Unenhanced Helical Computerized Tomography for the Evaluation of Patients With Acute Flank Pain

Vieweg, Johannes; Teh, Chu Leong; Freed, Kelly S.; Leder, Richard A.; SMITH, ROBERTS H. A.; NELSON, RENDON H.; Preminger, Glenn M.

doi:10.1097/00005392-199809010-00010

Cited by 51 publications

(56 citation statements)

References 10 publications

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“…The literature data for the sensitivity (95% up to 100%) and the specificity (96% up to 100%) of stone detection through helical CT were confirmed by our results, since we reached a sensitivity of 99% and a specificity of 97% [1, 3, 4, 5, 6, 7, 8](table 3). Problems in diagnosis may solely occur in patients with calculi of the distal portion of the ureter without a noteworthy dilatation of the renal pelvis and in very thin patients with little retroperitoneal adipose tissue [2, 3, 4, 5, 8, 9, 10, 11]. Those study groups who had initially chosen a slice thickness of 5 mm recommended additional reconstruction with a slice thickness of 3 mm [6, 9]or even 2 mm [4, 7]in case of unclear findings.…”

Section: Discussionsupporting

confidence: 87%

Unenhanced Helical Computed Tomography in the Evaluation of Acute Flank Pain

Hamm

Wawroschek²,

Weckermann³

et al. 2001

Eur Urol

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Section: Discussionsupporting

confidence: 87%

Unenhanced Helical Computed Tomography in the Evaluation of Acute Flank Pain

Hamm

Wawroschek²,

Weckermann³

et al. 2001

Eur Urol

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“…Computed tomography has a sensitivity of 98% and overall accuracy of 96% in detecting ureteric calculi (6). It is also advantageous in detecting extraurinary retroperitoneal and pelvic masses that may cause ureteral compression as was the case with this patient.…”

Section: Discussionmentioning

confidence: 84%

Ovarian Dermoid Cyst Causing Distal Ureteral Obstruction

et al. 2015

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“…1,[4][5][6][7][8][9][10][11][12][13] In particular, using CT for following up residual fragments after stone treatment can reduce unnecessary follow-up ureteroscopies by up to 20% and can therefore save theatre time and cost. 13 Conversely, our results suggest non-contrast CT is inferior in identifying stones when a ureteral stent is in situ.…”

Section: Discussionmentioning

confidence: 99%

Computed tomography versus ureteroscopy in identification of renal tract stone with ureteral stent in situ

Tang

Attwell-Heap

2011

annals

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Non-contrast helical computed tomography (CT) is well validated in diagnosing urinary tract stone disease. It has been shown that this technique is superior to all other imaging modalities with a 97% sensitivity and a 96% specificity in detecting renal tract calculi.1 Nevertheless, using CT to diagnose stones in the urinary tract with a ureteral stent in situ is more difficult due to the complexity in differentiating between the stent and stones. Tanrikut et al 2 and Yoshida et al 3 suggested that stone density has a Hounsfield unit value of between 400 and 1,600 whereas a ureteral stent has a Hounsfield unit value of over 2,000. When using abdominal window settings to analyse CT, it is difficult to differentiate between stent and stone because they would have a similar bright white appearance. By using bone window settings, however, there would be a visual distinction between the stent and stone. 2,3The method of using bone window settings in the diagnosis of a stone with a stent in situ has not yet been validated. In our study, we attempted to validate this method by comparing the results of CT and ureteroscopy in identification of renal tract stones with a ureteral stent in situ. Ureteroscopy is often perceived as the current 'gold standard' as it allows clinicians to directly visualise stones in the renal tract. In spite of this, it is still possible to miss small stones with ureteroscopy.If CT were proven to be as good as ureteroscopy, then clinicians could safely rely on CT to pre-operatively diagnose stone clearance with a stent in situ. This would have implications for the type of surgery offered to patients, namely local anaesthetic removal of ureteral stents versus the more invasive and more time consuming ureteroscopy procedure. This would ultimately offer improvements in theatre efficiency. MethodsAll patients who had stents inserted for renal tract stones and underwent non-contrast CT with the stent in situ followed by ureteroscopy between May 2008 and October 2009 at The Canberra Hospital, Australia, were analysed retrospectively.Helical CT was performed using a 1mm slice collimation without intravenous or oral contrast administration. CT was reported in bone window settings to determine the presence and size of stones by consultant radiologists from the same department. The aim of this study was to validate the use of non-contrast computed tomography (CT) with a ureteral stent in situ instead of ureteroscopy for identification of renal tract stones. METHODS All patients who had stents inserted for renal tract stones and underwent non-contrast CT with the stent in situ followed by ureteroscopy between May 2008 and October 2009 at The Canberra Hospital, Australia, were analysed retrospectively. Statistical analysis was performed to compare any differences between CT and ureteroscopy in the identification of stones. RESULTS Overall, 57 patients were included in the study. The difference between CT and ureteroscopy findings was statistically significant. CT identification of stones with a stent in sit...

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Unenhanced Helical Computerized Tomography for the Evaluation of Patients With Acute Flank Pain

Cited by 51 publications

References 10 publications

Unenhanced Helical Computed Tomography in the Evaluation of Acute Flank Pain

Unenhanced Helical Computed Tomography in the Evaluation of Acute Flank Pain

Ovarian Dermoid Cyst Causing Distal Ureteral Obstruction

Computed tomography versus ureteroscopy in identification of renal tract stone with ureteral stent in situ

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