Diagnostic Efficacy of Ultrasonography in the Evaluation of Haematuria Compared With Multidetector Computed Tomography Urography

Introduction: Haematuria is a common clinical presentation that may result from a wide range of urinary tract disorders.Ultrasonography (USG) is frequently used as an initial imaging modality because it is noninvasive and free from ionising radiation, whereas multidetector computed tomography urography (MDCTU) provides comprehensive evaluation of the urinary tract.This study evaluated the diagnostic performance of USG in patients with haematuria in comparison with MDCTU.Materials and methods: A prospective observational study was conducted in the Department of Radiodiagnosis, Vydehi Institute of Medical Sciences and Research Centre, Bengaluru, from June 2024 to December 2025.Eighty-five patients with haematuria underwent both USG and MDCTU within 24 hours.The two imaging modalities were interpreted independently by different radiologists who were blinded to the findings of the other modality.Imaging findings were categorised as benign renal lesion, bladder/urothelial mass, calculus, obstructive findings, or renal mass.MDCTU was considered the imaging reference standard.Diagnostic performance of USG for identifying lesions classified as suspicious for malignancy on MDCTU was assessed using sensitivity, specificity, positive predictive value, and negative predictive value.Results: The study included 85 patients, with a mean age of 39.86 ± 14.89 years; 50 (58.80%)were males, and 35 (41.20%) were females.Microscopic haematuria was present in 66 (77.60%) patients and gross haematuria in 19 (22.40%).On MDCTU, calculus was the most frequent finding, identified in 69 (81.18%) patients, followed by renal mass in 10 (11.76%), bladder/urothelial mass in 5 (5.88%), and benign renal lesion in 1 (1.18%).USG identified calculus in 52 (61.18%), obstructive findings in 17 (20.00%),renal mass in 10 (11.76%), and bladder/urothelial mass in 6 (7.06%).The association between USG and MDCTU findings was statistically significant (p<0.001).For identifying lesions classified as suspicious for malignancy on MDCTU, USG demonstrated a sensitivity of 80.00% (95% CI: 54.81-92.95%),specificity of 94.29% (95% CI: 86.21-97.76%),positive predictive value of 75.00% (95% CI: 50.50-89.82%),and negative predictive value of 95.65% (95% CI: 87.98-98.51%).Conclusion: USG demonstrated good diagnostic utility in the evaluation of haematuria, particularly for identifying renal masses and showed good agreement with MDCTU in the imaging-based classification of lesions suspicious for malignancy.It may serve as a useful initial imaging modality, while MDCTU provides a more comprehensive assessment when further evaluation or characterisation of urinary tract abnormalities is required.Further multicentre studies with larger sample sizes and histopathological correlation are warranted to validate these findings.