Table 1.

Summary of ACR appropriateness criteria related to CT urography

Clinical indication	Appropriateness of CT urography
Hematuria	First-line modality in patients with hematuria who do not meet 1 of 2 criteria: History of associated vigorous exercise, infection, recent viral illness, or recent menstruation Patients with renal parenchymal disease known to cause hematuria, such as glomerulonephritis
Staging of muscle-invasive bladder cancer	Used to evaluate for concomitant upper tract urothelial carcinoma, as well as staging of pelvic lymph nodes or more distant metastases in the abdomen
Surveillance of bladder cancer post-treatment	Generally appropriate in any patient with findings of invasive urothelial carcinoma or superficial urothelial carcinoma with risk factors. Risk factors include carcinoma in situ (CIS) on pathology, size > 3 cm, higher-grade, adjacent or remote atypia or high-grade dysplasia of the bladder mucosa, multifocal cancer, upper tract obstruction at presentation, lymphatic invasion, involvement of the prostate
Acute onset flank pain with suspicion for urolithiasis	Excretory phase imaging may be appropriate if non-contrast CT is indeterminate in distinguishing a calcific density as within the ureter versus adjacent phlebolith, while standard contrast-enhanced CT may be appropriate if a non-contrast exam does not elicit the cause of the patient’s pain.

Adapted with permission from American College of Radiology (ACR) Appropriateness Criteria