Current Concepts in Imaging Asymptomatic Hematuria

Hematuria is a very common clinical condition that most clinicians will encounter. Hematuria is divided into gross and microscopic hematuria with a wide variety of etiologies. The imaging evaluation of asymptomatic hematuria is generally tailored to identifying a common cause (urinary tract stones) and the most worrisome cause (carcinoma). The workup for asymptomatic gross hematuria is generally agreed upon and includes both CT and cystoscopy. However, the imaging evaluation of asymptomatic microscopic hematuria is controversial due to the much lower risk of urinary tract malignancies. The purpose of this article is to review the imaging of the upper urinary tract focusing on CT, MRI, and ultrasound. Current European and North American society guidelines, imaging techniques, typical imaging findings, diagnostic accuracy, and risks will all be addressed highlighting the current knowledge gaps, particularly between CT and ultrasound.