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
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Dr. med. Harriet Thoeny
Institut für Diagnostische Radiologie Universitätsspital Bern
Freiburgstrasse 10
3010 Bern, Schweiz
Telefon: 0041 31 632-2939
Fax: 0041 31 332-4873
eMail: harriet.thoeny@insel.ch
