Tim Nestler1,2, Stefan Haneder3, Nils Große Hokamp3. 1. Department of Urology, Uro-Oncology, Robot Assisted and Reconstructive Urologic Surgery, University Hospital Cologne, Cologne. 2. Department of Urology and Uro-Oncology, Federal Armed Services Hospital Koblenz, Koblenz. 3. Institute for Diagnostic and Interventional Radiology, University Hospital Cologne, Cologne, Germany.
Abstract
PURPOSE OF REVIEW: Radiological imaging techniques are a fast developing field in medicine. Therefore, the purpose of this review was to identify and discuss the latest changes of modern imaging techniques in the management of urinary stone disease. RECENT FINDINGS: The introduction of iterative image reconstruction enables low-dose and ultra-low-dose (ULD) protocols. Although current guidelines recommend their utilization in nonobese patients recent studies indicate that low-dose imaging may be feasible in obese (<30 kg/m) but not in bariatric patients. Use of dual energy computed tomography (CT) technologies should balance between additional information and radiation dose aspects. If available on a dose neutral basis, dual energy imaging and analysis should be performed. Current guidelines recommend measuring the largest diameter for clinical decision making; however, recent studies suggest a benefit from measuring the volume based on multiplanar reformation. Quantitative imaging is still an experimental approach. SUMMARY: The use of low-dose and even ULD CT protocols should be diagnostic standard, even in obese patients. If dual energy imaging is available, it should be limited to specific clinical questions. The stone volume should be reported in addition to the largest diameter for treatment decision and a more valid comparability of upcoming studies.
PURPOSE OF REVIEW: Radiological imaging techniques are a fast developing field in medicine. Therefore, the purpose of this review was to identify and discuss the latest changes of modern imaging techniques in the management of urinary stone disease. RECENT FINDINGS: The introduction of iterative image reconstruction enables low-dose and ultra-low-dose (ULD) protocols. Although current guidelines recommend their utilization in nonobese patients recent studies indicate that low-dose imaging may be feasible in obese (<30 kg/m) but not in bariatric patients. Use of dual energy computed tomography (CT) technologies should balance between additional information and radiation dose aspects. If available on a dose neutral basis, dual energy imaging and analysis should be performed. Current guidelines recommend measuring the largest diameter for clinical decision making; however, recent studies suggest a benefit from measuring the volume based on multiplanar reformation. Quantitative imaging is still an experimental approach. SUMMARY: The use of low-dose and even ULD CT protocols should be diagnostic standard, even in obesepatients. If dual energy imaging is available, it should be limited to specific clinical questions. The stone volume should be reported in addition to the largest diameter for treatment decision and a more valid comparability of upcoming studies.