Journal of the Chinese Medical Association
Volume 71, Issue 1 , Pages 30-36, January 2008

Prospective Comparison of Unenhanced Spiral Computed Tomography and Intravenous Urography in the Evaluation of Acute Renal Colic

  • Jia-Hwia Wang

      Affiliations

    • Department of Radiology, Taipei Veterans General Hospital, Taipei
    • National Yang-Ming University School of Medicine, Taipei
    • ,
  • Shu-Huei Shen

      Affiliations

    • Department of Radiology, Taipei Veterans General Hospital, Taipei
    • National Yang-Ming University School of Medicine, Taipei
    • Corresponding Author InformationCorrespondence to: Dr Shu-Huei Shen, Department of Radiology, Taipei Veterans General Hospital, 201, Section 2, Shih-Pai Road, Taipei 112, Taiwan, R.O.C
    • ,
  • Shan-Su Huang

      Affiliations

    • Department of Radiology, Taipei Veterans General Hospital, Taipei
    • Department of Radiological Technology, Yuan-Pei University of Science and Technology, Hsinchu, Taiwan, R.O.C.
    • ,
  • Cheng-Yen Chang

      Affiliations

    • Department of Radiology, Taipei Veterans General Hospital, Taipei
    • National Yang-Ming University School of Medicine, Taipei

Received 9 May 2007; accepted 29 October 2007.

Article Outline

Background

The purpose of this prospective study was to evaluate the feasibility of replacing intravenous urography (IVU) with unenhanced computed tomography (CT) as the first line diagnostic modality for acute renal colic in the emergency department.

Methods

In the 1-year study period, 82 patients who presented themselves to the emergency room with acute renal colic and who were suspected to have ureteral stones were included. They received both IVU and unenhanced CT on the same day.

Results

Sixty-six patients were proven to have ureteral stone. Four had other urologic pathology (acute pyelonephritis, angiomyolipoma with hemorrhage, ureteropelvic junction stenosis). The remaining 12 had no definite urologic problem. Among the 66 patients with ureteral stone, the sensitivity for detecting ureteral stone was 98.5% for unenhanced CT and 59.1% for IVU. Correct diagnosis could be obtained in most of the patients receiving unenhanced CT, while IVU could provide only limited information about the intra-abdominal pathology other than urologic system, and as many as 31.7% of the patients needed further imaging examination (sonography, CT, magnetic resonance imaging). In 5 patients, the relationship of the calcified spot and ureter were unclear on axial images. With curved multiplanar reformatted reconstruction, the diagnosis of ureter stone could be confidently made. No side effect (renal toxicity, allergic reaction) from intravenous administration of iodine-containing contrast medium should be taken into consideration in CT. Besides, the average examination time was 108 minutes for IVU, which was significantly more than the 30 minutes for CT, including the time for curved multiplanar reformatted reconstruction.

Conclusion

We consider that unenhanced CT is more effective and efficient than IVU and should replace IVU as the first-line diagnostic tool for ureteral stone in the emergency department.

Key Words:  computed tomography , intravenous urography , ureteral stone

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References 

  1. Handrigan MT , Thompson I , Foster M . Diagnostic procedures for the urogenital system . Emerg Med Clin North Am . 2001;19:745–761
  2. Miller OF, Rineer SK, Reichard SR, Buckley RG, Donovan MS, Graham IR, et al  Prospective comparison of unenhanced spiral computed tomography and intravenous urogram in the evaluation of acute flank pain . Urology . 1998;52:982–987
  3. Heneghan JP , Kim DH , Leder RA , DeLong D , Nelson RC . Compression CT urography: a comparison with IVU in the opacification of the collecting system and ureters . J Comput Assist Tomogr . 2001;25:343–347
  4. Niall O , Russell J , MacGregor R , Duncan H , Mullins J . A comparison of noncontrast computerized tomography with excretory urography in the assessment of acute flank pain . J Urol . 1999;161:534–537
  5. Van Beers BE , Dechambre S , Hulcelle P , Materne R , Jamart J . Value of multislice helical CT scans and maximum-intensity-projection images to improve detection of ureteral stones at abdominal radiography . AJR Am J Roentgenol . 2001;177:1117–1121
  6. McNicholas MM, Raptopoulos VD, Schwartz RK, Sheiman RG, Zormpala A, Prassopoulos PK, et al  Excretory phase CT urography for opacification of the urinary collecting system . AJR Am J Roentgenol . 1998;170:1261–1267
  7. Perlman ES , Rosenfield AT , Wexler JS , Glickman MG . CT urography in the evaluation of urinary tract disease . J Comput Assist Tomogr . 1996;20:620–626
  8. Mostafavi MR , Ernst RD , Saltzman B . Accurate determination of chemical composition of urinary calculi by spiral computerized tomography . J Urol . 1998;159:673–675
  9. Lin WC , Wang JH , Wei CJ , Chang CY . Assessment of CT urography in the diagnosis of urinary tract abnormalities . J Chin Med Assoc . 2004;67:73–78
  10. Lang EK, Macchia RJ, Thomas R, Watson RA, Marberger M, Lechner G, et al  Improved detection of renal pathologic features on multiphasic helical CT compared with IVU in patients presenting with microscopic hematuria . Urology . 2003;61:528–532
  11. Etemad A , Brems-Dalgaard E , Thomsen HS . Outcome of intravenous urography in the year 2000 . Abdom Imaging . 2003;28:226–229

PII: S1726-4901(08)70069-8

doi:10.1016/S1726-4901(08)70069-8

Journal of the Chinese Medical Association
Volume 71, Issue 1 , Pages 30-36, January 2008

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