Preferred radiological modalities in the diagnosis and management of kidney and urinary tract stones; a systematic review

Introduction: Kidney and urinary tract stones are a common health concern, with a rising global incidence and significant impact on patient quality of life. Accurate diagnosis and effective management of these stones rely heavily on radiological imaging modalities. This systematic review aimed to synthesize the existing literature on preferred radiological modalities for diagnosing and managing kidney and urinary tract stones, focusing on their diagnostic accuracy, clinical efficacy, and impact on treatment outcomes. Methods: This systematic review was conducted based on PRISMA guidelines to evaluate preferred radiological modalities for diagnosing and managing kidney and urinary tract stones. A comprehensive literature search across multiple databases, including PubMed, Embase, Cochrane Library, Scopus, and Google Scholar, was conducted up to July 2024, using a comprehensive set of MeSH keywords. Quality assessment was performed using the STROBE checklist, with medium and high-quality studies considered acceptable. Data extraction by two independent reviewers captured essential information, with discrepancies resolved through discussion or consultation with a third reviewer. Results: The results of 12 included studies in this review indicated that, while CT scans are the most accurate imaging modality for diagnosing kidney and urinary tract stones, ultrasound presents a viable alternative due to its lower radiation exposure. Most studies reported ultrasound sensitivities above 55% and specificities over 95% compared to CT, although some studies noted significantly lower sensitivities. Additionally, X-ray imaging showed limitations, with sensitivities of only 46% to 57%, particularly for smaller stones. Conclusion: This study highlights that while CT scans are the gold standard for diagnosing kidney and urinary tract stones due to their accuracy, ultrasound presents a valuable alternative as an initial diagnostic tool, primarily because of its lower radiation exposure, which enhances patient safety, especially for those needing repeated imaging. Furthermore, the limitations of X-ray imaging in detecting smaller stones caution against its exclusive use. The review also emphasizes the importance of balancing diagnostic accuracy with safety when considering high-dose versus low-dose CT scans. Registration: This study has been compiled based on the PRISMA checklist, and its protocol was registered on the PROSPERO (ID: CRD42024579547) and Research Registry (UIN: reviewregistry1873) websites.