Urinary stone assessment in a single-phase may replace the unenhanced and multiphase computed tomography protocol in painless visible haematuria.

IF 1.4 4区 医学 Q3 UROLOGY & NEPHROLOGY
Kristina Flor Galtung,Peter Mæhre Lauritzen,Gunnar Sandbæk,Dag Bay,Eduard Baco,Erik Rud
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Abstract

OBJECTIVE Painless visible haematuria (VH) necessitates a computed tomography (CT) usually consisting of one unenhanced and two to three contrast enhanced acquisitions to detect urinary tract stones and malignancy. Recently, we demonstrated that a single nephrographic phase (NP) CT sufficed in detecting malignancy in patients with painless VH. Now, we aim to evaluate the diagnostic performance of single NP CT in stone detection and size measurements in the same cohort. MATERIAL AND METHODS "A Prospective Trial for Examining Haematuria using Computed Tomography" (PROTEHCT) was a single-center prospective diagnostic study in patients with painless VH between September 2019 and June 2021. All underwent four-phase CT (reference standard) from which a single NP CT (experimental) was extracted. Two randomised readers independently assessed the experimental CT for urinary stones and size. Statistical analysis included diagnostic accuracies and inter-reader agreement (kappa) of experimental CT, and size correlation (Spearman's ρ) between experimental CT and reference standard. RESULTS In 308 included patients (median age: 68 years, 250 males), urinary stones (median size 5 mm) were diagnosed in 21%. The per-patient experimental CT sensitivity was 86% (97% for stones ≥ 5 mm), specificity was 98% and accuracy was 96%. The experimental CT sensitivity for detecting kidney stones was 78% (89% for stones ≥ 5 mm), and 100% for bladder and ureteral stones. No missed stone required active treatment. The inter-reader agreement was almost perfect (96%, k = 0.85). The correlation in stone size was very strong (ρ = 0.91). Conclusions: A single NP CT is sufficient in detecting and measuring urinary stones in patients with painless VH.
在无痛肉眼血尿中,单相尿石评估可取代无增强和多相计算机断层扫描方案。
目的:无痛性肉眼血尿(VH)需要进行计算机断层扫描(CT),通常包括一次未增强扫描和两到三次造影剂增强扫描,以检测尿路结石和恶性肿瘤。最近,我们证实单次肾图相 (NP) CT 就足以检测出无痛性 VH 患者的恶性肿瘤。材料与方法 "使用计算机断层扫描检查血尿的前瞻性试验"(PROTEHCT)是一项单中心前瞻性诊断研究,研究对象为 2019 年 9 月至 2021 年 6 月期间的无痛 VH 患者。所有患者均接受了四期 CT(参考标准),并从中提取了单期 NP CT(实验)。两名随机阅片员独立评估实验 CT 的尿路结石和大小。统计分析包括实验 CT 的诊断准确率和阅片员之间的一致性(kappa),以及实验 CT 和参考标准之间的大小相关性(Spearman's ρ)。每名患者的实验 CT 灵敏度为 86%(结石≥ 5 毫米时为 97%),特异性为 98%,准确性为 96%。实验性 CT 检测肾结石的灵敏度为 78%(结石≥ 5 毫米时为 89%),检测膀胱和输尿管结石的灵敏度为 100%。没有漏检的结石需要积极治疗。读数者之间的一致性几乎完美(96%,k = 0.85)。结石大小的相关性非常强(ρ = 0.91)。结论:一次 NP CT 就足以检测和测量无痛 VH 患者的尿路结石。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Scandinavian Journal of Urology
Scandinavian Journal of Urology UROLOGY & NEPHROLOGY-
CiteScore
2.90
自引率
6.70%
发文量
70
期刊介绍: Scandinavian Journal of Urology is a journal for the clinical urologist and publishes papers within all fields in clinical urology. Experimental papers related to clinical questions are also invited.Important reports with great news value are published promptly.
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