Low-Dose Unenhanced Computed Tomography with Iterative Reconstruction for Diagnosis of Ureter Stones
1
조회
0
다운로드
0
인용
0
참고문헌
키워드
초록
Purpose: To study the clinical application of low-dose unenhanced computed tomography with iterative reconstruction technique(LDCT-IR) on renal colic in the emergency department. Materials and Methods: We conducted a prospective, single-blinded, randomized, and non-inferiority study. From March 2014to August 2015, 112 patients with renal colic were included, and were randomized to either LDCT-IR (n=46) or standard-dose unenhancedCT (SDCT) (n=66) groups. The accuracy of urolithiasis diagnosis was the primary endpoint of this study. Radiationdose, size and location of the stone, hydronephrosis, other diseases except urolithiasis, and results of treatment were analyzedbetween the two groups. Results: The average effective dose radiation of SDCT was approximately four times higher than that of LDCT-IR (6.52 mSv vs. 1.63 mSv, p<0.001). There was no significant difference in the accuracy of ureteral stone diagnosis between the two groups (LDCTIRgroup: 96.97% vs. SDCT group: 98.96%, p=0.392). No significant difference was observed regarding the size and location of astone, hydronephrosis, and diagnosis of other diseases, except urolithiasis. False negative results were found in two LDCT-IR patientsand in one SDCT patient. In these patients, stones were misread as vascular calcification, and were difficult to diagnose becauseevidence of hydronephrosis and ureteral dilatation was not found. Conclusion: LDCT-IR, as a first-line imaging test, was non-inferior to SDCT with respect to diagnosis of ureter stones, and wasclinically available for the evaluation of renal colic.
Abstract
Purpose: To study the clinical application of low-dose unenhanced computed tomography with iterative reconstruction technique(LDCT-IR) on renal colic in the emergency department. Materials and Methods: We conducted a prospective, single-blinded, randomized, and non-inferiority study. From March 2014to August 2015, 112 patients with renal colic were included, and were randomized to either LDCT-IR (n=46) or standard-dose unenhancedCT (SDCT) (n=66) groups. The accuracy of urolithiasis diagnosis was the primary endpoint of this study. Radiationdose, size and location of the stone, hydronephrosis, other diseases except urolithiasis, and results of treatment were analyzedbetween the two groups. Results: The average effective dose radiation of SDCT was approximately four times higher than that of LDCT-IR (6.52 mSv vs. 1.63 mSv, p<0.001). There was no significant difference in the accuracy of ureteral stone diagnosis between the two groups (LDCTIRgroup: 96.97% vs. SDCT group: 98.96%, p=0.392). No significant difference was observed regarding the size and location of astone, hydronephrosis, and diagnosis of other diseases, except urolithiasis. False negative results were found in two LDCT-IR patientsand in one SDCT patient. In these patients, stones were misread as vascular calcification, and were difficult to diagnose becauseevidence of hydronephrosis and ureteral dilatation was not found. Conclusion: LDCT-IR, as a first-line imaging test, was non-inferior to SDCT with respect to diagnosis of ureter stones, and wasclinically available for the evaluation of renal colic.
참고문헌 (20)
- 지병훈, "Daily Mean Temperature and Urolithiasis Presentation in Six Cities in Korea: Time-Series Analysis", Journal of Korean Medical Science, 32(6), pp.999~1008 (2017), 대한의학회
- Choi SY, "Urbanization may affect the incidence of urolithiasis in South Korea", Springerplus, 5, pp.1891~ (2016)[DOI]
- 정재동, "Influence of Overweight on 24-Hour Urine Chemistry Studies and Recurrent Urolithiasis in Children", Investigative and Clinical Urology, 53(4), pp.268~274 (2012), 대한비뇨의학회[DOI]
- Kim SC, "Prevalence and risk factors of urinary stones in Koreans", J Korean Med Sci, 13, pp.138~146 (1998)[DOI]
- Boulay I, "Ureteral calculi: diagnostic efficacy of helical CT and implications for treatment of patients", AJR Am J Roentgenol, 172, pp.1485~1490 (1999)[DOI]
- Fulgham PF, "Clinical effectiveness protocols for imaging in the management of ureteral calculous disease: AUA technology assessment", J Urol, 189, pp.1203~1213 (2013)[DOI]
- Lee DH, "Usefulness of nonenhanced computed tomography for diagnosing urolithiasis without pyuria in the emergency department", Biomed Res Int, 2015, pp.810971~ (2015)
- Ahn S, "LOCAT (low-dose computed tomography for appendicitis trial) comparing clinical outcomes following lowvs standard-dose computed tomography as the first-line imaging test in adolescents and young adults with suspected acute appendicitis: study protocol for a randomized controlled trial", Trials, 15, pp.28~ (2014)[DOI]
- Ibrahim M, "Raise the bar and lower the dose: current and future strategies for radiation dose reduction in head and neck imaging", AJNR Am J Neuroradiol, 35, pp.619~624 (2014)[DOI]
- Kwon JK, "Usefulness of low-dose nonenhanced computed tomography with iterative reconstruction for evaluation of urolithiasis: diagnostic performance and agreement between the urologist and the radiologist", Urology, 85, pp.531~538 (2015)[DOI]
- Choi SY, "Determination of optimal imaging settings for urolithiasis CT using filtered back projection (FBP), statistical iterative reconstruction (IR) and knowledge-based iterative model reconstruction (IMR): a physical human phantom study", Br J Radiol, 89, pp.20150527~ (2016)[DOI]
- 박상호, "Pilot Study of Low-Dose Nonenhanced Computed Tomography With Iterative Reconstruction for Diagnosis of Urinary Stones", Investigative and Clinical Urology, 55(9), pp.581~586 (2014), 대한비뇨의학회
- Malkawi IM, "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, 30, pp.493~496 (2016)[DOI]
- Park SB, "Knowledge-based iterative model reconstruction (IMR) algorithm in ultralow-dose CT for evaluation of urolithiasis: evaluation of radiation dose reduction, image quality, and diagnostic performance", Abdom Imaging, 40, pp.3137~3146 (2015)[DOI]
- Guest AR, "Assessment of the clinical utility of the rim and comet-tail signs in differentiating ureteral stones from phleboliths", AJR Am J Roentgenol, 177, pp.1285~1291 (2001)[DOI]
- Bell TV, "Unenhanced helical CT criteria to differentiate distal ureteral calculi from pelvic phleboliths", Radiology, 207, pp.363~367 (1998)[DOI]
- Heneghan JP, "Soft-tissue rim sign in the diagnosis of ureteral calculi with use of unenhanced helical CT", Radiology, 202, pp.709~711 (1997)[DOI]
- Boridy IC, "Ureterolithiasis: value of the tail sign in differentiating phleboliths from ureteral calculi at nonenhanced helical CT", Radiology, 211, pp.619~621 (1999)[DOI]
- Poletti PA, "Low-dose versus standard-dose CT protocol in patients with clinically suspected renal colic", AJR Am J Roentgenol, 188, pp.927~933 (2007)[DOI]
- Tack D, "Suspected acute colon diverticulitis: imaging with low-dose unenhanced multi-detector row CT", Radiology, 237, pp.189~196 (2005)[DOI]