Sonographic detection of renal and ureteral stones. Value of the twinkling sign.
OBJECTIVE
To compare the detection of urinary stones using standard gray scale ultrasound for diagnostic accuracy using the color Doppler "twinkling sign".


METHODS
Our study population consisted of forty-one patients who demonstrated at least one urinary stone on unenhanced CT evaluation of the kidneys or ureters. Each patient was evaluated using gray scale ultrasound and color Doppler imaging by an observer who was blinded to the CT results.


RESULTS
Seventy-seven stones were present in 41 patients, including 47 intrarenal stones, 5 stones in the renal pelvis, 8 stones at the ureteropelvic junction, 5 ureteral stones and 12 stones at the ureterovesical junction. Based upon gray scale sonography the diagnosis of stone was made with confidence in 66% (51/77) of locations. Based upon Doppler sonography using the twinkling sign, the diagnosis of stone was made with confidence in 97% (75/77) of locations. Clustered ROC analysis demonstrated that the Doppler twinkling sign (Az = 0.99) was significantly better than conventional gray scale criteria (Az = 0.95) for the diagnosis of urinary stones (p = 0.005, two-sided test).


CONCLUSIONS
The color Doppler twinkling sign improves the detection, confidence and overall accuracy of diagnosis for renal and ureteral stones with minimal loss of specificity.
Department of Urology, Medical University Innsbruck, Innsbruck, Austria. Michael.Mitterberger@i-med.ac.at
Michael
M
Mitterberger
Friedrich
F
Aigner
Leo
L
Pallwein
Germar-Michael
GM
Pinggera
Richard
R
Neururer
Peter
P
Rehder
Ferdinand
F
Frauscher
D000328:Adult; D000368:Aged; D003287:Contrast Media; D005260:Female; D006801:Humans; D007669:Kidney Calculi / Q000000981:diagnostic imaging*; D008297:Male; D008875:Middle Aged; D012372:ROC Curve; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed; D018615:Ultrasonography, Doppler, Color; D014514:Ureteral Calculi / Q000000981:diagnostic imaging*; D055815:Young Adult
D003287:Contrast Media