Comparison between ultrasound and noncontrast helical computed tomography for identification of acute ureterolithiasis in a teaching hospital setting

Comparison between ultrasound and noncontrast helical computed tomography for identification of acute ureterolithiasis in a teaching hospital setting

Alternative title Comparação entre a ultra-sonografia e a tomografia computadorizada helicoidal sem contraste em atendimento radiológico de urgência no diagnóstico da litíase ureteral em pacientes com cólica renal aguda
Author Souza, Luís Ronan Marquez Ferreira de Autor UNIFESP Google Scholar
Goldman, Suzan Menasce Autor UNIFESP Google Scholar
Faintuch, Salomão Autor UNIFESP Google Scholar
Faria, Juliano Ferreira Autor UNIFESP Google Scholar
Bekhor, Daniel Autor UNIFESP Google Scholar
Tiferes, Dario Ariel Autor UNIFESP Google Scholar
Ortiz, Valdemar Autor UNIFESP Google Scholar
Choyke, Peter Autor UNIFESP Google Scholar
Szejnfeld, Jacob Autor UNIFESP Google Scholar
Institution Universidade Federal de São Paulo (UNIFESP)
Abstract CONTEXT AND OBJECTIVE: Recent studies have shown noncontrast computed tomography (NCT) to be more effective than ultrasound (US) for imaging acute ureterolithiasis. However, to our knowledge, there are few studies directly comparing these techniques in an emergency teaching hospital setting. The objectives of this study were to compare the diagnostic accuracy of US and NCT performed by senior radiology residents for diagnosing acute ureterolithiasis; and to assess interobserver agreement on tomography interpretations by residents and experienced abdominal radiologists. DESIGN AND SETTING: Prospective study of 52 consecutive patients, who underwent both US and NCT within an interval of eight hours, at Hospital São Paulo. METHODS: US scans were performed by senior residents and read by experienced radiologists. NCT scan images were read by senior residents, and subsequently by three abdominal radiologists. The interobserver variability was assessed using the kappa statistic. RESULTS: Ureteral calculi were found in 40 out of 52 patients (77%). US presented sensitivity of 22% and specificity of 100%. When collecting system dilatation was associated, US demonstrated 73% sensitivity, 82% specificity. The interobserver agreement in NCT analysis was very high with regard to identification of calculi, collecting system dilatation and stranding of perinephric fat. CONCLUSIONS: US has limited value for identifying ureteral calculi in comparison with NCT, even when collecting system dilatation is present. Residents and abdominal radiologists demonstrated excellent agreement rates for ureteral calculi, identification of collecting system dilatation and stranding of perinephric fat on NCT.

CONTEXTO E OBJETIVO: Estudos atuais demonstram que a tomografia computadorizada helicoidal sem contraste (TC) apresenta maior acurácia do que a ultra-sonografia (US) no diagnóstico da ureterolitíase aguda, porém, poucos estudos a esse respeito foram realizados em atendimento radiológico de urgência de hospital universitário. Nossos objetivos foram comparar a sensibilidade diagnóstica da US com a TC realizadas por residentes no diagnóstico de ureterolitíase aguda e comparar a análise da TC interpretada por residentes e radiologistas experientes. TIPO DE ESTUDO E LOCAL: Estudo prospectivo de 52 pacientes com cólica renal aguda, que foram submetidos a exame de US seguido de TC em período máximo de oito horas no Hospital São Paulo. MÉTODOS: Os exames de US foram realizados por médicos residentes e conferidos pelos preceptores, já os de TC foram analisados por outro residente e posteriormente analisados por três radiologistas independentes. RESULTADOS: Nos 52 pacientes analisados foram encontrados 40 cálculos ureterais na TC (77%). A US apresentou uma sensibilidade de 22% e especificidade de 100%, que aumentou para 73% e 82% respectivamente, quando se associou a identificação da dilatação do sistema coletor. A TC analisada pelo residente e pelos radiologistas apresentou uma excelente correlação para identificação do cálculo ureteral, para heterogeneidade da gordura peri-renal e para dilatação do sistema coletor. CONCLUSÕES: A US realizada pelos residentes tem menor sensibilidade no diagnóstico da litíase ureteral, quando comparada à TC, mesmo quando associada à presença de dilatação do sistema coletor. Residentes e radiologistas especialistas apresentaram excelente concordância no diagnóstico de litíase ureteral.
Keywords Spiral computed tomography
Ultrasonography
Ureteral calculi
Lithiasis
Flank pain
Tomografia computadorizada espiral
Ultra-sonografia
Cálculos ureterais
Litíase
Dor no flanco
Language English
Date 2007-03-01
Published in SOUZA, Luís Ronan Marquez Ferreira de et al . Comparison between ultrasound and noncontrast helical computed tomography for identification of acute ureterolithiasis in a teaching hospital setting. Sao Paulo Med. J., São Paulo , v. 125, n. 2, p. 102-107, mar. 2007
ISSN 1516-3180 (Sherpa/Romeo, impact factor)
Publisher Associação Paulista de Medicina - APM
Extent 102-107
Origin http://dx.doi.org/10.1590/S1516-31802007000200007
Access rights Open access Open Access
Type Article
Web of Science ID WOS:000258506900007
SciELO ID S1516-31802007000200007 (statistics in SciELO)
URI http://repositorio.unifesp.br/handle/11600/3620

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