Abstract
Background: From calculus disease to hematuria, imaging has been of great importance in the diagnosis of many diseases of the urinary tract. Advances in imaging technology have changed the practice of uroradiology significantly. CT urography represents one of the most advanced developments in imaging the urinary tract to date. Excretory urography has been the initial modality for upper tract imaging in patients with hematuria, flank pain, and other urologic diseases for the past 5 decades. With the recent introduction of multi-detector row helical CT, the uroradiologic evaluation of patients with common and complex disease is changing rapidly. This study is an attempt to review the role of IVU or CT Urography, should supercede as investigation of choice in varied settings and evaluate the obstructed tract anatomy in patients with non-functioning kidneys and various urinary tract disorders.
Materials And Method: It was a hospital based, comparative study, with a sample size of 60 patients, during the period of 2 years, in the department of Radio-Diagnosis, Krishna institute of Medical sciences, karad.
Patients referred with acute flank pain, hematuria or ultrasonologically detected cases of urinary tract calculopathy were included in the study.
Patients were randomly allocated in following two groups of 30 patients – IVU Group and CT Urography Group.
Then according to the analysis of both the groups, the results were compiled and compared statistically and graphically to depict the individualistic role of each modality, their cons and pros in varied settings and management in patients with urinary tract calculopathy.
Results: Amongst the two groups the number of patients whose urinary stones were detected was higher in the CT Urography group than IVU group. Urography group had a higher proportion of Renalstones, mid & lower ureteral stones, than the IVU group. The mean size of obstructing calculi detected by IVU was 6.03±1.08 mm as compared 6.80±2.01 mm as detected by CT Urography. The accuracy of detecting etiology by CT Urography was 100% as compared to 66.7% of IVU.CT was able to differentiate the acute and chronic changes in the renal parenchyma due to obstructive uropathy in many cases however IVU was unable to do so.
Conclusion: CTU is better than IVU in detection of urinary stone, saves time and is cost effective however IVU involves less radiation dose. From this study we conclude that CT provides a better diagnostic information in the patients with urinary tract calculopathy.
Keywords: IVU, Computed Tomography, Caluculopathy, IVP, CT KUB.
References
- Heneghan JP, Kim DH, Leder RA, et al. Compression CT urography: a comparison with IVU in the opacification of the collecting system and ureters.J Comput Assist Tomogr. 2001;25:343-347.
- Kekelidze M, Dijkshoorn ML, Dwarkasing S, et al. Initial experience and perspectives of a low-dose two-phase triple bolus single scan multidetector CT urography (MDCTU) protocol. Eur Radiol. 2006;16 (Suppl):181.
- Lim GS, Jang SH, Son JH, Lee JW, Hwang JS, Lim CH, Kim DJ, Cho DS. Comparison of Non–contrast-Enhanced Computed Tomography and Intravenous Pyelogram for Detection of Patients With Urinary Calculi.
- Bali VM and Lohit HP. Acute ureteric colic: ultrasound as the initial diagnostic tool. American Journal of Oral Medicine and Radiology. 2016;3(1):24-27.
- Lee DH, Chang IH, Kim JW, Chi BH, and Park SB. Usefulness of Nonenhanced Computed Tomography for Diagnosing Urolithiasis without Pyuria in the Emergency Department. BioMed Research International. Volume 2015, Article ID 810971, 6 pages
- Xie C, Guo J, Wang G, Wang H. Comparison between Intravenous Urography and Computed Tomography. Nephro-Urol Mon. 2011;3(4):258-263
- Erbas G, Oktar S, Kilicc K, Sen I, Budakoglu II, Arac M. Unenhanced urinary CT: value of parenchymal attenuation measurements in differentiating acute vs. chronic renal obstruction. European Journal of Radiology 2012;81(5):825–9.
- Gupta R, Raghuvanshi S Multi–detector CT Urography in the diagnosis of urinary tract abnormalities. Int J Med Res Rev 2016;4(2):222-226.
- Khan N, Anwar Z, Zafar AM, Ahmed F, Ather MH. A comparison of non-contrast CT and intravenous urography in the diagnosis of urolithiasis and obstruction. African Journal of Urology. 2012. 18, 108–111
- Song HJ, Cho ST, Kim KK. Investigation of the location of the ureteral stone and diameter of the ureter in patients with renal colic. Korean J Urol 2010;51:198-201.
- Fielding JR, Steele G, Fox LA, Heller H, Loughlin KR. Spiral computerized tomography in the evaluation of acute flank pain: a replacement for excretory urography. J Urol 1997;157:2071-3.
- CT urography: Silverman’s Atlas 1st edition, 2007, chapter three, P23-26.
- Maher MM, Jhaveri KS, Lucey BC, et al. Does the administration of saline flush during CT urography (CTU) improve ureteric distension and opacification? A prospective study. Radiology. 2001;221 (P):500.
- Chow LC, Sommer FG. Multidetector CT urography with abdominal compression and three-dimensional reconstruction. AJR Am J Roentgenol. 2001;177:849–855.
- Coakley FV, Yeh BM. Invited commentary. RadioGraphics 2003; 23:1455-1456. [Commentary on: Joffe SA, Servaes S, Okon S, Horowitz M. Multi-detector row CT urography in the evaluation of hematuria. RadioGraphics 2003; 23:1441–1455
- Dyer RB, Chen MY, Zagoria RJ. Intravenous urography: technique and interpretation.RadioGraphics 2001; 21:799-821.
- Song HJ, Cho ST, Kim KK. Investigation of the location of the ureteral stone and diameter of the ureter in patients with renal colic. Korean J Urol 2010;51:198-201.
- Ahmad NA, Ather MH, Rees J. Unenhanced helical computed tomography in the evaluation of acute flank pain. Int J Urol 2003; 10:287-92.
- Smith RC, Verga M, McCarthy S, Rosenfield AT. Diagnosis of acute flank pain: value of unenhanced helical CT. AJR Am J Roentgenol 1996;166:97-101.
Corresponding Author
Varun Goyal
Department of Radiodiagnosis, Krishna Institute of Medical Sciences,
Karad, Maharashtra, India-415110
Email: This email address is being protected from spambots. You need JavaScript enabled to view it., Phone No- + 91 7057871508
DOI: https://dx.doi.org/10.18535/jmscr/v6i1.80
