| 1. Scales CD, Jr., Smith AC, Hanley JM, Saigal CS, Urologic Diseases in America P. Prevalence of kidney stones in the United States. Eur Urol 2012;62:160-5. |
Review/Other-Dx |
National Health and Nutrition Examination Survey data, n=12110 |
To describe the current prevalence of stone disease in the United States, and identify factors associated with a history of kidney stones. |
The prevalence of kidney stones was 8.8% (95% confidence interval [CI], 8.1-9.5). Among men, the prevalence of stones was 10.6% (95% CI, 9.4-11.9), compared with 7.1% (95% CI, 6.4-7.8) among women. Kidney stones were more common among obese than normal-weight individuals (11.2% [95% CI, 10.0-12.3] compared with 6.1% [95% CI, 4.8-7.4], respectively; p<0.001). Black, non-Hispanic and Hispanic individuals were less likely to report a history of stone disease than were white, non-Hispanic individuals (black, non-Hispanic: odds ratio [OR]: 0.37 [95% CI, 0.28-0.49], p<0.001; Hispanic: OR: 0.60 [95% CI, 0.49-0.73], p<0.001). Obesity and diabetes were strongly associated with a history of kidney stones in multivariable models. The cross-sectional survey design limits causal inference regarding potential risk factors for kidney stones. |
4 |
| 2. Ferraro PM, Curhan GC, D'Addessi A, Gambaro G. Risk of recurrence of idiopathic calcium kidney stones: analysis of data from the literature. J Nephrol 2017;30:227-33. |
Review/Other-Dx |
2168 participants |
To estimate recurrence of kidney stones, overall and in specific subgroups, from randomized controlled trials (RCTs) of calcium stone formers. |
The analysis included 21 RCTs with 2168 participants over a median follow-up of 3.2 years (range 0.5-9.7). The median recurrence of kidney stones was 15 per 100 person-years (range 0-110). Recurrence was higher in those with two or more previous stone episodes compared to those with a single episode at enrolment (16 vs. 6 per 100 person-years, p < 0.001) and in those untreated or treated with dietary changes compared to those treated with drugs (26 vs. 23 vs. 9 per 100 person-years, p < 0.001). |
4 |
| 3. Coll DM, Varanelli MJ, Smith RC. Relationship of spontaneous passage of ureteral calculi to stone size and location as revealed by unenhanced helical CT. AJR Am J Roentgenol. 2002;178(1):101-103. |
Observational-Dx |
172 patients |
To study the relationship of spontaneous passage of ureteral calculi to stone size and location as revealed by unenhanced HCT. |
Rate of spontaneous passage of ureteral stones varies with stone size and location. |
3 |
| 4. Preminger GM, Tiselius HG, Assimos DG, et al. 2007 guideline for the management of ureteral calculi. J Urol. 2007;178(6):2418-2434. |
Review/Other-Dx |
N/A |
Practice guideline for the management of ureteral calculi. Systematic review of literature published since 1997 and an analysis of outcomes data from identified studies was performed. |
Panel concluded based on findings that when removal becomes necessary, shock-wave lithotripsy and ureteroscopy remain the 2 primary treatment modalities for the management of symptomatic ureteral calculi. |
4 |
| 5. Porter KK, Zaheer A, Kamel IR, et al. ACR Appropriateness Criteria® Acute Pancreatitis. J Am Coll Radiol 2019;16:S316-S30. |
Review/Other-Dx |
N/A |
Evidence-based guidelines to assist referring physicians and other providers in making the most appropriate imaging or treatment decision for acute pancreatitis. |
No results stated in abstract. |
4 |
| 6. Boll DT, Patil NA, Paulson EK, et al. Renal stone assessment with dual-energy multidetector CT and advanced postprocessing techniques: improved characterization of renal stone composition--pilot study. Radiology. 2009;250(3):813-820. |
Observational-Dx |
50 renal calculi |
To prospectively evaluate the capability of noninvasive, simultaneous dual-energy MDCT to improve characterization of human renal calculi in an anthropomorphic dual energy renal phantom by introducing advanced postprocessing techniques, with ex vivo renal stone spectroscopy as the reference standard. |
Dual-energy CT with advanced post-processing techniques can be used to determine urinary calculus composition. |
3 |
| 7. Zilberman DE, Ferrandino MN, Preminger GM, Paulson EK, Lipkin ME, Boll DT. In vivo determination of urinary stone composition using dual energy computerized tomography with advanced post-acquisition processing. J Urol 2010;184:2354-9. |
Observational-Dx |
25 patients |
To assess whether dual energy computerized tomography with advanced post-image processing can accurately differentiate urinary calculi composition in vivo. |
Attenuatio profiles showed substantial overlap among various stones on DECT140 kVp (uric acid 427.3±168.1 HU, ammonium urate 429.9±99.7 HU, struvite 480.2±123.5 HU, calcium oxalate monohydrate 852.4±301.4 HU, brushite 863.7±180.1 HU and polycrystalline 858.1±210.5 HU) and on DECT80 kVp (uric acid 493.6±182.8 HU, ammonium urate 591.5±157.9 HU, struvite 712.4±173.9 HU, calcium oxalate monohydrate 1,240.5±494.7 HU, brushite 1,532.1±273.1 HU and polycrystalline 1,358.7±316.8 HU). Statistically spectral separation was not sufficient to characterize stones unambiguously based on DECT140 kVp/DECT80 kVp attenuation. Analysis of attenuation showed sufficient spectral separation on DECTSlope (uric acid 14.9±10.9 U, ammonium urate 56.1±1.8 U, struvite 42.7±1.4 U, calcium oxalate monohydrate 62.8±1.8 U and brushite 113.2±5.3 U). Polycrystalline stones (51.8±3.7 U) overlapped with struvite and ammonium urate stones. This overlap was resolved as all struvite/ammonium urate stones measured 900 HU or less and all polycrystalline stones measured more than 900 HU on DECT80 kVp. |
2 |
| 8. Spek A, Strittmatter F, Graser A, Kufer P, Stief C, Staehler M. Dual energy can accurately differentiate uric acid-containing urinary calculi from calcium stones. World J Urol. 34(9):1297-302, 2016 Sep. |
Observational-Dx |
64 patients |
To retrospectively evaluate the accuracy of dual-energy CT (DECT) in the detection of the chemical composition of urinary calculi in correlation with infrared spectroscopic stone analysis. |
Thirty eight out of sixty four (59 %) patients had >1 stone. DECT was used to differentiate stones by using DEI. Stones harboring calcium (CA) were color-coded in blue, while stones containing uric acid (UA) were colored red. Median DEI in UA-containing stones were 0.001. Non-UA-containing stones had a DEI between 0.073 for pure CA stones and 0.077 containing CA and other substances (p = 0.001; p = 0.03, respectively). Sensitivity of DECT was 98.4 % for differentiation of UA from non-UA-containing calculi. Specificity was 98.1 %. |
3 |
| 9. Cabrera FJ, Kaplan AG, Youssef RF, et al. Digital Tomosynthesis: A Viable Alternative to Noncontrast Computed Tomography for the Follow-Up of Nephrolithiasis?. J Endourol. 30(4):366-70, 2016 Apr. |
Observational-Dx |
62 patients, including 79 renal units. |
To compare DT with noncontrast computed tomography (NCCT) and to evaluate its potential role for the follow-up of patients with nephrolithiasis in a nonemergent setting. |
Of the 79 RUs assessed, 41 RUs showed exact stone counts on DT and NCCT. The mean difference in stone area was 16.5 mm(2) (-4.6 to 38.5), p = 0.121. The mean size of the largest stone on NCCT and DT was 9.27 and 8.87 mm, respectively. |
3 |
| 10. Wollin DA, Gupta RT, Young B, et al. Abdominal Radiography With Digital Tomosynthesis: An Alternative to Computed Tomography for Identification of Urinary Calculi?. Urology. 120:56-61, 2018 10. |
Experimental-Dx |
Seven fresh tissue cadaver. |
To compare the accuracy of plain abdominal radiography (kidneys, ureter, and bladder [KUB]) with digital tomosynthesis (DT) to noncontrast computed tomography (NCCT), the gold standard imaging modality for urinary stones. |
Total of 59 stones were identified on reference read. Overall, NCCT and DT were both superior to KUB alone (P < .001) while the difference between DT and NCCT was not significant (P = .06). When evaluating uric acid stones, NCCT and DT outperformed KUB (P < .01 and P < .05, respectively) while DT and NCCT were similar (P = .16). Intrarenal stones were better evaluated on DT and NCCT (P < .001 compared to KUB), while DT and NCCT were similar (P = 1.00). Accuracy was lower than anticipated across modalities due to use of the cadaver model. |
2 |
| 11. Gliga ML, Chirila CN, Podeanu DM, et al. Twinkle, twinkle little stone: an artifact improves the ultrasound performance!. Medical Ultrasonography. 19(3):272-275, 2017 Jun 17. |
Observational-Dx |
174 patients |
To evaluate the importance of the TwA in detecting kidney stones less than 5 mm in length. |
We found renal stones in 123 patients. The twinkling artifact was present in 113 cases and absent in the rest of 10 patients. In two patients the artifact was present but the stones were not confirmed by CT. The twinkling artifact had sensitivity, specificity, positive predictive value and negative predictive value of 99.12%, 90.91%, 99.12%, and 90.91% respectively. |
3 |
| 12. Dym RJ, Duncan DR, Spektor M, Cohen HW, Scheinfeld MH. Renal stones on portal venous phase contrast-enhanced CT: does intravenous contrast interfere with detection? Abdom Imaging. 2014;39(3):526-532. |
Observational-Dx |
97 CT exams |
To determine the sensitivity of portal venous phase contrast-enhanced CT for the detection of renal stones. |
The 97 cases included a total of 238 stones =1 mm, with a mean (+/-SD) of 1.2 +/- 1.9 stones per kidney and a stone diameter of 3.5 +/- 3.0 mm. Pooling data for the 3 reviewers, sensitivity for all stones was 81%; sensitivity for stones =2, =3, =4, and =5 mm was 88%, 95%, 99%, and 98%, respectively. Sensitivity for stone disease on a per-kidney basis was 94% when considering all stones; when considering only stones =2, =3, and =4 mm, sensitivity was 96%, 99%, and 100%, respectively. Specificity for stone disease on a per-kidney basis was 98% overall, 99% when considering only stones =2 mm, and 100% when considering only stones =3 mm. |
3 |
| 13. Odenrick A, Kartalis N, Voulgarakis N, Morsbach F, Loizou L. The role of contrast-enhanced computed tomography to detect renal stones. Abdom Radiol. 44(2):652-660, 2019 02. |
Observational-Dx |
50 patients, 136 total stones. |
To investigate the detectability of renal stones in corticomedullary and nephrographic phases on contrast-enhanced computed tomography (CT). |
The ICC was 0.86. There was no statistically significant difference between corticomedullary and nephrographic phases (p = 0.94). The detection rate for stones measuring 3-5 mm was 82-88% and 98% for stones = 6 mm. |
3 |
| 14. Corwin MT, Lee JS, Fananapazir G, Wilson M, Lamba R. Detection of Renal Stones on Portal Venous Phase CT: Comparison of Thin Axial and Coronal Maximum-Intensity-Projection Images. AJR Am J Roentgenol. 207(6):1200-1204, 2016 Dec. |
Observational-Dx |
72 patients |
To determine the sensitivity of thin axial and coronal maximum-intensity-projection (MIP) images for the detection of renal stones on contrast-enhanced CT performed in the portal venous phase. |
One hundred forty-eight stones were present; the mean number of stones per patient was 2.5 (SD, 2.7). The mean stone size was 2.5 mm (SD, 2.7). The sensitivity of thin axial images was 89.9%, 99.0%, and 100.0% for reviewer 1 and 83.1%, 98.0%, and 100.0% for reviewer 2 for all stones, stones = 2 mm, and stones = 3 mm, respectively. The sensitivity of coronal MIP images was 86.5%, 96.2%, and 100.0% for reviewer 1 and 79.0%, 91.4%, and 96.6% for reviewer 2 for all stones, stones = 2 mm, and stones = 3 mm, respectively. |
3 |
| 15. Smith RC, Verga M, McCarthy S, Rosenfield AT. Diagnosis of acute flank pain: value of unenhanced helical CT. AJR Am J Roentgenol. 1996;166(1):97-101. |
Observational-Dx |
210 patients |
To determine the value of unenhanced CT in the diagnosis of acute flank pain. |
Sensitivity of 97%, specificity of 96%, and accuracy of 97% for diagnosis of ureteral stone disease. Unenhanced CT is an accurate technique. |
2 |
| 16. Sheafor DH, Hertzberg BS, Freed KS, et al. Nonenhanced helical CT and US in the emergency evaluation of patients with renal colic: prospective comparison. Radiology. 2000;217(3):792-797. |
Observational-Dx |
45 patients |
Prospective comparison of nonenhanced helical CT and US for the depiction of urolithiasis. |
Diagnoses included 23 ureteral calculi and one each of renal cell carcinoma, appendicitis, ureteropelvic junction obstruction, renal subcapsular hematoma, cholelithiasis, medullary calcinosis, and myelolipoma. CT depicted 22 of 23 ureteral calculi (sensitivity, 96%). US depicted 14 of 23 ureteral calculi (sensitivity, 61%). Differences in sensitivity were statistically significant (P: =.02). Specificity for each technique was 100%. When modalities were compared for the detection of any clinically relevant abnormality (eg, unilateral hydronephrosis and/or urolithiasis in patients with an obstructing calculus), sensitivities of US and CT increased to 92% and 100%, respectively. One case of appendicitis was missed at US, whereas medullary calcinosis and myelolipoma were missed at CT. |
1 |
| 17. Bhojani N, Paonessa JE, El Tayeb MM, Williams JC Jr, Hameed TA, Lingeman JE. Sensitivity of Noncontrast Computed Tomography for Small Renal Calculi With Endoscopy as the Gold Standard. Urology. 117:36-40, 2018 Jul. |
Observational-Dx |
Eighteen renal units were studied in 11 patients. |
To compare the sensitivity of noncontrast computed tomography (CT) with endoscopy for detection of renal calculi. |
The mean number of calculi identified per kidney was 9.2 ± 6.1 for endoscopy and 5.9 ± 4.1 for CT (P <.004). The mean size of total renal calculi (sum of the longest stone diameters) per kidney was 22.4 ± 17.1 mm and 18.2 ± 13.2 mm for endoscopy and CT, respectively (P = .06). |
2 |
| 18. Ciaschini MW, Remer EM, Baker ME, Lieber M, Herts BR. Urinary calculi: radiation dose reduction of 50% and 75% at CT--effect on sensitivity. Radiology. 2009;251(1):105-111. |
Observational-Dx |
47 patients |
To retrospectively determine the effect of 50% and 75% dose reduction on sensitivity and specificity of CT for the detection of urinary calculi. |
For all calculi, the blinded readers demonstrated combined sensitivities of 91.7%, 83.3%, and 67.1% for the 100%, 50%, and 25% tube current reconstructions, respectively. For stones >3 mm, combined sensitivities were 97.7%, 93.0%, and 91.9%, respectively, for the 100%, 50%, and 25% reconstructions. There was no significant difference between the 100% examinations and the 50% and 25% reconstructions for detection of stones >3 mm (P=.106 and .099, respectively). |
3 |
| 19. Sohn W, Clayman RV, Lee JY, Cohen A, Mucksavage P. Low-dose and standard computed tomography scans yield equivalent stone measurements. Urology. 2013;81(2):231-234. |
Observational-Dx |
10 patients |
To ascertain the reliability of low-dose CT compared with standard CT in the determination of stone size, density, and skin-to-stone distance. |
No difference was found in stone size between the 2 dosage levels, as measured by the height, width, length, and volume of the stone (P=.9, P=.7, P=.8, and P=.8 respectively). In addition, no difference in HU was appreciated between the 2 scan types (P=.6). Finally, no significant difference was found in the skin-to-stone distance (P=.5). Between the 2 scans, the average effective dose reduction was 73%, from 23 to 6 mSv (P=.002). |
3 |
| 20. Lotan E, Weissman O, Guranda L, et al. Can Unenhanced CT Findings Predict Interventional Versus Conservative Treatment in Acute Renal Colic?. AJR Am J Roentgenol. 207(5):1016-1021, 2016 Nov. |
Observational-Dx |
80 patients |
To determine the value of clinical parameters and radiologic findings on unenhanced CT to the choice between interventional and conservative management for patients with acute renal colic. |
The relationship between shivering, fever, and leukocytosis and interventional treatment had low sensitivity (29%, 26%, and 16%, respectively) but very high specificity (98%, 95%, and 98%, respectively) (p < 0.05). Stone size and density were statistically significantly different between patients treated conservatively and those treated interventionally (size, 4.6 vs 6.7 mm; density, 730 vs 910 HU; p < 0.01). Stones larger than 6.5 mm with an attenuation value greater than 1100 HU and that were proximally located were more likely to be treated interventionally. |
3 |
| 21. Eisner BH, Kambadakone A, Monga M, et al. Computerized tomography magnified bone windows are superior to standard soft tissue windows for accurate measurement of stone size: an in vitro and clinical study. J Urol 2009;181:1710-5. |
Observational-Dx |
24 urinary calculi |
To determine the most accurate method of measuring urinary stones on computerized tomography. |
In the in vitro portion of the study the most accurate measurements were obtained using 5.13x magnified bone windows with a mean 0.13 mm difference from caliper measurement (p = 0.6). Measurements performed in the soft tissue window with and without magnification, and in the bone window without magnification were significantly different from hand caliper measurements (mean difference 1.2, 1.9 and 1.4 mm, p = 0.003, <0.001 and 0.0002, respectively). When comparing measurement errors between stones of different composition in vitro, the error for calcium oxalate calculi was significantly different from the gold standard for all methods except bone window settings with magnification. For uric acid calculi the measurement error was observed only in standard soft tissue window settings. In vivo 4.0x magnified bone windows was superior to 4.0x magnified soft tissue windows in measurement accuracy. Magnified bone window measurements were not statistically different from digital caliper measurements (mean underestimation vs digital caliper 0.3 mm, p = 0.4), while magnified soft tissue windows were statistically distinct (mean underestimation 1.4 mm, p = 0.001). |
3 |
| 22. Metser U, Ghai S, Ong YY, Lockwood G, Radomski SB. Assessment of urinary tract calculi with 64-MDCT: The axial versus coronal plane. AJR Am J Roentgenol. 2009;192(6):1509-1513. |
Observational-Dx |
80 consecutive CT exams |
To compare size measurements, detection rate, and conspicuity of renal calculi in coronal images as compared to axial images. |
Estimation of maximum stone diameter, detection rate of stones, and conspicuity of stones =5 mm in diameter were improved with coronal reformations. |
2 |
| 23. Berkovitz N, Simanovsky N, Katz R, Salama S, Hiller N. Coronal reconstruction of unenhanced abdominal CT for correct ureteral stone size classification. Eur Radiol. 2010;20(5):1047-1051. |
Review/Other-Dx |
151 stones in 150 patients |
To determine whether size measurement of a urinary calculus in coronal reconstruction of CT differs from stone size measured in the axial plane, and whether the difference alters clinical decision making. |
There were 151 stones in 150 patients (male:female 115:34, mean age 41 years). Transverse stone diameters ranged from 1 to 11 mm (mean 4 mm). On coronal images, 56 (37%) stones were upgraded in severity; 46 (30%) from below 5 mm to 6 mm or more, and 10 (7%) from 6–9 mm to 10 mm or more. Transverse measurement on the axial slices enabled correct categorization of 95 stones (63%). |
4 |
| 24. Hoppe H, Studer R, Kessler TM, Vock P, Studer UE, Thoeny HC. Alternate or additional findings to stone disease on unenhanced computerized tomography for acute flank pain can impact management. J Urol. 2006;175(5):1725-1730; discussion 1730. |
Review/Other-Dx |
1,500 patients |
To evaluate how many patients with renal colic had relevant alternative or additional findings on unenhanced CT. |
14% had other findings requiring immediate or deferred treatment. Only 7% of studies were completely normal. Unenhanced CT allows accurate diagnosis of urinary stone disease and can provide further important information leading to emergency or deferred treatment. |
4 |
| 25. Regan F, Kuszyk B, Bohlman ME, Jackman S. Acute ureteric calculus obstruction: unenhanced spiral CT versus HASTE MR urography and abdominal radiograph. Br J Radiol. 2005;78(930):506-511. |
Observational-Dx |
64 patients |
To compare the performance of unenhanced spiral CT to the combination of HASTE MRU and KUB in patients suspected of having acute calculus ureteric obstruction. |
The presence of perirenal fluid, presence and level of ureteric obstruction and calculi were assessed on both techniques. 44/64 (69%) patients had acute calculus ureteric obstruction based on clinical, radiographic or surgical findings. MRU showed perirenal fluid in acute ureteric obstruction (77%) with a greater sensitivity than CT showed stranding (45%). The combination of fluid and ureteric dilation on MRU showed a sensitivity of 93% (CT 80%), specificity of 95% (CT 85%), and accuracy of 94% (CT 81%). There were 61 findings of either fluid or ureteric dilatation on MRU in 44 acutely obstructed kidneys compared with 37 similar findings on CT (P<0.005). Although there was excellent reproducibility (Kappa=0.75) in the finding of perirenal fluid on MRU, there was only fair interobserver agreement (Kappa<0.4) regarding perirenal stranding on CT. MRU/KUB showed ureteric calculi in 21/29 (72%) of patients with calculi seen by CT. Overall, MRU/KUB revealed 2.4 abnormalities per acutely obstructed ureter compared with 1.8 abnormalities detected by CT. |
3 |
| 26. Regan F, Bohlman ME, Khazan R, Rodriguez R, Schultze-Haakh H. MR urography using HASTE imaging in the assessment of ureteric obstruction. AJR Am J Roentgenol. 1996;167(5):1115-1120. |
Observational-Dx |
56 patients |
To prospectively evaluate the use of MRU using HASTE imaging in the assessment of ureteric obstruction. |
HASTE MRU correctly diagnosed obstruction in 41 (100%) of 41 kidneys. Of the obstructed kidneys in which the ureter was shown by both excretory urography and MRU, agreement between the 2 techniques was high (kappa=.642). |
2 |
| 27. Sudah M, Vanninen R, Partanen K, Heino A, Vainio P, Ala-Opas M. MR urography in evaluation of acute flank pain: T2-weighted sequences and gadolinium-enhanced three-dimensional FLASH compared with urography. Fast low-angle shot. AJR Am J Roentgenol. 2001;176(1):105-112. |
Observational-Dx |
40 consecutive patients |
Prospective study to compare the usefulness of breath-hold heavily T2-weighted sequences with gadolinium-enhanced 3D FLASH MRU in the evaluation of patients with acute flank pain. Excretory urography and the final clinical diagnosis used as reference. |
26 patients had unilateral obstruction caused by ureteral stones. Both MRU methods were excellent for detecting obstruction. In the detection of stones, 3D FLASH was superior, with a sensitivity of 96.2% and 100% and specificity of 100% and 100% for observers A and B, respectively, compared with a sensitivity of 57.7% and 53.8% and a specificity of 100% and 100%, respectively, for T2-weighted sequences. The best degree of obstruction was seen with 3D FLASH, and the interobserver agreement was excellent for stone detection (kappa = 0.97). T2-weighted sequences alone are not sufficient for examining patients with acute flank pain. However, the combined use of both T2-weighted and 3D FLASH sequences will ensure better confidence in the evaluation of acute suspected renal colic. MRU can replace conventional excretory urography when the latter is contraindicated or undesirable. |
2 |
| 28. Semins MJ, Feng Z, Trock B, Bohlman M, Hosek W, Matlaga BR. Evaluation of acute renal colic: a comparison of non-contrast CT versus 3-T non-contrast HASTE MR urography. Urolithiasis. 41(1):43-6, 2013 Feb. |
Observational-Dx |
22 patients |
Prospective study was performed to compare the performance of CT with HASTE MRU in the evaluation of patients with suspected renal colic. |
20 (91 %) were diagnosed with an upper tract stone by radiographic findings. MRU detected a discrete stone in 50% of the patients with stones detected by CT. Perinephric fluid was noted in 12 MRUs, compared to 7 CTs. Using CT as the reference standard, the combination of stone or perinephric fluid and ureteral dilation gave MRU a sensitivity of 84%, specificity of 100%, and accuracy of 86% (95% CI, 0.72–1.0). HASTE MRU with a 3-T MR scanner can reliably detect the presence of upper urinary tract obstruction. Although CT imaging remains the superior modality with which to detect calculi, MRU detects a greater number of secondary signs of upper tract obstruction. For situations in which the use of ionizing radiation is undesirable, MRU is a reasonable imaging alternative. |
3 |
| 29. Jung SI, Kim YJ, Park HS, et al. Sensitivity of digital abdominal radiography for the detection of ureter stones by stone size and location. J Comput Assist Tomogr. 2010;34(6):879-882. |
Observational-Dx |
163 patients |
To assess the sensitivity of digital KUB in the detection of ureteral stones by stone size and location. |
In 163 ureteral stones, 77 stones (47.2%) were in the proximal ureter and 86 stones (52.8%) were in the distal ureter. The mean (SD) size of the ureteral stones was 3.4 (1.7) mm (range, 1–9 mm). Overall sensitivity of digital radiography for ureteral stones was 29.4%. The sensitivity of digital radiography for the proximal ureteral stones was 37.7% and that for the distal ureteral stones was 22.1% (P<0.05). The sensitivity of digital radiography for small ureteral stones was 23.6% and that for large ureteral stones was 50.0% (P< 0.05). As a group, the sensitivity of digital radiography for large proximal ureteral stones was the highest sensitivity-72.2% in all groups (P< 0.05). |
2 |
| 30. Kanno T, Kubota M, Funada S, Okada T, Higashi Y, Yamada H. The Utility of the Kidneys-ureters-bladder Radiograph as the Sole Imaging Modality and Its Combination With Ultrasonography for the Detection of Renal Stones. Urology. 104:40-44, 2017 Jun. |
Observational-Dx |
992 patients |
To investigate the efficacy of plain radiography and ultrasonography, each as the sole imaging tool as well as combined, for detecting renal stones using unenhanced computed tomography as a standard reference. |
Of 1644 kidneys, unenhanced computed tomography detected at least 1 stone in 994 kidneys. Ultrasonography and plain radiography detected at least 1 stone in 882 and 488 kidneys, yielding a sensitivity of 88.7% and 49.1% and a specificity of 68.3% and 99.1%, respectively. Of 488 stones detected by plain radiography, 476 stones were also detected by ultrasound, with a sensitivity of 89.9% and specificity of 68.1% for the combination of the 2 modalities. The detection rate for plain radiography for stones <5 mm was low. |
2 |
| 31. Pfister SA, Deckart A, Laschke S, et al. Unenhanced helical computed tomography vs intravenous urography in patients with acute flank pain: accuracy and economic impact in a randomized prospective trial. Eur Radiol 2003;13:2513-20. |
Experimental-Dx |
122 patients with acute flank pain suggestive of urolithiasis. |
To analyse the diagnostic accuracy of UHCT vs IVU in the normal clinical setting with special interest on economic impact, applied radiation dose and time savings in patient management. |
Mild to moderate adverse reactions for contrast material were seen in 3 (5%) patients. The UHCT was safe, as no contrast material was needed. The mean applied radiation dose was 3.3 mSv for IVU and 6.5 mSv for UHCT. Alternative diagnoses were identified in 4 (7%) UHCT patients and 3 (5%) IVU patients. Sensitivity and specificity of UHCT and IVU was 94.1 and 94.2%, and 85.2 and 90.4%, respectively. |
1 |
| 32. Miller OF, Rineer SK, Reichard SR, et al. Prospective comparison of unenhanced spiral computed tomography and intravenous urogram in the evaluation of acute flank pain. Urology 1998;52:982-7. |
Observational-Dx |
75 patients |
To prospectively compare the diagnostic ability of unenhanced spiral computed tomography (NCCT) and intravenous urogram (IVU) in the evaluation of adults with acute flank pain. |
Seventy-five of 106 patients evaluated were diagnosed with ureterolithiasis. Clinical follow-up was available in 74 (98%) stone patients and in 31 (100%) of 31 non-stone patients. In 72 of the 75 patients diagnosed with ureteral calculi, the NCCT made the diagnosis. IVU made the diagnosis in 65 of the 75 patients. Of the 31 patients without ureterolithiasis, the NCCT was negative in all cases. IVU was negative in 29 of the 31 cases. Unenhanced spiral CT was 96% sensitive and 100% specific (P <0.001). IVU was 87% sensitive and 94% specific (P <0.001). Compared with IVU, using the log odds ratio and Fisher's exact test, NCCT was significantly better able to predict the presence of urolithiasis (P=0.015). |
1 |
| 33. Fowler KA, Locken JA, Duchesne JH, Williamson MR. US for detecting renal calculi with nonenhanced CT as a reference standard. Radiology. 2002;222(1):109-113. |
Observational-Dx |
123 patients |
To determine the sensitivity and specificity of US as compared to NCCT for detection of renal parenchymal and collecting system calcifications. |
Sensitivity and specificity of US for detection of renal calculi were 24% and 90%, respectively. |
3 |
| 34. Ulusan S, Koc Z, Tokmak N. Accuracy of sonography for detecting renal stone: comparison with CT. J Clin Ultrasound. 2007; 35(5):256-261. |
Observational-Dx |
50 patients |
To determine accuracy of US in the detection of renal stones. Noncontrast CT is used as the gold standard. Also correlated the accuracy of US with stone size, kidney affected (right vs. left) and body mass index (BMI). |
Sensitivity of US was 52%-57% for the right kidney and 32%-39% for the left kidney. The overall accuracy of US in detecting a stone in the right kidney by radiologists 1 and 2 was 67% and 77%, respectively. The corresponding accuracy values for the left kidney were 53% and 54%, respectively. |
2 |
| 35. Sternberg KM, Eisner B, Larson T, Hernandez N, Han J, Pais VM. Ultrasonography Significantly Overestimates Stone Size When Compared to Low-dose, Noncontrast Computed Tomography. Urology. 95:67-71, 2016 Sep. |
Observational-Dx |
155 patients |
To evaluate the differences between low-dose noncontrast computed tomography (NCCT) and renal ultrasound (US) in the identification and measurement of urinary calculi. |
One hundred fifty-five patients received both a renal US and NCCT within 1 day. In 79 patients (51.0%), both US and NCCT identified a stone for size comparison. Fifty-eight patients (37.4%) had a stone visualized on NCCT but not on US, and 2 patients (1.3%) had a stone documented on US but not seen on NCCT. The average NCCT size of the stones missed on US was 4.5 mm. When comparing the average largest stone diameter for US (9.1 mm) vs NCCT (6.9 mm), US overestimated stone size by 2.2 mm (P < .001). US overestimated stone size by 84.6% for stones =5 mm, 27.1% for stones 5.1-10 mm, and 3.0% for stones >10 mm. |
3 |
| 36. Ganesan V, De S, Greene D, Torricelli FC, Monga M. Accuracy of ultrasonography for renal stone detection and size determination: is it good enough for management decisions?. BJU International. 119(3):464-469, 2017 03.BJU Int. 119(3):464-469, 2017 03. |
Observational-Dx |
552 US and CT examinations |
To determine the sensitivity and specificity of ultrasonography (US) for detecting renal calculi and to assess the accuracy of US for determining the size of calculi and how this can affect counselling decisions. |
Overall, the sensitivity and specificity of US was 54 and 91%, respectively. There was a significant association between sensitivity of US and stone size (P < 0.001), but not with stone location (P = 0.58). US significantly overestimated the size of stones in the 0-10 mm range (P < 0.001). Assuming patients with stones 0-4 mm in size will be selected for observation and those with stones =5 mm could be counselled on the alternative of intervention, we found that in 14% (54/384) of cases where CT would suggest observation, US would lead to a recommendation for intervention. By contrast, when CT results would suggest intervention as management, US would suggest observation in 39% (65/168) of cases. An average of 22% (119/552) of patients could be inappropriately counselled. Stones classified as 5-10 mm according to US had the highest probability (43% [41/96]) of having their management recommendation changed when CT was performed. The use of plain abdominal film of kidney, ureter and bladder and US increases sensitivity (78%), but 37% (13/35) of patients may still be counselled inappropriately to undergo observation. |
3 |
| 37. Ripolles T, Agramunt M, Errando J, Martinez MJ, Coronel B, Morales M. Suspected ureteral colic: plain film and sonography vs unenhanced helical CT. A prospective study in 66 patients. Eur Radiol. 2004;14(1):129-136. |
Observational-Dx |
66 patients |
Prospective study to compare value of KUB plus US with nonenhanced CT for the diagnosis of ureteral colic in patients with acute flank pain. |
CT had greater sensitivity (93% vs 79%) and NPV (71% vs 46%) for the detection of lithiasis. Combination of lithiasis plus obstructive signs showed sensitivity and a specificity of 100% for CT and of 100% and 90%, respectively, for US. CT is the most accurate technique for the detection of ureteral lithiasis but the combination of radiograph and US is an alternative to nonenhanced CT with a lower sensitivity and radiation dose that has a good practical value. |
2 |
| 38. Varanelli MJ, Coll DM, Levine JA, Rosenfield AT, Smith RC. Relationship between duration of pain and secondary signs of obstruction of the urinary tract on unenhanced helical CT. AJR Am J Roentgenol. 2001;177(2):325-330. |
Review/Other-Dx |
227 patients |
To investigate the relationship between duration of flank pain and the frequency of secondary signs of ureteral obstruction on unenhanced HCT. |
The frequency of moderate or severe perinephric stranding increased from 5% at 1–2 hours to 51% at 7–8 hours (P<0.001); ureteral dilatation increased from 84% at 1–2 hours to 97% at more than 8 hours (P<0.03); moderate or severe perinephric fluid increased from 0% at 1–2 hours to 22% at 3–4 hours (P<0.03); collecting system dilatation increased from 68% at 1–2 hours to 89% at 7–8 hours (P<0.03); periureteral stranding increased from 35% at 1–2 hours to 76% at 7–8 hours (P<0.004); and nephromegaly increased from 40% at 1–2 hours to 54% at 7–8 hours (P<0.36). |
4 |
| 39. Sternberg KM, Pais VM Jr, Larson T, Han J, Hernandez N, Eisner B. Is Hydronephrosis on Ultrasound Predictive of Ureterolithiasis in Patients with Renal Colic?. J Urol. 196(4):1149-52, 2016 Oct. |
Observational-Dx |
144 patients |
To investigate whether the presence of hydronephrosis on ultrasound is associated with a ureteral stone in patients who undergo both ultrasound and computerized tomography during the evaluation of acute renal colic. |
Ureteral stones were present in 85 of 144 patients. Ultrasound identified hydronephrosis in 89.8% of patients and a ureteral stone in 25.9%. Computerized tomography identified hydronephrosis in 91.8% of patients and a ureteral stone in 98.8%. In 75.0% of cases the presence or absence of hydronephrosis on ultrasound correctly predicted the presence or absence of a ureteral stone on computerized tomography. Hydronephrosis on ultrasound had a positive predictive value of 0.77 for the presence of a ureteral stone and a negative predictive value of 0.71 for the absence of a ureteral stone. |
3 |
| 40. Leo MM, Langlois BK, Pare JR, et al. Ultrasound vs. Computed Tomography for Severity of Hydronephrosis and Its Importance in Renal Colic. West J Emerg Med. 18(4):559-568, 2017 Jun. |
Observational-Dx |
302 patients |
To determine if EP-performed US can detect severity (none, mild, moderate, severe) of hydronephrosis in ED patients with suspected renal colic when compared to CT. |
CT and EP ultrasound results were comparable in detecting severity of hydronephrosis (x2=51.7, p<0.001). Hydronephrosis on EP-performed ultrasound was predictive of a ureteral stone on CT (PPV 88%; LR+ 2.91), but lack of hydronephrosis did not rule it out (NPV 65%). Lack of hydronephrosis on EP-performed ultrasound makes larger stone size >5mm less likely (NPV 89%; LR- 0.39). Larger stone size > 5mm was associated with 30-day events (OR 2.30, p=0.03). |
1 |
| 41. Masch WR, Cohan RH, Ellis JH, Dillman JR, Rubin JM, Davenport MS. Clinical Effectiveness of Prospectively Reported Sonographic Twinkling Artifact for the Diagnosis of Renal Calculus in Patients Without Known Urolithiasis. AJR Am J Roentgenol. 206(2):326-31, 2016 Feb. |
Observational-Dx |
85 patients |
To determine the clinical effectiveness of prospectively reported sonographic twinkling artifact for the diagnosis of renal calculus in patients without known urolithiasis. |
Eighty-five patients formed the study population. Isolated sonographic twinkling artifact had sensitivity of 0.78 (82/105), specificity of 0.40 (26/65), and a positive likelihood ratio of 1.30 for the diagnosis of renal calculus. Specificity and positive likelihood ratio improved and sensitivity declined when the following additional diagnostic features were present: sonographic twinkling artifact and echogenic focus (sensitivity, 0.61 [64/105]; specificity, 0.65 [42/65]; positive likelihood ratio, 1.72); sonographic twinkling artifact and posterior acoustic shadowing (sensitivity, 0.31 [33/105]; specificity, 0.95 [62/65]; positive likelihood ratio, 6.81); all three features (sensitivity, 0.31 [33/105]; specificity, 0.95 [62/65]; positive likelihood ratio, 6.81). |
2 |
| 42. Abdel-Gawad M, Kadasne RD, Elsobky E, Ali-El-Dein B, Monga M. A Prospective Comparative Study of Color Doppler Ultrasound with Twinkling and Noncontrast Computerized Tomography for the Evaluation of Acute Renal Colic. Journal of Urology. 196(3):757-62, 2016 Sep. |
Observational-Dx |
815 adults |
To perform a prospective comparison of the use of twinkling color Doppler ultrasound and noncontrast computerized tomography in the diagnosis of renal colic in emergency room patients. |
Of 815 patients 723 (88.72%) had ureteral stones, 60 (7.36%) had kidney stones and 32 (3.93%) had pain from extra-urinary causes. Mean patient age was 37.17±11 years. Of the 723 patients with ureteral stones 619 (85.6%) were male and 104 (14.4%) were female. The stones were located on the right side in 340 (47%) patients and on the left side in 383 (53%). Color Doppler ultrasound successfully identified the stones in 702 (97.1%) patients and failed in 21 (2.9%). Noncontrast computerized tomography confirmed stones in 720 (99.6%) patients and was negative in 3 (0.4%). The diagnosis was 166 (23%) upper ureter stones, 63 (8.7%) in the middle and 494 (68.3%) in the lower ureter. The color Doppler ultrasound results were significantly affected by the stone site and maximum transverse diameter (p = 0.03 and 0.007, respectively). |
3 |
| 43. Desai V, Cox M, Deshmukh S, Roth CG. Contrast-enhanced or noncontrast CT for renal colic: utilizing urinalysis and patient history of urolithiasis to decide. Emergency Radiology. 25(5):455-460, 2018 Oct. |
Observational-Dx |
350 patients |
To investigate the combined utility of urinalysis and history of urolithiasis in identifying patients who are unlikely to have urolithiasis and may benefit from a contrast-enhanced study. |
175 patients (62%) had an obstructing calculus. RBC-positive urinalysis was present in 231 patients with calculi on CT (sensitivity 82%). Patient history of urolithiasis plus urinalysis had a sensitivity of 94% for detecting calculi. Thirty-five patients (10%) had alternative diagnoses, 33 of which were in patients without obstructing calculi. Sixty-seven patients underwent noncontrast CT despite no history of urolithiasis and a negative urinalysis, 10 of which (15%) had alternative diagnoses. Only three cases in this subset (4%) had nonobstructing 1-2-mm calculi, potentially missed with contrast. In this subset, the projected proportion of optimally characterized cases with intravenous contrast is 96%, compared to 85% without contrast (p = .03). |
3 |
| 44. Agarwal MD, Levenson RB, Siewert B, Camacho MA, Raptopoulos V. Limited added utility of performing follow-up contrast-enhanced CT in patients undergoing initial non-enhanced CT for evaluation of flank pain in the emergency department. EMERG. RADIOL.. 22(2):109-15, 2015 Apr. |
Observational-Dx |
322 patients |
To review the experience of a single institution with this protocol and to assess the utility of CECT. |
Three hundred twenty-two patients underwent NECT for obstructing NU stones during the study period. Renal or ureteral calculi were detected in 143/322 (44.4 %). One hundred fifty-four patients (47.8 %) underwent CECT. CECT added information in 17/322 cases (5.3 %) but only changed management in 6/322 patients (1.9 %). In four of these patients with final diagnosis of renal infarct, splenic infarct, pyelonephritis and early acute appendicitis in a thin patient, there was no abnormality on the NECT (4/322 patients, 1.2 %). In the remaining 2 patients, an abnormality was visible on the NECT. In patients presenting with flank pain with a clinical suspicion of nephroureterolithiasis, CECT may not be indicated. While CECT provided better delineation of an abnormality in 5.3 % of cases, changes in management after CECT occurred only in 2 %. This included 1 % of patients in whom a diagnosis of organ infarct, pyelonephritis or acute appendicitis in a thin patient could only be made on CECT. |
3 |
| 45. Robert C, Gandon Y, Peyronnet B, Gauthier S, Aube C, Paisant A. Utility of enhanced CT for patients with suspected uncomplicated renal colic and no acute findings on non-enhanced CT. Clin Radiol. 74(10):813.e11-813.e18, 2019 Oct. |
Observational-Dx |
76 patients |
To determine the utility of CECT in patients with suspected URC with no acute findings explaining symptoms on NECT by evaluating the prevalence of CECT-only diagnosis, without acute findings on NECT. |
Among the 76 patients with no acute findings on NECT, CECT led to find acute lesions in 14/76 (18%) cases, but only 2/76 (3%) resulted in a change of management. Predictive factors of abnormal finding on CECT were: low renal clearance and high leukocyte count with OR 0.96 (95% confidence interval [CI]: 0.93-0.99), p=0.0189 and OR 5.79 (95% CI: 1.55-21.64), p=0.0091, respectively. |
3 |
| 46. Rasmussen PE, Nielsen FR. Hydronephrosis during pregnancy: a literature survey. Eur J Obstet Gynecol Reprod Biol. 1988;27(3):249-259. |
Review/Other-Dx |
N/A |
To review occurrence of hydronephrosis and hydroureters during pregnancy. |
Conclusion is reached after survey of literature that there is every probability that hydronephrosis during pregnancy develops as a result of compression of the ureters between the pregnant uterus and the linea terminalis. It seems acute hydronephrosis or worsening of an existing hydronephrosis has been somewhat overlooked as a possible cause of uncertain abdominal pain during pregnancy. These conditions should be examined by means of US, and an attempt at treatment by a change in position should be made. In cases of continued pain or affected renal function, treatment should consist of the insertion of a ureteral catheter. |
4 |
| 47. White WM, Zite NB, Gash J, Waters WB, Thompson W, Klein FA. Low-dose computed tomography for the evaluation of flank pain in the pregnant population. J Endourol. 2007;21(11):1255-1260. |
Review/Other-Dx |
20 patients |
The authors report their institution's experience using low-dose CT in the evaluation of pregnant patients with refractory flank pain. |
Between April 2004 and December 2006, 20 patients with an average gestational age of 26.5 weeks presented to our institution with acute, refractory flank pain consistent with a diagnosis of urolithiasis. All patients underwent renal US evaluation before unenhanced CT of the abdomen and pelvis using a low-dose protocol. The average radiation exposure was 705.75 mrads (range 210–1372; SD +/- 338.66 mrads). Of the 20 patients, CT demonstrated urinary stones (1–12 mm) in 13. Of those patients with documented stones, 4 were treated conservatively, 2 underwent intrapartum stent placement, 5 had ureteroscopy with stone extraction, and 2 were treated postpartum. |
4 |
| 48. Roy C, Saussine C, Jahn C, et al. Fast imaging MR assessment of ureterohydronephrosis during pregnancy. Magn Reson Imaging. 1995;13(6):767-772. |
Observational-Dx |
15 pregnant women |
To assess the value of the fast imaging sequence called RARE-MRU for the diagnosis of pathologic ureterohydronephrosis during pregnancy. Results were compared with those of US, radiographs, and the evolution of symptoms. |
The accuracy of RARE-MRU in the detection of urinary tract dilatation and the localization of the level of obstruction was excellent (100%). The determination of the type of obstruction, intrinsic vs extrinsic, was always exact. RARE-MRU alone cannot specify the exact nature of the intrinsic obstruction. US gave less sensitive information in terms of level (60%) and type of obstruction (53%). RARE-MRU is able to differentiate a physiological from a pathologic ureterohydronephrosis during pregnancy. It could be considered as a procedure of choice for special cases when US failed to establish this differential diagnosis. |
2 |
| 49. Shokeir AA, El-Diasty T, Eassa W, et al. Diagnosis of ureteral obstruction in patients with compromised renal function: the role of noninvasive imaging modalities. J Urol. 2004;171(6 Pt 1):2303-2306. |
Observational-Dx |
149 patients (110 had bilateral obstruction and 39 had obstruction of a solitary kidney), 259 renal units |
Prospective study to compare the role of NCCT, MRU, and combined KUB and US in the diagnosis of the cause of ureteral obstruction in patients with compromised renal function. The gold standard included retrograde or antegrade ureterogram, ureteroscopy and/or open surgery. |
The definitive cause of ureteral obstruction was calculous in 146 and noncalculous in 113 renal units. The site of stone impaction was identified by NCCT in all 146 renal units (100% sensitivity), by MRU in 101 (69.2% sensitivity), and by combined KUB and US in 115 (78.7% sensitivity). Ureteral strictures were identified by NCCT in 18/65 cases (28%) and by MRU in 54/65 (83%). Overall of the 113 kidneys with noncalculous obstruction the cause could be identified by MRU in 101 (89% sensitivity), by NCCT in 45 (40% sensitivity), and by combined KUB and US in only 20 (18% sensitivity) with a difference of significant value in favor of MRU (P<0.001). In patients with renal impairment due to ureteral obstruction NCCT has superior diagnostic accuracy for detecting calculous causes of obstruction but MRU is superior for identifying noncalculous lesions. |
3 |
| 50. Jaffe TA, Miller CM, Merkle EM. Practice patterns in imaging of the pregnant patient with abdominal pain: a survey of academic centers. AJR. 2007;189(5):1128-1134. |
Review/Other-Dx |
183 radiology residency programs |
To evaluate current practice patterns in the imaging of pregnant women with abdominal complaints. Survey was sent to abdominal imaging division of radiology residency programs in the United States. |
85 surveys (46%) were returned. 82 (96%) of 85 perform CT in pregnant women when benefits outweigh risks, with 58 (68%) obtaining written informed consent before CT examination. 80 (94%) of 85 perform MRI in pregnant women, and 43 (51%) obtain written consent before MRI. 57 (67%) of 85 respondents do not administer gadolinium in pregnancy. In the setting of trauma, respondents choose CT over MRI for imaging in all three trimesters (75% vs 5%, 85% vs 5%, and 88% vs 4%). In the second and third trimesters, respondents prefer CT to MRI to evaluate for maternal renal calculus (35% vs 20% and 48% vs 18%, respectively), appendicitis (48% vs 38% and 58% vs 29%), and abscess (49% vs 41% and 58% vs 35%). However, MRI is preferred for imaging of appendicitis and abscesses in the first trimester (39% vs 32% and 46% vs 32%). Most academic radiology departments have written policies regarding imaging of pregnant women. Academic radiologists prefer CT to MRI for imaging abdominal complaints in pregnant women, especially in the second and third trimesters. |
4 |
| 51. Stothers L, Lee LM. Renal colic in pregnancy. J Urol 1992;148:1383-7. |
Review/Other-Dx |
80 patients |
To present a scheme for managing renal calculi in pregnancy. |
Calculi were confirmed in 57 patients. Of the patients 66% were multiparous and 99% of the calculi occurred during either the second or third trimester. The most common symptom was flank pain seen in 89% of the patients, while greater than 95% displayed either microscopic or gross hematuria. Methods of radiographic diagnosis included ultrasonography and limited stage excretory urography. A total of 84% of patients passed stones spontaneously. Indications for urological or obstetrical intervention included persistent pain, sepsis, progressive hydronephrosis, solitary kidney or high grade obstruction. There were 37 procedures done in 23 patients. The most common procedure was placement of a ureteral stent. The complication rate associated with intrapartum intervention and stent passage in the 23 patients was 16%. All patients with a ureteral stent subsequently had spontaneous vaginal delivery without complication. |
4 |
| 52. McAleer SJ, Loughlin KR. Nephrolithiasis and pregnancy. Curr Opin Urol. 2004;14(2):123-127. |
Review/Other-Dx |
N/A |
To determine the most appropriate way to evaluate urinary calculus in pregnant women. |
A combination of US and radiographs is recommended for pregnant patients. |
4 |
| 53. Wieseler KM, Bhargava P, Kanal KM, Vaidya S, Stewart BK, Dighe MK. Imaging in pregnant patients: examination appropriateness. Radiographics. 2010;30(5):1215-1229; discussion 1230-1213. |
Review/Other-Dx |
N/A |
Review examination appropriateness when imaging pregnant patients. |
Modalities that do not use ionizing radiation, such as US and MRI, should be the preferred examinations for evaluating an acute condition in a pregnant patient. However, no examination should be withheld when an important clinical diagnosis is under consideration. Exposure to ionizing radiation may be unavoidable, but there is no evidence to suggest that the risk to the fetus after a single imaging study and an interventional procedure is significant. All efforts should be made to minimize the exposure, with consideration of the risk vs benefit for a given clinical scenario. |
4 |
| 54. Masselli G, Derme M, Laghi F, et al. Imaging of stone disease in pregnancy. Abdom Imaging. 2013;38(6):1409-1414. |
Review/Other-Dx |
N/A |
To review imaging of renal colic in pregnant women. |
US is widely used as the first-line diagnostic test in pregnant women with nephrolithiasis, despite it is highly nonspecific and may be unable to differentiate between ureteral obstruction secondary to calculi and physiologic hydronephrosis. MRI should be considered as a second-line test, when US fails to establish a diagnosis and there are continued symptoms despite conservative management. |
4 |
| 55. American College of Radiology. ACR–SPR Practice Parameter for the Safe and Optimal Performance of Fetal Magnetic Resonance Imaging (MRI). Available at: https://www.acr.org/-/media/ACR/Files/Practice-Parameters/mr-fetal.pdf |
Review/Other-Dx |
N/A |
To promote safe and optimal performance of fetal magnetic resonance imaging (MRI). |
No abstract available. |
4 |
| 56. American College of Radiology. ACR-SPR Practice Parameter for Imaging Pregnant or Potentially Pregnant Patients with Ionizing Radiation. Available at: http://www.acr.org/~/media/ACR/Documents/PGTS/guidelines/Pregnant_Patients.pdf. |
Review/Other-Dx |
N/A |
To assist practitioners in providing appropriate radiologic care for pregnant or potentially pregnant adolescents and women by describing specific training, skills and techniques. |
No abstract available. |
4 |
| 57. American College of Radiology. ACR-ACOG-AIUM-SMFM-SRU Practice Parameter for the Performance of Standard Diagnostic Obstetrical Ultrasound. Available at: https://www.acr.org/-/media/ACR/Files/Practice-Parameters/us-ob.pdf |
Review/Other-Dx |
N/A |
To promote the safe and effective use of diagnostic and therapeutic radiology by describing the key elements of standard ultrasound examinations in the first, second, and third trimesters of pregnancy. |
No abstract available. |
4 |
| 58. American College of Radiology. ACR Committee on Drugs and Contrast Media. Manual on Contrast Media. Available at: https://www.acr.org/-/media/ACR/Files/Clinical-Resources/Contrast_Media.pdf. |
Review/Other-Dx |
N/A |
Guidance document to assist radiologists in recognizing and managing the small but real risks inherent in the use of contrast media. |
No abstract available. |
4 |
| 59. American College of Radiology. ACR Committee on MR Safety. 2024 ACR Manual on MR Safety. Available at: https://www.acr.org/-/media/ACR/Files/Radiology-Safety/MR-Safety/Manual-on-MR-Safety.pdf. |
Review/Other-Dx |
N/A |
Guidance document to promote the use of magnetic resonance (MR) safe practices. |
No abstract available. |
4 |
| 60. American College of Radiology. ACR Appropriateness Criteria® Radiation Dose Assessment Introduction. Available at: https://www.acr.org/-/media/ACR/Files/Appropriateness-Criteria/RadiationDoseAssessmentIntro.pdf. |
Review/Other-Dx |
N/A |
To provide evidence-based guidelines on exposure of patients to ionizing radiation. |
No abstract available. |
4 |
