A COMPARISON BETWEEN DIAGNOSTIC VALUE OF HELICAL CT SCAN AND ROUTINE IMAGING MODALITIES (IVP AND RETROGRADE PYELOGRAPHY) IN PATIENTS WITH ACUTE FLANK PAIN AND NON-DIAGNOSTIC KUB AND ULTRASONGRAPHIC FINDINGS.

Fallah, M.M and Tagipoor Bazargani, S and Alizadeh, M and Sharafi, A.H and Afsharian, M and Baradaran Safa, B (2008) A COMPARISON BETWEEN DIAGNOSTIC VALUE OF HELICAL CT SCAN AND ROUTINE IMAGING MODALITIES (IVP AND RETROGRADE PYELOGRAPHY) IN PATIENTS WITH ACUTE FLANK PAIN AND NON-DIAGNOSTIC KUB AND ULTRASONGRAPHIC FINDINGS. J Urmia Univ Med Sci. 2008; 19 (2) :149-154, 19 (2). pp. 149-154.

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Abstract

In this study, we aimed to compare helical CT scan with routine imaging modalities (IVP and/or retrograde pyelography) in patients with acute flank pain and non-diagnostic findings in KUB and ultrasonography. Materials & Methods: During a five month period, 32 patients referring to the emergency center with acute flank pain, and having nondiagnostic KUB and ultrasonography were selected for the study. All patients underwent regular diagnostic procedures. IVP and retrograde pyelography were done when necessary and Helical CT scan without oral or IV contrast media as well. The results were reported by a radiologist positive and an urologist as well. Results included observation of stone plus its secondary signs. Merely positive secondary signs without finding any stones were considered negative. Any other pathologies resulting in acute flank pain e.g. UPJO, tumor, and strictures presumed as a positive result as well. Result: Among 32 patients, 25 entered the study, in 7 patients no pathologies were found - stone or other, and the resulting lack of gold-standard made us put them off. Of the remaining 25, five had pathology other than stone. One case was of ureteral stricture with polyp and 4 cases of UPJO. Helical CT scan was precise in accurate diagnosis of all 25 patients. In one occasion, the study continued with oral and IV contrast CT. Conclusion: Helical CT scan is more accurate than other imaging tools in diagnosing radiolucent stones and other causes of acute flank pain. Also CT scan can definitely rule out a urologic origin of acute flank pain. While suspicion remains about causes other than stone, oral, and IV contrast enhanced CT increases the accuracy. Finally, when there is a contraindication for using contrast media, non- contract helical CT poses as a double value. We propose using non-contrast helical CT as the next step for patient with non - diagnostic KUB and ultra sonograpic findings

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