Difference between revisions of "CT of kidney stone disease"
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==Evaluation== | ==Evaluation== | ||
[[File:CT measurement of kidney stone in soft tissue and bone window.jpg|thumb|Measurement of a 5.6 mm large kidney stone in soft tissue window (at left, with width of 400 HU, and center at 50 HU) versus skeletal window (right, W1800,C400). 145 HU is regarded as an appropriate cutoff to distinguish a stone from surrounding tissue.<ref name="LidénThunberg2015">{{cite journal|last1=Lidén|first1=Mats|last2=Thunberg|first2=Per|last3=Broxvall|first3=Mathias|last4=Geijer|first4=Håkan|title=Two- and three-dimensional CT measurements of urinary calculi length and width: a comparative study|journal=Acta Radiologica|volume=56|issue=4|year=2015|pages=487–492|issn=0284-1851|doi=10.1177/0284185114528490}}</ref>]] | [[File:CT measurement of kidney stone in soft tissue and bone window.jpg|thumb|Measurement of a 5.6 mm large kidney stone in soft tissue window (at left, with width of 400 HU, and center at 50 HU) versus skeletal window (right, W1800,C400). 145 HU is regarded as an appropriate cutoff to distinguish a stone from surrounding tissue.<ref name="LidénThunberg2015">{{cite journal|last1=Lidén|first1=Mats|last2=Thunberg|first2=Per|last3=Broxvall|first3=Mathias|last4=Geijer|first4=Håkan|title=Two- and three-dimensional CT measurements of urinary calculi length and width: a comparative study|journal=Acta Radiologica|volume=56|issue=4|year=2015|pages=487–492|issn=0284-1851|doi=10.1177/0284185114528490}}</ref>]] | ||
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| − | == | + | Objectives of the evaluation are mainly:<ref>{{cite web|url=https://emedicine.medscape.com/article/381993-overview|title=Urinary Calculi Imaging|author=J Kevin Smith, Mark E Lockhart, Nicole W Berland and Philip J Kenney|website=Medscape|date=2015-10-27}}</ref> |
| − | + | *Presence of stones within the urinary tract | |
| − | + | *Complications such as hydronephrosis (''See: [[Hydronephrosis]]'') | |
| − | <ref | + | *Measure the size of stones. Proper sizing of a stone is important at around 5 mm and above, since smaller stones generally pass spontaneously.<ref group="notes">Ureteric stones less than 5 mm in diameter pass spontaneously in up to 98% of cases, while those measuring 5 to 10 in diameter pass spontaneously in less than 53% of cases.<br> - {{cite journal|last=Gettman|first=MT|last2=Segura|first2=JW|title=Management of ureteric stones: Issues and controversies|journal=British Journal of Urology International|volume=95|issue=Supplement 2|pages=85–93|year=2005|pmid=15720341|doi=10.1111/j.1464-410X.2005.05206.x}}</ref> Sizing of larger stones is also important in order to decide which treatment to choose.<ref group="notes">Small proximal ureteral calculi of less than 10 mm are best treated with shock wave lithotripsy and ureteroscopy, while those larger than 10 mm are best treated with flexible ureteroscopy combined with holmium laser lithotripsy. |
| − | <ref | ||
| − | Small proximal ureteral calculi of less than 10 mm are best treated with shock wave lithotripsy and ureteroscopy, while those larger than 10 mm are best treated with flexible ureteroscopy combined with holmium laser lithotripsy. | ||
<br> - {{cite web|url=https://www.uptodate.com/contents/management-of-ureteral-calculi|title=Management of ureteral calculi|author=Glenn M Preminger, Section Editors:Stanley Goldfarb, Michael P O'Leary. Deputy Editor:Albert Q Lam|date=2018-01-19|website=UpToDate}}</ref> | <br> - {{cite web|url=https://www.uptodate.com/contents/management-of-ureteral-calculi|title=Management of ureteral calculi|author=Glenn M Preminger, Section Editors:Stanley Goldfarb, Michael P O'Leary. Deputy Editor:Albert Q Lam|date=2018-01-19|website=UpToDate}}</ref> | ||
| − | + | *Confirm any stone passage | |
| − | + | *Assess the stone burden | |
| + | <gallery> | ||
| + | File:3mmstone.png|[[Transverse plane|Axial]] CT without contrast, showing a 3-mm stone (marked by an arrow) in the left proximal ureter | ||
| + | </gallery> | ||
{{Bottom}} | {{Bottom}} | ||
Revision as of 13:16, 8 November 2018
Author:
Mikael Häggström [notes 1]
Contents
Planning
- Choice of modality: In the acute setting, ultrasonography in urolithiasis is the optimal first investigation rather than CT.[1]
Evaluation
Measurement of a 5.6 mm large kidney stone in soft tissue window (at left, with width of 400 HU, and center at 50 HU) versus skeletal window (right, W1800,C400). 145 HU is regarded as an appropriate cutoff to distinguish a stone from surrounding tissue.[2]
Objectives of the evaluation are mainly:[3]
- Presence of stones within the urinary tract
- Complications such as hydronephrosis (See: Hydronephrosis)
- Measure the size of stones. Proper sizing of a stone is important at around 5 mm and above, since smaller stones generally pass spontaneously.[notes 2] Sizing of larger stones is also important in order to decide which treatment to choose.[notes 3]
- Confirm any stone passage
- Assess the stone burden
Axial CT without contrast, showing a 3-mm stone (marked by an arrow) in the left proximal ureter
Notes
- ↑ For a full list of contributors, see article history. Creators of images are attributed at the image description pages, seen by clicking on the images. See Radlines:Authorship for details.
- ↑ Ureteric stones less than 5 mm in diameter pass spontaneously in up to 98% of cases, while those measuring 5 to 10 in diameter pass spontaneously in less than 53% of cases.
- Gettman, MT; Segura, JW (2005). "Management of ureteric stones: Issues and controversies ". British Journal of Urology International 95 (Supplement 2): 85–93. doi:. PMID 15720341. - ↑ Small proximal ureteral calculi of less than 10 mm are best treated with shock wave lithotripsy and ureteroscopy, while those larger than 10 mm are best treated with flexible ureteroscopy combined with holmium laser lithotripsy.
- Glenn M Preminger, Section Editors:Stanley Goldfarb, Michael P O'Leary. Deputy Editor:Albert Q Lam (2018-01-19). Management of ureteral calculi. UpToDate.
References
- ↑ Smith-Bindman, Rebecca; Aubin, Chandra; Bailitz, John; Bengiamin, Rimon N.; Camargo, Carlos A.; Corbo, Jill; Dean, Anthony J.; Goldstein, Ruth B.; et al. (2014). "Ultrasonography versus Computed Tomography for Suspected Nephrolithiasis ". New England Journal of Medicine 371 (12): 1100–1110. doi:. ISSN 0028-4793.
- ↑ Lidén, Mats; Thunberg, Per; Broxvall, Mathias; Geijer, Håkan (2015). "Two- and three-dimensional CT measurements of urinary calculi length and width: a comparative study ". Acta Radiologica 56 (4): 487–492. doi:. ISSN 0284-1851.
- ↑ J Kevin Smith, Mark E Lockhart, Nicole W Berland and Philip J Kenney (2015-10-27). Urinary Calculi Imaging. Medscape.
