Institute of Diagnostic Radiology, Department of Medical Radiology, University Hospital of Zurich, and Biostatistics Unit, Institute of Social and Preventive Medicine, University of Zurich, Raemistrasse 100, 8006 Zurich, Switzerland.
Eur J Radiol. 2012 Mar;81(3):417-22. doi: 10.1016/j.ejrad.2010.12.054. Epub 2011 Jan 15.
To compare the impact of unenhanced and contrast-enhanced multi-detector computed tomography (MDCT) for the detection of urinary stones and urinary obstruction in patients with suspected renal colic.
95 patients with suspected renal colic underwent a three-phase MDCT for evaluation of the urinary tract. The unenhanced scan and the multiphase examination were reviewed retrospectively by two radiologists for the characterization of urinary stones and signs of obstruction. Results of unenhanced MDCT were compared with those obtained during the second review of the entire multiphase examination.
Overall diagnosis of urinary stones revealed an accuracy of 97.0% for unenhanced, and 98.9% for multiphase MDCT with a significant difference between both protocols (mixed-effects logistic regression: odds ratio 3.3; p=0.019). With 3 versus 15 false positive ratings, multiphase MDCT was superior to unenhanced MDCT for the diagnosis of urinary stones. There was no significant difference in detecting signs of obstruction. Inter-reader agreement for overall stone detection was excellent on both unenhanced (kappa 0.84) and multiphase (kappa 0.88) MDCT.
Contrast-enhanced multiphase MDCT offers distinct advantages compared to an unenhanced approach for the assessment of urinary stone disease, and therefore should be considered as a complementary examination for patients with inconclusive findings.
比较平扫与增强多排螺旋 CT（MDCT）在疑似肾绞痛患者中对尿路结石和尿路梗阻的检出效果。
95 例疑似肾绞痛患者行三期 MDCT 尿路成像检查。两位放射科医生回顾性地分析平扫和多期增强 MDCT 扫描图像，以对尿路结石和梗阻征象进行特征描述。平扫 MDCT 结果与多期增强 MDCT 第二次综合评估结果进行比较。
平扫和多期增强 MDCT 对尿路结石的总体诊断准确率分别为 97.0%和 98.9%，两种方法间存在显著差异（混合效应逻辑回归：比值比 3.3；p=0.019）。平扫组有 3 例误诊，而多期增强组无误诊，多期增强 MDCT 诊断尿路结石的准确率优于平扫组。两种方法对梗阻征象的检出率无显著差异。平扫和多期增强 MDCT 对尿路结石的总体检出率的两位阅片者间一致性极好（平扫：kappa 值 0.84；多期增强：kappa 值 0.88）。
与平扫相比，增强多期 MDCT 对尿路结石病的评估具有明显优势，因此对于疑似病例，应将其作为补充检查手段。
