Halachmi Sarel, Ghersin Eduard, Ginesin Yeoshua, Meretyk Shimon
Department of Urology, Rambam Medical Center, Haifa, Israel.
J Endourol. 2007 May;21(5):473-7. doi: 10.1089/end.2006.0364.
In patients with a percutaneous nephrostomy tube (PCN) inserted for symptomatic stone disease, antegrade pyelography is an accepted modality to assess the collecting system and residual stone status prior to PCN removal. Recently, unenhanced multidetector CT (UMDCT) has shown its superiority for the assessment of urinary-tract stones. Comparison of UMDCT with antegrade pyelography has never been done; hence, our aim was to compare the two methods for the assessment of urinary stones in patients with a PCN.
Between July 2004 and July 2005, we prospectively imaged 49 consecutive patients with known urinary-tract stone disease who had PCN (27 men and 22 women; average age 57 +/- 20 years; range 4-88 years). All patients underwent UMDCT and antegrade pyelography within 24 hours. Both examinations were prospectively and blindly evaluated by two attending radiologists for the presence, location, and size of urinary-tract stones.
According to the findings of both imaging modalities, 18 patients were stone free, and 31 patients had urinary stones. In 20 of the latter 31 patients (64.5%), the urinary stones were diagnosed only by UMDCT. Antegrade pyelography missed renal as well as ureteral stones, with a significant mean size (5.1 x 6.2 mm, and 6 x 5.3 mm, respectively). Antegrade pyelography missed radiolucent (8/20) as well as radiopaque (12/20) stones. In 11 of the 31 patients (35.5%), urinary stones were diagnosed by both UMDCT and antegrade pyelography. The average size of these renal stones was 6 x 11 mm, and the mean ureteral stone size was 11 x 13 mm. In 64% (7/11), the stones were radiolucent and in 36% (4/11) radiopaque. There was no patient in whom urinary stones were diagnosed by antegrade pyelography but missed by UMDCT.
Unenhanced multidetector CT is more accurate than antegrade pyelography via a PCN for the assessment of urinary-tract stones, with the advantage of reducing the risks of contrast injection side effects.
对于因症状性结石病而插入经皮肾造瘘管（PCN）的患者，顺行肾盂造影是一种公认的在拔除PCN之前评估集合系统和残余结石状态的方法。最近，非增强多层螺旋CT（UMDCT）已显示出其在评估尿路结石方面的优势。UMDCT与顺行肾盂造影的比较尚未进行；因此，我们的目的是比较这两种方法在评估有PCN的患者尿路结石方面的效果。
在2004年7月至2005年7月期间，我们对49例已知患有尿路结石病且有PCN的患者进行了前瞻性成像（27例男性和22例女性；平均年龄57±20岁；范围4 - 88岁）。所有患者在24小时内接受了UMDCT和顺行肾盂造影检查。两位主治放射科医生对这两项检查进行了前瞻性和盲法评估，以确定尿路结石的存在、位置和大小。
根据两种成像方式的结果，18例患者无结石，31例患者有尿路结石。在这31例患者中的20例（64.5%），尿路结石仅通过UMDCT被诊断出来。顺行肾盂造影漏诊了肾内和输尿管结石，这些结石的平均大小分别为5.1×6.2毫米和6×5.3毫米。顺行肾盂造影漏诊了透光性结石（8/20）以及不透光性结石（12/20）。在31例患者中的11例（35.5%），尿路结石通过UMDCT和顺行肾盂造影均被诊断出来。这些肾结石的平均大小为6×11毫米，输尿管结石的平均大小为11×13毫米。在64%（7/11）的病例中，结石为透光性，在36%（4/11）的病例中为不透光性。没有患者其尿路结石通过顺行肾盂造影被诊断出来但被UMDCT漏诊。
对于评估尿路结石，非增强多层螺旋CT比通过PCN进行的顺行肾盂造影更准确，具有降低造影剂注射副作用风险的优势。
