A prospective, matched comparison of ultra‐low and standard‐dose computed tomography for assessment of renal colic

Abstract

Objective To determine the diagnostic accuracy of ultra‐low‐dose computed tomography (ULDCT) compared with standard‐dose CT (SDCT) in the evaluation of patients with clinically suspected renal colic, in addition to secondary features (hydroureteronephrosis, perinephric stranding) and additional pathological entities (renal masses). Patients and methods A prospective, comparative cohort study was conducted amongst patients presenting to the emergency department with signs and symptoms suggestive of renal or ureteric colic. Patients underwent both SDCT and ULDCT. Single‐blinded review of the image sets was performed independently by three board‐certified radiologists. Results Among 21 patients, the effective radiation dose was lower for ULDCT [mean (SD) 1.02 (0.16) mSv] than SDCT [mean (SD) 4.97 (2.02) mSv]. Renal and/or ureteric calculi were detected in 57.1% (12/21) of patients. There were no significant differences in calculus detection and size estimation between ULDCT and SDCT. A higher concordance was observed for ureteric calculi (75%) than renal calculi (38%), mostly due to greater detection of calculi of <3 mm by SDCT. Clinically significant calculi (≥3 mm) were detected by ULDCT with high specificity (97.6%) and sensitivity (100%) compared to overall detection (specificity 91.2%, sensitivity 58.8%). ULDCT and SDCT were highly concordant for detection of secondary features, while ULDCT detected less renal cysts of <2 cm. Inter‐observer agreement for the ureteric calculi detection was 93.9% for SDCT and 87.8% for ULDCT. Conclusion ULDCT performed similarly to SDCT for calculus detection and size estimation with reduced radiation exposure. Based on this and other studies, ULDCT should be considered as the first‐line modality for evaluation of renal colic in routine practice.

What is the best way to manage ureteric calculi in the time of COVID‐19? A comparison of extracorporeal shockwave lithotripsy (SWL) and ureteroscopy (URS) in an Australian health‐care setting

“…Follow-up imaging in these patients occurred via ultrasound, plain x-ray, or computer tomography scan (ultra-low dose when appropriate). 11 Both SWL and URS continue to evolve with the implementation of new technology. There is variation in published prospective studies that compare SWL to URS; some studies measure the stone-free rates after the initial procedure as a primary outcome, while others after additional subsequent procedures.…”

“…This current study seeks to look more broadly at the real post‐procedure care requirements, in order to ascertain if the advantages of SWL are maintained when subsequent emergency department presentations, further procedures and hospital admissions are considered. Follow‐up imaging in these patients occurred via ultrasound, plain x‐ray, or computer tomography scan (ultra‐low dose when appropriate) 11 …”

“…Follow‐up imaging in these patients occurred via ultrasound, plain x‐ray, or computer tomography scan (ultra‐low dose when appropriate). 11 …”

THE COMPARATIVE STUDY TO DETECT RENAL & URINARY TRACT CALCULI (NEPHROLITHIASIS AND UROLITHIASIS) ON ULTRASOUND AND CT.

“…Calculi that are clinically important (3 mm) ULDCT identified them with excellent specificity (97.6 percent) and sensitivity (100%) in comparison to total detection (specificity) 91.2 percent, with a sensitivity of 58.8 percent). ULDCT and SDCT were both extremely effective 13 .…”

Application of deep learning reconstruction of ultra-low-dose abdominal CT in the diagnosis of renal calculi

“…The radiation dose used for ULDCT was < 1 mSv, a significant (77%) decrease over that for LDCT. This was the equivalent of the dose used for a single abdominal x-ray [ 28 ].…”