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Low Dose Unenhanced Helical Computerized Tomography For The Evaluation Of Acute Flank Pain

2002; Lippincott Williams & Wilkins; Volume: 167; Issue: 4 Linguagem: Inglês

10.1016/s0022-5347(05)65178-6

1527-3792

Michael W. Hamm, E. Knöpfle, Susanne Wartenberg, Friedhelm Wawroschek, Dorothea Weckermann, R. Harzmann,

Anesthesia and Pain Management

No AccessJournal of UrologyCLINICAL UROLOGY: Original Articles1 Apr 2002Low Dose Unenhanced Helical Computerized Tomography For The Evaluation Of Acute Flank Pain Michael Hamm, Egbert Knöpfle, Susanne Wartenberg, Friedhelm Wawroschek, Dorothea Weckermann, and Rolf Harzmann Michael HammMichael Hamm , Egbert KnöpfleEgbert Knöpfle , Susanne WartenbergSusanne Wartenberg , Friedhelm WawroschekFriedhelm Wawroschek , Dorothea WeckermannDorothea Weckermann , and Rolf HarzmannRolf Harzmann View All Author Informationhttps://doi.org/10.1016/S0022-5347(05)65178-6AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: Unenhanced helical computerized tomography (CT) has proved to be an excellent diagnostic tool for evaluating acute flank pain with reported 95% to 100% sensitivity, 92% to 100% specificity, 96% to 100% positive and 91% to 100% negative predictive values. The diagnostic value of a new low dose protocol was prospectively studied and compared with the results of conventional unenhanced helical CT in a previous series with an effective dose equivalent (HE) of 3.1 to 4.3 mSv. and in current literature with an estimated HE of 4.3 to 4.7 mSv. Materials and Methods: In 109 patients 18 to 86 years old with acute flank pain we performed low dose unenhanced helical CT in addition to abdominal ultrasound and urinalysis with new CT parameters (120 kV. 70 mA., 5 mm. collimation, pitch 2 and incremental reconstruction each 5 mm.) that led to a more than 50% decrease in radiation exposure to 1.50 mSv. in females and 0.98 mSv. in males. Ureteral calculi were confirmed or excluded by retrograde ureteropyelography in 51 cases. In the other cases the diagnosis was verified by the clinical and ultrasound course, and/or stone asservation. Results: In 80 of the 109 patients the flank pain was caused by a ureteral calculus. Low dose unenhanced helical CT precisely identified 77 ureteral calculi with 1 false-positive finding. Thus, the sensitivity and specificity of low dose unenhanced helical CT were 96% and 97% with a 99% positive and 90% negative predictive value. In 15 of 29 patients with CT findings negative for stone disease different causes of pain were established by low dose unenhanced helical CT. Conclusions: Even with the significantly decreased radiation exposure of the low dose protocol unenhanced helical CT is still an excellent and rapid diagnostic tool for evaluating acute flank pain with lower radiation exposure than excretory urography (HE 1.3 to 2.3 mSv.) at our departments. Only in obese patients with a body mass index of greater than 31 kg./m.2 is conventional unenhanced helical CT with higher radiation exposure recommended to achieve adequate image quality. References 1 : Nativ-Spiral-Computertomographie bei Patienten mit akutem Flankenschmerz: Sinn oder Unsinn?. 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Google Scholar From the Departments of Urology and Diagnostic Radiology, Klinikum Augsburg, Augsburg, Germany© 2002 by American Urological Association, Inc.FiguresReferencesRelatedDetailsCited byAbdel-Gawad M, Kadasne R, Elsobky E, Ali-El-Dein B and Monga M (2016) A Prospective Comparative Study of Color Doppler Ultrasound with Twinkling and Noncontrast Computerized Tomography for the Evaluation of Acute Renal ColicJournal of Urology, VOL. 196, NO. 3, (757-762), Online publication date: 1-Sep-2016.Freifeld Y, Stein A, Avitan O, Mulner R, Hashoul S, May T, Klein I, Boyarsky L, Goldin D, Mecz Y, Peled N and Dekel Y (2014) Limited Field Noncontrast Computerized Tomography for Followup of Ureteral Stones: Initial ResultsJournal of Urology, VOL. 192, NO. 3, (781-785), Online publication date: 1-Sep-2014.Johnson E, Graham D, Chow J and Nelson C (2014) Nationwide Emergency Department Imaging Practices for Pediatric Urolithiasis: Room for ImprovementJournal of Urology, VOL. 192, NO. 1, (200-206), Online publication date: 1-Jul-2014.Heldt J, Smith J, Anderson K, Richards G, Agarwal G, Smith D, Schlaifer A, Pittenger N, Han D, Baldwin B, Schroeder G and Baldwin D (2012) Ureteral Calculi Detection Using Low Dose Computerized Tomography Protocols is Compromised in Overweight and Underweight PatientsJournal of Urology, VOL. 188, NO. 1, (124-129), Online publication date: 1-Jul-2012.Zilberman D, Tsivian M, Lipkin M, Ferrandino M, Frush D, Paulson E and Preminger G (2011) Low Dose Computerized Tomography for Detection of Urolithiasis—Its Effectiveness in the Setting of the Urology ClinicJournal of Urology, VOL. 185, NO. 3, (910-914), Online publication date: 1-Mar-2011.Nirmal T (2010) Re: Efficacy of Selective α1D-Blocker Naftopidil as Medical Expulsive Therapy for Distal Ureteral StonesJournal of Urology, VOL. 183, NO. 3, (1260-1261), Online publication date: 1-Mar-2010.Passerotti C, Chow J, Silva A, Schoettler C, Rosoklija I, Perez-Rossello J, Cendron M, Cilento B, Lee R, Nelson C, Estrada C, Bauer S, Borer J, Diamond D, Retik A and Nguyen H (2009) Ultrasound Versus Computerized Tomography for Evaluating UrolithiasisJournal of Urology, VOL. 182, NO. 4S, (1829-1834), Online publication date: 1-Oct-2009.Jin D, Lamberton G, Broome D, Saaty H, Bhattacharya S, Lindler T and Baldwin D (2009) Renal Stone Detection Using Unenhanced Multidetector Row Computerized Tomography—Does Section Width Matter?Journal of Urology, VOL. 181, NO. 6, (2767-2773), Online publication date: 1-Jun-2009. Volume 167Issue 4April 2002Page: 1687-1691 Advertisement Copyright & Permissions© 2002 by American Urological Association, Inc.Keywordsureteral calculiuretertomography, x-ray, computedflank painradiation dosageMetricsAuthor Information Michael Hamm More articles by this author Egbert Knöpfle More articles by this author Susanne Wartenberg More articles by this author Friedhelm Wawroschek More articles by this author Dorothea Weckermann More articles by this author Rolf Harzmann More articles by this author Expand All Advertisement PDF downloadLoading ...