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. 2018 Sep-Oct;51(5):287-292.
doi: 10.1590/0100-3984.2017.0113.

Epidemiological and imaging features that can affect the detection of ureterolithiasis on ultrasound

Daniela Rebouças Nery  1 , Yves Boher Costa  2 , Thais Caldara Mussi  3 , Ronaldo Hueb Baroni  3
Affiliations

Epidemiological and imaging features that can affect the detection of ureterolithiasis on ultrasound

Daniela Rebouças Nery et al. Radiol Bras. 2018 Sep-Oct.

Abstract
in English, Portuguese

Objective: To identify, in patients with clinical suspicion of ureterolithiasis, epidemiological and imaging features that affect calculus detection on ultrasound, as well as to compare ultrasound with multidetector computed tomography (MDCT).

Materials and methods: We searched our database for patients who underwent ultrasound, followed by MDCT (if the ultrasound was negative), for suspected ureterolithiasis in an emergency setting. Patients were divided into three groups: positive ultrasound (US+); negative ultrasound/positive MDCT (US-/MDCT+); and negative ultrasound/negative MDCT (US-/MDCT-). We evaluated age, gender, ureterolithiasis laterality, location of the calculus within the ureter, body mass index, calculus diameter, and calculus attenuation on MDCT.

Results: Of a total of 292 cases of suspected ureterolithiasis, 155 (53.1%) were in the US+ group, 46 (15.7%) were in the US-/MDCT+ group, and 91 (31.2%) were in the US-/MDCT- group. There were no significant differences among the groups in terms of age, gender, ureterolithiasis laterality, and mean MDCT attenuation values. Distal ureterolithiasis was most common in the US+ group, and calculi at other ureteral locations were more common in the US-/MDCT+ group. The mean body mass index was significantly higher in the US-/MDCT+ group than in the US+ group, and the mean calculus diameter was significantly greater in the US+ group than in the US-/MDCT+ group.

Conclusion: A high body mass index, large calculus diameter, and calculus location in the distal third of the ureter are the major factors favoring ureterolithiasis detection on ultrasound.

Objetivo: Identificar achados epidemiológicos e de imagem em pacientes com suspeita clínica de ureterolitíase que afetam a detecção do cálculo no ultrassom (US), comparado com a tomografia computadorizada multidetectores (TCMD).

Materiais e métodos: Procuramos, em nosso banco de dados, por pacientes que realizaram US no serviço de emergência, seguido por TCMD (se US negativo), por suspeita de ureterolitíase. Os pacientes foram divididos em: 1) US positivo; 2) US negativo e TCMD positiva; 3) US e TCMD negativos. Avaliamos idade, sexo, lateralidade, localização ureteral, índice de massa corporal, diâmetro e densidade do cálculo.

Resultados: Foram incluídos no estudo 292 pacientes. Constatamos que 53,1% das ureterolitíases foram detectadas por US (grupo 1), 15,7% apenas por TCMD (grupo 2), e em 31,2% ambos os métodos foram negativos (grupo 3). Idade, sexo, lateralidade e densidade do cálculo pela TCMD não tiveram diferença significativa entre os grupos. No grupo 1, ureterolitíase foi detectada, preferencialmente, em localização distal, e fora do ureter distal no grupo 2. O índice de massa corporal foi significativamente maior em pacientes do grupo 2, comparado ao grupo 1. O diâmetro do cálculo detectado no grupo 1 foi significativamente maior do que no grupo 2.

Conclusão: Índice de massa corporal, diâmetro e localização do cálculo no terço distal do ureter foram os principais fatores que contribuíram para a detecção do cálculo pelo US.

Keywords: Body mass index; Tomography, X-ray computed; Ultrasonography; Ureterolithiasis.

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Figures

Figure 1
Figure 1
Flow chart of inclusion and exclusion criteria.
Figure 2
Figure 2
Three-dimensional reconstruction of an MDCT examination of the urinary tract. Note the ureteral anatomic division: the UPJ (A); the proximal ureter (B); the mid-ureter (C), between the upper border of sacroiliac joint (dashed line) and its lower border (solid line); the distal ureter (D); and the UVJ (E).
Figure 3
Figure 3
A 43-year-old male, BMI = 39, with abdominal pain. Ultrasound image (A) showing marked left collecting system dilatation without detecting the obstructive cause. Following ultrasound, MDCT was performed which confirmed the collecting system dilatation (B) and a calculus in the distal ureter (C) (arrows), measuring 0.6 cm.
Figure 4
Figure 4
A 47-year-old female with a BMI of 22 kg/m2 and ureteral colic. Ultrasound showing a calculus measuring 0.5 cm (arrow) in the mid-ureter (A), 7.0 cm below the renal pelvis (B).
Figure 5
Figure 5
ROC curve analysis for ultrasound detection of ureterolithiasis, according to BMI.
See this image and copyright information in PMC

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