Shokeir A A, Abdulmaaboud M
Urology and Nephrology Center, Mansoura University, Mansoura, Egypt.
J Urol. 2001 Apr;165(4):1082-4.
We evaluate the accuracy of nonenhanced helical computerized tomography (CT) and Doppler ultrasonography for the diagnosis of renal colic.
Our study includes 109 patients, with 218 kidneys, who presented with unilateral flank pain. All patients underwent nonenhanced helical CT, Doppler ultrasonography and excretory urography (IVP). CT was evaluated for the presence of ureteral stones and manifestation of ureteral obstruction. For Doppler ultrasonography the renal resistive index was measured for the left and right kidneys in each patient, and change in resistive index between ipsilateral and contralateral kidneys was calculated and considered positive for ureteral obstruction with values 0.04 or greater. As a reference standard, absence of obstruction was considered if IVP was negative and the cause of flank pain was confirmed not to be urological. Obstruction was diagnosed not only by positive IVP, but also by patient followup until passage or retrieval of ureteral stones. Results of CT and change in resistive index were compared with those of the reference standard.
Unilateral ureteral obstruction was confirmed in 52 patients, while no obstruction was found in 57. Of the 57 patients without ureterolithiasis the change in resistive index results was negative in all patients with a specificity of 100%, while CT was negative in 55 with a specificity of 96%. Of the 52 patients with ureteral obstruction CT was positive in 50, and change in resistive index was positive in 47 with a sensitivity of 96% and 90%, respectively, with a difference of no significant value.
Nonenhanced helical CT and change in resistive index are sensitive and specific tests that can contribute significantly to the diagnosis of acute unilateral renal obstruction. They can replace IVP, particularly in situations in which it is undesirable.
我们评估非增强螺旋计算机断层扫描（CT）和多普勒超声检查对肾绞痛诊断的准确性。
我们的研究纳入了109例患者，共218个肾脏，均表现为单侧胁腹疼痛。所有患者均接受了非增强螺旋CT、多普勒超声检查和排泄性尿路造影（IVP）。评估CT检查输尿管结石的存在情况及输尿管梗阻的表现。对于多普勒超声检查，测量每位患者左右肾的肾阻力指数，并计算同侧和对侧肾脏阻力指数的变化，阻力指数变化值≥0.04则认为输尿管梗阻为阳性。作为参考标准，如果IVP为阴性且胁腹疼痛原因经证实并非泌尿系统问题，则认为无梗阻。不仅通过IVP阳性诊断梗阻，还通过对患者进行随访直至输尿管结石排出或取出。将CT结果和阻力指数变化与参考标准进行比较。
52例患者确诊为单侧输尿管梗阻，57例未发现梗阻。在57例无输尿管结石的患者中，所有患者的阻力指数变化结果均为阴性，特异性为100%，而CT检查55例为阴性，特异性为96%。在52例输尿管梗阻患者中，CT检查50例为阳性，阻力指数变化47例为阳性，敏感性分别为96%和90%，差异无统计学意义。
非增强螺旋CT和阻力指数变化是敏感且特异的检查，对急性单侧肾梗阻的诊断有重要作用。它们可替代IVP，尤其是在不适合进行IVP的情况下。
