Diagnostic value ultrasound signs of stones less than or equal to 10 mm and clinicoradiological variants of ureteric colic

Objective:To determine the diagnostic value of ultrasound signs of urinary stones less than or equal to 10 mm and to determine clinico-radiological variants of ureteric colic.Methods:A total of 455 ultrasound investigations were performed in patients referring to emergency department with urolithiasis and symptoms suspected of ureteric colic between January 2021 and May 2021.In addition to microscopic evaluation of urine sediment to detect different crystals and non-contrast spiral computed tomography to detect stones,B-mode and color Doppler sonography was performed to assess the presence of acoustic shadow(AS)and twinkle artifacts(TA)as possible signs of stone(s)in ureter.Results:While the sensitivity and specificity of AS and TA were higher than 90%in patients with stones greater than 5 mm;positive prognostic values of these parameters were found to be extremely low for stones with sizes of 1-3 mm with specificity and sensitivity values not exceeding 53%.The sensitivity and specificity of AS and TA in the upper and lower ureters were higher for stones greater than or equal to 5 than for compared to those less than 5 mm.At the same time,the diagnostic values of TA and AS for middle ureter stones were very limited.The most prevalent clinico-radiological variants of ureteric colic were types I,III,and V being observed in 39%,28% and 21% cases,respectively.Conclusion:Our results demonstrate that TA and AS parameters seem to have a very low sensitivity and specificity in the diagnosis of urinary stones less than 5 mm.The diagnostic value of TA and AS increase significantly in stones greater than or equal to 5 mm.Therefore,clinicians need to be very careful for overestimating the diagnostic values of TA and AS for stones less than 5 mm and non-contrast spiral computed tomography must be the method of choice for patients presenting to emergency department with ureteric colic.

Utility of trans-vaginal ultrasound in diagnosis and follow-up of non-pregnant sexually active females with lower ureteric calculi

objective:To assess the utility of trans-vaginal ultrasonography in evaluation of non-pregnant sexually active female patients with lower ureteric calculi.Methods:A prospective study was done from January 2015 to December 2017 including non-pregnant sexually active females with suspected ureteric calculus.Trans-abdominal ultrasound was initially done in all patients.In those patients in whom trans-abdominal ultrasound was inconclusive or there was indirect evidence of lower ureteric calculus in form of ureteral dila-tion but no calculus was evident,trans-vaginal ultrasound was done.The patients with ureteric calculi detected on trans-vaginal ultrasound and kept on conservative management were also followed up with trans-vaginal ultrasound.Non-contrast computed tomography was done in patients with inconclusive trans-vaginal ultrasound.Results:As per the study protocol,156 out of the total 468 patients evaluated by trans-abdominal ultrasound were eligible for trans-vaginal ultrasound.Trans-vaginal ultrasound was done in 149 patients,as seven patients did not give consent.Seventy-nine patients were detected with a lower ureteric calculus on trans-vaginal ultrasound and 27 patients had gyne-cologic or other cause for their symptoms.Forty-three patients had an inconclusive trans-vaginal ultrasound of which 36 underwent non-contrast computed tomography,among them only one patient had a lower ureteric calculus.Stone free status could be easily demonstrated on follow-up trans-vaginal ultrasound.

Assessment of the efficacy of reduced-radiation noncontrast computed tomography scan compared with the standard noncontrast computed tomography scan for detecting urolithiasis:A prospective single-center study

Background:Noncontrast computed tomography(CT)scan of the kidneys,ureter and bladder is the standard investigative modality for diagnosing and following up patients with urolithiasis.With each scan,a patient receives radiation of 18-34 mGy.Dose considerations become pertinent because of a 10%lifetime incidence rate and higher than 50%risk of recurrence,necessitating repeated imaging in the lifetime of a stone former.Hence,this study aimed to assess the sensitivity of"reduced-radiation"CT imaging by altering scan settings to lower than the"standard"norms.Materials and methods:Altogether,222 patients(255"kidney-ureter"stone-bearing units or"renal units")with urolithiasis and patients undergoing CT for other reasons with incidental findings of renal/ureteric calculi between 2017 and 2019 were included.All patients were subjected to 3 sequential scans at tube current settings of 250 mA(CT-N/Standard),100 mA(CT-100),and 50 mA(CT-50)at a constant voltage of 120 kV.Their clinicodemographic and radiological findings were recorded and assessed for significance.Results:Of the 255 renal units,117 were between 30 and 44 years of age,75%were men.Of the 255 patients,178(70.1%)reported a first stone episode and 77 had recurrence.Lower ureteric calculi were predominant(40.4%).All calculi were identified on CT-N;CT-100 failed to detect calculi in 1 patient,and CT-50 failed in 3 patients,where all calculi were<3 mm in size.Meanwhile,none were undetected among patients with obesity.The sensitivity was 99.61%for the CT-100 and 98.82%for the CT-50,which indicated a 2.5 and 5 times lower radiation and dose/length,respectively,than CT-N.Conclusions:The reduced-radiation CT scan is safe,sensitive,and accurate for the diagnosis and follow-up of patients with urolithiasis with significantly lower radiation exposures.Our study lays the foundation to accept low-dose CT in general and CT-50 in particular,as the new"standard of care,"and attempt further dose reduction without loss of diagnostic efficacy.