Comparison of conventional radiography combined with ultrasonography versus nonenhanced helical computed tomography in evaluation of patients with renal colic
Tóm tắt
The aim of this study is to determine whether kidneys ureters bladder X-ray (KUB) film combined with ultrasound (US) can be effectively used in evaluation of renal colic and miss stones with clinically significant size identified on nonenhanced computed tomography (NECT) in patients with urolithiasis. This retrospective study evaluated the clinical and radiological records of 300 patients at our institution undergoing KUB and/or US and/or NECT for the evaluation of renal colic from June 2007 to December 2010. Of patients with negative findings on KUB and/or US, 22 had renal stones on NECT (mean size 4.4 mm, range 3–8), 3 had lower ureteral stone (mean size 3.3 mm, range 2–5). In patients with isolated suspicious renal ectasia without stone image, two had renal stone on NECT (mean size 4 mm, range 2–6), 5 had upper ureteral stone (mean size 4.4 mm, range 4–6), 7 had middle ureteral stone (mean size 3.7 mm, range 3–4) and 14 had lower ureteral stone (mean size 4 mm, range 2–6). The cost-effective and almost radiation-free combination of KUB and US should be preferred for diagnosis of urolithiasis, as it detects most of the ureteral and renal calculi which are clinically significant.
Tài liệu tham khảo
Rekant EM, Gibert CL, Counselman FL (2001) Emergency department time for evaluation of patients discharged with a diagnosis of renal colic:unenhanced helical computed tomography versus intravenous urography. J Emerg Med 21:371–374
Teichman JM (2004) Clinical practice: acute renal colic from ureteral calculus. N Engl J Med 350:684–693
Baumann BM, Chen EH, Mills AM et al (2011) Patient perceptions of computed tomographic imaging and their understanding of radiation risk and exposure. Ann Emerg Med 58(1):1–7.e2. doi:10.1016/j.annemergmed.2010.10.018 (Epub 2010 Dec 13)
Kartal M, Eray O, Erdogru T et al (2006) Prospective validation of a current algorithm including bedside US performed by emergency physicians for patients with acute flank pain suspected for renal colic. Emerg Med J 23(5):341–344
Noble VE, Brown DFM (2004) Renal ultrasound. Emerg Med Clin N Am 22:641–659
Wright PJ, English PJ, Hungin AP et al (2002) Managing acute renal colic across the primary-secondary care interface: a pathway of care based evidence and consensus. BMJ 325:1408–1412
Rosen CL, Brown DF, Sagarin MJ et al (1998) Ultrasonography by emergency physicians in patients with suspected ureteral colic. J Emerg Med 16:865–870
Henderson SO, Hoffner RJ, Aragona JL et al (1998) Bedside emergency department ultrasonography plus radiography of the kidneys, ureters, and bladder vs intravenous pyelography in the evaluation of suspected ureteral colic. Acad Emerg Med 5:666–671
Caoili EM, Cohan RH, Korobkin M et al (2002) Urinary tract abnormalities: initial experience with multi-detector row CT urography. Radiology 222:353–360
Sheafor DH, Hertzberg BS, Freed KS et al (2000) Nonenhanced helical CT and US in the emergency evaluation of patients with renal colic: prospective comparison. Radiology 217:792–797
Boulay I, Holtz P, Foley WD et al (1999) Ureteral calculi: diagnostic efficacy of helical CT and implications for treatment of patients. AJR Am J Roentgenol 172:1485–1490
Haddad MC, Sharif HS, Shahed MS et al (1992) Renal colic: diagnosis and outcome. Radiology 184:83 ± 88
Dalla Palma L, Pozzi-Mucelli R, Stacul F (2001) Present-day imaging of patients with renal colic. Eur Radiol 11:4 ± 17
Catalano O, Nunziata A, Altei F et al (2002) Suspected ureteral colic: primary helical CT versus selective helical CT after unenhanced radiography and sonography. AJR Am J Roentgenol 178:379–387
Tamm EP, Silverman PM, Shuman WP (2003) Evaluation of the patient with flank pain and possible ureteral calculus. Radiology 228:319–329
Jindal G, Ramchandani P (2007) Acute flank pain secondary to urolithiasis: radiologic evaluation and alternate diagnoses. Radiol Clin North Am 45:395–410
Ahmed NA, Ather MH, Rees J (2003) Unenhanced helical computed tomography in the evaluation of acute flank pain. Int J Urol 10:287–292
Smith RC, Rosenfield AT (1995) Acute flank pain: comparison of noncontrast enhanced CT and intravenous pyelography. Radiology 194:789–794
Miller OF, Kane CJ (1999) Time to stone passage for observed ureteral calculi: a guide for patient education. J Urol 162:688–690 (discussion 90–1)
Segura JW, Preminger GM, Assimos DG et al (1997) Ureteral stones clinical guidelines panel summary report on the management of ureteral calculi. The American Urological Association. J Urol 158:1915–1921
Hubner WA, Irby P, Stoller ML (1993) Natural history and current concepts for the treatment of small ureteral calculi. Eur Urol 24:172–176
Radiological Society of North America. Safety in Medical Imaging Procedures. Available at: http://www.radiologyinfo.org/en/safety/index.cfm?pg=sfty_xray
Brenner DJ, Hall EJ (2007) Computed tomography—an increasing source of radiation exposure. N Engl J Med 357:2277–2284
Brenner DJ, Doll R, Goodhead DT et al (2003) Cancer risks attributable to low doses of ionizing radiation: assessing what we really know. Proc Natl Acad Sci USA 100:13761–13766
Birnbaum S (2008) Radiation safety in the era of helical CT: a patient-based protection program currently in place in two community hospitals in New Hampshire. J Am Coll Radiol 5(714–718):e5
Johnston R, Lin A, Du J et al. (2009) Comparison of kidney-ureter-bladder abdominal radiography and computed tomography scout films for identifying renal calculi BJU Int. 2009 Sep 104(5):670–673
Spital A, Volvo JR, Segal AJ (1988) Non-dilated obstructive uropathy. Urology 31:478–482
Mos C, Holt G, Iuhasz S et al (2010) The sensitivity of transabdominal ultrasound in the diagnosis of ureterolithiasis Medical Ultrasonography 12(3):188–197