What is the role of imaging in the diagnosis of nephrolithiasis?

Updated: Jun 21, 2018
  • Author: Chirag N Dave, MD; Chief Editor: Bradley Fields Schwartz, DO, FACS  more...
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Answer

Acute renal colic with resultant flank pain is a common and sometimes complex clinical problem. Whereas noncontrast abdominopelvic computed tomography (CT) scans have become the imaging modality of choice, in some situations, renal ultrasonography or a contrast study such as intravenous pyelography (IVP) may be preferred.

A kidneys-ureters-bladder (KUB) radiograph, in addition to the renal colic CT scan, facilitates the review and follow-up of stone patients. Alternatively, the “CT scout” (a digital reconstruction from the CT that has an appearance similar to a KUB) is almost as sensitive as a KUB and is a good substitute at the initial assessment if the stone seen on the CT scan is visible on the CT scout. Adding contrast to the CT scan study may sometimes help clarify a difficult or confusing case, but, in general, contrast obscures calcific densities, and, as such, contrast scans are usually indicated only during subsequent evaluation of patients with stones. The noncontrast CT is the cornerstone of initial radiographic assessment.

Most authors recommend diagnostic imaging to confirm the diagnosis in first-time episodes of ureterolithiasis, when the diagnosis is unclear, or if associated proximal urinary tract infection (UTI) is suspected. Lindqvist et al found that patients who are pain-free after receiving analgesics could be discharged from the emergency department (ED) and undergo radiologic imaging after 2-3 weeks without increasing morbidity. [21]


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