1887
  1. Home
  2. A-Z Publications
  3. Journal of Emergency Medicine, Trauma and Acute Care
  4. Volume 2012, Issue 1
  5. Article
Volume 2012, Issue 1
  • ISSN: 1999-7086
  • EISSN: 1999-7094

Abstract

To assess urinary calculi and the secondary signs of obstruction, in patients referred from the accident and emergency department, by unenhanced computed tomography examination and to review the radiation dose the patients received with the use of automatic dose modulation technique, care dose 4D. Medical records of unenhanced multi-slice computed tomography (MSCT) examinations for 114 patients referred to the emergency department for analysis of suspected urinary calculi were reviewed retrospectively. Their treatment involved automatic tube current modulation, a dose reduction method (care dose 4D), in Hamad General Hospital. The cases were analyzed for the presence of stones, size, site, density and the secondary signs of obstruction, namely hydronephrosis, hydroureter, perinephric fat stranding, peri-ureteric fat stranding and renal enlargement. A search for alternate diagnosis was made if no stone was found. The final diagnosis was noted from the discharge summary in medical records. The radiation dose, Computed Tomographic Dose Index volume (CTDI) and Dose Length Product (DLP) in each patient was recorded from patient protocol. Of 114 patients referred to CT scan for suspected urinary calculi, between March and June 2008, urinary calculi were noted in 75.4%. An alternate diagnosis was offered to 5.3% and a diagnosis of normal was given to 19.3%. The size of stones detected varied from 2 mm–35 mm. Density of stones varied from 110–1250 hounsfield units (HU). Solitary stones were seen in 54.4% of cases observed and multiple stones in 22%. Renal stones were observed in 6.1% of cases, urteric stones in 26.3%, vesico-uretric junction stones in 18.4%, multiple sites in 23.7%. Hydronephrosis was seen in 68% of cases, hydroureter in 63%, perinephric fat stranding in 51%, periureteral fat stranding in 34%, ureteric rim sign in 28% and renomegaly in 24%.

Time interval between onset of symptoms to imaging varied from 4 to 12 hours. The radiation dose, CTDI, ranged from 6.5–15.8 mGy and DLP from 257 to 918 mGy/cm with the use of automatic tube current modulation, care dose 4D. Final diagnosis and MSCT diagnosis were in concordance in 86 (75% of) patients of renal calculi and alternate diagnosis in 6 (5.3%) of patients and normal in rest of the patients. In clinically-suspected urinary calculi, unenhanced MSCT of abdomen with the use of care dose 4D, an automatic tube current modulation technique, is a fast and reliable investigation in an emergency setting to detect stones and secondary signs of obstruction. It offers alternate diagnosis with substantial reduction in radiation dose—both the computed tomography dose index (CTDI) and dose length product (DLP).

© 2012 Nabir, Vajjala, licensee Bloomsbury Qatar Foundation Journals.
Loading

Article metrics loading...

/content/journals/10.5339/jemtac.2012.15
2013-07-01
2024-04-24
Loading full text...

Full text loading...

/deliver/fulltext/jemtac/2012/1/jemtac.2012.15.html?itemId=/content/journals/10.5339/jemtac.2012.15&mimeType=html&fmt=ahah

References

  1. Tamm EP, Silverman PM, Shuman WP. Evaluation of the patient with flank pain and possible ureteral calculus. Radiology. 2003; 228::319–329
     [Google Scholar]
  2. Smith R, Rosenfield AT, Choe KA, Essenmacher KR, Verga M, Glickman MG, Lange RC. Acute flank pain: Comparison of non-contrast-enenhanced CT and intravenous urography. Radiology. 1995; 194::789–794
     [Google Scholar]
  3. Smith RC, Vergam M, McCarthy S, Rosenfield AT. Diagnosis of acute flank pain-Value of unenhanced helical CT. Am J Roentgenol. 1996; 166::97–101
     [Google Scholar]
  4. Sheafor DH, Hertzberg BS, Freed KS, Carroll BA, Keogan MT, Paulson EK, DeLong DM, Nelson RC. Nonenhanced helical CT and US in the emergency evaluation of patients with renal colic: prospective comparison. Radiology. 2000; 217::792–797
     [Google Scholar]
  5. Smith RC, Verga M, Dalrymple N, McCarthy S, Rosenfield AT. Acute ureteral obstruction: value of secondary signs of helical unenhanced CT. Am J Roentgenol. 1996; 167::1109–1113
     [Google Scholar]
  6. Varanelli MJ, Coll DM, Levine JA, Rosenfield AT, Smith RC. Relationship between duration of pain and secondary signs of obstruction of the urinary tract on unenhanced helical CT. Am J Roentgenol. 2001; 177::325–330
     [Google Scholar]
  7. Catalano O. Suspected ureteral colic: Primary helical CT versus selective helical CT after unenhanced radiography and sonography. Am J Roentgenol. 2002; 178::379–387
     [Google Scholar]
  8. Abramson I, Walders N, Applegate KE, Gilkeson RC, Robbin MR. Impact in the emergency department of unenhanced CT on diagnostic confidence and therapeutic efficacy in patients with suspected renal colic: A prospective survey. Am J Roentgenol. 2000; 175::1689–1695
     [Google Scholar]
  9. Dalrymple NC, Casford B, Raiken DP, Elsass KD, Pagan RA. Pearls and pitfalls in diagnosis of urolithiasis with unenhenced helical CT. Radiographics. 2000; 20::439–447
     [Google Scholar]
  10. Zagoria RJ, Khatod EG, Chen MY. Abdominal radiography after CT reveals urinary calculus: A method to predict usefulness of abdominal radiography on basis of size and CT attenuation. Am J Roentgenol. 2001; 176::1117–1122
     [Google Scholar]
  11. Paulson EK, Weaver C, Ho LM, Martin L, Li J, Darsie J, Frush DP. Conventional and reduced radiation dose of 16- MDCT for detection of nephrolithiasis and ureterolithiasis. Am J Roentgenol. 2008; 190:1:151–157
     [Google Scholar]
  12. Katz SI, Saluja S, Brink JA, Forman HP. Radiation dose associated with unenhanced CT for suspected renal colic: Impact of Repetitive Studies. Am J Roentgenol. 2006; 186::1120–1124
     [Google Scholar]
  13. Kirpalani A, Khalili K, Lee S, Haider MA. Renal colic: Comparison of use and outcomes of unenhanced helical CT for emergency investigation in 1998 and 2002. Radiology. 2005; 236::554–558
     [Google Scholar]
  14. Memarsadeghi M, Heinz-Peer G, Helbich TH, Schaefer-Prokop C, Kramer G, Scharitzer M, Prokop M, Unenhanced MDCT  in patients suspected of having urinary stone disease: Effect of section thickness on diagnosis. Radiology. 2005; 235::530–536
     [Google Scholar]
  15. Zagoria RJ. Retrospective view of diagnosis of acute flank pain: Value of unenhanced helical CT. Am J Roentgenol. 2006; 187::603–604
     [Google Scholar]
  16. Memarasadeghi M, Schaefer-Prokop C, Prokop M, Helbich TH, Seitz CC, Noebauer-Huhmann IM, Heinz-Peer G, Unenhanced MDCT  in suspected urinary stone disease: Do coronal reformation improves diagnostic performance. Am J Roentgenol. 2007; 189:2:1160–1164
     [Google Scholar]
  17. Zangos S, Steenburg SD, Phillips KD, Kerl JM, Nguyen SA, Herzog C, Schoepf UJ, Vogl TJ, Costello P. Acute abdomen: Added diagnostic value of coronal reformation with 64-slice MDCT. Acad Radiol. 2007; 14::19
     [Google Scholar]
  18. Tublin ME, Murphy ME, Delong DM, Tessler FN, Kliewer MA. Conspicuity of renal calculi at unenhanced CT: Effects of calculus composition, size and CT technique. Radiology. 2002; 225::91–96
     [Google Scholar]
  19. Zelenko N, Coll D, Rosenfeld AT, Smith RC. Normal ureter size on unenhanced helical CT. Am J Roentgenol. 2004; 182::1039–1041
     [Google Scholar]
  20. Tracy TA, Yoshizumi TT, Toncheva GI, Nguyen G, Hurwitz LM, Nelson RC. Early first-trimester fetal radiation dose estimation in 16-MDCT without and with automated tube current modulation. Am J Roentgenol. 2008; 860:–864
     [Google Scholar]
  21. Tack D, Sourtzis S, Delpierre I, de Maertelaer V, Gevenois PA. Low dose unenhanced MDCT of patients with suspected renal colic. Am J Roentgenol. 2003; 180::305–311
     [Google Scholar]
  22. Poletti PA, Platon A, Rutschmann OT, Schmidlin FR, Iselin CE, Becker CD. Low-dose versus standard-dose CT protocol in patients with clinically suspected renal colic. Am J Roentgenol. Apr. 2007; 188::927–933
     [Google Scholar]
  23. Niemann T, Kollmann T, Bongartz G. Diagnostic performance of Low-Dose CT for the detection of urolithiasis: A Meta-Analysis. Am J Roentgenol. 2008; 191:2:396–401
     [Google Scholar]
http://instance.metastore.ingenta.com/content/journals/10.5339/jemtac.2012.15
Loading
Emergency unenhanced multi-slice computed tomography in suspected urinary calculi—with dose reduction method (care dose 4D)
Journal of Emergency Medicine, Trauma and Acute Care 2012, 15 (2012); https://doi.org/10.5339/jemtac.2012.15
/content/journals/10.5339/jemtac.2012.15
/content/journals/10.5339/jemtac.2012.15
Loading

Data & Media loading...

Supplements

Supplementary File 1

  • Article Type: Research Article
Keyword(s): automatic dose modulation, MSCT and Urinary calculi

Most Cited Most Cited RSS feed

This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error