Assessment of Computed Tomography and Ultrasonography in Detection of Ureteric Calculi

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.