Pfister S A, Deckart A, Laschke S, Dellas S, Otto U, Buitrago C, Roth J, Wiesner W, Bongartz G, Gasser T C
Department of Radiology, University Hospital, Petersgraben 4, 4031, Basel, Switzerland.
Eur Radiol. 2003 Nov;13(11):2513-20. doi: 10.1007/s00330-003-1937-1. Epub 2003 Jul 24.
Unenhanced helical computed tomography (UHCT) has evolved into a well-accepted alternative to intravenous urography (IVU) in patients with acute flank pain and suspected ureterolithiasis. The purpose of our randomized prospective study was to analyse the diagnostic accuracy of UHCT vs IVU in the normal clinical setting with special interest on economic impact, applied radiation dose and time savings in patient management. A total of 122 consecutive patients with acute flank pain suggestive of urolithiasis were randomized for UHCT ( n=59) or IVU ( n=63). Patient management (time, contrast media), costs and radiation dose were analysed. The films were independently interpreted by four radiologists, unaware of previous findings, clinical history and clinical outcome. Alternative diagnoses if present were assessed. Direct costs of UHCT and IVU are nearly identical (310/309 Euro). Indirect costs are much lower for UHCT because it saves examination time and when performed immediately initial abdominal plain film (KUB) and sonography are not necessary. Time delay between access to the emergency room and start of the imaging procedure was 32 h 7 min for UHCT and 36 h 55 min for IVU. The UHCT took an average in-room time of 23 min vs 1 h 21 min for IVU. Mild to moderate adverse reactions for contrast material were seen in 3 (5%) patients. The UHCT was safe, as no contrast material was needed. The mean applied radiation dose was 3.3 mSv for IVU and 6.5 mSv for UHCT. Alternative diagnoses were identified in 4 (7%) UHCT patients and 3 (5%) IVU patients. Sensitivity and specificity of UHCT and IVU was 94.1 and 94.2%, and 85.2 and 90.4%, respectively. In patients with suspected renal colic KUB and US may be the least expensive and most easily accessable modalities; however, if needed and available, UHCT can be considered a better alternative than IVU because it has a higher diagnostic accuracy and a better economic impact since it is more effective, faster, less expensive and less risky than IVU. In addition, it also has the capability of detecting various additional renal and extrarenal pathologies.
在患有急性腰痛且怀疑输尿管结石的患者中，非增强螺旋计算机断层扫描（UHCT）已发展成为静脉肾盂造影（IVU）广泛接受的替代方法。我们这项随机前瞻性研究的目的是分析在正常临床环境中UHCT与IVU的诊断准确性，特别关注经济影响、应用的辐射剂量以及患者管理中的时间节省情况。共有122例连续的提示尿路结石的急性腰痛患者被随机分为UHCT组（n = 59）或IVU组（n = 63）。分析了患者管理（时间、造影剂）、成本和辐射剂量。这些片子由四位放射科医生独立解读，他们不知道先前的检查结果、临床病史和临床结局。评估了是否存在其他诊断。UHCT和IVU的直接成本几乎相同（310/309欧元）。UHCT的间接成本要低得多，因为它节省了检查时间，并且在立即进行检查时无需进行初步腹部平片（KUB）和超声检查。从进入急诊室到开始成像检查的时间延迟，UHCT为32小时7分钟，IVU为36小时55分钟。UHCT的平均室内检查时间为23分钟，而IVU为1小时21分钟。3例（5%）患者出现了轻度至中度的造影剂不良反应。UHCT是安全的，因为不需要造影剂。IVU的平均应用辐射剂量为3.3 mSv，UHCT为6.5 mSv。4例（7%）UHCT患者和3例（5%）IVU患者发现了其他诊断。UHCT和IVU的敏感性和特异性分别为94.1%和94.2%，以及85.2%和90.4%。在疑似肾绞痛的患者中KUB和超声检查可能是最便宜且最容易获得的检查方式；然而，如果有需要且可行，UHCT可以被认为是比IVU更好的选择，因为它具有更高的诊断准确性和更好的经济影响，因为它比IVU更有效、更快、更便宜且风险更小。此外，它还能够检测各种其他肾脏和肾外病变。
