Miller O F, Rineer S K, Reichard S R, Buckley R G, Donovan M S, Graham I R, Goff W B, Kane C J
Department of Urology, Naval Medical Center San Diego, California 92134-5000, USA.
Urology. 1998 Dec;52(6):982-7. doi: 10.1016/s0090-4295(98)00368-9.
To prospectively compare the diagnostic ability of unenhanced spiral computed tomography (NCCT) and intravenous urogram (IVU) in the evaluation of adults with acute flank pain.
After giving informed consent, 106 adult patients with acute flank pain suspected of having urolithiasis underwent NCCT followed by IVU. Subsequent follow-up was scheduled within 72 hours in the Urology Clinic. Each NCCT was read by a single radiologist who was unaware of clinical history and IVU results. Each IVU was read by a different radiologist who was unaware of clinical history and NCCT results. Sensitivity, specificity, and positive and negative predictive values were determined for NCCT and IVU.
The diagnosis of ureterolithiasis was defined as unequivocal evidence of urolithiasis on either NCCT or IVP. Seventy-five of 106 patients evaluated were diagnosed with ureterolithiasis. Clinical follow-up was available in 74 (98%) stone patients and in 31 (100%) of 31 non-stone patients. In 72 of the 75 patients diagnosed with ureteral calculi, the NCCT made the diagnosis. IVU made the diagnosis in 65 of the 75 patients. Of the 31 patients without ureterolithiasis, the NCCT was negative in all cases. IVU was negative in 29 of the 31 cases. Unenhanced spiral CT was 96% sensitive and 100% specific (P <0.001). IVU was 87% sensitive and 94% specific (P <0.001). Compared with IVU, using the log odds ratio and Fisher's exact test, NCCT was significantly better able to predict the presence of urolithiasis (P=0.015).
NCCT accurately diagnoses ureterolithiasis in patients presenting with acute flank pain. NCCT is significantly better than IVU in determining the presence of urolithiasis.
前瞻性比较非增强螺旋计算机断层扫描（NCCT）和静脉肾盂造影（IVU）在评估成人急性腰痛患者时的诊断能力。
在获得知情同意后，106例怀疑患有尿石症的成人急性腰痛患者先接受NCCT检查，随后进行IVU检查。随后安排在泌尿外科门诊72小时内进行随访。每位NCCT图像由一位不了解临床病史和IVU检查结果的放射科医生解读。每位IVU图像由另一位不了解临床病史和NCCT检查结果的放射科医生解读。确定NCCT和IVU的敏感性、特异性以及阳性和阴性预测值。
输尿管结石的诊断定义为在NCCT或IVP上有明确的尿石症证据。106例接受评估的患者中有75例被诊断为输尿管结石。74例（98%）结石患者和31例非结石患者中的31例（100%）有临床随访资料。在75例诊断为输尿管结石的患者中，72例通过NCCT做出诊断。75例患者中有65例通过IVU做出诊断。在31例无输尿管结石的患者中，NCCT在所有病例中均为阴性。31例中有29例IVU为阴性。非增强螺旋CT的敏感性为96%，特异性为100%（P<0.001）。IVU的敏感性为87%，特异性为94%（P<0.001）。与IVU相比，使用对数优势比和Fisher精确检验，NCCT在预测尿石症的存在方面明显更优（P=0.015）。
NCCT能准确诊断急性腰痛患者的输尿管结石。在确定尿石症的存在方面，NCCT明显优于IVU。
