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Urinary Disorders

Interpreting CT scan results

05/20/2008

Question:

I have had continual microscopic hematuria for over a year now. Left side flank pain also. Five months ago, they did a CT scan without contrast and noted several hyperdense lesions in left kidney. Had a cytoscopy and they sent urine off for cytology, though I haven`t heard results yet. Had a CT with contrast last week, and the hyperdense areas showed up as hypodense in the posterior upper pole, lateral interpole, and anterior lower pole. Also noted were ill-defined hyperdense areas in the the corticomedullary and subcortical regions of left kidney. Since the areas changed from hyper to hypo dense, does this mean they enhanced? That terminology confuses me, and I can`t seem to find the answer to that. Please clarify for me.

Answer:

I would need to see the images and this is a question that you should review with your urologist while he or she is looking at the films. Typically, CT scans performed to determine enhancement are without and with in the same setting -- not delayed by repeat on another day.

I would guess that the hypodense is based upon comparison of the lesions to the normal kidney with the contrast. I am not a radiologist. I would say that the hyperdense was the lesions compared to the normal kidney without contrast. The radiologist would have to decide if the first film density can be compared to the second film density. Enhancement is not based upon comparison to the adjacent normal kidney but the lesion's density before contrast compared to the lesion's density after contrast.

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Response by:

James F Donovan, Jr, MD James F Donovan, Jr, MD
Professor of Surgery
Director of UC Urology
College of Medicine
University of Cincinnati