Fielding J R, Silverman S G, Samuel S, Zou K H, Loughlin K R
Department of Radiology, Brigham and Women's Hospital, Boston, MA 02115, USA.
AJR Am J Roentgenol. 1998 Oct;171(4):1051-3. doi: 10.2214/ajr.171.4.9762995.
The purpose of this study was to determine whether unenhanced helical CT alone can be used for diagnosis and treatment planning of patients with obstructing ureteral stones.
Medical records of 100 patients with ureteral stones and a clearly discernible clinical outcome who had undergone unenhanced helical CT were reviewed to determine the number of urography procedures and results of excretory urograms performed within 72 hr of helical CT. CT scans were then reviewed by two radiologists for six findings: in-plane stone diameter, z-axis stone diameter, location of stone, periureteral stranding, hydronephrosis, and perinephric fluid. Seventy-one patients passed stones spontaneously, and 29 patients required intervention including basket retrieval, extracorporeal shock-wave lithotripsy, laser lithotripsy, or a combination of the three treatments. Data were analyzed to determine those findings that correlated with the need for intervention.
Five excretory urograms were obtained, all of which agreed with findings revealed by CT. Excretory urography added no information. CT findings of in-plane diameter (p < .001), z -axis diameter (p < .001), and location of stone (p = .003) all significantly correlated with the need for intervention.
Helical CT can be used in place of excretory urography to plan treatment of patients with flank pain caused by obstructing ureteral stones. Stones that are larger than 5 mm, located within the proximal two thirds of the ureter, and seen on two or more consecutive CT images are more likely to require endoscopic removal, lithotripsy, or both.
本研究旨在确定单纯非增强螺旋CT是否可用于输尿管梗阻性结石患者的诊断及治疗规划。
回顾100例接受非增强螺旋CT检查且临床结局清晰可辨的输尿管结石患者的病历，以确定在螺旋CT检查后72小时内进行的尿路造影检查次数及排泄性尿路造影结果。然后由两名放射科医生对CT扫描结果进行评估，观察六项指标：平面内结石直径、z轴结石直径、结石位置、输尿管周围条索状阴影、肾积水及肾周积液。71例患者结石自行排出，29例患者需要干预，包括网篮取石、体外冲击波碎石、激光碎石或三种治疗方法联合使用。对数据进行分析，以确定与干预需求相关的指标。
共获得5份排泄性尿路造影结果，均与CT显示的结果一致。排泄性尿路造影未提供额外信息。平面内直径（p <.001）、z轴直径（p <.001）及结石位置（p =.003）的CT表现均与干预需求显著相关。
螺旋CT可替代排泄性尿路造影用于规划输尿管梗阻性结石所致胁腹疼痛患者的治疗。直径大于5 mm、位于输尿管近端三分之二且在连续两张或更多张CT图像上可见的结石更有可能需要内镜取石、碎石或两者兼用。
