Krakhotkin Denis V, Chernylovskyi Volodymyr A, Sarica Kemal, Tsaturyan Arman, Liatsikos Evangelos, Makevicius Jurijus, Iglovikov Nikolay Yu, Pikhovkin Dmitry N
Central District Hospital, Outpatient Clinic, Sadovaya Lane 23, Kamenolomni, Rostov Region, Russia.
Private Urological Practice, Dnipro, Ukraine.
Asian J Urol. 2023 Jan;10(1):39-49. doi: 10.1016/j.ajur.2022.03.015. Epub 2022 Nov 13.
To determine the diagnostic value of ultrasound signs of urinary stones less than or equal to 10 mm and to determine clinico-radiological variants of ureteric colic.
A total of 455 ultrasound investigations were performed in patients referring to emergency department with urolithiasis and symptoms suspected of ureteric colic between January 2021 and May 2021. In addition to microscopic evaluation of urine sediment to detect different crystals and non-contrast spiral computed tomography to detect stones, B-mode and color Doppler sonography was performed to assess the presence of acoustic shadow (AS) and twinkle artifacts (TA) as possible signs of stone(s) in ureter.
While the sensitivity and specificity of AS and TA were higher than 90% in patients with stones greater than 5 mm; positive prognostic values of these parameters were found to be extremely low for stones with sizes of 1-3 mm with specificity and sensitivity values not exceeding 53%. The sensitivity and specificity of AS and TA in the upper and lower ureters were higher for stones greater than or equal to 5 than for compared to those less than 5 mm. At the same time, the diagnostic values of TA and AS for middle ureter stones were very limited. The most prevalent clinico-radiological variants of ureteric colic were types I, III, and V being observed in 39%, 28% and 21% cases, respectively.
Our results demonstrate that TA and AS parameters seem to have a very low sensitivity and specificity in the diagnosis of urinary stones less than 5 mm. The diagnostic value of TA and AS increase significantly in stones greater than or equal to 5 mm. Therefore, clinicians need to be very careful for overestimating the diagnostic values of TA and AS for stones less than 5 mm and non-contrast spiral computed tomography must be the method of choice for patients presenting to emergency department with ureteric colic.
确定直径小于或等于10毫米的尿路结石超声征象的诊断价值，并确定输尿管绞痛的临床放射学变异类型。
2021年1月至2021年5月期间，对因尿石症到急诊科就诊且怀疑有输尿管绞痛症状的患者进行了455次超声检查。除了对尿沉渣进行显微镜检查以检测不同晶体以及进行非增强螺旋计算机断层扫描以检测结石外，还进行了B超和彩色多普勒超声检查，以评估声影（AS）和闪烁伪像（TA）的存在情况，作为输尿管结石的可能征象。
对于直径大于5毫米的结石患者，AS和TA的敏感性和特异性均高于90%；而对于直径为1 - 3毫米的结石，这些参数的阳性预测值极低，特异性和敏感性值均不超过53%。对于直径大于或等于5毫米的结石，AS和TA在输尿管上段和下段的敏感性和特异性高于直径小于5毫米的结石。同时，TA和AS对输尿管中段结石的诊断价值非常有限。输尿管绞痛最常见的临床放射学变异类型为I型、III型和V型，分别见于39%、28%和21%的病例。
我们的结果表明，TA和AS参数在诊断小于5毫米的尿路结石时敏感性和特异性似乎非常低。对于直径大于或等于5毫米的结石，TA和AS的诊断价值显著增加。因此，临床医生在高估TA和AS对小于5毫米结石的诊断价值时需格外谨慎，对于因输尿管绞痛到急诊科就诊的患者，非增强螺旋计算机断层扫描必须是首选方法。
