Limitations of ultrasound compared with computed tomography for kidney stone surveillance

Renal ultrasound (US) offers less radiation exposure than computed tomography (CT) for kidney stone surveillance but has lower sensitivity and specificity for nephrolithiasis diagnosis. Additionally, US may overestimate stone size, leading to unnecessary surgical interventions. Evidence on US performance for kidney stone surveillance is variable, making its clinical utility unclear. We aimed to assess US accuracy against CT and identify factors influencing US performance.

We performed a retrospective review of patients with known nephrolithiasis seen in urology clinic at Stanford who underwent both renal US and CT within 90 days for surveillance from January to December 2022. Patients with spontaneous stone passage or interventions were excluded. Stone characteristics were recorded, and statistical analysis compared the diagnostic accuracy of US and CT.

A total of 107 patients and 128 stones were included, with a mean time difference of 25.7 days between US and CT. US sensitivity was 77%, with a positive predictive value (PPV) of 75% for stone detection. The PPV was only 59% for stones >4 mm by CT. Mean stone size was 8.7 mm on US vs. 5.5 mm on CT (p=0.02), with more pronounced overestimation in smaller stones and higher body mass index (BMI) (p<0.05). No significant differences in US performance were found by stone location, laterality, or time between scans. Differences in stone detection (p=0.01) and size (p=0.03) were associated with the individual performing the ultrasound.

US performance is limited compared to CT and is influenced by stone size, BMI, and sonographer. Overestimation by US may lead to unnecessary interventions in up to 40% of patients with stones >4 mm.