predictive role of non-contrast spiral computerized tomography on

7/31/2019 Predictive Role of Non-contrast Spiral Computerized Tomography On

1/36

Predictive role of non-contrast spiral

computerized tomography on spontaneous passage

of ureteral stonesDepartment of Urology, Radiology, and Emergency, The

German Hospital, Antalya, Turkey Vol. 28 (6): 516-521, November - December, 2010

2012.4.26EM 3


2/36

In 1995, Smith demonstrated superiority of CTKUB over IVU, in sensitivity, specificity,accuracyNumerous subsequent studies replicatedSensitivity 94-96%VS 75-87%Specificity 94-100%VS 92%-94%


3/36

The primary sign of ureteric colic on CTKUBis the identification of a high-attenuationwithin the lumen a ureter


4/36

Phleboliths can mimic ureteric stones


5/36

Soft tissue rim sign

1-2mm edematous rim of soft tissueattenuation(20-40HU) surrounding stone


6/36

Comet tail sign


7/36

Secondary signs

Hydronephrosis 69%Hydroureter 67%Perinephric edema 65%


8/36

Hydroureter


9/36

Perinephric edema


10/36

hydronephrosis


11/36


12/36


13/36

Introduction

Demonstrating ureter stone1. Unenhanced spiral computerized

tomography(CT)2. Intravenous urography(IVU)


14/36

1. Smaller stone size2. Location of the stone3. Soft tissue rim sign

correlate with spontaneous stonepassage


15/36

Material and method

185 patients who is acute, severe flankpain in emergency roomFever and septicemia and pregnancy areexcluded

History, Physical examination, Laboratorytests

Subsequently spiral CT


16/36

Spiral techniqueTable speed of 7mm/sec5mm interval covering the urinary trackWithout contrast applicationScan time 40 and 50 secThe greatest width after computerizedmagnification


17/36

1. Presence of opaque calculi2. Tissue rim sign3. Hydronephrosis4. Hydroureter

5. Perirenal fluid6. Prinephric fat stranding

All CT image were jointly reviewed byradiologist and urologist


18/36

Size of each stoneGreatest dimension within the axial planeof the CT section

Location of stone1. Proximal above sacro-iliac joint2. Mid level of S-I joint

3. Distal below S-I joint-UV junction


19/36

1. Spontaneous passage(utmost 3weeks)2. Eradication by ureterscioy3. ESWL

Two groupsLess 7mm VS more 7mm


20/36

RESULTS

Among 185 patients, 173 patients isapproved by ureter stone1. 94 unilateral ureter stone2. 2 bilateral ureter stone

Among unilateral 94 patients1. Proximal 6 patients2. Mid 14 patients3. Distal 74 patients

2 Bilateral both distal, distal and mid


21/36

Spontaneous passage 38(40%)Ureterscopy 41(43.2%)ESWL 16(16.8%)Expire 1 bilateral ureter stone patient(during HD)


22/36

Among 96 patientObstruction sign(hydroureter, hydronephrosis, perinephricfluid or fat stranding) 63 patientsNo obstruction sign 33 patient


23/36

Size

Spontaneous passage1. Less than 7mm 32(66.7%) in 48 patients2. More than 7mm 6(19.3%) in 31 patients

All passed stones were smaller than7.4mm!!


24/36

Passed group (2mm-7.4mm, mean4.37mm)Unpassed group (4mm-10mm, mean7.35mm)


25/36


26/36

Ureteral tissue rim sign

All passed stone did not ureteral tissue rimsign

Unpassed stone1. Mid-ureter stone 4(80%) in 5 patients2. Distal-ureter stone 23(67%) in 34 patients


27/36


28/36

i


29/36

Location

S f i i i


30/36

Soft tissue rim sign

S f i i i il i


31/36

Soft tissue rim sign, comet tail sign

H d


32/36

Hydroureter

P i h i d


33/36

Perinephric edema

N h l


34/36

Nephromegaly

U i t ti


35/36

Urine extravasation


36/36

predictive role of non-contrast spiral computerized tomography on

Documents