超声联合X线摄影对急性腰痛患者输尿管梗阻性结石的诊断是否足够？
Is Combined Ultrasound with Radiography Sufficient for the Diagnosis of Obstructive Ureteric Stone in Patients with Acute Flank Pain?
作者信息
Thungkatikajonkit Pornprom, Wongwaisayawan Sirote, Wibulpolprasert Arrug, Viseshsindh Wit, Kaewlai Rathachai
机构信息
Department of Diagnostic and Therapeutic Radiology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
Department of Emergency Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
出版信息
J Med Ultrasound. 2019 Dec 10;28(2):86-91. doi: 10.4103/JMU.JMU_49_19. eCollection 2020 Apr-Jun.
CONTEXT
Ultrasound (US) is excellent for detection of hydronephrosis but has poor sensitivity for stone detection. In contrast, radiography of the kidney-ureter-bladder has better sensitivity for detection of stone but limited sensitivity for hydronephrosis detection. A combination of these two modalities may improve both sensitivity and specificity for the diagnosis of obstructive ureteric stone.
AIMS
This study aims to investigate the diagnostic accuracy of combined US with radiography for the diagnosis of obstructive ureteric stone in adult patients.
SETTINGS AND DESIGN
Retrospective study with retrospective data collection performed in a 1500-bed university hospital.
MATERIALS AND METHODS
A total of 90 patients were included. The electronic medical record, radiological reports, laboratory results, and patient management were extracted and analyzed.
STATISTICAL ANALYSIS USED
The diagnostic performance of US, radiography, and combined US with radiography were calculated and compared. The computed tomography was used as diagnostic reference.
RESULTS
US alone had a sensitivity of 73.5%, specificity of 92.7%, and negative predictive value (NPV) of 74.5% for hydronephrosis. When US showed both ureteric stone and hydronephrosis, sensitivity dropped to 14.3% but specificity increased to 100%. Radiography alone had a sensitivity of 34.7%, specificity of 100%, and NPV of 56.2% for the detection of ureteric stone. Combining radiography with US raised the sensitivity for diagnosis of obstructive ureteric stone to 88% with a specificity of 93% and accuracy of 90%.
CONCLUSIONS
Combined US with radiography was accurate for the diagnosis of obstructive ureteric stone in patients presenting with acute flank pain.
背景
超声（US）对检测肾积水效果极佳，但对结石检测的敏感性较差。相比之下，泌尿系统平片对结石检测的敏感性较好，但对肾积水检测的敏感性有限。这两种检查方式相结合可能会提高诊断输尿管梗阻性结石的敏感性和特异性。
目的
本研究旨在探讨超声联合泌尿系统平片对成年患者输尿管梗阻性结石的诊断准确性。
设置与设计
在一家拥有1500张床位的大学医院进行回顾性研究并收集回顾性数据。
材料与方法
共纳入90例患者。提取并分析电子病历、放射学报告、实验室检查结果及患者管理情况。
所用统计分析方法
计算并比较超声、泌尿系统平片以及超声联合泌尿系统平片的诊断性能。以计算机断层扫描作为诊断参考。
结果
单独超声检查对肾积水的敏感性为73.5%，特异性为92.7%，阴性预测值（NPV）为74.5%。当超声显示输尿管结石和肾积水时，敏感性降至14.3%，但特异性增至100%。单独泌尿系统平片对输尿管结石检测的敏感性为34.7%，特异性为100%，NPV为56.2%。超声与泌尿系统平片相结合将输尿管梗阻性结石的诊断敏感性提高至88%，特异性为93%，准确性为90%。
结论
超声联合泌尿系统平片对表现为急性腰腹痛的患者诊断输尿管梗阻性结石准确。
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