Luca Villa1, Guido Giusti2, Thomas Knoll3, Olivier Traxer4. 1. Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy. Electronic address: l.villa@hotmail.it. 2. Department of Urology, IRCCS Ospedale San Raffaele Ville Turro, Milan, Italy. 3. Department of Urology, Klinikum Sindelfingen-Boeblingen, University of Tuebingen, Sindelfingen, Germany. 4. Department of Urology, Tenon Hospital, Pierre et Marie Curie University, Paris, France.
Abstract
CONTEXT: Imaging is essential for the diagnosis and the clinical decision-making process of patients with urinary stones. OBJECTIVE: To assess the benefits and limitations of various imaging techniques by specifically focusing on different phases of stone patients' management. EVIDENCE ACQUISITION: PubMed and Web of Science databases were used to identify studies published in the last 10 yr on this argument. Search terms included 'urolithiasis', nephrolithiasis', or 'urinary stones' in combination (AND) with the terms 'imaging', 'computer tomography', 'ultrasonography', 'intravenous pyelogram', or 'radiation exposure'. Study selection was based on an independent peer-review process of all the authors after the structured data search. EVIDENCE SYNTHESIS: Noncontrast-enhanced computer tomography (CT) provides the highest value of diagnostic accuracy for urinary stones. Stone composition can be specifically assessed through the use of dual-energy CT. When information about the anatomy of the renal collecting system is required or alternative pathologies are suspected, CT with contrast injection is recommended. Low-dose protocols allowed a drastic reduction of the effective dose administered to the patient, thus limiting the biological risk due to ionising radiations. Other strategies to contain the radiation exposure include the dual-split bolus dual energy CT and the adaptive statistical image reconstruction. Abdomen ultrasound may be a valid alternative as an initial approach since it does not change the outcome of patients compared with CT, and should be the imaging of choice in children and pregnant women. CONCLUSIONS: Noncontrast-enhanced CT is the most accurate imaging technique to identify urinary stones. Abdomen ultrasound seems to be a valid alternative in the initial evaluation of urinary colic. New low-dose protocols and strategies have been developed to contain radiation exposure, which is a major issue especially in specific circumstances. PATIENT SUMMARY: Noncontrast-enhanced computer tomography has been increasingly used for the diagnosis and management of urinary stones. Low-dose protocols as well as alternative imaging should be considered by clinicians in specific circumstances to minimise radiation exposure.
CONTEXT: Imaging is essential for the diagnosis and the clinical decision-making process of patients with urinary stones. OBJECTIVE: To assess the benefits and limitations of various imaging techniques by specifically focusing on different phases of stone patients' management. EVIDENCE ACQUISITION: PubMed and Web of Science databases were used to identify studies published in the last 10 yr on this argument. Search terms included 'urolithiasis', nephrolithiasis', or 'urinary stones' in combination (AND) with the terms 'imaging', 'computer tomography', 'ultrasonography', 'intravenous pyelogram', or 'radiation exposure'. Study selection was based on an independent peer-review process of all the authors after the structured data search. EVIDENCE SYNTHESIS: Noncontrast-enhanced computer tomography (CT) provides the highest value of diagnostic accuracy for urinary stones. Stone composition can be specifically assessed through the use of dual-energy CT. When information about the anatomy of the renal collecting system is required or alternative pathologies are suspected, CT with contrast injection is recommended. Low-dose protocols allowed a drastic reduction of the effective dose administered to the patient, thus limiting the biological risk due to ionising radiations. Other strategies to contain the radiation exposure include the dual-split bolus dual energy CT and the adaptive statistical image reconstruction. Abdomen ultrasound may be a valid alternative as an initial approach since it does not change the outcome of patients compared with CT, and should be the imaging of choice in children and pregnant women. CONCLUSIONS: Noncontrast-enhanced CT is the most accurate imaging technique to identify urinary stones. Abdomen ultrasound seems to be a valid alternative in the initial evaluation of urinary colic. New low-dose protocols and strategies have been developed to contain radiation exposure, which is a major issue especially in specific circumstances. PATIENT SUMMARY: Noncontrast-enhanced computer tomography has been increasingly used for the diagnosis and management of urinary stones. Low-dose protocols as well as alternative imaging should be considered by clinicians in specific circumstances to minimise radiation exposure.