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[Native spiral computerized tomography in patients with acute flank pain--sense or nonsense?]
A J Ruppert-Kohlmayr1, R Stacher, K W Preidler
1Universitätsklinik für Radiologie Graz.
Rofo : Fortschritte Auf Dem Gebiete Der Rontgenstrahlen Und Der Nuklearmedizin
|April 2, 1999
Summary
Native unenhanced spiral computed tomography (CT) is superior to intravenous urography (IVU) for diagnosing acute flank pain. This CT method is more effective, cost-efficient, and provides alternative diagnoses, establishing it as the preferred first-line imaging modality.
Area of Science:
- Radiology
- Diagnostic Imaging
- Urology
Background:
- Acute flank pain is a common clinical presentation often caused by urolithiasis.
- Traditional diagnostic methods like intravenous urography (IVU) have limitations in efficacy and cost-effectiveness.
- The need for a more efficient and accurate imaging modality for acute flank pain management is evident.
Purpose of the Study:
- To compare the diagnostic efficacy of native unenhanced spiral computed tomography (CT) versus intravenous urography (IVU).
- To evaluate the cost-effectiveness of both imaging modalities in patients presenting with acute flank pain.
- To determine the optimal first-line imaging approach for acute flank pain.
Main Methods:
- A comparative study involving 66 patients with acute flank pain.
- Patients underwent native unenhanced spiral CT followed by IVU.
- Radiological analysis included morphology assessment (calculi, stranding, dilatation) and cost-effectiveness evaluation.
Main Results:
- Native unenhanced spiral CT demonstrated a significantly higher detection rate for renal and ureteric calculi (100%) compared to IVU (69%).
- The 'rim sign' on CT was a highly sensitive and specific indicator for ureteric calculi.
- Spiral CT facilitated alternative diagnoses in 13 of 14 patients without urolithiasis and proved more cost-effective.
Conclusions:
- Native unenhanced spiral CT is faster, more effective, and less expensive than IVU for managing acute flank pain.
- Spiral CT offers the advantage of identifying alternative diagnoses, reducing the need for further investigations.
- Unenhanced spiral CT should be adopted as the primary diagnostic modality for patients with acute flank pain.