in the urinary tract in excretory phase imaging, respectively. Opacification of the urinary tract was graded on volume rendered images.


Oral hydration did not significantly alter renal parenchymal enhancement in both the nephrographic and the excretory phase (p > 0.001), but significantly decreased mean attenuation of the urinary tract in the excretory phase (p ≤ 0.001), and improved continuous opacification of all ureter segments (p < 0.01). Higher volumes of contrast medium improved renal parenchymal enhancement (p ≤ 0.001) and continuous opacification of the urinary tract (p ≤ 0.01).


Oral hydration leads to lower attenuation values in the urinary tract but improves the continuous opacification of the tract. Increase in contrast medium volume leads to higher renal parenchymal enhancement as well as to an increased continuous opacification of the urinary tract. Decrease in contrast medium volume cannot be compensated for by oral hydration in terms of parenchymal enhancement.


Computed tomography CT urography CT contrast material CT kidneys CT urinary tract 


  1. 1.
    Akbar S, Mortele K, Baeyens K, Kekelidze M, Silverman S (2004) Multidetector CT urography: techniques, clinical applications, and pitfalls. Semin Ultrasound CT MR 25:41–54CrossRefPubMedGoogle Scholar
  2. 2.
    Caoili E, Cohan R, Korobkin M et al (2002) Urinary tract abnormalities: initial experience with multi-detector row CT urography. Radiology 222:353–360CrossRefPubMedGoogle Scholar
  3. 3.
    Caoili E, Inampudi P, Cohan R, Ellis J (2005) Optimization of multi-detector row CT urography: effect of compression, saline administration, and prolongation of acquisition delay. Radiology 235:116–123CrossRefPubMedGoogle Scholar
  4. 4.
    Caoili EM, Cohan RH, Korobkin M et al (2001) Effectiveness of abdominal compression during helical renal CT. Academ Radiol 8:1100–1106CrossRefGoogle Scholar
  5. 5.
    Chow LC, Sommer FG (2001) Multidetector CT urography with abdominal compression and three-dimensional reconstruction. AJR Am J Roentgenol 177:849–855PubMedGoogle Scholar
  6. 6.
    Hattery RR, Williamson B, Hartman GW, LeRoy AJ, Witten DM (1988) Intravenous urographic technique. Radiology 167:593–599PubMedGoogle Scholar
  7. 7.
    Heneghan JP, Kim DH, Leder RA, DeLong D, Nelson RC (2001) Compression CT urography: a comparison with IVU in the opacification of the collecting system and ureters. J Comput Assist Tomogr 25:343–347CrossRefPubMedGoogle Scholar
  8. 8.
    Kawamoto S, Horton K, Fishman E (2006) Opacification of the collecting system and ureters on excretory-phase CT using oral water as contrast medium. AJR Am J Roentgenol 186:136–140CrossRefPubMedGoogle Scholar
  9. 9.
    Maher MM JK, Lucey BC, Sahani DV, Saini S, Mueller PR (2001) Does the administration of saline flush during CT urography improve ureteric distension and opacification? A prospective study. Radiology 221(Suppl P):500Google Scholar
  10. 10.
    McNicholas MM, Raptopoulos VD, Schwartz RK et al (1998) Excretory phase CT urography for opacification of the urinary collecting system. AJR Am J Roentgenol 170:1261–1267PubMedGoogle Scholar
  11. 11.
    McTavish J, Jinzaki M, Zou K, Nawfel R, Silverman S (2002) Multi-detector row CT urography: comparison of strategies for depicting the normal urinary collecting system. Radiology 225:783–790CrossRefPubMedGoogle Scholar
  12. 12.
    Nawfel R, Judy P, Schleipman AR, Silverman S (2004) Patient radiation dose at CT urography and conventional urography. Radiology 232:126–132CrossRefPubMedGoogle Scholar
  13. 13.
    Nolte-Ernsting CC, Wildberger JE, Borchers H, Schmitz-Rode T, Gnther RW (2001) Multi-slice CT urography after diuretic injection: initial results. RöFo 173:176–180PubMedGoogle Scholar
  14. 14.
    Sadow CA SS (2007) CT urography in patients 40 years old or younger: is it worth it? In: Abstfracts of the Radiological Society of North America Scientific Assembly and Annual Meeting Program. Radiological Society of North America, Oak Brook, p 300Google Scholar
  15. 15.
    Silverman S, Leyendecker J, Amis ES (2009) What is the current role of CT urography and MR urography in the evaluation of the urinary tract? Radiology 250:309–323CrossRefPubMedGoogle Scholar
  16. 16.
    Sudakoff G, Dunn D, Hellman R et al (2006) Opacification of the genitourinary collecting system during MDCT urography with enhanced CT digital radiography: nonsaline versus saline bolus. AJR Am J Roentgenol 186:122–129CrossRefPubMedGoogle Scholar
  17. 17.
    O’Connor OJ, McSweeney SE, Maher MM (2008) Imaging of hematuria. Radiol Clin N Am 46:113–132CrossRefPubMedGoogle Scholar
  18. 18.
    Nolte-Ernsting C, Cowan N (2006) Understanding multislice CT urography techniques: many roads lead to Rome. Eur Radiol 16:2670–2686CrossRefPubMedGoogle Scholar

Copyright information

© European Society of Radiology 2010

Authors and Affiliations

  • Dieter H. Szolar
    • 1
    Email author
  • Manfred Tillich
    • 1
  • Klaus W. Preidler
    • 1
  1. 1.Diagnostikum Graz-SüdwestGrazAustria

Personalised recommendations