Ultrasound versus computed tomography for the detection of ureteral calculi in the pediatric population: a clinical effectiveness study

  • Nathaniel P. Roberson
  • Jonathan R. DillmanEmail author
  • Pramod O. Reddy
  • William DeFoorJr.
  • Andrew T. Trout
Kidneys, Ureters, Bladder, Retroperitoneum



To determine the diagnostic performance of ultrasound for diagnosing ureteral calculi in children using a clinical effectiveness approach.


Billing records and imaging reports were used to identify children (≤ 18 years old) evaluated for suspected urolithiasis using ultrasound between March 2012 and March 2017. Patients without unenhanced CT within 24 h (reference standard) were excluded. Imaging (ultrasound and CT) reports were reviewed for presence, number, size, and location of calculi. Diagnostic performance of ultrasound (versus CT) was calculated on an individual ureter basis both by direct calculus visualization as well as direct visualization combined with suspected presence of ureteral stone based on indirect ultrasound findings.


41 ureteral calculi were present in 38 of 69 (55.1%) patients. Mean patient age was 14.7 ± 3.6 years, and 35 of 69 (51%) patients were boys. Based on direct calculus visualization, ultrasound had a sensitivity of 12.8% (95% CI 5.6–26.7%), specificity of 100% (95% CI 96.3–100%), positive predictive value (PPV) of 100% (95% CI 56.6–100%), and negative predictive value (NPV) of 74.4% (95% CI 66.4–81.1%). When ultrasound examinations reported as suspicious for ureteral calculi based on indirect findings also were considered positive, ultrasound had a sensitivity of 41.0% (95% CI 27.1–56.6%), specificity of 95.0% (95% CI 88.7–97.8%), PPV of 76.2% (95% CI 54.9–89.4%), and NPV of 80.3% (95% CI 72.2–86.5%).


In clinical practice, ultrasound has low sensitivity for directly visualizing ureteral calculi subsequently identified by CT, although sensitivity improves when considering suspicious examinations as positive.


Children Calculi Ureter Ultrasound Computed tomography Diagnostic performance 


Compliance with ethical standards

Conflicts of interest

All authors declare that they have no conflict of interest.


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© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Unvierstiy of Cincinnati College of MedicineCincinnatiUSA
  2. 2.Department of RadiologyCincinnati Children’s Hospital Medical CenterCincinnatiUSA
  3. 3.Department of RadiologyUniversity of Cincinnati College of MedicineCincinnatiUSA
  4. 4.Division of Pediatric UrologyCincinnati Children’s Hospital Medical CenterCincinnatiUSA

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