Spiral CT versus IVU for the evaluation of renal/Ureteric colic
Date First Published:
July 12, 2006
Last Updated:
May 1, 2009
Report by:
Victor Ameh, Specialist Registrar (Hope Hospital Manchester, and Wythenshawe Hospital, Manchester, UK )
Search checked by:
Deepak Doshi, Hope Hospital Manchester, and Wythenshawe Hospital, Manchester, UK
Three-Part Question:
[In patients presenting to the Emergency department with features suggestive of ureteric colic,] is [spiral CT scan better than IVU] in the [detection of ureteric calculi?]
Clinical Scenario:
A 45-year-old man presented to the emergency department with a history of sudden onset left-sided loin pain radiating to the left groin. Urinalysis revealed 2+ blood and nil else. Plain abdominal x ray did not reveal any radio-opaque calculus. You wonder whether a spiral computed tomography (CT) scan or intravenous urography (IVU) will be more appropriate for the further evaluation of the patient.
Search Strategy:
OvidSP Medline 1966 to January week 3 2009
Search Details:
[{exp tomography, x ray computed/or exp tomography, spiral computed/or helical computed.mp or CT scan.mp. or CAT scan.mp. or comput$ tomography.mp.} AND {exp urography/or IVU.mp. OR exp ureteral obstruction/or exp contrast media/or exp Colic/or intravenous pyelography.mp. or intravenous urography.mp.}]. Limited to humans and the English language.<br><br>The Cochrane Library Issue 1 2009 [MeSH descriptor Tomography, X-Ray Computed explode all trees] AND [MeSH descriptor Urography explode all trees].
Outcome:
Overall, 1081 papers were found, with only nine having direct relevance to the three-part question. One was a meta-analysis that included four of the other papers. This and the additional four papers are shown in the table.
Relevant Paper(s):
| Study Title | Patient Group | Study type (level of evidence) | Outcomes | Key results | Study Weaknesses |
|---|---|---|---|---|---|
| Randomised prospective comparison of non-contrast enhanced helical CT and IVU in the diagnosis of acute ureteric colic. Homer JA, Davies-Payne DL, Peddinti BS 2001, New Zealand | 228 adults 123 had CT and 105 had IVU Gold standard (spontaneous stone passage, surgical retrieval or identification on retrograde pyelography) CT vs IVU |
Prospective randomised diagnostic cohort |
Sensitivity | 100% vs 99% | Indeterminate results considered positive in 18 patients in the IVU group. However, presence of stone confirmed in only 8 of these |
| Specificity | 100% vs 100% | ||||
| Detection of alternative diagnosis | 27% vs 4% | ||||
| Renal colic: A prospective evaluation of non-enhanced spiral CT versus IVU Mendelson RM, Arnold-Reed DE, Kuan M et al. 2003, Australia | 200 patients 102 had CT and 98 had IVU Gold standard (documented passage of calculus, patient reporting passage of calculus or surgical intervention). CT vs IVU |
Randomised diagnostic cohort |
Detection of other pathologies | 6 vs 10 | Not controlled No follow up Retrospective |
| The accuracy of noncontrast helical computer tomography versus intravenous pyelography in the diagnosis of suspected urolithiasis. A meta-analysis. Worster A, Preya I, Weaver B, et al. 2002, Canada | Four diagnostic cohort studies Non-contrast helical CT vs IVU |
Meta-analysis | Pooled positive likelihood ratio | 23.15 (11.53–47.23) vs 9.32 (5.23–16.61) p = 0.046 | |
| Pooled negative likelihood ratio | 0.05 (0.02–0.15) vs 0.33 (0.23–0.48) p = 0.013 | ||||
| Unenhanced helical CT vs intravenous urography in patients acute flank pain: accuracy and economic impact. Pfister SA, Deckart A, Laschke S, et al. 2003, Switzerland | 113 Patients 55 had CT 58 had IVU Gold standard (spontaneous passage, endoscopic retrieval or stone identification on retrograde pyelography) CT vs IVU |
Randomised prospective trial | Sensitivity | 94.1% vs 94.2% | No indication of how patients were randomly assigned Direct procedural costs in hospital perspective only analysed Both imaging modalities not applied to every patient. No details of follow up |
| Specificity | 85.2% vs 90.4% | ||||
| Detection of other pathologies | 7% vs 5% | ||||
| Prospective comparison of unenhanced spiral CT and IVU in the evaluation of acute renal colic. Wang J-H, Sha S-H, Huang S-S, et al. 2008, Taiwan | 82 Patients All had unenhanced CT and IVU on same day Composite gold standard (endoscopic evaluation, operative findings and pathology report) CT vs IVU |
Diagnostic cohort | Sensitivity | 98.5% vs 59.1% | No documentation of radiation dose utilised Cost effectiveness assumed but not analysed |
| Specificity | 100% vs 100% | ||||
| Detection of other diagnosis | 58% vs 0% |
Author Commentary:
Most of the papers appraised showed that spiral CT has a better sensitivity and specificity than IVU. It also takes less time to perform and is better at revealing an alternative diagnosis, which may or may not be related to the patient’s symptoms. However spiral CT appears to be more expensive (although two studies showed no significant difference in costs from the hospital perspective) and is associated with a higher radiation dose than IVU. Furthermore, IVU is able to provide an idea of the functional status of the kidneys, whereas spiral CT has the advantage of being able to detect other pathologies.
Bottom Line:
Spiral CT is more effective than IVU in the detection of renal or ureteric calculi.
References:
- Homer JA, Davies-Payne DL, Peddinti BS. Randomised prospective comparison of non-contrast enhanced helical CT and IVU in the diagnosis of acute ureteric colic.
- Mendelson RM, Arnold-Reed DE, Kuan M et al.. Renal colic: A prospective evaluation of non-enhanced spiral CT versus IVU
- Worster A, Preya I, Weaver B, et al.. The accuracy of noncontrast helical computer tomography versus intravenous pyelography in the diagnosis of suspected urolithiasis. A meta-analysis.
- Pfister SA, Deckart A, Laschke S, et al.. Unenhanced helical CT vs intravenous urography in patients acute flank pain: accuracy and economic impact.
- Wang J-H, Sha S-H, Huang S-S, et al.. Prospective comparison of unenhanced spiral CT and IVU in the evaluation of acute renal colic.