Dual-Energy CT for Urinary Stone Evaluation
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NEW IMAGING TECHNIQUES (S RAIS-BAHRAMI AND K PORTER, SECTION EDITORS)
Dual-Energy CT for Urinary Stone Evaluation Alex Nourian 1 & Eric Ghiraldi 1 & Justin I. Friedlander 1,2 Accepted: 16 November 2020 # Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Purpose of Review Conventional CT imaging is an excellent tool for the diagnosis of nephrolithiasis however is limited in its ability to detect stone composition. Dual-energy CT (DECT) scans have demonstrated promise in overcoming this limitation. We review the current utility of DECT in nephrolithiasis. Recent Findings DECT is superior to conventional CT in differentiating uric acid stones from non-uric acid stones, with numerous studies reporting sensitivities and specificities approaching > 95%. Dose reduction protocols incorporating low-dose CT scans are commonly used, providing significantly lower effective radiation doses compared to conventional CT. DECT remains an effective diagnostic tool in patients with large body habitus. Summary DECT can accurately detect uric acid stones, which can help guide which stones may be suitable to medical dissolution. Further studies evaluating the effectiveness of DECT in guiding management of patients with nephrolithiasis can help to promote its widespread use. Keywords Nephrolithiasis . Imaging . Dual-energy CT . Stone composition . Uric acid . Radiation exposure
Introduction CT Imaging in Nephrolithiasis Imaging is an essential component of the evaluation of kidney stones. It helps confirm the diagnosis, reveal stone burden, and confirm the location of the stone. This information is important in determining which patients will require an intervention as opposed to those who may be managed with a trial of passage. Currently, ultrasound, KUB (kidney, ureter, and bladder) plain film, and CT are the most commonly used imaging This article is part of the Topical Collection on New Imaging Techniques * Justin I. Friedlander [email protected] Alex Nourian [email protected] Eric Ghiraldi [email protected] 1
Department of Urology, Einstein Healthcare Network, 1200 Tabor Road, 3rd Floor Sley Building, Philadelphia, PA 19141, USA
2
Division of Urologic Oncology and Urology, Fox Chase Cancer Center, Philadelphia, PA 19111, USA
modalities for stone disease. CT imaging remains the gold standard for detecting nephrolithiasis, as non-enhanced scans have a sensitivity and specificity of > 95% [1]. This remains superior to the reported accuracies of ultrasound (sensitivity 84%, specificity 53%), KUB (sensitivity 57%, specificity 76%), and MRI (sensitivity 82%, specificity 98%) [2]. Furthermore, the use of CT continues to increase in the acute presentation of stones. The rate of CT use for the diagnosis of urinary tract stones tripled in the emergency department from 1992 to 2009, and currently stands at approximately 90% [3, 4]. Additionally, CT imaging in the acute presentation of nephrolithiasis is often preferred as it can help detect other pathologies responsible for acute abdominal pain in the
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