Can obstructive urolithiasis be safely excluded on contrast CT? A retrospective analysis of contrast-enhanced and noncontrast CT
| Autor: | Morris Hayim, Brandon Lei, Seleshi Demissie, Jonathan Scheiner, Nassier Harfouch |
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| Rok vydání: | 2020 |
| Předmět: |
Adult
Male Flank medicine.medical_specialty Flank pain Contrast Media Flank Pain 03 medical and health sciences 0302 clinical medicine Urolithiasis Predictive Value of Tests Retrospective analysis Medicine Humans Clinical significance Pelvis Aged Retrospective Studies business.industry 030208 emergency & critical care medicine Retrospective cohort study General Medicine Emergency department Middle Aged medicine.anatomical_structure Emergency Medicine Abdomen Female Radiology business Emergency Service Hospital Tomography X-Ray Computed |
| Zdroj: | The American journal of emergency medicine. 47 |
| ISSN: | 1532-8171 |
| Popis: | Purpose The aim of this study was to determine if contrast-enhanced CT can safely exclude obstructive urolithiasis in patients with flank plain. We performed a retrospective cohort analysis to compare the negative predictive values of contrast-enhanced and non-contrast CTs for the detection of obstructing urolithiasis. Methods Through report analysis, we identified all non-contrast and contrast-enhanced CT examinations of the abdomen and pelvis performed on adult patients in the emergency department at a single, multi-site academic medical institution in 2017 with an indication of flank pain. The prevalence of obstructive urolithiasis in each group was calculated. We subsequently analyzed 200 consecutive studies from each of these groups (reported negative for obstructive urolithiasis) for negative predictive value calculation. Follow up abdominal imaging within 7 days from original presentation was used as a reference standard for analysis. Results In the noncontrast group, 1 study out of 200 was false negative (negative predictive value = 99.5%). In the contrast-enhanced group, there were no false negatives (negative predictive value = 100%). The prevalence of obstructive urolithiasis was 44.0% (351/797) in the noncontrast group and 18.7% (86/459) in the contrast-enhanced group. Conclusion Our results suggest that contrast-enhanced CT can safely exclude obstructing ureteral calculi in the setting of acute flank pain. This finding is of clinical relevance given the inherent benefit of IV contrast in diagnosing abdominopelvic pathology. |
| Databáze: | OpenAIRE |
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