A Prospective Comparative Study of Color Doppler Ultrasound with Twinkling and Noncontrast Computerized Tomography for the Evaluation of Acute Renal Colic

Abstract

We performed a prospective comparison of the use of twinkling color Doppler ultrasound and noncontrast computerized tomography in the diagnosis of renal colic in emergency room patients. A total of 815 consecutive adult patients with suspected renal colic presented to the emergency room and were evaluated immediately with color Doppler ultrasound and noncontrast computerized tomography. The site, side and maximum transverse diameter of the stones were assessed. The patients were followed for 4 to 8 weeks. Of 815 patients 723 (88.72%) had ureteral stones, 60 (7.36%) had kidney stones and 32 (3.93%) had pain from extra-urinary causes. Mean patient age was 37.17±11 years. Of the 723 patients with ureteral stones 619 (85.6%) were male and 104 (14.4%) were female. The stones were located on the right side in 340 (47%) patients and on the left side in 383 (53%). Color Doppler ultrasound successfully identified the stones in 702 (97.1%) patients and failed in 21 (2.9%). Noncontrast computerized tomography confirmed stones in 720 (99.6%) patients and was negative in 3 (0.4%). The diagnosis was 166 (23%) upper ureter stones, 63 (8.7%) in the middle and 494 (68.3%) in the lower ureter. The color Doppler ultrasound results were significantly affected by the stone site and maximum transverse diameter (p = 0.03 and 0.007, respectively). The initial use of color Doppler ultrasound in the emergency room has led to the diagnosis and characterization of ureteral stones in the majority of patients. Color Doppler ultrasound results were comparable to those of the concomitant use of noncontrast computerized tomography. Therefore, color Doppler ultrasound can replace noncontrast computerized tomography in the emergency room.