Department of Radiology, Mubarak Al-Kabeer Hospital, Kuwait.
Med Princ Pract. 2010;19(2):118-21. doi: 10.1159/000273072. Epub 2010 Feb 4.
The purpose of this study was to compare unenhanced computed tomography (UECT) to intravenous urography (IVU) for detecting urinary tract calculi, signs of obstruction and non-renal causes in the assessment of acute flank pain, and in their interobserver agreement.
In this prospective study, carried out at a university hospital over a period of 1 year, 36 patients (27 males and 9 females) participated. Mean age was 44 +/- 15 years (range: 14-73 years). The patients presented with acute flank pain and underwent UECT and IVU. The images were blindly evaluated by 2 experienced radiologists and the two techniques compared using the two-tailed McNemar's test for matched pairs; p values <0.05 were considered significant.
UECT detected stones in 11 (30.6%) patients, while IVU found them in only 8 (22.2%). The increased detection by UECT was due to its ability to detect smaller stones (<6 mm). UECT was also found to be better than IVU in determining calculus position, in detecting primary or secondary signs of obstruction and in identifying non-urinary causes of flank pain. The overall average of agreement, as indicated by kappa values, was 0.88 for UECT and 0.61 for IVU.
UECT showed better detectability and interobserver agreement tan IVU, suggesting that UECT could replace IVU as the first imaging modality in the evaluation of acute renal colic.
本研究旨在比较尿路平片（IVU）和非增强计算机断层扫描（UECT）在急性腰痛评估中检测尿路结石、梗阻和非肾性病因的能力，并评估它们的观察者间一致性。
在这项前瞻性研究中，在一家大学医院进行了为期 1 年的研究，共有 36 名患者（27 名男性和 9 名女性）参与。平均年龄为 44±15 岁（范围：14-73 岁）。这些患者表现为急性腰痛，接受了 UECT 和 IVU 检查。由 2 名经验丰富的放射科医生对图像进行盲法评估，并使用配对双侧 McNemar 检验比较两种技术；p 值<0.05 被认为具有统计学意义。
UECT 在 11 名（30.6%）患者中检测到结石，而 IVU 仅在 8 名（22.2%）患者中发现结石。UECT 检测到更多结石的原因是其能够检测到更小的结石（<6mm）。UECT 在确定结石位置、检测原发性或继发性梗阻迹象以及识别腰痛的非泌尿道原因方面也优于 IVU。总体平均一致性，由 kappa 值表示，UECT 为 0.88，IVU 为 0.61。
UECT 在检测能力和观察者间一致性方面优于 IVU，表明 UECT 可以替代 IVU 作为急性肾绞痛评估的首选影像学方法。
