Diagnostic Accuracy of Non-Contrast Computed Tomography in Identification of Renal Calculi in Suspected Patients with Negative Intravenous Pyelogram
Article Sidebar
Main Article Content
Abstract
Background: Renal calculi, commonly known as kidney stones, are mineral deposits found in the renal calyces and pelvis, either free or attached to the renal papillae. These stones can cause significant pain and health complications, making accurate diagnosis crucial. While intravenous pyelogram (IVP) has been a traditional diagnostic method, non-contrast computed tomography (NCCT) has emerged as a potentially superior alternative due to its higher sensitivity and specificity.
Objective: To determine the accuracy of non-contrast computed tomography (NCCT) in identifying renal calculi in symptomatic patients with negative intravenous pyelogram (IVP) results.
Methods: This cross-sectional study was conducted at the University of Lahore Teaching Hospital from August 7, 2023, to March 20, 2024. A total of 416 symptomatic patients, aged 19 to 49 years, with negative IVP results were included. Patients previously diagnosed with urolithiasis/nephrolithiasis by other imaging modalities, those who were uncooperative, pregnant, severely ill, or with congenital urinary tract abnormalities, were excluded. Demographic and clinical data were collected through interviews. Each patient underwent an NCCT scan, which was interpreted by an experienced radiologist. Data analysis was performed using SPSS version 25, with continuous variables summarized as means and standard deviations, and categorical variables as frequencies and percentages. Chi-square tests were used to assess associations, with a significance level set at p<0.05.
Results: Of the 416 patients, 250 (60.09%) were diagnosed with urolithiasis/nephrolithiasis on NCCT, while 166 (39.90%) were negative. The majority of positive cases were male (n=156, 70.90%), with the most common age group being 19-29 years (n=91, 58.33%). The most frequent anatomical site for calculi was the ureter (n=151, 36.30%), followed by the kidneys (n=60, 14.42%) and the urinary bladder (n=39, 9.37%). The size of the single calculi varied, with the most common sizes being 0.4-0.5 cm (27.81%).
Conclusion: NCCT demonstrated a significantly higher diagnostic accuracy for urolithiasis/nephrolithiasis compared to IVP. Given its superior sensitivity and specificity, NCCT should be considered the preferred diagnostic modality for patients presenting with acute renal colic and negative IVP results. These findings can improve patient outcomes through timely and accurate diagnosis, reducing the need for unnecessary diagnostic procedures.
Article Details
This work is licensed under a Creative Commons Attribution 4.0 International License.
References
Khan SR, Pearle MS, Robertson WG, Gambaro G, Canales BK, Doizi S, Traxer O, Tiselius HG. Kidney Stones. Nat Rev Dis Primers. 2016 Feb 25;2(1):1-23.
Xu H, Zisman AL, Coe FL, Worcester EM. Kidney Stones: An Update on Current Pharmacological Management and Future Directions. Expert Opin Pharmacother. 2013 Mar 1;14(4):435-47.
Sakhaee K, Maalouf NM, Sinnott B. Kidney Stones 2012: Pathogenesis, Diagnosis, and Management. J Clin Endocrinol Metab. 2012 Jun 1;97(6):1847-60.
Bhutani K, Singh U, Rani P. Significance of Chemical Composition Analysis in Urolithiasis. Indian J Public Health Res Dev. 2020 Jun 25;11(6):441-5.
Andrabi Y, Patino M, Das CJ, Eisner B, Sahani DV, Kambadakone A. Advances in CT Imaging for Urolithiasis. Indian J Urol. 2015 Jul 1;31(3):185-93.
Weinrich JM, Bannas P, Regier M, Keller S, Kluth L, Adam G, Henes FO. Low-Dose CT for Evaluation of Suspected Urolithiasis: Diagnostic Yield for Assessment of Alternative Diagnoses. Am J Roentgenol. 2018 Mar;210(3):557-63.
Blackwell RH, Kirshenbaum EJ, Zapf MA, Kothari AN, Kuo PC, Flanigan RC, Gupta GN. Incidence of Adverse Contrast Reaction Following Nonintravenous Urinary Tract Imaging. Eur Urol Focus. 2017 Feb 1;3(1):89-93.
Chang DH, Slebocki K, Khristenko E, Herden J, Salem J, Große Hokamp N, Mammadov K, Hellmich M, Kabbasch C. Low-Dose Computed Tomography of Urolithiasis in Obese Patients: A Feasibility Study to Evaluate Image Reconstruction Algorithms. Diabetes Metab Syndr Obes. 2019 Apr 5:439-45.
Soliman AA, Sakr LK. Evaluation of the Accuracy of Low Dose CT in the Detection of Urolithiasis in Comparison to Standard Dose CT. Al-Azhar Int Med J. 2020 Feb 1;1(2):209-14.
Keoghane S, Austin T, Coode-Bate J, Deverill S, Drake T, Sanpera-Iglesias J, Johnston T. The Diagnostic Yield of Computed Tomography in the Management of Acute Flank Pain and the Emergency Intervention Rate for a Proven Acute Ureteric Stone. Ann R Coll Surg Engl. 2018 Nov;100(8):598-605.
Hameed T, Mengal S, Mengal MA, Yousaf M. The Study on Urolithiasis in Human Population of Baluchistan. Pak-Euro J Med Life Sci. 2019 Nov 15;2(1):1-4.
Marsoul AD, Rasool HA, Judi MR. A Comparison Between Low Dose and Standard Dose Computed Tomography Scan in Detection of Urolithiasis. Med J Babylon. 2018 Jul 1;15(3):258-62.
Smith C, Narula L, Arnfield E. Evaluating the Diagnostic Yield of CT KUB at a Tertiary Institution. Eur Congr Radiol-2017 ASM.
Imran F, Zaman Z, Iqbal MJ. Diagnostic Accuracy of IVU Compared to Unenhanced CT KUB for Detection of Urinary Tract Calculi. J Islamabad Med Dent Coll. 2017;6(4):234-9.
O'Kane D, D'Arcy FT, Papa N, Smith N, McClintock S, Lawrentschuk N, Bolton DM, Jeon SH. Radiation Dosing in the Investigation and Follow-Up of Urolithiasis: Comparison Between Historical and Contemporary Practices. Investig Clin Urol. 2016 Mar 1;57(2):113-8.
Alrwaili A. A Non-Contrast Computed Tomography and Intravenous Urography Interrogation in Patients with Renal Colic at Hospitals. SM J Clin Med. 2018;4(1):1036.
Smith RC, Rosenfield AT, Choe KA, Essenmacher KR, Verga M, Glickman MG, Lange RC. Acute Flank Pain: Comparison of Non-Contrast-Enhanced CT and Intravenous Urography. Radiology. 1995 Mar;194(3):789-94.
Wang JH, Shen SH, Huang SS, Chang CY. Prospective Comparison of Unenhanced Spiral Computed Tomography and Intravenous Urography in the Evaluation of Acute Renal Colic. J Chin Med Assoc. 2008 Jan 1;71(1):30-6.
Sommer FG, Jeffrey RB Jr, 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 Am J Roentgenol. 1995 Sep;165(3):509-13.
Fani P, Patlas MN, Monteiro S, Katz DS. Non-Contrast MDCT for Ureteral Calculi and Alternative Diagnoses: Yield in Adult Women vs in Adult Men. Curr Probl Diagn Radiol. 2019 Mar 1;48(2):148-51.
Yilmaz S, Sindel T, Arslan G, Özkaynak C, Karaali KA, Kabaalioğlu A, Lüleci E. Renal Colic: Comparison of Spiral CT, US and IVU in the Detection of Ureteral Calculi. Eur Radiol. 1998 Feb;8:212-7.
Kishore TA, Pedro RN, Hinck B, Monga M. Estimation of Size of Distal Ureteral Stones: Noncontrast CT Scan Versus Actual Size. Urology. 2008 Oct 1;72(4):761-4.
Sarla GS. Epidemiology of Urolithiasis. Res Rev J Surg. 2019;8(2):8-11.
Njau BK. CT Findings in Suspected Renal Colic Patients Undergoing Unenhanced Low-Dose Multi-Detector Computed Tomography (Doctoral Dissertation, University of Nairobi).