1 / 9

Evidence in the ED Renal Stones

Evidence in the ED Renal Stones. Is a KUB an Appropriate Imaging Technique for Renal Stones? TJ Lydon, MD PhD. Twinem, Am J Surg 17:389-394, 1932. “10% of urinary calculi cast no shadows at all.”

higbee
Télécharger la présentation

Evidence in the ED Renal Stones

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Evidence in the EDRenal Stones Is a KUB an Appropriate Imaging Technique for Renal Stones? TJ Lydon, MD PhD

  2. Twinem, Am J Surg 17:389-394, 1932 • “10% of urinary calculi cast no shadows at all.” • Analysis of 207 calculi reveal that 16 (7.7%) were composed of uric acid and 6 (2.9%) were cystine. • Radiographs and photographs of a second set of calculi demonstrated that uric acid stones cast no shadows while cystine “cast faint shadows.”

  3. New Imaging Technique: Spiral CT • Fielding et al, J Urology, 157(6):2071, 1997: Spiral CT is 98% sensitive and 100% specific for stone detection. • Vieweg et al, J Urology, 160(3):679, 1998: Spiral CT is 98% sensitive and 98% specific for stone detection.

  4. Fielding et al, Urology, 1997 • 100 ED pts with acute flank pain • Exclusion criteria were fever, chills, or pregnancy • By spiral CT, 55/100 had renal stones • All pts were followed by urology either with a clinic visit or by telephone interview. • Outcomes were resolution of symptoms, documented passage of stone, or retrieval of the stone by retrograde urography (aka, IVP). • 11 patients did not have adequate follow-up.

  5. Compare KUB to Spiral CT • Levine et al, Radiology, 204: 27-31, 1997: KUB has a 45% sensitivity and a 77% specificity (178 patients with acute flank pain). • Hamm et al, Euro Uro, 39:460-465, 2001: KUB has 46% sensitivity and 76% specificity (125 patients with acute flank pain). • Zagoria et al, AJR, 176:1117-1122, 2001: KUB detected 53% of calculi (26 patients with stones).

  6. Levine et al, Radiology, 1997 • 178 pts presenting to ED with acute flank pain and had a spiral CT as part of their work-up. All had KUB’s. • CT scans were reviewed retrospectively by two radiologists blinded to the results of the KUB. • KUB’s were read three times: first by the radiologist covering the ED, then a blinded retrospective reading by two radiologists, finally, a repeat retrospective reading by the same two radiologist who were un-blinded to the results of the CT scans.

  7. Levine et al, Radiology, 1997 • When the ED radiologist’s KUB reading was compared to the spiral CT: KUB had a sensitivity of 45% and a specificity of 77%. • When the two blinded radiologists’ retrospective reading was compared to the CT: KUB had a sensitivity of 59% and a specificity of 71%. • When the two radiologists re-read the KUB in light of spiral CT results: sensitivity of 59%.

  8. HUPism • There is no diagnostic value in obtaining a KUB on a patient presenting with acute flank pain.

  9. Caveat • Zagoria et al, AJR, 176:1117-1120, 2001: KUB detected 15 of 19 (79%) of calculi > 5mm. • But how many renal stones are > 5mm across? Coll et al, AJR, 178:101-103, 2002: 850 pts with acute flank pain, 172 pts diagnosed with renal stones. Only 34% of stones were > 5 mm across.

More Related