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. 2014 Jul;6(3):218-23.
doi: 10.4103/0974-7796.134270.

Use of computed tomography scout film and Hounsfield unit of computed tomography scan in predicting the radio-opacity of urinary calculi in plain kidney, ureter and bladder radiographs

Michael E Chua  1 , Odina R Gomez  2 , Lorelei D Sapno  1 , Steve L Lim  1 , Marcelino L Morales Jr  3
Affiliations

Use of computed tomography scout film and Hounsfield unit of computed tomography scan in predicting the radio-opacity of urinary calculi in plain kidney, ureter and bladder radiographs

Michael E Chua et al. Urol Ann. 2014 Jul.

Abstract

Objective: The objective of this study is to determine the diagnostic utility of computed tomography (CT)- scout film with an optimal non-contrast helical CT scan Hounsfield unit (HU) in predicting the appearance of urinary calculus in the plain kidneys, ureter, urinary bladder (KUB)-radiograph.

Methods: A prospective cross-sectional study was executed and data were collected from June 2007 to June 2012 at a tertiary hospital. The included subjects were diagnosed to have <10mm urolithiasis with non-contrast helical CT scan and KUB X-ray, which were carried out on the same day. Both KUB radiographs and CT-scout film were read by two qualified radiologists with inter-observer standardization prior to the study. Urolithiasis characteristics such as stone location, CT attenuation value, CT-scout film and KUB radiograph appearance were recorded independently by two observers. Univariate logistic analysis with receiver operating characteristic curve was generated to determine the best cut-off HU value of urolithiases not identified in CT-scout film, but determined radio-opaque in KUB X-ray. Subsequently, its sensitivity, specificity, predictive values and likelihood ratios were calculated. Statistical significance was set at P value of 0.05 or less.

Results: Two hundred and three valid cases were included. 73 out of 75 CT-scout film detected urolithiasis were identified on plain radiograph and determined as radio-opaque. The determined best cut off value of HU utilized for prediction of radiographic characteristics was 630HU at which urinary calculi were not seen at CT-scout film and were KUB X-ray radio-opaque. The set HU cut-off was established of ideal accuracy with an overall sensitivity of 82.2%, specificity of 96.9% and a positive predictive value of 96.5% and negative predictive value of 83.5%.

Conclusion: Urolithiases identified on the CT-scout film were also seen as radiopaque on the KUB radiograph while those stones not visible on the CT-scout film, but above the optimal HU cut-off value of 630 are also likely to be radiopaque.

Keywords: Computed tomography scout film; Hounsfield units; kidneys; non-contrast helical computed tomography scan; ureter; urinary bladder radiograph; urolithiasis.

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Conflict of interest statement

Conflict of Interest: None declared.

Figures

Figure 1
Figure 1
Appearance of stone by location: Upper collecting system
Figure 2
Figure 2
Appearance of stone by location: Lower collecting system
Figure 3
Figure 3
Receiver operating characteristic curve for determination of Hounsfield unit (HU) 630 set as the best HU cut-off value for determination of urolithiasis appearance unidentified in computed tomography scout and kidneys, ureter, urinary bladder X-ray determined radio-opaque
See this image and copyright information in PMC

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