Ureteral calculi imaging: a literature review comparing plain film studies, contrast media studies, ultrasound and computed tomography

Abstract

Purpose: Through a study of the literature this paper aims to investigate the imaging pathway which should be undertaken by patients presenting to the emergency department with renal colic and flank pain. Method: The British Journal of Radiology, Journal of Endourology, Radiology, RadioGraphics, American Journal of Radiology and Adult Urology were searched to find any previous studies into this area through the use of keywords: calculi, renal, computed tomography (CT), plain imaging, abdominal, ultrasound, intravenous urogram (IVU) and x-ray. Conclusion: This literature review determined that the use of non-enhanced helical CT scanning of the abdomen and pelvis should be utilised as the initial imaging technique. CT is able to demonstrate all stones, can be performed rapidly and can diagnose other pathologies which may be mimicking renal colic. Plain film and contrast imaging studies including intravenous urography (IVU) are seen as being of little diagnostic value for frontline identification due to their inability to demonstrate a large number of stones due to size, location and composition. Ultrasound has been shown to be of use as a tool for pregnant or paediatric patients, however its inability to accurately demonstrate the ureters and diagnose extra-urinary pathology limits its use for the general population. The use of low-dose CT is also discussed, and its use advocated for patients with repeat presentation of these symptoms. As more eduction is provided into this area, the authors believe this will become the modality and technique of choice. An imaging pathway flowchart devised by this review is provided.