Evaluation of patients with suspected ureteral calculi using sonography as an initial diagnostic tool: how can we improve diagnostic accuracy?
OBJECTIVE
The purpose of this study was to evaluate the usefulness of sonography as an initial diagnostic tool in patients with suspected ureterolithiasis.


METHODS
We performed a prospective study of 318 patients with suspected ureteral stones over a 14-month period. All patients underwent sonography after fasting for 8 hours and bladder filling. If no cause of the flank pain was found by sonography, computed tomography or intravenous urography was performed immediately to confirm the absence of ureteral stones.


RESULTS
We found urolithiasis with sonography in 291 of 296 patients with confirmed urolithiasis. The 5 remaining cases were identified after non-contrast-enhanced computed tomography (n = 3), intravenous urography (n = 1), or the passage of a stone (n = 1, pregnant patient). We detected 313 calculi in the 291 patients with sonography as follows: 307 ureteral calculi in 285 patients, 5 urinary bladder calculi that were probably passed from the ureter in 5 patients, and 1 urethral calculus. The locations of the 313 calculi in the 291 patients with a sonographic diagnosis were as follows: 21 were in the ureteropelvic junction, 96 in the proximal half of the ureter, 69 in the distal half of the ureter, 121 in the ureterovesical junction, 5 in the urinary bladder, and 1 in the urethra. Hydronephrosis was seen in 200 of the 291 patients with calculi identified by sonography (68.7%). Twinkling artifacts helped confirm the presence of tiny calculi in 184 of the 214 calculi (86%).


CONCLUSIONS
Sonography can be used as an initial diagnostic tool in patients with suspected ureterolithiasis.
Park
Seong Jin
SJ
Department of Radiology, Soonchunhyang University Bucheon Hospital, Gyeonggi-do 420-021, Korea. indawn@hanafos.com
Yi
Boem Ha
BH
Lee
Hae Kyung
HK
Kim
Young Ho
YH
Kim
Gong Jo
GJ
Kim
Hyun Cheol
HC
D000293:Adolescent; D000328:Adult; D000368:Aged; D042241:Early Diagnosis; D005260:Female; D006801:Humans; D007089:Image Enhancement / Q000379:methods*; D008297:Male; D008875:Middle Aged; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D014463:Ultrasonography / Q000379:methods*; D014514:Ureteral Calculi / Q000000981:diagnostic imaging*; D055815:Young Adult