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Imaging modalities for nephrolithiasis

Imaging modalities for nephrolithiasis
  Advantages Disadvantages
Ultrasound kidneys and bladder
  • No ionizing radiation; lower cumulative radiation dose in patients undergoing repeated imaging
  • Reliably detects hydronephrosis
  • Low to moderate sensitivity and wide variability in diagnostic performance; detects 24 to 57% of stones seen with CT[1,2]
  • Inaccurate stone size measurements and ureteral localization for treatment planning
  • Likely nondiagnostic in patients with large body habitus (males >285 lb, females >250 lb), or those with end-stage kidney disease
Noncontrast CT abdomen and pelvis
  • Highest diagnostic accuracy; pooled sensitivity 0.97 and specificity 0.95 for low-dose examination[3]
  • Reliably detects hydronephrosis
  • Accurate stone size measurements and ureteral localization for treatment planning
  • Ionizing radiation; effective dose 2 to 3 mSv with low-dose and 10 to 12 mSv with standard-dose examination
  • Rarely, a second set of images after intravenous contrast are needed for definitive diagnosis of urolithiasis*
Abdomen radiograph
  • Accurate stone size measurements and ureteral localization for treatment planning
  • Low to moderate sensitivity and wide variability in diagnostic performance; detects 29 to 59% of stones seen with CT[4,5]
  • Does not detect hydronephrosis
  • Ionizing radiation; effective dose 0.8 mSv with each view
MRI abdomen and pelvis
  • No ionizing radiation
  • Reliably detects hydronephrosis
  • Accurately localizes the site of ureteral obstruction for treatment planning
  • Very low sensitivity as stones are nearly invisible
  • Inaccurate stone size measurements for treatment planning
  • Requires patient lie still in enclosed scanner for 10 to 20 minutes
Intravenous pyelography (IVP)
  • Reliably detects hydronephrosis
  • Accurate stone size measurements and ureteral localization for treatment planning
  • Diagnostic performance not quantified; less accurate than CT
  • Ionizing radiation; effective dose 3 mSv
  • Intravenous contrast required
CT: computed tomography; MRI: magnetic resonance imaging.
* To distinguish ureteral stones from phleboliths.
References:
  1. Fowler KA, Locken JA, Duchesne JH, Williamson MR. US for detecting renal calculi with nonenhanced CT as a reference standard. Radiology 2002; 222:109.
  2. Ulusan S, Koc Z, Tokmak N. Accuracy of sonography for detecting renal stone: Comparison with CT. J Clin Ultrasound 2007; 35:256.
  3. Niemann T, Kollmann T, Bongartz G. Diagnostic performance of low-dose CT for the detection of urolithiasis: a meta-analysis. AJR Am J Roentgenol 2008;191:396.
  4. Jung SI, Kim YJ, Park HS, et al. Sensitivity of digital abdominal radiography for the detection of ureter stones by stone size and location. J Comput Assist Tomogr 2010; 34:879.
  5. Levine JA, Neitlich J, Verga M, et al. Ureteral calculi in patients with flank pain: correlation of plain radiography with unenhanced helical CT. Radiology 1997; 204:27.
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