Detection Of Calculi Research Articles

Assessment of Computed Tomography and Ultrasonography in Detection of Ureteric Calculi

Background: Urolithiasis, a common urological condition, presents diagnostic challenges. While CT scans are considered the gold standard for detecting ureteric calculi, the role of ultrasonography is also significant, especially in varied clinical scenarios. Objective: This study aims to assess the diagnostic accuracy of ultrasonography compared to CT scans in the detection of ureteric calculi. Methods: An observational study was conducted on 200 patients at the Combined Military Hospital, Peshawar. Participants included males and females aged 18-60 years, presenting with acute renal pain. Exclusion criteria included individuals without informed consent, multiple comorbidities, a history of kidney donations, or a family history of renal calculi. Ultrasonography was performed using an Ecoste Mylab 7 color Doppler machine with 3.5, 5, and 7.5 MHz probes. CT scans were conducted using the Siemens CT Somatom Sensation 64, without the administration of any contrast medium. Data were analyzed using SPSS version 26.0. Results: Ultrasonography detected ureteric calculi in 33% of patients (66 calculi), while CT scans detected 60% (118 calculi). The breakdown of calculi location for ultrasonography included 20 renal, 15 pelvic ureteric junction, 12 upper ureter, 8 lower ureter, 7 vesicoureteric junction obstruction, and 4 bladder. CT scan results showed 45 renal, 25 pelvic ureteric junction, 20 upper ureter, 11 lower ureter, 9 vesicoureteric junction obstruction, and 8 bladder calculi. The gender distribution in the study was 55% male and 45% female, with the mean age being 35 ± 16.79 years for males and 36 ± 17.24 years for females. The most common presenting complaints were flank pain (36%), lower back pain (25%), and burning micturition (15%). Conclusion: CT scans exhibit higher diagnostic accuracy for ureteric calculi compared to ultrasonography, thus reaffirming their role as the gold standard in this context. However, the radiation risks and economic implications of CT scanning necessitate a balanced approach to its use, emphasizing the importance of comprehensive patient evaluation and physician awareness of radiation risks.

Simultaneous Uptake of 18F-NaF and 18F-FDG by Bladder and Prostate Calculi.

Calcification and formation of calculi in the genitourinary system such as the bladder, kidney, and prostate are common processes of aging. Despite being in different parts of the body, these calculi can share risk factors; for instance, bladder and prostate calculi are seen in older men with benign prostatic hyperplasia. There have been increasing reports of detection of calculi using PET tracers such as 18F-NaF and 18F-FDG, suggesting their role for detection of extraosseous calcification. In this report, we present simultaneous detection of bladder and prostate calculi with both 18F-NaF and 18F-FDG avidity in a 74-year-old man with multiple myeloma.

Tin-filtered 100 kV Ultra-low-dose Abdominal CT for Calculi Detection in the Urinary Tract: A Comparative Study of 510 Cases

For detection of urinary calculi, unenhanced low-dose computed tomography is the method of choice, outperforming radiography and ultrasound. This retrospective monocentric study aims to compare a clinically established, dedicated low-dose imaging protocol for detection of urinary calculi with an ultra-low-dose protocol employing tin prefiltration at a standardized tube voltage of 100 kVp. Two study arms included a total of 510 cases. The "low-dose group" was comprised of 290 individuals (96 women; age 49 ± 16 years; BMI 27.23 ± 5.60 kg/m2). The "ultra-low-dose group" with Sn100 kVp consisted of 220 patients (84 women; age 47 ± 17 years; BMI 26.82 ± 5.62 kg/m2). No significant difference was ascertained for comparison of age (p=0.132) and BMI (p=0.207) between cohorts. For quantitative assessment of image quality, image noise was assessed. No significant difference regarding frequency of calculi detection was found between groups (p=0.596). Compared to the low-dose protocol (3.08 mSv; IQR 2.22-4.02 mSv), effective dose was reduced by 62.35% with the ultra-low-dose protocol employing spectral shaping (1.16 mSv; IQR 0.89-1.54 mSv). Image noise was calculated at 18.90 (IQR 17.39-21.20) for the low-dose protocol and at 18.69 (IQR 17.30-21.62) for the ultra-low-dose spectral shaping protocol. No significant difference was ascertained for comparison between groups (p=0.793). For urinary calculi detection, ultra-low-dose scans utilizing spectral shaping by means of tin prefiltration at 100 kVp allow for considerable dose reduction of up to 62% over conventional low-dose CT without compromising image quality.

Relative contribution of susceptibility weighted imaging, compared to conventional MRI, in the detection of common bile-duct calculi.

PURPOSE We aimed to evaluate the relative contribution of susceptibility weighted imaging (SWI) in the detection of common bile-duct (CBD) stones in comparison to the conventional MRI protocol containing magnetic resonance cholangiopancreatography (MRCP), balanced turbo field echo (BTFE), and T2-weighted spin-echo imaging techniques. METHODS MRI data containing MRCP, BTFE, T2-weighted imaging, and abdominal SWI were independently evaluated by 2 sets of experienced radiologists in 44 patients with confirmed CBD stones. Endoscopic retrograde cholangiopancreatography, and endoscopic ultrasound where available, was used as the reference gold standard. Evaluation was performed for the visualization of CBD stones in each of the MRI techniques. Relative contribution of SWI was classified into one of four categories for each case: (1) no contribution to CBD stone visualization; (2) same as conventional techniques; (3) improved diagnostic confidence; and (4) critical for diagnosis. Stone size was also assessed. RESULTS Inter-rater agreement coefficient for CBD stone visualization was found to be "good" in MRCP (0.77), "very good" in SWI (0.94) and BTFE (0.84), and moderate in T2-weighted imaging (0.54). CBD stones were visualized with SWI in 86.4% and 82%, with MRCP in 70.5% and 70.5% cases, with BTFE in 73% and 61.4% cases, with T2-weighted imaging in 45.5% and 52.3% cases by reviewers 1 and 2, respectively. SWI did not contribute to CBD stone visualization in 2.3% (1/44); was the same as conventional techniques in 31.8% (14/44) cases; improved diagnostic confidence in 34.1%; and was critical for diagnosis in 20.5% cases. CONCLUSION SWI has the potential to serve as a strong adjunct to conventional MRI protocols used for CBD stone evaluation with very small scan-time penalty.

A deep learning system for automated kidney stone detection and volumetric segmentation on noncontrast CT scans.

Early detection and size quantification of renal calculi are important for optimizing treatment and preventing severe kidney stone disease. Prior work has shown that volumetric measurements of kidney stones are more informative and reproducible than linear measurements. Deep learning-based systems that use abdominal noncontrast computed tomography (CT) scans may assist in detection and reduce workload by removing the need for manual stone volume measurement. Prior to this work, no such system had been developed for use on noisy low-dose CT or tested on a large-scale externaldataset. We used a dataset of 91 CT colonography (CTC) scans with manually marked kidney stones combined with 89 CTC scans without kidney stones. To compare with a prior work half the data was used for training and half for testing. A set of CTC scans from 6185 patients from a separate institution with patient-level labels were used as an external validation set. A 3D U-Net model was employed to segment the kidneys, followed by gradient-based anisotropic denoising, thresholding, and region growing. A 13 layer convolutional neural network classifier was then applied to distinguish kidney stones from false positiveregions. The system achieved a sensitivity of 0.86 at 0.5 false positives per scan on a challenging test set of low-dose CT with many small stones, an improvement over an earlier work that obtained a sensitivity of 0.52. The stone volume measurements correlated well with manual measurements ( ). For patient-level classification, the system achieved an area under the receiver-operating characteristic of 0.95 on an external validation set (sensitivity = 0.88, specificity = 0.91 at the Youden point). A common cause of false positives were small atherosclerotic plaques in the renal sinus that simulated kidneystones. Our deep-learning-based system showed improvements over a previously developed system that did not use deep learning, with even higher performance on an external validationset.

Diagnostic Accuracy of Ultrasonography in Detecting Ureteric Calculi in Patients with Renal Colic Taking Non-Contrast Multidetector Computerized Tomography of Kidney, Ureter, and Bladder (CT KUB) as the Gold Standard

Introduction: The goal of this study is to find the sensitivity, specificity, and diagnostic accuracy of ultrasonography in detecting ureteric calculi in patients with renal colic taking NECT KUB as the gold standard.
 Methods: All patients with acute renal colic presenting in the radiology department for ultrasonography and NECT KUB were enrolled in the study. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and diagnostic accuracy of ultrasonography in detecting ureteric calculi were calculated by taking NECT KUB as the gold standard test.
 Results: A total of 88 patients were enrolled in the study. The mean age was 37 years. The sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy of ultrasonography for the detection of ureteric calculi were found to be 85.8 %, 80 %, 97.1 %, 42.1 %, and 85.2 % respectively in the present study.
 Conclusion: Ultrasonography shows high sensitivity and specificity for the diagnosis of ureteric calculi. It is a cheap, non-invasive, and easily available modality and there is no risk of radiation exposure. NECT KUB should be reserved for that patient for whom ultrasonography is not able to give a diagnosis.

The role of magnetic resonance imaging and magnetic resonance sialography in the evaluation of salivary sialolithiasis: radiologic-endoscopic correlation.

PurposeTo evaluate the role of magnetic resonance imaging (MRI) and MR sialography in salivary gland calculi in correlation with sialendoscopy.Material and methodsIn this prospective study, pre-therapeutic MRI was performed for patients with clinically suspected sialolithiasis. In addition, sialendoscopy with or without surgery was performed. The detectability, number, size, and location of calculi (distance of obstruction from the ostium and masseter line) and the condition of the main duct at MRI were reported. Agreement between the 2 readers was confirmed for all MRI findings. Data regarding the detectability, number, and size of calculi were correlated with endoscopy.ResultsThere was excellent agreement between the 2 readers regarding the detection and number of calculi at MR sialography (κ = 1, p < 0.001). As regards MRI measurements, excellent interclass correlation was found between the 2 readers regarding size of calculi, distance of calculi from the ostium, and distance from the masseter line (κ = 0.98, 0.98, 0.97, respectively; p < 0.001). In correlation with sialendoscopy, MRI was false negative in 1 patient, and it missed 1 calculus in 3 patients with multiple calculi. There was no statistically significant difference between the size of calculi detected by MRI and true size of calculi retrieved by sialendoscopy.ConclusionMR sialography is an accurate modality for diagnosis of the presence, size, and location of sialolithiasis and offers accurate ductal mapping for sialendoscopists.

Transitional Cell Carcinoma with Distal Urethra: A Case Report

Introduction: Transitional cell carcinoma (TCC) of the ureter, also called urothelial cell carcinoma (UCC) of the ureter, are uncommon compared to similar tumors elsewhere along the urinary tract but are nonetheless the most common primary tumor of the ureter. Transitional cells can stretch and change form. The lining of the renal pelvis, ureters, bladder, and urethra is made up of them. In the body, there are many different types of cells, each with its function. Transitional cells can stretch and change form. They are the cells lining line the inside of the renal. When urine is stored in or flowing through these organs, the lining required cells that can stretch to extend. TCC of the kidney begins in the renal pelvis. TCC may begin in the ureters, bladder, or urethra.&#x0D; Patient Information: A 75 years old male was admitted to Acharya Vinoba Bhave Rural hospital sawangi meghe Wardha with chief complaints of low urine output vomiting, loss of appetite, swelling of the abdomen crampy abdominal pain that comes and goes.&#x0D; Therapeutic Intervention and Outcomes: The emerging technique of CT urography allows detection of urinary tract tumors and calculi, assessment of perirenal tissues, and staging of lesions; it may offer the opportunity for one-stop evaluation in the initial assessment of hematuria and follow-up of TCC. Similar MR imaging protocols can be used in patients who are not candidates for CT urography, although detection of urinary tract calcifications may be suboptimal.

Detection of urinary tract calculi on CT images reconstructed with deep learning algorithms.

Deep learning Computed Tomography (CT) reconstruction (DLR) algorithms promise to improve image quality but the impact on clinical diagnostic performance remains to be demonstrated. We aimed to compare DLR to standard iterative reconstruction for detection of urolithiasis by unenhanced CT in children and young adults. This was an IRB approved retrospective study involving post-hoc reconstruction of clinically acquired unenhanced abdomen/pelvis CT scans. Images were reconstructed with six different manufacturer-standard DLR algorithms and reformatted in 3 planes (axial, sagittal, and coronal) at 3mm intervals. De-identified reconstructions were loaded as independent examinations for review by 3 blinded radiologists (R1, R2, R3) tasked with identifying and measuring all stones. Results were compared to the clinical iterative reconstruction images as a reference standard. IntraClass correlation coefficients and kappa (k) statistics were used to quantify agreement. CT data for 14 patients (mean age: 17.3 ± 3.4years, 5 males and 9 females, weight class: 31-70kg (n = 6), 71-100kg (n = 7), > 100kg (n = 1)) were reconstructed into 84 total exams. 7 patients had urinary tract calculi. Interobserver agreement on the presence of any urinary tract calculus was substantial to almost perfect (k = 0.71-1) for all DLR algorithms. Agreement with the reference standard on number of calculi was excellent (ICC = 0.78-0.96) and agreement on the size of the largest calculus was fair to excellent (ICC = 0.51-0.97) depending on reviewer and DLR algorithm. Deep learning reconstruction of unenhanced CT images allows similar renal stone detectability compared to iterative reconstruction.

Comparison of nonenhanced computed tomography and ultrasonography for detection of ureteral calculi in cats: A prospective study.

BackgroundRadiographs and ultrasound (US) are the primary imaging modalities used to assess ureteral calculi in cats. Reports describing the use of nonenhanced computed tomography (CT) are scarce.Hypothesis/ObjectivesTo compare US and nonenhanced CT for detection, number and localization of ureteral calculi in cats.AnimalsFifty‐one cats with at least 1 ureteral calculus, and 101 ureters.MethodsProspective case series. All cats underwent an US followed by a nonenhanced CT. Cats were included in the study if at least 1 ureteral calculus was diagnosed on either modality. Number of calculi and their localization (proximal, middle, and distal) were recorded on both modalities. Pelvic dilatation and maximal ureteral diameter were recorded with US.ResultsMore calculi were detected by nonenhanced CT (126) compared to US (90), regardless of localization (P < .001). More ureters were affected on nonenhanced CT (70) compared to US (57; P < .001). The number of calculi detected was significantly different between US and nonenhanced CT in the proximal (P = .02) and distal ureteral region (P < .001). Bilateral calculi were more frequent with nonenhanced CT (19 cats) compared to US (9 cats; P < .001). A pelvic size superior to 5 mm and a maximal ureteral diameter value superior to 3 mm were always associated with ureteral calculi.Conclusions and Clinical ImportanceComputed tomography is an emerging imaging modality in cats with a suspected ureteral obstruction. Combination of CT and US can be beneficial for case management.

The color Doppler twinkling artifact of implants after endoscopic treatment of vesicoureteral reflux in children: A common finding with high potential for misdiagnosis

Endoscopic treatment of vesicoureteral reflux (VUR) is a common therapeutic procedure in children. Over the last years several studies reported on calcified deflux implants that were misinterpreted as ureteral stones leading to unnecessary diagnostic and therapeutic procedures. Based on an own case, where a calcified implant with a strong twinkling artifact was misdiagnosed as a ureteral stone, the purpose of our study was to evaluate the sonographic imaging appearance of implants after endoscopic VUR repair with special emphasis on the color twinkling artifact. In 40 children (mean age 9.5 years) with 62 treated ureteral units follow-up sonography was performed after a mean time interval of 48.8 months after surgery. The injected deposit was evaluated with B-mode sonography and color Doppler sonography and deposit volume, posterior acoustic shadowing and the appearance and extension of the twinkling artifact were evaluated. 47 of 62 injected units (75.8%) could be identified on follow-up sonography. In 13 of 47 units (27.7%) posterior acoustic shadowing was noted. On color Doppler sonography a twinkling artifact appeared in 26 of the 47 visible cases (55.3%). There was a statistically significant correlation between a positive twinkling sign and the deposit age. In conclusion our study shows that the twinkling artifact is a common finding in follow-up sonography of children after endoscopic treatment of VUR. As the twinkling artifact is a sensitive imaging sign for the detection of ureteral calculi the risk of misinterpretation and mistreatment is given.

Role of Unenhanced Multi-Detector Computed Tomography in Detection of Urinary Calculi in Comparison with Ultrasonography

Introduction Urinary calculi are solid deposits found in the urinary tract from minerals dissolved in the urine.1 Calculi located in the kidneys, ureters, urinary bladder or urethra and are one of the major diseases that have affected people since ancient times.2 The prevalence of urinary tract c

Early detection and prevention of renal complex calculi

Objective To provide the information for early detection, treatment and prevention of renal complex calculi by analyzing on the characteristics of the patients and stone composition. Methods From January 2009 to November 2010, 118 cases of renal complex calculi underwent treatment in our department. Clinical data including previous history, medical history, stone composition, urinary system infection and renal function were analyzed retrospectively. Results Of the 118 patients, 7(5.9%)cases underwent regular medical examination and 64(56.2%) cases were with urinary calaculus history, 86(72.9%) cases were with a chief complaint of back pain, hematuria or fever, 92(78.0%)cases were with urinary system infection and 18(15.3%) cases were with renal dysfunction. Of the 118 patients, calcium oxalate stones were found in 94 cases(79.7%), infection stones in 55 cases(46.6%), uric stones in 28 cases(23.7%). The majority of stones were mixed compositions, it was most commonly found which was made of calcium mixed infection stone, 51 cases(43.2%). Conclusions The renal complex calculi has a significant impact on renal function, it's crystalline composition is multiplicity, many factors are involved in its growth, and it has a close relationship with urinary tract infection.It is important to attach importance to early diagnosis, control the progression of stone by undergoing regular medical examination, and prevention calculi recur by analyzing stone composition, enhancing anti-infective therapy. Key words: Kidney Calculi; Principal Component Analysis; Early Diagnosis

Ultrasonography in Detection of Renal Calculi in Children; a Systematic Review and Meta-analysis.

Although numerous studies have been done to evaluate the diagnostic value of ultrasonography in diagnosis of renal calculi in children, there is still no consensus. Therefore, in the present systematic review and meta-analysis, we aimed to evaluate the diagnostic accuracy of ultrasonography in identifying renal stones in children. A comprehensive search of the electronic databases including Medline, Embase, Scopus and Web of Science was conducted up to July 2019. Diagnostic accuracy studies in children were included. Data was summarized and pooled. Area under the curve (AUC), sensitivity, specificity, diagnostic score and diagnostic odds ratio were reported with 95% confidence interval (95% CI). Data from 7 articles were included. Pooled analysis showed that the area under the curve of ultrasonography in diagnosis of pediatric renal calculi was 0.94 (95% CI: 0.92 to 0.96). The sensitivity and specificity of this diagnostic modality were 0.80 (95% CI: 0.70 to 0.87) and 1.00 (95% CI: 0.84 to 1.00), respectively. Diagnostic score and diagnostic odds ratio of ultrasonography in detection of renal calculi were 110.32 (95% CI: 2.88 to 19.76) and 82362.41 (95% CI: 17.80 to 3.8 × 108), respectively. Overall, the low level of evidence indicates that sensitivity and specificity of ultrasonography in detecting renal calculi in children are 80% and 100%, respectively. However, due to the serious limitations of the included studies, well-designed prospective diagnostic accuracy studies are recommended for future studies.

Diagnostic Accuracy of Doppler Twinkling Artifact for Identifying Urinary Tract Calculi.

IntroductionFlank pain is a frequent cause of emergency department visits and is often due to renal or ureteric colic. Ultrasound is often the initial imaging study used for the detection of urinary tract calculi. Twinkling artifact is a Doppler artifact usually seen on echogenic rough surfaces such as calculi. Its presence can improve the sensitivity and specificity of ultrasound in stone detection. The objective of the current study was to determine the diagnostic accuracy of the Doppler twinkling artifact for detecting urinary calculi using non-contrast computed tomography as the gold standard.Materials and methodsIn this cross-sectional study, both male and female patients of any age having flank pain, burning micturition with or without hematuria were included. Ultrasound was performed and the presence or absence of Doppler twinkling artifact on calculus was noted. Following ultrasound, patients underwent plain CT scan and findings of stones were documented. Sensitivity, specificity, positive and negative predictive values, and diagnostic accuracy of Doppler twinkling artifact was calculated considering CT findings as the gold standard.ResultsOut of the total 221 patients, 146 (66.1%) were males and 75 (33.9%) were females. The mean age of the patients was 45.98 ± 16.30 years. Urinary tract calculi on ultrasound were observed in 74 (33.50%) patients, while on CT urinary tract calculi were observed in 127 (57.50%) patients. Diagnostic accuracy of Doppler twinkling artifact was found to be 71.49% with sensitivity, specificity, positive predictive value, and negative predictive value of 54.33%, 94.68%, 93.24%, and 60.54%, respectively.ConclusionDoppler twinkling artifact has low sensitivity, high specificity, and suboptimal diagnostic accuracy for the diagnosis of urinary tract calculi. Integration of this artifact has a lower sensitivity as compared to non-contrast CT scan. Multicentric studies with larger sample size and focusing on interobserver and intraobserver variability are recommended to have a consensus regarding Doppler twinkling artifact in the evaluation of renal and ureteric calculi.

EFFICACY OF LIVER FUNCTION TEST IN PATIENTS WITH SYMPTOMATIC GALL STONE DISEASE

Background: Cholelithiasis is a common clinical problem in surgical practice all over the world. Liver function tests (LFT’s) are routinely performed in patients undergoing cholecystectomy for symptomatic gall stones.&#x0D; Objective: To evaluate the effectiveness of routine LFTs in patients with symptomatic gall stones attending Shridev Suman Subharti Medical College attached with Dr. K.K. Bhatnagar Memorial Subharti Hospital, Dehradun, Uttarakhand, India&#x0D; Material and Methods: The present prospective observational study was conducted from December 2016 to November 2017 in the Dept. of Surgery in collaboration with Dept. of Biochemistry at Shridev Suman Subharti Medical College attached with Dr. K.K. Bhatnagar Memorial Subharti Hospital, Dehradun, Uttarakhand, India. All patients clinically diagnosed with symptomatic cholelithiasis were included in the study. Patients with past and present history of jaundice, pancreatitis, cholangitis and abnormal calibre common bile duct on ultrasonography (more than 8mm) were excluded from the study. Data regarding relevant history, clinical examination findings, LFT’s and ultrasound examination findings were analyzed and noted in pre-designed proforma.&#x0D; Results: Study composed of 120 patients comprising 100(83.33%) female and 20(16.67%) male with the mean age of 45±25 years. Out of 120 patients, 85(70.83%) presented as chronic calculous cholecystitis, 29(24.17%) as biliary colic and 6(5.00%) with acute calculous cholecystitis. The LFT’s were within normal range in 107(89.16%) patient, which labeled as group A. In group A, 80(74.76%) patients were presented as chronic calculous cholecystitis, 24 (22.42%) as biliary colic and 3(2.8%) as acute calculous cholecystitis. The levels of LFT’s were found abnormal in 13 patients (8.33%) which is labeled as group B. In group B, clinical presentation of 2 (40.00%) patients were as chronic calculous cholecystitis, 8(30.00%) patients as biliary colic &amp; 3(30.00%) patients as acute calculous cholecystitis. Parameters of LFTs, Bilirubin were elevated in 2, AST in 3 and ALP in 8 patients. All patients from either group had normal Common Bile Duct (CBD) caliber on preoperative ultrasound examination and per operatively (in open surgery), no CBD dilatation or palpable calculi.&#x0D; Conclusion: Routine LFT’s in preoperative assessment of symptomatic cholelithiasis usually reveals normal findings and is not recommended as a good predictive marker for the detection of silent CBD calculi.&#x0D; Keywords: Cholelithiasis, Choledocholithiasis, Common bile duct (CBD), LFT, Cholecystectomy, Laparoscopic

Iterative Model Reconstruction (IMR) in MDCT Below 2 mSv for the Detection of Urinary Calculi: Diagnostic Accuracy and Image Quality in Comparison to Filtered Back-Projection and 4th Generation Iterative Reconstruction (iDose4).

The purpose of the study was to assess the impact of iterative model reconstruction (IMR) on reader confidence with respect to stone detection and image quality in comparison to filtered back-projection (FBP) and iDose level 4 (iDose4) in abdominal MDCT with radiation doses below 2 mSv. For 32 consecutive patients with suspected ureteral stone disease, the raw data of unenhanced 256 slice MDCT (120 kV, 40 reference mAs, mean CTDIvol: 2.7 ± 0.8 mGy, mean DLP: 126 ± 38 mGy × cm) were reconstructed using a prototype version of IMR (levels 1 - 3), iDose4 (level 4) and FBP at a 3 mm slice thickness. Image analysis was independently performed by two radiologists in a blinded fashion. The reader confidence level with respect to stone detection was recorded based on a 5-point scale (1 - certain exclusion; 5 - concrement definitely present) as well as for the evaluation of image quality regarding the depiction of anatomical details (1 - poor; 5 - excellent). A clinical reference standard for stone detection was not established. Statistical evaluation included weighted kappa analysis and Wilcoxon test. 17 pelvic and ureteral stones were found. 11 further concrements were located within the ostium of the urinary bladder or the bladder itself. Applying IMR, a distinct improvement in image quality was observed at every level (mean value for FBP, 2.0; iDose4, 2.9; IMR L1, 4.2; IMR L2, 4.0; IMR L3, 3.9; all p < 0.001). Applying the higher IMR levels L2 and L3, a certain level of so-called "blotchiness" of anatomical contours was observed. Reader confidence was significantly improved and was independent of IMR level (certain stone detection FBP, 69 %; iDose4, 81 %; IMR L1 to L3, 95 %; all p > 0.001). With increasing IMR levels, the reduction in streak artifacts was quantified by a decrease in image noise. A loss of anatomical information was not observed. The sensitivity rates for stone detection were equivalent for all MDCTs reconstructed with FBP, iDose4 and IMR. A mean effective dose of 1.9 ± 0.6 mSv was calculated. In comparison to FBP and iDose4, a significant increase in mean image quality, reduction in image noise and improvement in subjective reader confidence can be achieved by applying IMR even at significantly reduced dose settings below 2 mSv. Results indicate that a further dose reduction might be possible with IMR. · Urinary tract. · urolithiasis. · iterative reconstruction. · Schmidt-Holtz J, Laqmani A, Butscheidt S et al. Iterative Model Reconstruction (IMR) in MDCT Below 2mSv for the Detection of Urinary Calculi: Diagnostic Accuracy and Image Quality in Comparison to Filtered Back-Projection and 4th Generation Iterative Reconstruction (iDose4). Fortschr Röntgenstr 2018; 190: 630 - 636.

Diagnostic Accuracy of Magnetic Resonance Cholangio- Pancreatography in Choledocholithiasis

Objectives: To estimate the diagnostic accuracy of MRCP in the detection of bile duct calculi in patients with obstructive jaundice using ERCP as gold standard. Study Design: This is a cross sectional study. The study was conducted at Department of Diagnostic Radiology and Imaging Civil Hospital Karachi, from 01-08-2013 to 31-12-2014. Materials & Methods: This study comprises 249 cases of clinically observed obstructive jaundice which were referred by hospital consultants or by general practitioner to the Radiology Department for Magnetic Resonance Cholangio-Pancreatography (MRCP). Inclusion criteria were Patients of either gender between 26- 70 years of age with obstructive jaundice, raised direct bilirubin levels of 3 mg/dl and above, raised alkaline phosphatase levels and abdominal ultrasound showed suspicion of stone in dilated or non-dilated common bile duct. Previously Diagnosed cases of Choledocholithiasis, patients of chronic liver disease and those for which MRI is contraindicated such as those with surgical clips, braces were excluded from the study. Standard MRI technique carried out for evaluation of bile duct calculi in obstructive jaundice patients. Its features were carefully evaluated in terms of presence and absence of calculus / calculi, dilatation of CBD and pancreatic duct and presence of intrahepatic cholestasis by the consultant radiologist. Data entered and Statistical analyses were carried out by using SPSS version 17. Sensitivity, specificity, diagnostic accuracy positive and negative predictable values were calculated. Mean and frequency distribution for ages and gender was calculated respectively. Results: Mean age of the patients was 45.54 ±11.352 years. Gender distribution shows, 42 patients (17%) were male while remaining 207 patients (83%) were female. True positive cases for stones were 145 (58%) and false positive cases were 80 (32%). Positive predictive value was 91.77%, negative predictive value 87.91% with sensitivity 92.95%, specificity 86.02% and Diagnostic accuracy were found to be 90.36%. Conclusion: It is conclude that Magnetic Resonance Cholangio-Pancreatography (MRCP) is a safe, precise, relatively fast, with no ionizing radiation and non-invasive imaging modality for the assessment of common bile duct stones in patients of obstructive jaundice. The result of this study recommends that MR Imaging showed high Sensitivity and positive predictive values in the detection of bile duct calculi.

Comparing the diagnostic accuracy of ultrasound in the community and in the hospital setting for urinary calculi: A retrospective cohort study

Objective: The objective of this article is to test whether there is a significant difference in diagnostic accuracy between hospital and community-based ultrasound (US) for the detection of urinary calculi in the United Kingdom (UK). Materials and methods: A 30-month, single-blind, retrospective cohort study of all patients referred to Kent and Canterbury Hospital urology multidisciplinary meeting for suspected urinary calculi was conducted. Only those investigated with US and non-contrast computed tomography (NCCT, the gold standard) for their calculi were included. Concordance of US and NCCT was stratified by US location: i.e. either the hospital or community setting (e.g. the latter via general practitioners (GPs) or independent radiographers). Fisher’s exact test was subsequently utilised to test for any significant difference between these two patient groups. Results: Of 2464 patients referred, 257 had both ultrasound and NCCT in their diagnostic workup. Of these, 150 and 107 patients had their US performed in hospital and community settings, respectively. No significant difference in the accuracy of US was detected between the two groups for the detection of urinary calculi when compared with NCCT. Conclusion: US carried out by independent radiographers and GPs in the community is just as accurate as US carried out by hospital sonographers for the detection of urinary calculi in the UK. Greater use of community US for the diagnosis of urinary calculi may promote greater patient/GP satisfaction and reduce hospital attendance without loss of diagnostic accuracy.

Management of alternative pathology detected using CT KUB in suspected ureteric colic

Acute flank pain is a common presentation to the emergency department (ED), and imaging studies play an important role in establishing an accurate diagnosis. Computed Tomography of Kidneys, Ureters, Bladder (CT KUB) has surpassed all other imaging modalities to become the gold standard in detection of ureteric calculi. The purpose of this study is to identify the range and management of alternative diagnoses established by CT KUB in patients with suspected ureteric colic. Two hundred and fifteen consecutive CT KUB examinations ordered in the ED of a tertiary-care centre for suspected ureteric colic were retrospectively reviewed. This comprised of 134 male (62.3%) and 81 female (37.7%) patients with a mean age of 53 years old. The positive detection rate for ureteric calculi in males was 43.3% compared to a lower rate for females of 29.6% (p < 0.05). Almost two-thirds of patients were discharged following CT KUB imaging, and admission rates were significantly higher in those with alternative radiological findings (p < 0.04) Alternative radiological findings occurred in 72 patients (33.5%), including 15 patients (7.0%) who had clinically important alternative pathology. The rate of clinically important alternative findings was significantly higher in males than females, 9.7% versus 2.5% respectively (p = 0.04). Surgical intervention was more common in patients with alternative radiological findings classified as gastrointestinal (18.2%) compared to non-gastrointestinal (3.6%), however this did not reach statistical significance (p = 0.07). In conclusion, significant alternative pathology was identified using CT KUB in 7% of patients with suspected ureteric colic. The low rates of detection of ureteric calculi and significant alternative pathology in female patients suggests a more thorough clinical assessment is warranted to improve their management, prior to ordering investigations with exposure to radiation.