Intravenous urography: Technique and interpretation

Intravenous urography has long been the cornerstone of the imaging evaluati on of urinary tract disease. However, other imaging modalities such as ultr asonography, computed tomography, and magnetic resonance imaging are being used with increasing frequency. The declining use of urography in clinical practice presents a challenge for instruction in urographic technique and i nterpretation. In addition, alternative modalities also have their limitati ons, and despite their increasing use, the ideal "global" urinary tract exa mination remains controversial. Nevertheless, urography may still be import ant in the diagnosis of some urinary tract disease processes. It is frequen tly performed in the evaluation of hematuria. Urography may also be perform ed in the pre- or posttherapeutic evaluation of stone disease that has been discovered with other imaging modalities. The urographic imaging sequence is designed to optimize depiction of specific portions of the urinary tract during maximal contrast material opacification, and a tailored urographic study may provide diagnostic detail beyond the current capabilities of othe r imaging modalities. However, this can be accomplished only with good tech nique, an understanding of the limitations of the procedure, and adherence to basic rules of interpretation. The ability to relate urographic findings of disease processes to other imaging modalities will remain an important skill until the ideal urinary tract imaging technique emerges.