Low Dose Computerized Tomography for Detection of Urolithiasis-Its Effectiveness in the Setting of the Urology Clinic

被引:31
作者
Zilberman, Dorit E. [1 ]
Tsivian, Matvey [1 ]
Lipkin, Michael E. [1 ]
Ferrandino, Michael N. [1 ]
Frush, Donald P. [2 ]
Paulson, Erik K. [2 ]
Preminger, Glenn M. [1 ]
机构
[1] Duke Univ, Med Ctr, Div Urol Surg, Comprehens Kidney Stone Ctr, Durham, NC 27710 USA
[2] Duke Univ, Med Ctr, Dept Radiol, Durham, NC 27710 USA
关键词
tomography; x-ray computed; urolithiasis; radiation dosage; TUBE CURRENT MODULATION; CT; STANDARD; URETEROLITHIASIS; NEPHROLITHIASIS; REDUCTION;
D O I
10.1016/j.juro.2010.10.052
中图分类号
R5 [内科学]; R69 [泌尿科学(泌尿生殖系疾病)];
学科分类号
1002 ; 100201 ;
摘要
Purpose: Low dose noncontrast computerized tomography is becoming a common imaging tool to diagnose urolithiasis. We investigated its usefulness as a diagnostic tool in the outpatient setting. Materials and Methods: A total of 62 patients with suspected urolithiasis underwent standard renal stone protocol computerized tomography with a tube current of 160 mA. Images were modified by adding image noise to simulate tube currents of 70, 100 and 130 mA. Three urologists independently interpreted the original and simulated dose scans for stone number, location and associated signs of obstruction. In addition, the investigators rated the ease of interpreting the scans and their overall level of confidence. Results: There were no statistically significant differences in interobserver and intra-observer variability for stone detection or obstruction signs except significant interobserver variability in hydronephrosis and intra-observer variability in stranding categories. Each 1 mm increase in stone size increased the likelihood of a concordant response 3.55, 2.7 and 2-fold when reducing the tube current level by 19%, 38% and 56%, respectively (p = 0.001, 0.008 and 0.021, respectively). Multiple stones or index stone location were not associated with agreement. The overall level of confidence decreased with lower simulated doses, particularly in the bony pelvis (p <0.02). Conclusions: Low dose computerized tomography may serve as an effective tool in the setting of the urology clinic in patients with urolithiasis. This imaging tool can better assess urolithiasis and associated obstruction than plain abdominal radiographs, but it may be problematic with small stones (less than 2 mm) and evidence of distal ureteral obstruction. Its effectiveness as a long-term followup tool requires further prospective trials.
引用
收藏
页码:910 / 914
页数:5
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