Helical CT scanning: the primary imaging modality for acute flank pain

Area of Science:

• Radiology
• Urology
• Emergency Medicine

Background:

• Acute flank pain is a common presentation in emergency departments.
• Accurate diagnosis is crucial for timely and appropriate management.
• Distinguishing between calculus and noncalculus etiologies is essential.

Purpose of the Study:

• To evaluate the diagnostic accuracy of nonenhanced helical computed tomography (CT) for detecting urinary calculi in patients presenting with acute flank pain.
• To assess the utility of nonenhanced helical CT in identifying alternative, noncalculus causes of acute flank pain.

Main Methods:

• A prospective study involving 412 consecutive patients with acute flank pain.
• All patients underwent noncontrast-enhanced helical CT.
• Diagnosis was confirmed by subsequent radiographic studies, urologic intervention, or spontaneous stone passage in 281 patients.

Main Results:

• Nonenhanced helical CT detected stones in 92 of 281 confirmed cases (32.7%).
• In patients without stones on CT (189/281), 60 (32%) had an alternative diagnosis identified.
• The imaging demonstrated high sensitivity (97%), specificity (92%), positive predictive value (88%), and negative predictive value (98%) for stone detection.

Conclusions:

• Noncontrast-enhanced helical CT is a highly accurate and rapid imaging modality for diagnosing calculus disease in patients with acute flank pain.
• This technique offers the significant advantage of identifying noncalculus causes of flank pain in a substantial proportion of patients, aiding in comprehensive diagnosis and management.