Skip to main content

Advertisement

Log in

Limited added utility of performing follow-up contrast-enhanced CT in patients undergoing initial non-enhanced CT for evaluation of flank pain in the emergency department

  • Original Article
  • Published:
Emergency Radiology Aims and scope Submit manuscript

Abstract

In our emergency department (ED), patients with flank pain often undergo non-enhanced computed tomography (NECT) to assess for nephroureteral (NU) stone. After immediate image review, decision is made regarding need for subsequent contrast-enhanced CT (CECT) to help assess for other causes of pain. This study aimed to review the experience of a single institution with this protocol and to assess the utility of CECT. Over a 6 month period, we performed a retrospective analysis on ED patients presenting with flank pain undergoing CT for a clinical diagnosis of nephroureterolithiasis. Patients initially underwent abdominopelvic NECT. The interpreting radiologist immediately decided whether to obtain a CECT to evaluate for another etiology of pain. Medical records, CT reports and images, and 7-day ED return were reviewed. CT diagnoses on NECT and CECT were compared. Additional information from CECT and changes in management as documented in the patient’s medical record were noted. Three hundred twenty-two patients underwent NECT for obstructing NU stones during the study period. Renal or ureteral calculi were detected in 143/322 (44.4 %). One hundred fifty-four patients (47.8 %) underwent CECT. CECT added information in 17/322 cases (5.3 %) but only changed management in 6/322 patients (1.9 %). In four of these patients with final diagnosis of renal infarct, splenic infarct, pyelonephritis and early acute appendicitis in a thin patient, there was no abnormality on the NECT (4/322 patients, 1.2 %). In the remaining 2 patients, an abnormality was visible on the NECT. In patients presenting with flank pain with a clinical suspicion of nephroureterolithiasis, CECT may not be indicated. While CECT provided better delineation of an abnormality in 5.3 % of cases, changes in management after CECT occurred only in 2 %. This included 1 % of patients in whom a diagnosis of organ infarct, pyelonephritis or acute appendicitis in a thin patient could only be made on CECT.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Westphalen AC, Hsia RY, Maselli JH, Wang R, Gonzales R (2011) Radiological imaging of patients with suspected urinary tract stones: national trends, diagnoses, and predictors. Acad Emerg Med 18(7):699–707

    Article  PubMed Central  PubMed  Google Scholar 

  2. Reddy S (2008) State of the art trends in imaging renal of colic. Emerg Radiol 15(4):217–225

    Article  PubMed  Google Scholar 

  3. Coursey CA, Casalino DD, Remer EM, Arellano RS, Bishoff JT, Dighe M, Fulgham P, Goldfarb S, Israel GM, Lazarus E, Leyendecker JR, Majd M, Nikolaidis P, Papanicolaou N, Prasad S, Ramchandani P, Sheth S, Vikram R (2011) Expert Panel on Urologic Imaging. ACR Appropriateness Criteria® acute onset flank pain — suspicion of stone disease. Reston (VA): American College of Radiology (ACR) p 7 [70 references]

  4. Smith RC, Rosenfield AT, Choe KA, Essenmacher KR, Verga M, Glickman MG, Lange RC (1995) Acute flank pain: comparison of noncontrast enhanced CT and intravenous urography. Radiology 194(3):789–794

    Article  CAS  PubMed  Google Scholar 

  5. Smith RC, Verga M, McCarthy S, Rosenfield AT (1996) Diagnosis of acute flank pain: value of unenhanced helical CT. Am J Roentgenol 166(1):97–101

    Article  CAS  Google Scholar 

  6. Katz DS, Lane MJ, Sommer FG (1997) Non-contrast spiral CT for patients with suspected renal colic. Eur Radiol 7(5):680–685

    Article  CAS  PubMed  Google Scholar 

  7. Dalrymple NC, Verga M, Anderson KR, Bove P, Covey AM, Rosenfield AT, Smith RC (1998) The value of unenhanced helical computerized tomography in the management of acute flank pain. J Urol 159(3):735–740

    Article  CAS  PubMed  Google Scholar 

  8. Fielding JR, Silverman SG, Rubin GD (1999) Helical CT of the urinary tract. Am J Roentgenol 172(5):1199–1206

    Article  CAS  Google Scholar 

  9. Coll DM, Varanelli MJ, Smith RC (2002) Relationship of spontaneous passage of ureteral calculi to stone size and location as revealed by unenhanced helical CT. Am J Roentgenol 178(1):101–103

    Article  Google Scholar 

  10. Katz DS, Scheer M, Lumerman JH, Mellinger BC, Stillman CA, Lane MJ (2000) Alternative or additional diagnoses on unenhanced helical computed tomography for suspected renal colic: experience with 1000 consecutive examinations. Urology 56(1):53–57

    Article  CAS  PubMed  Google Scholar 

  11. Rucker CM, Menias CO, Bhalla S (2004) Mimics of renal colic: alternative diagnoses at unenhanced helical CT. Radiographics 24(Suppl 1):S11–S28

    Article  PubMed  Google Scholar 

  12. Koroglu M, Wendel JD, Ernst RD, Oto A (2004) Alternative diagnoses to stone disease on unenhanced CT to investigate acute flank pain. Emerg Radiol 10(6):327–333

    PubMed  Google Scholar 

  13. Costello JE, Cecava ND, Tucker JE, Bau JL (2013) CT radiation dose: current controversies and dose reduction strategies. AJR Am J Roentgenol 201(6):1283–1290

    Article  PubMed  Google Scholar 

  14. McCollough CH, Primak AN, Braun N, Kofler J, Yu L, Christner J (2009) Strategies for reducing radiation dose in CT. Radiol Clin N Am 47(1):27–40

    Article  PubMed Central  PubMed  Google Scholar 

  15. Miller FH, Kraemer E, Dalal K, Keppke A, Huo E, Hoff FL (2005) Unexplained renal colic: what is the utility of IV contrast? Clin Imaging 29(5):331–336

    Article  PubMed  Google Scholar 

  16. Baig A, Ciril E, Conteras G, Lenz O, Borra S (2012) Acute renal infarction: an underdiagnosed disorder. J Med Cases 3(3):197–200

    Google Scholar 

  17. Poletti P-A, Platon A, Rutschmann OT, Schmidlin FR, Iselin CE, Becker CD (2007) Low-dose versus standard-dose ct protocol in patients with clinically suspected renal colic. Am J Roentgenol 188(4):927–933

    Article  Google Scholar 

  18. Kim BS, Hwang IK, Choi YW, Namkung S, Kim HC, Hwang WC, Choi KM, Park JK, Han TI, Kang W (2005) Low-dose and standard-dose unenhanced helical computed tomography for the assessment of acute renal colic: prospective comparative study. Acta Radiol 46(7):756–763

    Article  PubMed  Google Scholar 

  19. Marin D, Boll DT, Mileto A, Nelson RC (2014) State of the art: dual-energy CT of the abdomen. Radiology 271(2):327–342

    Article  PubMed  Google Scholar 

  20. Aran S, Shaqdan KW, Abujudeh HH (2014) Dual-energy computed tomography (DECT) in emergency radiology: basic principles, techniques, and limitations. Emerg Radiol 21(4):391–405

    Article  PubMed  Google Scholar 

  21. Mangold S, Thomas C, Fenchel M, Vuust M, Krauss B, Ketelsen D, Tsiflikas I, Claussen CD, Heuschmid M (2012) Virtual nonenhanced dual-energy CT urography with tin-filter technology: determinants of detection of urinary calculi in the renal collecting system. Radiology 264(1):119–125

    Article  PubMed  Google Scholar 

Download references

Conflict of interest

The authors declare that they have no conflict of interest.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Robin B. Levenson.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Agarwal, M.D., Levenson, R.B., Siewert, B. et al. Limited added utility of performing follow-up contrast-enhanced CT in patients undergoing initial non-enhanced CT for evaluation of flank pain in the emergency department. Emerg Radiol 22, 109–115 (2015). https://doi.org/10.1007/s10140-014-1259-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10140-014-1259-4

Keywords

Navigation