Department of Urology, Uro-Oncology, Robot Assisted and Reconstructive Urologic Surgery, University Hospital Cologne, Cologne.
Department of Urology and Uro-Oncology, Federal Armed Services Hospital Koblenz, Koblenz.
Curr Opin Urol. 2019 Mar;29(2):81-88. doi: 10.1097/MOU.0000000000000572.
Radiological imaging techniques are a fast developing field in medicine. Therefore, the purpose of this review was to identify and discuss the latest changes of modern imaging techniques in the management of urinary stone disease.
The introduction of iterative image reconstruction enables low-dose and ultra-low-dose (ULD) protocols. Although current guidelines recommend their utilization in nonobese patients recent studies indicate that low-dose imaging may be feasible in obese (<30 kg/m) but not in bariatric patients. Use of dual energy computed tomography (CT) technologies should balance between additional information and radiation dose aspects. If available on a dose neutral basis, dual energy imaging and analysis should be performed. Current guidelines recommend measuring the largest diameter for clinical decision making; however, recent studies suggest a benefit from measuring the volume based on multiplanar reformation. Quantitative imaging is still an experimental approach.
The use of low-dose and even ULD CT protocols should be diagnostic standard, even in obese patients. If dual energy imaging is available, it should be limited to specific clinical questions. The stone volume should be reported in addition to the largest diameter for treatment decision and a more valid comparability of upcoming studies.
放射影像学技术是医学领域中快速发展的领域。因此，本综述的目的是确定并讨论现代影像学技术在尿路结石病管理中的最新变化。
迭代图像重建的引入使低剂量和超低剂量（ULD）方案成为可能。尽管目前的指南建议在非肥胖患者中使用，但最近的研究表明，低剂量成像在肥胖（<30kg/m）患者中可能是可行的，但在肥胖患者中不可行。双能 CT 技术的应用应在增加信息量和辐射剂量方面取得平衡。如果在剂量中性的基础上可用，则应进行双能成像和分析。目前的指南建议基于最大直径进行临床决策，但最近的研究表明基于多平面重建测量体积有获益。定量成像仍然是一种实验方法。
即使在肥胖患者中，低剂量甚至 ULD CT 方案的使用也应成为诊断标准。如果有双能成像，则应将其限于特定的临床问题。除了最大直径外，还应报告结石体积，以便做出治疗决策，并提高未来研究的可比性。
