Dalrymple N C, Verga M, Anderson K R, Bove P, Covey A M, Rosenfield A T, Smith R C
Department of Diagnostic Radiology, Yale University School of Medicine, New Haven, Connecticut, USA.
J Urol. 1998 Mar;159(3):735-40.
We developed an algorithm using unenhanced computerized tomography (CT) for the management of acute flank pain and suspected ureteral obstruction.
During a 25-month interval 417 patients with acute flank pain underwent unenhanced helical CT. The final diagnosis was confirmed by additional imaging or clinical followup. For all patients who underwent additional imaging studies the official dictated radiology reports were used to determine whether the studies were recommended based on CT findings. Cases requiring intervention were evaluated to determine whether additional imaging was performed before the procedure. Medical records were reviewed and/or patients were interviewed to document the course of therapy and long-term outcome.
Unenhanced helical CT diagnosed ureteral stone disease with 95% sensitivity, 98% specificity and 97% accuracy. Of the 38 patients requiring intervention, including nephrostomy catheters in 18, lithotripsy in 3 and ureteroscopic stone extraction in 7, additional imaging (excretory urography) was performed in only 1. Additional imaging studies generated by CT were done in 3 cases in which the dictated reports were indeterminate for ureteral stones, including negative excretory urography in 2 and retrograde urography in 1. In 1 patient in whom CT misdiagnosed a ureteral stone unnecessary retrograde urography revealed the calcification to be a gonadal vein phlebolith. Seven patients with false-negative examinations reported spontaneous stone passage with no complications.
Unenhanced helical CT accurately determines the presence or absence of ureterolithiasis in patients with acute flank pain. CT precisely identifies stone size and location. When ureterolithiasis is absent, other causes of acute flank pain can be identified. In most cases additional imaging is not required.
我们开发了一种利用非增强计算机断层扫描（CT）来管理急性胁腹痛和疑似输尿管梗阻的算法。
在25个月的时间里，417例急性胁腹痛患者接受了非增强螺旋CT检查。最终诊断通过额外的影像学检查或临床随访得以证实。对于所有接受额外影像学检查的患者，使用官方记录的放射学报告来确定这些检查是否基于CT结果而被推荐。对需要干预的病例进行评估，以确定在手术前是否进行了额外的影像学检查。查阅病历和/或对患者进行访谈，以记录治疗过程和长期结果。
非增强螺旋CT诊断输尿管结石病的敏感性为95%，特异性为98%，准确性为97%。在38例需要干预的患者中，包括18例放置肾造瘘管、3例进行碎石术和7例进行输尿管镜取石术，只有1例进行了额外的影像学检查（排泄性尿路造影）。在3例CT检查结果对输尿管结石诊断不明确的病例中进行了由CT引发的额外影像学检查，其中2例排泄性尿路造影为阴性，1例为逆行尿路造影。在1例CT误诊为输尿管结石的患者中，不必要的逆行尿路造影显示钙化灶为性腺静脉静脉石。7例检查结果为假阴性的患者报告结石自行排出且无并发症。
非增强螺旋CT能准确判断急性胁腹痛患者是否存在输尿管结石。CT能精确识别结石的大小和位置。当不存在输尿管结石时，可识别急性胁腹痛的其他病因。在大多数情况下，无需进行额外的影像学检查。
