Subscribe to RSS
DOI: 10.1055/s-2003-40426
Native Spiral-CT bei Urolithiasis: Indikation, Durchführung und Interpretation
Unenhanced Spiral CT in Urolithiasis: Indication, Performance and InterpretationPublication History
Publication Date:
08 July 2003 (online)
Zusammenfassung
Die Computertomographie (CT) ohne Kontrastmittelgabe findet heute bei Patienten mit akutem Flankenschmerz zunehmend Verwendung zur Abklärung eines Konkrementes im harnableitenden System. Bezüglich ihrer Erkennungsrate von Konkrementen übertrifft die Nativ-CT andere Untersuchungsmethoden wie die konventionelle Röntgenaufnahme, den Ultraschall oder die intravenöse Urographie und ist auch in der Niedrigdosistechnik durchführbar. Nahezu sämtliche Konkremente, einschließlich jener aus Harnsäure, Xanthin und Cystin, können computertomographisch nachgewiesen werden. Neben einer Bestimmung der Konkrementgröße und -lokalisation kann mit der Nativ-CT zusätzlich eine Aussage über die Steinbeschaffenheit getroffen werden. Ferner sind auch sekundäre Zeichen einer Obstruktion wie eine Dilatation des Nierenbeckenkelchsystems oder perirenale Veränderungen nachweisbar. Wenn kein Konkrement nachweisbar ist, lassen sich mittels der Nativ-CT häufig auch andere Ursachen akuter Flankenschmerzen nachweisen oder ausschließen, wodurch eine zusätzlich Bildgebung und das weitere therapeutische Management in die richtige Richtung gelenkt werden.
Abstract
Unenhanced spiral computed tomography is now applied in the investigation of patients with acute flank pain to search for suspected urinary tract calculi. Spiral CT can depict urinary calculi more accurately than plain radiographs, sonography or excretory urography, and can be performed using a low dose protocol. Almost all urinary calculi, including calculi composed of uric acid, xanthine and cystine, can be detected. In addition to determining size and location of the stone, unenhanced helical CT can predict its composition. Furthermore, it reveals secondary signs of obstruction, such as dilatation of the renal collecting system and perinephric stranding. In the absence of urolithiasis, CT can frequently detect or exclude other causes of acute flank pain, thus guiding subsequent imaging and the therapeutic management.
Key words
Unenhanced helical CT - urolithiasis - kidney - urinary tract
Literatur
- 1 Smith R C, Rosenfield A T, Choe K A, Essenmacher K R, Verga M, Glickman M G, Lange R C. Acute flank pain: comparison of non-contrast-enhanced CT and intravenous urography. Radiology. 1995; 194 789-794
- 2 Spielmann A L, Heneghan J P, Lee L J, Yoshizumi T, Nelson R C. Decreasing the radiation dose for renal stone CT: A feasibility study of Single- and Multidetector CT. AJR. 2002; 178 1058-1062
- 3 Dalrymple N C, Verga M, Anderson K R. et al . The value of unenhanced helical computerized tomography in the management of acute flank pain. J Urol. 1998; 159 735-740
- 4 Smith R C, Varanelli M. Diagnosis and management of acute ureterolithiasis: CT is truth. AJR. 2000; 175 3-6
- 5 Katz D S, Hines J, Rausch D R, Perlmutter S, Sommer F G, Lumerman J H, Friedman R M, Lane M J. Unenhanced helical CT for suspected renal colic. AJR. 1999; 173 425-430
- 6 Fowler K AB, Locken J A, Duchesne J H, Williamson M R. US for detecting renal calculi with nonenhanced CT as a reference standard. Radiology. 2001; 222 109-113
- 7 Hofmockel G, Frohmüller H. Ausgewählte urologische Notfälle. Dtsch Ärztebl. 2002; 99 A 2780-2791
- 8 Yilmaz S, Sindel T, Arslan G. et al . Renal colic: comparison of spiral CT, US and IVU in the detection of ureteral calculi. Eur Radiol. 1998; 8 212-217
- 9 Ruppert-Kohlmayr A J, Stacher R, Preidler K W. et al . Nativ-Spiral-Computertomographie bei Patienten mit akutem Flankenschmerz - Sinn oder Unsinn?. Fortschr Röntgenstr. 1999; 170 168-173
- 10 Marincek B. Akutes Abdomen: Bildgebung heute. Dtsch Ärztebl. 2002; 99 A 3010-3017
- 11 Zagoria R. Urinary tract obstruction and infection. Davos, Switzerland; IDKD 2002
- 12 Katz D S, Scheer M, Lumerman J H, Mellinger B C, Stillman C A, Lane M J. Alternative or additional diagnoses on unenhanced helical computed tomography for suspected renal colic: experience with 1000 consecutive examinations. Urology. 2000; 56 53-57
- 13 Fielding J R, Steele G, Fox L A, Heller H, Loughlin K R. Spiral computerized tomography in the evaluation of acute flank pain: a replacement for excretory urography. J Urol. 1997; 157 2071-2073
- 14 Grenier N, Pariente J L, Trillaud H, Soussotte C, Douws C. Dilatation of the collecting system during pregnancy: physiologic vs obstructive dilatation. Eur Radiol. 2000; 10 271-279
- 15 Sudah M, Vanninen R L, Partanen K. et al . Patients with acute flank pain: comparison of MR urography with unenhanced helical CT. Radiology. 2002; 223 98-105
- 16 Saw K C, McAlteer J A, Monga A G. et al . Helical CT of urinary calculi: effect of composition, stone size, and scan collimation. AJR. 2000; 175 329-332
- 17 Kalender W A. Grundlagen und Technik der Spiral-CT. Radiologe. 1999; 39 809-819
- 18 van Beers B E, Dechambre S, Hulcelle P, Materne R, Jamart J. Value of helical multislice CT scans and maximum-intensity-projection images to improve detection of ureteral stones at abdominal radiography. AJR. 2001; 177 1117-1121
- 19 Coppenrath E, Schmid C, Brandl U, Szeimies U, Hahn K. Spiral-CT des Abdomens: Gewichtsadaptierte Dosisreduktion. Fortschr Röntgenstr. 2001; 173 52-56
- 20 Tublin M E, Murphy M E, Delong D M, Tessler F N, Kliewer M A. Conspicuity of renal calculi at unenhanced CT: effects of calculus composition and size at CT. Radiology. 2002; 225 91-96
- 21 Hamm M, Wawroschek F, Weckermann D. et al . Unenhanced helical computed tomography in the evaluation of acute flank pain. Eur Urol. 2001; 39 460-465
- 22 Smith R C, Verga M, McCarthy S, Rosenfield A T. Diagnosis of acute flank pain: value of unenhanced helical CT. AJR. 1995; 166 97-101
- 23 Denton E R, Mackenzie A, Greenwell T. et al . Unenhanced helical CT for renal colic: is the radiation dose justifiable?. Clin Radiol. 1999; 54 444-447
- 24 Hamm M, Knöpfle E, Wartenberg S, Wawroschek F, Weckermann D, Harzmann R. Low dose unenhanced helical computerized tomography for the evaluation of acute flank pain. J Urol. 2002; 167 1687-1691
- 25 Liu W, Esler S J, Kenny B J, Goh R H, Rainbow A J, Stevenson G W. Low- dose unenhanced helical CT of renal colic: assessement and measurement of effective dose equivalent. Radiology. 2000; 215 51-54
- 26 Meagher T, Sukumar V P, Colligwood J, Crawly T, Schofield D, Henson J, Lakin J, Connolly D, Gilles J. Low dose computed tomography in suspected acute renal colic. Clin Radiol. 2001; 56 873-876
- 27 Smith R C, Coll D M. Helical computed tomography in the diagnosis of ureteric colic. BJU International. 2000; 86 (Suppl. 1) 33-41
- 28 Ahn S H, Mayo-Smith W W, Murphy B L, Reinert S E, Cronan J J. Acute nontraumatic abdominal pain in adult patients: abdominal radiography compared with CT evaluation. Radiology. 2002; 225 159-164
- 29 Mostavi M R, Ernst R D, Saltzman D. Accurate determination of chemical composition of urinary calculi by spiral computerized tomography. J Urol. 1998; 159 673-675
- 30 Motley G, Dalrymple N, Keesling C, Fischer J, Harmon W. Hounsfield unit density in the determination of urinary stone composition. Urology. 2001; 58 170-173
- 31 Schwartz B F, Schenkman N, Armenkas N A, Stoller M L. Imaging characteristics of indinavir calculi. J Urol. 1999; 161 1085-1087
- 32 Hu H, Fox S H. The effect of helical pitch and beam collimation on the lesion contrast and slice profile in helical CT imaging. Med Phys. 1996; 23 1943-1954
- 33 Smith R C, Verga M, Dalrymple N C, McCarthy S M, Rosenfield A T. Acute ureteral obstruction: value of secondary signs on helical unenhanced CT. AJR. 1996; 167 1109-1113
- 34 Varanelli M J, Coll D M, Levine J A, Rosenfield A T, Smith R C. Relationship between duration of pain and secondary signs of obstruction of the urinary tract on unenhanced helical CT. AJR. 2001; 177 325-330
- 35 Boridy I C, Kawashima A, Goldman S M, Sandler C M. Acute ureterolithiasis: nonenhanced helical CT findings of perinephric edema for prediction of degree of ureteral obstruction. Radiology. 1999; 213 663-667
- 36 Bell T V, Fenlon H M, Davison B D, Ahari H K, Hussain S. Unenhanced helical CT criteria to differentiate distal ureteral calculi from pelvic phleboliths. Radiology. 1998; 207 363-367
- 37 Heneghan J, Dalrymple N C, Verga M, Rosenfield A T, Smith R C. Soft-tissue ‘rim sign’ in the diagnosis of ureteral calculi with use of unenhanced helical CT. Radiology. 1997; 202 709-711
Dr. med. Harriet Thoeny
Institut für Diagnostische Radiologie Universitätsspital Bern
Freiburgstrasse 10
3010 Bern, Schweiz
Phone: 0041 31 632-2939
Fax: 0041 31 332-4873
Email: harriet.thoeny@insel.ch