Key Points
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Noncontrast CT is the most accurate imaging modality for kidney stones owing to high sensitivity, specificity, accurate stone sizing, and the ability to evaluate non-stone-related pathologies
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Ultrasonography has a lower sensitivity and specificity than CT, but does not expose patients to ionizing radiation and is less expensive than CT
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Ultrasonography has several limitations, but a randomized controlled trial demonstrated similar performance in the emergency department to that of CT for patients with suspected kidney stones
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Ultrasonography is the first-line imaging modality for pregnant women and patients <14 years old
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Low-dose CT has many of the same advantages of standard CT and reduces radiation exposure; however, its diagnostic accuracy is reduced in obese patients and dose modulation should be considered
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In the future, improvements in CT, ultrasonography, kidney ureter bladder radiography, and MRI might improve the accuracy of imaging kidney stones
Abstract
Kidney stone imaging is an important diagnostic tool and initial step in deciding which therapeutic options to use for the management of kidney stones. Guidelines provided by the American College of Radiology, American Urological Association, and European Association of Urology differ regarding the optimal initial imaging modality to use to evaluate patients with suspected obstructive nephrolithiasis. Noncontrast CT of the abdomen and pelvis consistently provides the most accurate diagnosis but also exposes patients to ionizing radiation. Traditionally, ultrasonography has a lower sensitivity and specificity than CT, but does not require use of radiation. However, when these imaging modalities were compared in a randomized controlled trial they were found to have equivalent diagnostic accuracy within the emergency department. Both modalities have advantages and disadvantages. Kidney, ureter, bladder (KUB) plain film radiography is most helpful in evaluating for interval stone growth in patients with known stone disease, and is less useful in the setting of acute stones. MRI provides the possibility of 3D imaging without exposure to radiation, but it is costly and currently stones are difficult to visualize. Further developments are expected to enhance each imaging modality for the evaluation and treatment of kidney stones in the near future. A proposed algorithm for imaging patients with acute stones in light of the current guidelines and a randomized controlled trial could aid clinicians.
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Acknowledgements
This work and Review are part of a large collaborative effort, and we appreciate the help of our many collaborators at the University of Washington Center for Industrial and Medical Ultrasound, the University of Washington Department of Urology, Washington, and the National Institute of Diabetes and Digestive and Kidney Diseases Program Project DK043881, USA. This material is the result of work supported by resources from the VA Puget Sound Health Care System, Seattle, Washington, USA. Funding was provided by National Space Biomedical Research Institute through NASA NCC 9–58, grants from the National Institute of Diabetes and Digestive and Kidney Diseases (DK043881 and DK092197), the University of Washington Applied Physics Laboratory, and the University of Washington Department of Urology.
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Brisbane, W., Bailey, M. & Sorensen, M. An overview of kidney stone imaging techniques. Nat Rev Urol 13, 654–662 (2016). https://doi.org/10.1038/nrurol.2016.154
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DOI: https://doi.org/10.1038/nrurol.2016.154
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