Vieweg J, Teh C, Freed K, Leder R A, Smith R H, Nelson R H, Preminger G M
Department of Urology, The Comprehensive Kidney Stone Center, Duke University Medical Center, Durham, North Carolina 27710, USA.
J Urol. 1998 Sep;160(3 Pt 1):679-84. doi: 10.1016/S0022-5347(01)62754-X.
We determined the value of unenhanced helical computerized tomography (CT) in the diagnosis of acute flank pain in 105 patients evaluated for suspected stone disease.
Noncontrasted spiral CT was done in 105 consecutive patients seen in our emergency department to evaluate acute flank pain. All CT studies were reviewed for the presence of ureteral or renal calculi, perinephric or periureteral stranding, presence and degree of pelvicalicectasis or other radiological findings. If necessary, an excretory urogram was performed to confirm the presence or absence of urinary stones. Patients were followed to determine clinical outcome including the need for urological intervention.
Of the 49 patients determined to have stones 24 (49%) had spontaneous stone passage, 10 (20%) had improved symptoms without documented stone passage and 14 (29%) required surgical intervention. In 29 of 51 patients (57%) with negative CT readings for stone disease a diagnosis was established by other intra-abdominal findings. In 21 patients (41%) no clinical diagnosis could be established, and 1 scan in a patient with a distal ureteral calculus was interpreted as falsely positive. These findings yielded a sensitivity of 98%, specificity 98% and overall accuracy 96% for diagnosing ureteral stones.
Despite the limitations of helical CT in evaluating renal function and nonobstructing ureteral calculi, noncontrasted CT is a sensitive imaging modality for the detection of urinary tract calculi and obstruction. The majority of our patients required no further imaging to determine the need for urological intervention. At our institution spiral CT has become the standard method to evaluate patients with acute flank pain leading to more rapid turnover in the emergency department at similar or even reduced cost to conventional excretory urography.
我们确定了非增强螺旋计算机断层扫描（CT）在诊断105例疑似结石病的急性腰痛患者中的价值。
对我院急诊科连续就诊的105例急性腰痛患者进行了非增强螺旋CT检查，以评估病情。所有CT检查均复查是否存在输尿管或肾结石、肾周或输尿管周围条索状阴影、肾盂肾盏扩张的情况及程度或其他影像学表现。必要时，进行排泄性尿路造影以确认是否存在尿路结石。对患者进行随访以确定临床结果，包括是否需要泌尿外科干预。
在确诊为结石的49例患者中，24例（49%）结石自然排出，10例（20%）症状改善但未记录结石排出情况，14例（29%）需要手术干预。在51例结石病CT检查结果为阴性的患者中，29例（57%）通过其他腹部检查结果确诊。21例（41%）无法确立临床诊断，1例输尿管远端结石患者的扫描结果被误诊为假阳性。这些结果显示，诊断输尿管结石的敏感性为98%，特异性为98%，总体准确率为96%。
尽管螺旋CT在评估肾功能和非梗阻性输尿管结石方面存在局限性，但非增强CT是检测尿路结石和梗阻的一种敏感的成像方式。我们的大多数患者无需进一步影像学检查即可确定是否需要泌尿外科干预。在我院，螺旋CT已成为评估急性腰痛患者的标准方法，这使得急诊科的周转更快，费用与传统排泄性尿路造影相似甚至更低。
