Spiral CT in the evaluation of flank pain: overall accuracy and feature analysis

Our goal was to assess test reliability and identify those features that have the strongest positive and negative predictive values in the diagnosis of renal colic using spiral CT.

Fifty non-contrast-enhanced CT scans (5 mm slice thickness) obtained in patients presenting with flank pain were reviewed by three radiologists blinded to the final diagnoses. The sensitivity, specificity, and positive and negative predictive values for nine pertinent findings were determined as compared to clinical follow-up.

Twenty-nine cases had findings of ureteral obstruction. Findings with the strongest positive predictive values (> 0.90) were ureteral stone, hydronephrosis, hydroureter, periureteral stranding, and ureterovesical junction edema. Findings with the strongest negative predictive values (> 0.89) were absence of hydronephrosis and hydroureter. The areas under the receiver operating curves for Readers 1, 2, and 3 were 0.970 +/- 0.030, 0.942 +/- 0.036, and 0.982 +/- 0.020.

Absence of hydroureter and hydronephrosis on spiral CT images should prompt a search for a diagnosis other than an obstructing ureteral stone.