Ömer YILMAZ, Hatice ERMİŞ, Olcay Akay CİNER, U?ur KOŞAR

Üriner sistemde taş şüphesinde spiral bilgisayarlı tomografi ne zaman kullanılmalı

Amaç: Çalışmanın amacı, ön tanısı üriner sistem taş hastalığı olan hastalarda ultrasonografi (US) duyarlılığını kontrastsız spiral Bilgisayarlı Tomografi (BT) ile karşılaştırmaktır. Gereç Yöntem: Çalışmaya 116 hasta dahil edildi. Hastalara spiral BT tetkikinden önce tetkiki inceleyecek radyolog dışında başka bir radyolog tarafından üriner sistem US yapıldı. Spiral BT incelemeleri, Hitachi Pronto SE BT cihazında, kontrast madde kullanılmaksızın gerçekleştirildi. BT bulguları temel alınarak US sonuçlarının böbrekler, üreterler ve tüm üriner sistem taşları için duyarlılık, özgüllük, pozitif ve negatif öngörü değerleri hesaplandı. Bulgular: Çalışmamıza dahil edilen 116 hastadan 78'inde BT ve US' da taş tespit edildi. 78 hastanın 48'inde BT ile saptanabilen böbrek taşı ve 34'ünde üreter taşı mevcuttu. hastanın böbrek taşı, 14 hastanın üreter taşı US ile tespit edilemedi. US'un böbrek taşı tanısında %87,5 duyarlılık, %95 özgüllük, %95 pozitif öngörü ve %87,5 negatif öngörü; üreter taşı tesbitinde %58 duyarlılık, %98 özgüllük, %94 pozitif öngörü ve %84 negatif öngörü değerine sahip olduğu bulundu. Sonuç: Üriner sistemin taş hastalıklarında US'un böbrek taşını saptamadaki duyarlılığı oldukça yüksek olup üriner kolik vakaları çoğunlukla direkt grafi US yardımı ile aydınlatabilmektedir. Ancak kliniği açıklanamayan semptomatik hastalarda; özellikle üreter taşı şüphesinde ve üriner sistem dışı patolojileri saptama açısından ek tetkik ihtiyacı doğmuşsa US'un üreter taşım saptamadaki duyarlılığının düşük olduğu akılda tutulmalı ve düşük doz kontrastsız spiral BT ilk tercih edilecek yöntem olmalıdır.

What is the correct time of helical Computed Tomography in suspicion of urinary system calculi

The aim: The purpose of this study is comparing the sensitivity of ultrasonography (US) and the helicalcomputed tomography (CT) for cases who have stone in urinary tract in the primary diagnose. MaterialMethod: The research includes 116 cases. US and CT examinations are performed by different radiologists.Hitachi Pronto SE was used for CT examination. Contrast agents did not used in CT examinations. Sensitivity,spesivity, positive and negative predictivity values of US calculated in the basis of CT results. Results: Renalcalculi determined in 78 of 116 cases both in CT and US examinations. Renal calculi was determined in 48of 78 cases, ureter calculi was determined 34 cases with CT. The sensitivity, spesivity, positive and negativepredictivity values of US in renal calculi was calculated as respectively 87,5 %; 95 %; 95 % and %87,5. Thesensitivity, spesivity, positive and negative predictivity values of US in ureterial calculi was calculated asrespectively 58 %; 98 %; 94 % and %84. Conclusion: Because of the high sensitivity of determining the urinarysystem calculi of US, the direct urinary system graph/US combination should be the first chosen radiologicmodality. However in non diagnosed symptomatic patients or ureter calculi suspicion low dose non-contrasthelical CT examination should be the chosen modality

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1. Pak CYC. Kidney stone. Lancet 1998;351:1797-801
2. Akýncý M, Esen T, Tellaloðlu S. Epidemiology of urinary stone disease in Turkey Türk Üroloji Dergisi 1992;18(1):33-7
3. Trinchieri A. Epidemiolgy of urolithiasis. Arch It Urol 1996;68:203-49
4. Gavant ML. Low-osmolar contrast media in the 1990s, Guidelines for urography in a cost-sensitive environment. Invest Radiol 1993;28(5):1320
5. Denton ER, Mackenzie A, Greenwell T,Popert R, Rankin SC. Unenhanced helical CT for renal colic is the radiation dose justifiable?. Clin Radiol 1999;54:444-7
6. Wong-You-Cheong JJ, Wagner BJ, Davis CJ. Transitional cell carcinoma of the urinary tract. Radiologicpathologic correlation. Radiographics 19 1998;18:12342
7. Takashý K, Kojý N, Jun W, And K.O. Clinical Characteristics of Ureteral Calculi Detected by Nonenhanced Computerized Tomography After Unclear Results of Plain Radiography and Ultrasonography The Journal of Urology 2003;170(3)799-802
8. Smith RC, Rosenfield AT, Choe KA, Essenmacher KR, Verga M, Glickman MG, et al. Acute flank pain: comparison of noncontrast-enhanced CT and intravenous urography. Radiology 1995;194:78994
9. Yilmaz S, Sindel T, Arslan G, Ozkaynak C, Karaali K, Kabaalioglu A, ve ark. Renal colic: comparison of spiral CT, US and IVU in the detection of ureteral calculi. Eur Radiol 1998;8:212-7
10. Catalano O, Nunziata A, Altei F, Siani A. Suspected ureteral colic: primary helical CT versus selective helical CT after unenhanced radiography and sonography. AJR Am J Roentgenol 2002;178(2):379- 87
11. Ripolles T, Agramunt M, Errando J, Martinez MJ, Coronel B, Morales M. Suspected ureteral colic: plain film and sonography vs unenhanced helical CT. A prospective study in 66 patients. EurRadiol 2004;14(1):129-36
12. Boulay I, Holtz P, Foley WD, White B, Begun FP. Ureteral calculi:diagnostic efficacy of helical CT and implications for treatment of patients. AJR Am J Roentgenol 1999;172(6):148590
13. Niemann T, Kollmann T, Bongartz G. Diagnostic Performance of Low-Dose CT for the Detection of Urolithiasis: A Meta-Analysis AJR 2008;191:396-401
14. Ozden E, Gogus C, Turkolmez K, Yagci C. Is Fluid Ingestion Really Necessary During Ultrasonography for Detecting Ureteral Stones?. A Prospective Randomized Study J Ultrasound Med 2005;24:1651- 7
15. Paulson EK, Weaver C, Ho LM, Martin L, Li J, Darsie J, et al. Conventional and Reduced Radiation Dose of 16-MDCT for Detection of Nephrolithiasis and Ureterolithiasis. AJR 2008;190(1):151-7
16. Sommer FG, Jeffrey RB, Rubin GD, Napel S, Rimmer SA, Benford J, et al. Detection of ureteral calculi in patients with suspected renal colic: value of reformatted noncontrast helical CT. AJR 1995;165(3):509-13
17. Ulusan S, Koc Z, Tokmak N. Accuracy of Sonography for Detecting Renal Stone: Comparison with CT. 2007;35(5):256-61
18. Mitterberger M, Pinggera GM, Pallwein L, Gradl J, Feuchtner G, Plattner R, et al. BJU Int. 2007 Oct;100(4):887-90
19. Heneghan JP, McGuire KA, Leder RA, DeLong DM, Yoshizumi T, Nelson RC. Helical CT for nephrolithiasis and ureterolithiasis: comparison of conventional and reduced radiation-dose techniques. Radiology 2003;229:57580
20. Liu W, Esler SJ, Kenny BJ, Goh RH, Rainbow AJ, Stevenson GW. Low-dose nonenhanced helical CT of renal colic: assessment of ureteric stone detection and measurement of effective dose equivalent. Radiology 2000;215:51-4
21. Katz SI, Saluja S, James A. Brink Radiation Dose Associated with Unenhanced CT for Suspected Renal Colic: Impact of Repetitive Studies. AJR 2006;186:1120-4
22. Kim S. Can Ultrasonography Be Useful in Evaluating Urolithiasis in the ED As Well As Computed Tomography?. Annals of Emergency Medicine 2008;51(4):544-54
23. Hamm M, Knopfle E, Wartenberg S,Wawroschek F, Weckermann D, Harzmann R. Low dose unenhanced helical computerized tomography for the evaluation of acute flank pain. J Urol 2002;167:168791
24. Ather MH, Jafri AH, Sulaiman MN. Diagnostic accuracy of ultrasonography compared to unenhanced CT for stone and obstruction in patients with renal failure. BMC Med Imaging 2004;4(1):2
25. Ray AA, Ghculete D, Pace KT, Honey RJ. Limitations to ultrasound in the detection and measurement of urinary tract calculi. Journal of Urology 2010;76(2):295- 300
26. Küpeli B, Gürocak S, Tunç L, Senocak S, Karaoðlan U, Bozkirli I. Value of ultrasonography and helical computed tomography in the diagnosis of stone free patients after extracorporeal shock wave lithotripsy (USG and helical CT after SWL). Int Urol Nephrol 2005;37(2):225-30
27. Tanrýkut C, Sahaný D, Dretler SP. Distinguishing Stent from Stone: Use of Bone Wýndows. Urology 2004;63(5):8237
28. Bellin MF, Renard-Penna R, Conort P, Bissery A, Meric JB, Daudan M, et al. Helical CT evaluation of the chemical composition of urinary tract calculi with a discriminant analysis of CT-attenuation values and density. Eur Radiol 2004;14(11):213440