Adel Hatem, Sattar Amjad, Rahim Anila, Aftab Anum, Adil Syed Omair
Radiology, Dow University of Health Sciences, Karachi, PAK.
Epidemiology and Public Health, Dow University of Health Sciences, Karachi, PAK.
Cureus. 2019 Sep 13;11(9):e5647. doi: 10.7759/cureus.5647.
Introduction Flank pain is a frequent cause of emergency department visits and is often due to renal or ureteric colic. Ultrasound is often the initial imaging study used for the detection of urinary tract calculi. Twinkling artifact is a Doppler artifact usually seen on echogenic rough surfaces such as calculi. Its presence can improve the sensitivity and specificity of ultrasound in stone detection. The objective of the current study was to determine the diagnostic accuracy of the Doppler twinkling artifact for detecting urinary calculi using non-contrast computed tomography as the gold standard. Materials and methods In this cross-sectional study, both male and female patients of any age having flank pain, burning micturition with or without hematuria were included. Ultrasound was performed and the presence or absence of Doppler twinkling artifact on calculus was noted. Following ultrasound, patients underwent plain CT scan and findings of stones were documented. Sensitivity, specificity, positive and negative predictive values, and diagnostic accuracy of Doppler twinkling artifact was calculated considering CT findings as the gold standard. Results Out of the total 221 patients, 146 (66.1%) were males and 75 (33.9%) were females. The mean age of the patients was 45.98 ± 16.30 years. Urinary tract calculi on ultrasound were observed in 74 (33.50%) patients, while on CT urinary tract calculi were observed in 127 (57.50%) patients. Diagnostic accuracy of Doppler twinkling artifact was found to be 71.49% with sensitivity, specificity, positive predictive value, and negative predictive value of 54.33%, 94.68%, 93.24%, and 60.54%, respectively. Conclusion Doppler twinkling artifact has low sensitivity, high specificity, and suboptimal diagnostic accuracy for the diagnosis of urinary tract calculi. Integration of this artifact has a lower sensitivity as compared to non-contrast CT scan. Multicentric studies with larger sample size and focusing on interobserver and intraobserver variability are recommended to have a consensus regarding Doppler twinkling artifact in the evaluation of renal and ureteric calculi.
引言
胁腹痛是急诊科就诊的常见原因，通常由肾绞痛或输尿管绞痛引起。超声常常是用于检测尿路结石的初始影像学检查。闪烁伪像是一种通常在诸如结石等回声粗糙表面上可见的多普勒伪像。它的存在可以提高超声检测结石的敏感性和特异性。本研究的目的是以非增强计算机断层扫描作为金标准，确定多普勒闪烁伪像检测尿路结石的诊断准确性。
材料与方法
在这项横断面研究中，纳入了任何年龄、有胁腹痛、伴有或不伴有血尿的灼痛性排尿的男性和女性患者。进行超声检查，并记录结石上多普勒闪烁伪像的有无。超声检查后，患者接受平扫CT扫描，并记录结石的检查结果。以CT检查结果作为金标准，计算多普勒闪烁伪像的敏感性、特异性、阳性和阴性预测值以及诊断准确性。
结果
在总共221例患者中，男性146例（66.1%），女性75例（33.9%）。患者的平均年龄为45.98±16.30岁。超声检查发现74例（33.50%）患者有尿路结石，而CT检查发现127例（57.50%）患者有尿路结石。发现多普勒闪烁伪像的诊断准确性为71.49%，其敏感性、特异性、阳性预测值和阴性预测值分别为54.33%、94.68%、93.24%和60.54%。
结论
多普勒闪烁伪像对尿路结石诊断的敏感性低、特异性高且诊断准确性欠佳。与非增强CT扫描相比，整合这种伪像的敏感性较低。建议开展样本量更大、关注观察者间和观察者内变异性的多中心研究，以便就多普勒闪烁伪像在肾和输尿管结石评估中的应用达成共识。
