Objective:Understanding the role of Multi-slice CT Urography(MSCTU) over Ultrasonography(US) in patients presenting with hematuria .Materials and Methods:Retrospective study enrolled 131 patients presen-ting with hematuria [ microscopic hematuria ( n=60 ) ] and macroscopic hematuria ( n=71 ) ] who have undergone both MSCTU and US of urinary tract system simultaneously .Results of tests were compared with respective surgical and histopathological analysis of lesion .The cases obtained were bladder carcinoma , ureter carcinoma , renal carci-noma, urinary tract calculi and bladder inflammation .PASW-18th statistical tool was used for obtaining statistical analysis and final interpretation of results .Results:The sensitivity and specificity of MSCTU and US for recognition of lesions presenting with macroscopic hematuria were 95.38%,83.33% and 81.54%,66.67% respectively and for those with microscopic hematuria were 96.08%,88.89%and 86.27%, 77.8%respectively.The positive and negative likelihood ratios of MSCTU and US in macroscopic category were 5.73, 0.055 and 2.46, 0.277 respec-tively while for those in microscopic category were 8.65, 0.044 and 3.88, 0.176 respectively.In context to the sensitivity of MSCTU and US in patients presenting with macroscopic hematuriathedifferenceswere significant ( Mc-Nemar′s test,P=0.039)suggesting the tests are not similar whereas for those with microscopic hematuria the differ-ences were not significant(McNemar′s test, P=2.68) indicatingsimilarity between these tests.Conclusion:Diag-nostic efficacy of MSCTU is found to be far superior over US for patients presenting with macroscopic hematuria , thus current practice of using it as a first line modality seems to be justified .However, for those presenting with mi-croscopic hematuria MSCTU and ultrasonography shows near to similar resultsin accordance to MSCTU , thus US alone seems sufficient to exclude significant urinary tract lesions .