Low dose computed tomography KUB region for management of urolithiasis in Indian scenario

Authors

  • Satyadeo Sharma Department of Urology, Ruby Hall Clinic, Pune, Maharashtra, India
  • Rajeev Chaudhari Department of Urology, Ruby Hall Clinic, Pune, Maharashtra, India
  • Krutik Rawal Department of Urology, Ruby Hall Clinic, Pune, Maharashtra, India
  • Shahil Khant Department of Urology, Ruby Hall Clinic, Pune, Maharashtra, India

DOI:

https://doi.org/10.18203/2349-2902.isj20180367

Keywords:

Low dose computed tomography, Noncontrast CT, Urolithiasis

Abstract

Background: The incidence, prevalence and recurrence of urolithiasis are very high; especially in the north-western part of India. Ultrasonography has decreased sensitivity and specificity as compared with NCCT for detection of both renal and ureteral calculi. Drawbacks of NCCT in terms of radiation exposure, cost and repeatability can be overcome by Low dose NCCT protocols. Low dose NCCT can be an investigation with high diagnostic accuracy, less radiation hazards and financial acceptability. Aim of this study was to evaluate use of Low dose CT-KUB over ultrasound (US) for diagnosis of urolithiasis, in Indian scenario.

Methods: This is a prospective study, at Tertiary Care Hospital. Patients with acute flank pain, who underwent both US and Low dose NCCT within an interval of 24 hours, at Tertiary Care Hospital. Helical CT scanner (Phillips 128 slice medical systems) with exposure factors setting of KVp 120 and mAs 70 was used.

Results: A total of 136 Patients with mean age of 33.01 years (range 19-62 years, SD 10.93), were examined with 82(60.29%) males and 54(39.7%) females, average BMI was 25.07(range 17.2 to 35.02). Low Dose NCCT has a sensitivity of 95% (CI of 89.43-98.14%) and specificity of 87.50% (95% CI of 61.65-98.45%) in the diagnosis of urolithiasis. Mean effective dose of radiation administered in low dose CT-KUB was 1.8-2.2 mSv.

Conclusions: In view of information, reliability, repeatability, radiation exposure and cost acceptability; unenhanced Low dose CT-KUB region should be the preferred investigation for the management of urolithiasis, in the scenario of a developing country.

Metrics

Metrics Loading ...

References

Bhatt K, Monga M, Remer EM. Low-Dose Computed Tomography in the Evaluation of Urolithiasis. J Endourol. 2015;29(5):504-11.

Ansari MS, Gupta NP, Hemal AK, Dogra PN, Seth A, Aron M, et al. Spectrum of stone composition: Structural analysis of 1050 upper urinary tract calculi from northern India. Int J Urol. 2005;12(1):12-6.

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.

Riddell J, Case A, Wopat R, Beckham S, Lucas M, McClung CD, et al. Sensitivity of Emergency Bedside Ultrasound to Detect Hydronephrosis in Patients with Computed Tomography-proven Stones. West J Emerg Med. 2014;15(1):96-100.

Niemann T, Kollmann T, Bongartz G. Diagnostic performance of low-dose CT for the detection of urolithiasis: A meta-analysis. Am J Roentgenol. 2008;191(2):396-401.

ICRP. Radiological protection and safety in medicine. ICRP Publication 73. Ann ICRP. 1996;26(2).

Drake T, Jain N, Bryant T, Wilson I, Somani BK. Should low-dose computed tomography kidneys, ureter and bladder be the new investigation of choice in suspected renal colic?: A systematic review. Indian J Urol. 2014;30(2):137-43.

Tack D, Sourtzis S, Delpierre I, de Maertelaer V, Gevenois PA. Low-Dose Unenhanced Multidetector CT of Patients with Suspected Renal Colic. Am J Roentgenol. 2003;180(2):305-11.

Sezer F, Atalar MH, Sezer F. Place of non-contrast computed tomography for evaluation of flank pain and suspected urinary stone in emergency service. 2014;42-50.

Poletti PA, Platon A, Rutschmann OT, Schmidlin FR, Iselin CE, Becker CD. Low-dose versus standard-dose CT protocol in patients with clinically suspected renal colic. Am J Roentgenol. 2007;188(4):927-33.

Katz SI, Saluja S, Brink JA, Forman HP. Radiation dose associated with unenhanced CT for suspected renal colic: Impact of repetitive studies. Am J Roentgenol. 2006;186(4):1120-4.

Kluner C, Hein PA, Gralla O, Hein E, Hamm B, Romano V, et al. Does ultra-low-dose CT with a radiation dose equivalent to that of KUB suffice to detect renal and ureteral calculi? J Comput Assist Tomogr. 2006;30(1):44-50.

Kim BS, Hwang IK, Choi YW, Namkung S, Kim HC, Hwang WC, et al. Low-dose and standard-dose unenhanced helical computed tomography for the assessment of acute renal colic: prospective comparative study. Acta radiol. 2005;46:756-63.

Abou El-Ghar ME, Shokeir AA, Refaie HF, El-Nahas AR. Low-dose unenhanced computed tomography for diagnosing stone disease in obese patients. Arab J Urol. 2012;10(3):279-83.

Alsyouf M, Smith DL, Olgin G, Heldt JP, Lightfoot M, Li R, et al. Comparing stone attenuation in low- and conventional-dose noncontrast computed tomography. J Endourol. 2014;28(6):704-7.

Sohn W, Clayman RV, Lee JY, Cohen A, Mucksavage P. Low-dose and standard computed tomography scans yield equivalent stone measurements. Urol. 2013;81(2):231-4.

Jin DH, Lamberton GR, Broome DR, Saaty HP, Bhattacharya S, Lindler TU, et al. Effect of reduced radiation CT protocols on the detection of renal calculi. J Urol. 2010;184(4):1379-80.

Kalra MK, Maher MM, Toth TL, Schmidt B, Westerman BL, Morgan HT, et al. Techniques and Applications of Automatic Tube Current Modulation for CT. Radiology. 2004;233(3):649-57.

Malkawi IM, Han E, Atalla CS, Santucci RA, O’Neil B, Wynberg JB. Low-Dose (10%) Computed Tomography May Be Inferior to Standard-Dose CT in the Evaluation of Acute Renal Colic in the Emergency Room Setting. J Endourol. 2016;30(5):493-6.

McLaughlin PD, Murphy KP, Hayes SA, Carey K, Sammon J, Crush L, et al. Non-contrast CT at comparable dose to an abdominal radiograph in patients with acute renal colic; impact of iterative reconstruction on image quality and diagnostic performance. Insights Imaging. 2014;5(2):217-30.

Turk C, Petrik A, Sarica K, Seitz C, Skolarikos A, Straub M, et al. EAU Guidelines on Urolithiasis. Eur Assoc Urol. 2015;69(3):475-82.

Wang JH, Shen SH, Huang SS, Chang CY. Prospective comparison of unenhanced spiral computed tomography and intravenous urography in the evaluation of acute renal colic. J Chinese Med Assoc. 2008;71(1):30-6.

Thomson JM, Glocer J, Abbott C, Maling TM. Computed tomography versus intravenous urography in diagnosis of acute flank pain from urolithiasis: A randomized study comparing imaging costs and radiation dose. Australas Radiol. 2001;45(3):291-7.

Smith-Bindman R, Aubin C, Bailitz J, Bengiamin RN, Camargo CA, Corbo J, et al. Ultrasonography versus Computed Tomography for Suspected Nephrolithiasis. N Engl J Med. 2014;371(12):1100-10.

Van-Der-Molen AJ, Cowan NC, Mueller-Lisse UG, Nolte-Ernsting CCA, Takahashi S, Cohan RH, et al. CT urography: definition, indications and techniques. A guideline for clinical practice. Eur Radiol. 2008;18(1):4-17.

Downloads

Published

2018-01-25

How to Cite

Sharma, S., Chaudhari, R., Rawal, K., & Khant, S. (2018). Low dose computed tomography KUB region for management of urolithiasis in Indian scenario. International Surgery Journal, 5(2), 638–642. https://doi.org/10.18203/2349-2902.isj20180367

Issue

Section

Original Research Articles