Ultrasound Versus Computerized Tomography for Evaluating Urolithiasis
Ultrasound Versus Computerized Tomography for Evaluating Urolithiasis
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DOI：
10.1016/j.juro.2009.03.072
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发表时间：
2009-10-01
影响因子：
6.6
通讯作者：
Nguyen, Hiep T.
中科院分区：
文献类型：
--
作者：
Passerotti, Carlo;Chow, Jeanne S.;Nguyen, Hiep T.
目的：我们前瞻性地评估了精确的超声和计算机断层扫描诊断泌尿系结石的儿童，并确定这些差异是否在放射学检查结果有任何影响临床management.Materials和方法：共50例连续怀疑尿路结石患者进行了计算机断层扫描和超声。两名放射科医师以盲法独立审查每项研究。当发现结果差异时，8名儿科泌尿科医生对该病例进行了审查。临床管理是基于每个放射学检查的结果独立。统计学分析采用Fisher精确检验。结果：与计算机断层扫描相比，超声具有76%的敏感性和100%的特异性。在8名患者中，计算机断层扫描显示的结石在超声检查中未发现。漏诊结石的平均大小为2.3 mm。7例患者的计算机断层扫描显示双侧结石，但超声仅在一侧看到结石。在评价临床影响时，除了4例病例外，超声/计算机断层扫描差异未导致临床管理发生任何显著变化。在这些情况下，超声检查结果表明，额外的成像是必需的，因此，结石（S）在远端输尿管将被确定在随后的imaging.Conclusions：虽然计算机断层扫描是更敏感的检测尿石症比超声，2放射学检查之间的有用性的差异可能没有临床意义。考虑到辐射的潜在有害累积长期效应，超声应被视为疑似尿石症儿童的首选影像学检查。
Purpose: We prospectively evaluated the precision of ultrasound and computerized tomography to diagnose urinary stones in children and determined whether these differences in radiological findings have any impact on clinical management.Materials and Methods: A total of 50 consecutive patients with suspected urolithiasis underwent computerized tomography and ultrasound. Two radiologists reviewed each study independently in blinded fashion. When a difference in findings was detected, 8 pediatric urologists reviewed the case. Clinical management was based on the results of each radiological test independently. Statistical analysis was performed using Fisher's exact test.Results: Compared to computerized tomography ultrasound had 76% sensitivity and 100% specificity. In 8 patients stone(s) seen on computerized tomography was not seen on ultrasound. The average size of missed stones was 2.3 mm. In 7 patients computerized tomography showed stones bilaterally but stone was seen on only 1 side on ultrasound. When evaluating the clinical impact, the ultrasound/computerized tomography discrepancy did not result in any significant change in clinical management except in 4 cases. In these cases ultrasound findings suggested that additional imaging was required and, thus, stone(s) in the distal ureter would have been identified on subsequent imaging.Conclusions: Although computerized tomography is more sensitive for detecting urolithiasis than ultrasound, the difference in usefulness between the 2 radiological tests may not be clinically significant. Given concerns for the potentially harmful cumulative long-term effect of radiation, ultrasound should be considered the first imaging test in children with suspected urolithiasis.