An overview of kidney stone imaging techniques

Brisbane, Wayne; Bailey, Michael R.; Sorensen, Mathew D.

doi:10.1038/nrurol.2016.154

Cited by 285 publications

(183 citation statements)

References 62 publications

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“…[8][9][10][11] These parameters can affect the selection of treatment modality as we discuss later. Patients with a BMI >30 should have a standard-dose non-contrast-enhanced CT to maintain sensitivity and specificity at 95% and 98%.…”

Section: Investigationsmentioning

confidence: 99%

Management of renal Stones for the non-specialist

Wilson¹,

Folkard²,

Somani³

2018

IJFCM

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Risk factors for stone formation are categorized into intrinsic and extrinsic causes. Intrinsic causes include age, family history and sex. The peak age of presentation is 40-60 years old. Patients with a first degree relative with renal stones have an increased risk (RR 2.5). 3The relative risk between men and women has narrowed over the past decade from 3:1 to 1.3:1 (ibid). Obesity, fluid intake and diet are the most important extrinsic risk factors. There is a strong correlation between BMI and stone formation. A BMI of >27.5 doubles the relative risk compared with a BMI of 20-22.5. 4 Fluid intake is inversely correlated with stone formation. Consuming >2500 mls/day halves the relative risk compared with <1250 mls/day. 5 A low meat intake (<50g/day) halves the risk of stone formation compared with a high meat intake (>100g/day). 4 Perversely a low, rather than high, calcium diet predisposes to calcium stone formation. 5 PresentationThe majority of renal stones remain asymptomatic. Up to 5% of abdominal ultrasounds and CTs find incidental renal stones.6 Small non-obstructing stones within the kidney are typically asymptomatic or have mild symptoms. The most common presentation of a renal stone is loin pain caused by ureteric obstruction. The classical presentation is severe colicky pain which reaches its peak within 1-2 hours and then becomes constant. Hospital presentation within 12 hours of onset of the pain is a significant predictor of renal colic.7 The location of the stone within the ureter determines the nature of the pain. The most common sites are the pelvico-ureteric junction (PUJ), the pelvic brim and vesico-ureteric junction. PUJ stones typically present with a deep loin pain without radiation, pelvic brim stones with flank or lower quadrant pain radiating into the groin and vesico-ureteric stones with irritative voiding symptoms. Flank pain is not specific to renal stones with stones being demonstrated on CT in 34-73% of these patient. Nausea, vomiting and a change in appetite are present in approximately 50% of cases.7 Other less common symptoms of renal stones include visible haematuria, recurrent urinary tract infections and the painless passage of grit. On examination, loin tenderness may be present in up to 86% of patients.7 Flank and iliac fossa tenderness may be palpated, but there should be no signs of peritonitis. A thorough examination of patient should be performed to rule out the red flags and other differentials mentioned below. InvestigationsDetection of haematuria on urine dipstick is the most discriminating bedside investigation. It has a sensitivity for renal stones of 84%, specificity of 48%, PPV of 72% and NPV of 65%.8 It should be noted that the sensitivity is 95% on day 0 from the onset of pain but decreases to 65% by day 3.9 Low dose non-contrast-enhanced CT (CT KUB) is the gold-standard investigation for most adults, with a sensitivity and specificity of 95% and 98%.9,10 All renal stone types are detectable by CT KUB except for Indinavir stones. These rare stones form as a...

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Section: Investigationsmentioning

confidence: 99%

Management of renal Stones for the non-specialist

Wilson¹,

Folkard²,

Somani³

2018

IJFCM

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“…During the last few decades, non-contrast CT scan became the diagnostic technique of choice in evaluating patients with urinary calculi. 14,15 It has a sensitivity of 92-95% in detecting urinary tract calculi.…”

Section: Non-contrast Ctmentioning

confidence: 99%

“…Furthermore, CT scan can localize the site of calculi through imaging the entire kidney, ureter, and bladder. 10,15 Bilateral calcified renal stones are visualized in Figure 1 in a non-contrast CT scan. Thin cuts through the abdomen and pelvis can be obtained which allows CT scan to be sensitive to visualize very small calculi down to 3 millimetres.…”

Section: Advantages Of Non-contrast Ct Scanmentioning

confidence: 99%

“…17 Because of the availability of axial, sagittal, and coronal sections, as well as the possibility to create multiplanar reconstruction provide sufficient data about the location, size, and burden of urinary calculi. 15,18 Additionally, noncontrast CT scan is a rapid accurate technique that can be performed in a few minutes (average 5 minutes) in comparison to an average of 80 minutes required to perform an intravenous urography (IVP). It does not necessitate previous prior renal function or blood tests, and it does not carry the risk of contrast reaction.…”

Section: Advantages Of Non-contrast Ct Scanmentioning

confidence: 99%

“…14,15 Several reasons are probably behind non-utilization of contrast CT in evaluation of patients with suspected urinary tract calculi. On the top of them are the risk of contrast reaction, the longer time consumed, and the belief that the intravenous contrast may decrease the sensitivity for calculi detection.…”

Section: Contrast Ctmentioning

confidence: 99%

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Contrast versus non-contrast CT in urinary tract calculi

Faidah

Banjar

Zarbah

et al. 2018

Int J Community Med Public Health

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The incidence and prevalence of urinary tract calculi has increased significantly during the past decade. Accurate fast diagnostic modalities were developed to cope with such an increased trend. To date, non-contrast CT scan remains the diagnostic modality of choice for evaluation of patients with urinary tract calculi. However, contrast CT scans are gaining more interest. In this review, both diagnostic modalities were reviewed with the advantages and disadvantages of each. Non-contrast CT scan is a rapid, accurate, less hazardous, less expensive imaging modality that has a high sensitivity in detection of urinary calculi as small as 3 mm. However, it cannot evaluate other probable causes of flank pain. Thus, contrast CT scans can be used in situations where clinical presentation is suspicious and the possibility of other differential diagnoses is considered. Contrast CT scans do not decrease the sensitivity of detecting urinary calculi, and they do have a higher sensitivity in detecting small grades of obstruction as well as evaluating other possible causes of flank pain such as neoplasms, infectious, or inflammatory aetiologies.

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Acute Kidney Stone Management

Ahn

Harper

2021

A Clinical Guide to Urologic Emergencies

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An overview of kidney stone imaging techniques

Cited by 285 publications

References 62 publications

Management of renal Stones for the non-specialist

Management of renal Stones for the non-specialist

Contrast versus non-contrast CT in urinary tract calculi

Acute Kidney Stone Management

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