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13.10.2020 | Emergency Radiology

Imaging strategies for patients with suspicion of uncomplicated colic pain: diagnostic accuracy and management assessment

verfasst von: Claire Faget, Ingrid Millet, Mustapha Sebbane, Rodolphe Thuret, Cécile Verheyden, Fernanda Curros-Doyon, Nicolas Molinari, Patrice Taourel

Erschienen in: European Radiology | Ausgabe 5/2021

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Abstract

Objective

Compare different imaging scenarios in the diagnosis of uncomplicated renal colic due to urolithiasis (URCU).

Materials and methods

A total of 206 prospectively included patients had been admitted with suspected URCU and had undergone abdominal plain film (APF), US and unenhanced CT after clinical STONE score evaluation. CT was the reference standard. We assessed sensitivity (Se), specificity (Spe) and Youden index for colic pain diagnosis, percentage of patients managed by urologic treatment with stone identified, percentage of alternative diagnoses (AD) and exposure to radiation, according to single imaging approaches, strategies driven by patient characteristics and conditional imaging strategies after APF and US.

Results

One hundred (48.5%) patients had a final diagnosis of URCU and 19 underwent urologic treatment. The conditional strategy, i.e. CT in patients who had no stone identified at US, had a perfect sensitivity and specificity. This enabled diagnosis of all stones requiring urology management while decreasing the number of CT exams by 22%. The strategy whereby CT was used when there was neither direct or indirect APF + US finding of colic pain nor alternative diagnoses in patients with a STONE score ≥ 10 had a sensitivity of 0.95 and a specificity of 0.99, identified 84% of stones managed by urologic treatment and decreased the number of CT examinations by 76%.

Conclusion

In patients with clinical findings consistent with URCU, the use of ultrasound as first-line imaging modality, with CT restricted to patients with negative US and a STONE score ≥ 10, led to a sensitivity and specificity of above 95%, identified 84% of stones requiring urological management and reduced the number of CT scans needed by fourfold.

Key Points

• For diagnosis, the use of APF + US as first-line imaging, with CT restricted to patients with both a normal APF + US and a STONE score ≥ 10, provides both a sensitivity and specificity superior or equal to 95% and reduces the number of CT scans necessary by fourfold.

• For management, the use of APF + US as first-line imaging, with CT restricted to patients with both a normal APF + US and a STONE score ≥ 10, maintains a 84% stone identification rate in urology-treated patients.

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Titel: Imaging strategies for patients with suspicion of uncomplicated colic pain: diagnostic accuracy and management assessment
verfasst von: Claire Faget
Ingrid Millet
Mustapha Sebbane
Rodolphe Thuret
Cécile Verheyden
Fernanda Curros-Doyon
Nicolas Molinari
Patrice Taourel
Publikationsdatum: 13.10.2020
Verlag: Springer Berlin Heidelberg
Erschienen in: European Radiology / Ausgabe 5/2021
Print ISSN: 0938-7994
Elektronische ISSN: 1432-1084
DOI: https://doi.org/10.1007/s00330-020-07264-z

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Imaging strategies for patients with suspicion of uncomplicated colic pain: diagnostic accuracy and management assessment