Coursey Courtney A, Casalino David D, Remer Erick M, Arellano Ronald S, Bishoff Jay T, Dighe Manjiri, Fulgham Pat, Goldfarb Stanley, Israel Gary M, Lazarus Elizabeth, Leyendecker John R, Majd Massoud, Nikolaidis Paul, Papanicolaou Nicholas, Prasad Srinivasa, Ramchandani Parvati, Sheth Sheila, Vikram Raghunandan
Department of Radiology, Emory University Hospital, 1364 Clifton Rd. NE, Atlanta, GA 30322, USA.
Ultrasound Q. 2012 Sep;28(3):227-33. doi: 10.1097/RUQ.0b013e3182625974.
Low dose (<3 mSv) noncontrast CT (NCCT) is the imaging study of choice for accurate evaluation of patients with acute onset of flank pain and suspicion of stone disease (sensitivity 97%, specificity 95%). NCCT can reliably characterize the location and size of an offending ureteral calculus, identify complications, and diagnose alternative etiologies of abdominal pain such as appendicitis. By comparison, the sensitivity of radiographs (59%) and ultrasound (24-57%) for the detection of renal and ureteral calculi is relatively poor. Ultrasound can accurately diagnose pelvicaliectasis and ureterectasis, but it may take several hours for these findings to develop. In the pregnant patient, however, ultrasound is a first line test as it does not expose the fetus to ionizing radiation. MR is an accurate test for the diagnosis of pelvicaliectasis and ureterectasis, but is less sensitive than CT for the diagnosis of renal and ureteral calculi. For patients with known stone disease whose stones are visible on radiographs, radiographs are a good tool for post-treatment follow-up.The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed every two years by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of current medical literature from peer reviewed journals and the application of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures by the panel. In those instances where evidence is lacking or not definitive, expert opinion may be used to recommend imaging or treatment.
低剂量（<3 mSv）非增强CT（NCCT）是对急性侧腹痛且怀疑有结石病患者进行准确评估的首选影像学检查（敏感性97%，特异性95%）。NCCT能够可靠地确定引起症状的输尿管结石的位置和大小，识别并发症，并诊断腹痛的其他病因，如阑尾炎。相比之下，X线平片（59%）和超声（24 - 57%）检测肾和输尿管结石的敏感性相对较差。超声能够准确诊断肾盂扩张和输尿管扩张，但这些表现可能需要数小时才会出现。然而，对于孕妇，超声是一线检查方法，因为它不会使胎儿暴露于电离辐射。磁共振成像（MR）是诊断肾盂扩张和输尿管扩张的准确检查方法，但在诊断肾和输尿管结石方面不如CT敏感。对于已知患有结石病且结石在X线平片上可见的患者，X线平片是治疗后随访的良好工具。美国放射学会适宜性标准是针对特定临床情况的循证指南，由多学科专家小组每两年进行一次审查。指南的制定和审查包括对同行评审期刊上当前医学文献的广泛分析，以及应用成熟的共识方法（改良德尔菲法）由专家小组对成像和治疗程序的适宜性进行评分。在缺乏证据或证据不明确的情况下，可能会采用专家意见来推荐成像或治疗方法。
