İlhan KILINÇ, Cihan Akgül ÖZMEN, Hatice AKAY, Aşur UYAR

Üreter taş hastalığı tanısında ultrasonografi ve kontrastsız spiral bilgisayarlı tomografi bulgularının karşılaştırılması

İntravenöz ürografi, ultrasonografi ve kontrastsız spiral bilgisayarlı tomografi üreter taş hastalığı tanısında kullanılmaktadır. Çalışmamızın amacı böğür ağrısıyla başvuran hastaların değerlendirilmesinde spiral bilgisayarlı tomografi ve ultrasonografinin tanısal değerini karşılaştırmaktır. Onbir aylık dönemde böğür ağrısıyla başvuran 41 hastaya üreter taş hastalığına yönelik üriner ultrasonografi ve kontrastsız spiral bilgisayarlı tomografi yapıldı. Üreter taş varlığı standart yöntemlerle doğrulanan 28 hastanın ultrasonografi ve bilgisayarlı tomografi bulguları karşılaştırıldı. Kırkbir hastanın 28’inde üreter taşı saptandı. Yirmisekiz hastanın 18’inde ultrasonografi ile, 27’sinde bilgisayarlı tomografi ile üreter taşı gösterilebildi. US ve BT’nin duyarlılığı %64.3 ve %96.4 bulundu. Her iki görüntüleme yönteminin özgüllüğü ise %100 olarak hesaplandı. Akut böğür ağrılı hastalarda üreter taşlarını göstermede bilgisayarlı tomografi daha üstündür. Ancak bilgisayarlı tomografi, yüksek maliyet ve radyasyon maruziyeti nedeniyle ultrasonografi ile tanı konamayan semptomatik akut böğür ağrısıyla başvuran hastalarda kullanılmalıdır.

Anahtar Kelimeler:

Duyarlılık ve özgüllük, Geriyedönük çalışma, Ultrasonografi, Üreter taşı, Tomografi, Spiral Bilgisayarlı

The comparison of ultrasonography and non enhanced helical computed tomography in the diagnosis of ureteral calculi

Intravenous urography, ultrasonography, and non-contrast spiral computed tomography have been used to diagnose ureteral calculi. We aimed to compare the accuracy of non-contrast spiral computed tomography with ultrasonography in the evaluation of patients with renal colic. Fourty-one patients with flank pain were examined with both computed tomography and ultrasonography over a period of 11 months. Findings of ultrasonography and computed tomography of 28 patients in whom üreteral stones were confirmed by standart methods were compared Ureteral calculi were diagnosed in 28 of 41 patients. Ureteral stones could be demonstrated in 18 patients by ultrasonography and in 27 patients by computed tomography. Ultrasonography showed 64.3% sensitivity and 100% specificity in the diagnosis of ureterolithiasis; computed tomography showed 96.4% and 100%, respectively. Spiral computed tomography is superior to ultrasonography in the demonstration of ureteral calculi in patients with renal colic. But because of higher cost and higher radiation dose, it should be reserved for symptomatic cases in whom ultrasonography is non-diagnostic.

Keywords:

Sensitivity and Specificity, Retrospective Studies, Ultrasonography, Ureteral Calculi, Tomography, Spiral Computed,

PDF

___

1. Fielding JR, Steele G, Fox LA, Heller H, Loughlin KR. Spiral computerized tomography in the evaluation of acute flank pain: a replacement for excretory urography. J Urol 1997;157:2071-2073.
2. Shehadi WH, Toniolo G. Adverse reactions to contrast media: a report from the Committee on Safety of Contrast Media of the International Society of Radiology. Radiology 1980;137:299-302.
3. Thurston W, Wilson SR. The urinary tract. In: Rumack CM, Wilson SR, Charboneau JW, eds. Diagnostic ultrasound, 2nd ed. St. Louis: Elsevier Mosby, 1998: 329-397.
4. Wolfmann NT, Bectold RE, Watson NE. Ultrasonography of the normal kidney and diffuse renal disease. In: Resnick MI, Rifkin MD, eds. Ultrasonography of the urinary tract, 3rd ed. Baltimore: Williams & Wilkins, 1991: 109-151.
5. Sheafor DH, Hertzberg BS, Freed KS, et al. Nonenhanced helical CT and US in the emergency evaluation of patients with renal colic: prospective comparison. Radiology 2000;217:792-797.
6. Smith RC, Rosenfield AT, Choe KA, et al. Acute flank pain: comparison of noncontrast- enhanced CT and intravenous urography. Radiology 1995;194:789-794.
7. Sommer FG, Jeffrey RB, Jr., Rubin GD, et al. Detection of ureteral calculi in patients with suspected renal colic: value of reformatted noncontrast helical CT. Am J Roentgenol 1995;165:509-513.
8. Yilmaz S, Sindel T, Arslan G, et al. Renal colic: comparison of spiral CT, US and IVU in the detection of ureteral calculi. Eur Radiol 1998;8:212-217.
9. Rosen CL, Brown DF, Sagarin MJ, et al. Ultrasonography by emergency physicians in patients with suspected ureteral colic. J Emerg Med 1998;16:865-870.
10. Henderson SO, Hoffner RJ, Aragona JL, et al. Bedside emergency department ultrasonography plus radiography of the kidneys, ureters, and bladder vs intravenous pyelography in the evaluation of suspected ureteral colic. Acad Emerg Med 1998;5:666- 671.
11. Patlas M, Farkas A, Fisher D, Zaghal I, Hadas-Halpern I. Ultrasound vs CT for the detection of ureteric stones in patients with renal colic. Br J Radiol 2001;74:901-904.
12. Katz DS, Lane MJ, Sommer FG. Unenhanced helical CT of ureteral stones. Am J Roentgenol 1996;166:1319-1322.
13. Heneghan JP, Dalrymple NC, Verga M, Rosenfield AT, Smith RC. Soft-tissue "rim" sign in the diagnosis of ureteral calculi with use of unenhanced helical CT. Radiology 1997;202:709-711.
14. Kawashima A, Sandler CM, Boridy IC, et al. Unenhanced helical CT of ureterolithiasis: value of the tissue rim sign. Am J Roentgenol 1997;168:997-1000.
15. Takahashi N, Kawashima A, Ernst RD, et al. Ureterolithiasis: can clinical outcome be predicted with unenhanced helical CT? Radiology 1998;208:97-102.