title: Coronal reconstruction of unenhanced abdominal CT for correct ureteral stone size classification.
abstract: OBJECTIVE
  To determine whether size measurement of a urinary calculus in coronal reconstruction of computed tomography (CT) differs from stone size measured in the axial plane, and whether the difference alters clinical decision making.
  
  
  METHODS
  We retrospectively reviewed unenhanced CT examinations of 150 patients admitted to the emergency room (ER) with acute renal colic. Maximal ureteral calculus size was measured on axial slices and coronal reconstructions. Clinical significance was defined as an upgrading or downgrading of stone size according to accepted thresholds of treatment: < or =5 mm, 6-9 mm and > or =10 mm.
  
  
  RESULTS
  There were 151 stones in 150 patients (male:female 115:34, mean age 41 years). Transverse stone diameters ranged from 1 to 11 mm (mean 4 mm). On coronal images, 56 (37%) stones were upgraded in severity; 46 (30%) from below 5 mm to 6 mm or more, and ten (7%) from 6-9 mm to 10 mm or more. Transverse measurement on the axial slices enabled correct categorization of 95 stones (63%).
  
  
  CONCLUSIONS
  Transverse calculus measurement on axial slices often underestimates stone size and provides incorrect clinical classification of the true maximal stone diameter. Coronal reconstruction provides additional information in patients with renal colic that may alter treatment strategy.
authors.affiliation: Department of Radiology, Hadassah Mount Scopus - Hebrew University Medical Center, POB 24035, Jerusalem, 91240, Israel.
authors.forename: Nadav
authors.initials: N
authors.lastname: Berkovitz
authors.forename: Natalia
authors.initials: N
authors.lastname: Simanovsky
authors.forename: Ran
authors.initials: R
authors.lastname: Katz
authors.forename: Shaden
authors.initials: S
authors.lastname: Salama
authors.forename: Nurith
authors.initials: N
authors.lastname: Hiller
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011857:Radiographic Image Interpretation, Computer-Assisted / Q000379:methods*; D011860:Radiography, Abdominal; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed / Q000379:methods*; D014514:Ureteral Calculi / Q000000981:diagnostic imaging*