Yonsei Med J.  2018 May;59(3):389-396. 10.3349/ymj.2018.59.3.389.

Low-Dose Unenhanced Computed Tomography with Iterative Reconstruction for Diagnosis of Ureter Stones

Affiliations
  • 1Department of Urology, College of Medicine, Chung-Ang University, Seoul, Korea.
  • 2Department of Emergency Medicine, College of Medicine, Chung-Ang University, Seoul, Korea. emdhlee@cau.ac.kr
  • 3Department of Radiology, College of Medicine, Chung-Ang University, Seoul, Korea.
  • 4Chung-Ang University School of Medicine, Seoul, Korea.

Abstract

PURPOSE
To study the clinical application of low-dose unenhanced computed tomography with iterative reconstruction technique (LDCT-IR) on renal colic in the emergency department.
MATERIALS AND METHODS
We conducted a prospective, single-blinded, randomized, and non-inferiority study. From March 2014 to August 2015, 112 patients with renal colic were included, and were randomized to either LDCT-IR (n=46) or standard-dose unenhanced CT (SDCT) (n=66) groups. The accuracy of urolithiasis diagnosis was the primary endpoint of this study. Radiation dose, size and location of the stone, hydronephrosis, other diseases except urolithiasis, and results of treatment were analyzed between the two groups.
RESULTS
The average effective dose radiation of SDCT was approximately four times higher than that of LDCT-IR (6.52 mSv vs. 1.63 mSv, p < 0.001). There was no significant difference in the accuracy of ureteral stone diagnosis between the two groups (LDCT-IR group: 96.97% vs. SDCT group: 98.96%, p=0.392). No significant difference was observed regarding the size and location of a stone, hydronephrosis, and diagnosis of other diseases, except urolithiasis. False negative results were found in two LDCT-IR patients and in one SDCT patient. In these patients, stones were misread as vascular calcification, and were difficult to diagnose because evidence of hydronephrosis and ureteral dilatation was not found.
CONCLUSION
LDCT-IR, as a first-line imaging test, was non-inferior to SDCT with respect to diagnosis of ureter stones, and was clinically available for the evaluation of renal colic.

Keyword

Low-dose; computed tomography; urolithiasis; renal colic
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