NON-CONTRAST ENHANCED MULTI-SLICE CT-KUB IN RENAL COLIC: SPECTRUM OF ABNORMALITIES DETECTED ON CT KUB AND ASSESSMENT OF REFERRAL PATTERNS
Abstract
Background: Renal colic is a common problem and significant number of patients presenting to ER, ED are suffering from acute or chronic renal colic. The conventional methods of investigating patients with renal colic are urine routine examination, plain radiograph for KUB (kidneys, ureters and bladder) and ultrasound followed by intravenous urography. Now a days non contrast enhanced computed tomography of kidneys, ureters and bladder is the first line investigation in suspected upper urinary tract obstruction. Radiation dose is one of the major limitations of CT KUB. Other limitations are cost and availability. The sensitivity and specificity of CT KUB is extremely high in the diagnosis of stones. Methods: This cross-sectional descriptive study was conducted in the department of Radiology Ayub Medical Teaching Institution Abbottabad from 1st July 2017 to 30th May 2018. Information obtained from history, clinical examination and CT KUB, ultrasound were recorded in an approved and prescribed pro forma. Results: Among total 350 patients, majority were male 66% and the age of study population ranged from 20 to 60 years. Most of the patients presented with flank pain and microscopic hematuria. Calculi were detected in 52 %. Patients with non obstructing stones were 63 %, ureteric stones and hydronephrosis were 22 %, ureterovesicle junction stone 4%. Patients with stones and incidental findings made 12.8% of the study population having abnormal CT KUB. Conclusion: Non contrast enhanced CT KUB, performed in a suitable clinical scenario, is an excellent imaging investigation for patients having renal colic and the initial ultrasound is inconclusive. In majority of cases it identifies the cause of lumbar or pelvic pain. This modality has the added advantage of showing alternate causes for pain other than stones.
Keywords: Renal colic; CT KUB; abnormalities;References
Ather MH, Jafri AH, Sulaiman MN. Diagnostic accuracy of ultrasonography compared to unenhanced CT for stone and obstruction in in patients with renal failure. BMC Med Imaging 2004;4(1):2.
Smith RC, Verga M, McCarthy S, Rosenfield AT. Diagnosis of acute flank pain: Value of unenhanced helical CT. AJR Am J Roentgenol 1996;166(1):97-101.
Dhar M, Denstedt JD. Imaging in diagnosis, treatment, and follow-up of stone patients. Adv Chronic Kidney Dis 2009;16(1):39-47.
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):1485-90.
Katz DS, Lane MJ, Sommer FG. Unenhanced helical CT of ureteral stones: Incidence of associated urinary tract findings. AJR Am J Roentgenol 1996;166(6):1319-22.
Schwartz BF, Schenkman N, Armenakas NA, Stoller ML. Imaging characteristics of indinavir calculi. J Urol 1999;161(4):1085-7.
Dalla Palma L, Pozzi-Mucelli R, Stacul F. Present-day imaging of patients with renal colic. Eur Radiol 2001;11(1):4-17.
Shaaban MS, Kotb AF. Value of non-contrast CT examination of the urinary tract (stone protocol) in the detection of incidental findings and its impact on the management. Alex J Med 2016;52(3):209-17.
Ather MH, Faizullah KF, Achakzai IA, Siwani R, Irani F. Alternate and incidental diagnoses on non contrastenhanced spiral computed tomography for acute flank pain. Urol J 2009;6(1):14-8.
Hoppe H, Studer R, Kessler TM, Vock P, Studer UE, Thoeny HC. Alternate or additional findings to stone disease on unenhanced computerized tomography for acute flank pain can impact management. J Urol 2006;175(5):1725-30.
McCarthy CJ, Baliyan V, Kordabacheh H, Sajjad Z, Sahani D, Kambadakone A. Radiology of renal stone disease. Int J Surg 2016;36(Pt D):638-46.
Kirpalani A, Khalili K, Lee S, Haider MA. Renal colic: comparison of use and outcomes of unenhanced helical CT for emergency investigation in 1998 and 2002. Radiology 2005;236(2):554-8.
Dyer J, Syrrat T, Sing S. Is CT KUB the gold standard in assessing flank pain with diagnostic uncertainty? A one-year review of 228 cases. J Clin Urol 2013;6(2):114-8.
Nachmann MM, Harkaway RC, Summerton SL, Horrow MM, Kirby CL, Fields RG, et al. Helical CT scanning: The primary imaging modality for acute flank pain. Am J Emerg Med 2000;18(6):649-52.
Yilmaz S, Sindel T, Arslan G, Ozkaynak C, Karaali K, Kabaalioglu A, et al. Renal colic: Comparison of spiral CT, US and IVU in detection of ureteral calculi. Eur Radiol 1998;8(2):212-7.
Downloads
Published
How to Cite
Issue
Section
License
Journal of Ayub Medical College, Abbottabad is an OPEN ACCESS JOURNAL which means that all content is FREELY available without charge to all users whether registered with the journal or not. The work published by J Ayub Med Coll Abbottabad is licensed and distributed under the creative commons License CC BY ND Attribution-NoDerivs. Material printed in this journal is OPEN to access, and are FREE for use in academic and research work with proper citation. J Ayub Med Coll Abbottabad accepts only original material for publication with the understanding that except for abstracts, no part of the data has been published or will be submitted for publication elsewhere before appearing in J Ayub Med Coll Abbottabad. The Editorial Board of J Ayub Med Coll Abbottabad makes every effort to ensure the accuracy and authenticity of material printed in J Ayub Med Coll Abbottabad. However, conclusions and statements expressed are views of the authors and do not reflect the opinion/policy of J Ayub Med Coll Abbottabad or the Editorial Board.
USERS are allowed to read, download, copy, distribute, print, search, or link to the full texts of the articles, or use them for any other lawful purpose, without asking prior permission from the publisher or the author. This is in accordance with the BOAI definition of open access.
AUTHORS retain the rights of free downloading/unlimited e-print of full text and sharing/disseminating the article without any restriction, by any means including twitter, scholarly collaboration networks such as ResearchGate, Academia.eu, and social media sites such as Twitter, LinkedIn, Google Scholar and any other professional or academic networking site.