Assessment of Computed Tomography and Ultrasonography in Detection of Ureteric Calculi
Article Sidebar
Main Article Content
Abstract
Background: Urolithiasis, a common urological condition, presents diagnostic challenges. While CT scans are considered the gold standard for detecting ureteric calculi, the role of ultrasonography is also significant, especially in varied clinical scenarios.
Objective: This study aims to assess the diagnostic accuracy of ultrasonography compared to CT scans in the detection of ureteric calculi.
Methods: An observational study was conducted on 200 patients at the Combined Military Hospital, Peshawar. Participants included males and females aged 18-60 years, presenting with acute renal pain. Exclusion criteria included individuals without informed consent, multiple comorbidities, a history of kidney donations, or a family history of renal calculi. Ultrasonography was performed using an Ecoste Mylab 7 color Doppler machine with 3.5, 5, and 7.5 MHz probes. CT scans were conducted using the Siemens CT Somatom Sensation 64, without the administration of any contrast medium. Data were analyzed using SPSS version 26.0.
Results: Ultrasonography detected ureteric calculi in 33% of patients (66 calculi), while CT scans detected 60% (118 calculi). The breakdown of calculi location for ultrasonography included 20 renal, 15 pelvic ureteric junction, 12 upper ureter, 8 lower ureter, 7 vesicoureteric junction obstruction, and 4 bladder. CT scan results showed 45 renal, 25 pelvic ureteric junction, 20 upper ureter, 11 lower ureter, 9 vesicoureteric junction obstruction, and 8 bladder calculi. The gender distribution in the study was 55% male and 45% female, with the mean age being 35 ± 16.79 years for males and 36 ± 17.24 years for females. The most common presenting complaints were flank pain (36%), lower back pain (25%), and burning micturition (15%).
Conclusion: CT scans exhibit higher diagnostic accuracy for ureteric calculi compared to ultrasonography, thus reaffirming their role as the gold standard in this context. However, the radiation risks and economic implications of CT scanning necessitate a balanced approach to its use, emphasizing the importance of comprehensive patient evaluation and physician awareness of radiation risks.
Article Details
This work is licensed under a Creative Commons Attribution 4.0 International License.
References
Nadeem M, Ather MH, Jamshaid A, Zaigham S, Mirza R, Salam B. Rationale use of unenhanced multi-detector CT (CT KUB) in evaluation of suspected renal colic. International Journal of Surgery. 2012 Jan 1;10(10):634-7.
Clark JY, Thompson IM, Optenberg SA. Economic impact of urolithiasis in the United States. The Journal of urology. 1995 Dec;154(6):2020-4.
Patti L, Leslie SW. Acute renal colic.
Shams HA, Riaz MA, Raziq HA, Khan MR, Wali G. Diagnostic accuracy of ultrasonography versus computed tomography in patients of acute renal colic. Pakistan J Medical Health Sci. 2019;13:918-21.
Leslie SW, Sajjad H, Murphy PB. Renal calculi. InStatPearls [Internet] 2022 May 27. StatPearls Publishing.
Sudah M, Vanninen RL, Partanen K, Kainulainen S, Malinen A, Heino A, Ala-Opas M. Patients with acute flank pain: comparison of MR urography with unenhanced helical CT. Radiology. 2002 Apr;223(1):98-105.
Smith-Bindman R, Aubin C, Bailitz J, Bengiamin RN, Camargo Jr CA, Corbo J, Dean AJ, Goldstein RB, Griffey RT, Jay GD, Kang TL. Ultrasonography versus computed tomography for suspected nephrolithiasis. New England Journal of Medicine. 2014 Sep 18;371(12):1100-10.
Ulusan S, Koc Z, Tokmak N. Accuracy of sonography for detecting renal stone: comparison with CT. Journal of Clinical Ultrasound. 2007 Jun;35(5):256-61.
Ather MH, Jafri AH, Sulaiman MN. Diagnostic accuracy of ultrasonography compared to unenhanced CT for stone and obstruction in patients with renal failure. BMC medical imaging. 2004 Dec;4:1-5.
Sommer FG, Jeffrey Jr RB, Rubin GD, Napel S, Rimmer SA, Benford J, Harter PM. Detection of ureteral calculi in patients with suspected renal colic: value of reformatted noncontrast helical CT. AJR. American journal of roentgenology. 1995 Sep;165(3):509-13.
Shams HA, Riaz MA, Raziq HA, Khan MR, Wali G. Diagnostic accuracy of ultrasonography versus computed tomography in patients of acute renal colic. Pakistan J Medical Health Sci. 2019;13:918-21.
Aslaksen A, Göthlin JH. Ultrasonic diagnosis of ureteral calculi in patients with acute flank pain. European journal of radiology. 1990 Sep 1;11(2):87-90.
Patlas M, Farkas A, Fisher D, Zaghal I, Hadas-Halpern I. Ultrasound vs CT for the detection of ureteric stones in patients with renal colic. The British journal of radiology. 2001 Oct;74(886):901-4.
Abramson S, Walders N, Applegate KE, Gilkeson RC, Robbin MR. Impact in the emergency department of unenhanced CT on diagnostic confidence and therapeutic efficacy in patients with suspected renal colic: a prospective survey. American Journal of Roentgenology. 2000 Dec;175(6):1689-95.
Aslaksen A, Göthlin JH. Ultrasonic diagnosis of ureteral calculi in patients with acute flank pain. European journal of radiology. 1990 Sep 1;11(2):87-90.
Green BR. Renal calculi: emergency department diagnosis and treatment. Emerg Med Pract. 2011;13(7):1-7.
Ather MH, Jafri AH, Sulaiman MN. Diagnostic accuracy of ultrasonography compared to unenhanced CT for stone and obstruction in patients with renal failure. BMC medical imaging. 2004 Dec;4:1-5.
Ahmad NA, Ather MH, Rees J. Unenhanced helical computed tomography in the evaluation of acute flank pain. International journal of urology. 2003 Jun;10(6):287-92.
Ahmad NA, Ather MH, Rees J. Incidental diagnosis of diseases on un-enhanced helical computed tomography performed for ureteric colic. BMC urology. 2003 Dec;3:1-6.
Clark JY, Thompson IM, Optenberg SA. Economic impact of urolithiasis in the United States. The Journal of urology. 1995 Dec;154(6):2020-4.