Pediatric Radiology

, Volume 48, Issue 7, pp 962–972 | Cite as

Comparison of ultrasound versus computed tomography for the detection of kidney stones in the pediatric population: a clinical effectiveness study

  • Nathaniel P. Roberson
  • Jonathan R. Dillman
  • Sara M. O’Hara
  • William R. DeFoorJr
  • Pramod P. Reddy
  • Richard M. Giordano
  • Andrew T. Trout
Original Article

Abstract

Background

The incidence of pediatric nephrolithiasis in the United States is increasing. There is a paucity of literature comparing the diagnostic performance of computed ultrasound (US) to tomography (CT) in the pediatric population.

Objective

To determine the diagnostic performance of renal US for nephrolithiasis in children using a clinical effectiveness approach.

Materials and methods

Institutional review board approval with a waiver of informed consent was obtained for this retrospective, HIPAA-complaint investigation. Billing records and imaging reports were used to identify children (≤18 years old) evaluated for nephrolithiasis by both US and unenhanced CT within 24 h between March 2012 and March 2017. Imaging reports were reviewed for presence, number, size and location of kidney stones. Diagnostic performance of US (reference standard=CT) was calculated per renal unit (left/right kidney) and per renal sector (four sectors per kidney). For sector analysis, US was considered truly positive if a stone was identified at CT in the same or an adjacent sector.

Results

There were 68 renal stones identified by CT in 30/69 patients (43%). Mean patient age was 14.7±3.6 years, and 35 were boys. For detecting nephrolithiasis in any kidney, US was 66.7% (48.8–80.8%) sensitive and 97.4% (86.8–99.9%) specific (positive predictive value=95.2% [77.3–99.8%], negative predictive value=79.2% [65.7–88.3%], positive likelihood ratio=26.0). Per renal sector, US was 59.7% (46.7–71.4%) sensitive and 97.4% (95.5–98.5%) specific (positive predictive value=72.3% [58.2–83.1%], negative predictive value=95.4% [93.2–96.9%], positive likelihood ratio=22.5). Of the 30 stones not detected by US, only 3 were >3 mm at CT.

Conclusion

In clinical practice, US has high specificity for detecting nephrolithiasis in children but only moderate sensitivity and false negatives are common.

Keywords

Children Clinical effectiveness Computed tomography Kidney Nephrolithiasis Ultrasound Urinary tract 

Notes

Compliance with ethical standards

Conflicts of interest

Drs. J. R. Dillman and A. T. Trout receive grant support from Siemens Healthcare and Toshiba America Medical Systems for US research unrelated to this work. Mr. N. P. Roberson, Dr. S. M. O’Hara, Dr. W. DeFoor Jr., Dr. P. P. Reddy, and Mr. R. M. Giordano declare no conflicts of interest.

References

  1. 1.
    Dwyer ME, Krambeck AE, Bergstralh EJ et al (2012) Temporal trends in incidence of kidney stones among children: a 25-year population based study. J Urol 188:247–252CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    Routh JC, Graham DA, Nelson CP (2010) Epidemiological trends in pediatric urolithiasis at United States freestanding pediatric hospitals. J Urol 184:1100–1104CrossRefPubMedGoogle Scholar
  3. 3.
    Tasian GE, Ross ME, Song L et al (2016) Annual incidence of nephrolithiasis among children and Aadults in South Carolina from 1997 to 2012. Clin J Am Soc Nephrol 11:488–496CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Expert Panel on Pediatric Imaging (2012) ACR appropriateness criteria hematuria - child. American College of Radiology. https://acsearch.acr.org/docs/69440/Narrative/. Accessed 15 Nov 2017
  5. 5.
    Fulgham PF, Assimos DG, Pearle MS et al (2013) Clinical effectiveness protocols for imaging in the management of ureteral calculous disease: AUA technology assessment. J Urol 189:1203–1213CrossRefPubMedGoogle Scholar
  6. 6.
    Riccabona M, Avni FE, Blickman JG et al (2009) Imaging recommendations in paediatric uroradiology. Minutes of the ESPR uroradiology task force session on childhood obstructive uropathy, high-grade fetal hydronephrosis, childhood haematuria, and urolithiasis in childhood. ESPR annual congress, Edinburgh, UK, June 2008. Pediatr Radiol 39:891–898CrossRefPubMedGoogle Scholar
  7. 7.
    Tasian GE, Pulido JE, Keren R et al (2014) Use of and regional variation in initial CT imaging for kidney stones. Pediatrics 134:909–915CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    Gartlehner G, Hansen RA, Nissman D et al (2006) Criteria for distinguishing effectiveness from efficacy trials in systematic reviews. Agency for Healthcare Research and Quality (US), Rockville (MD)Google Scholar
  9. 9.
    Centers for Disease Control and Prevention BMI percentile calculator for child and teen. https://nccd.cdc.gov/dnpabmi/calculator.aspx. Accessed 15 Nov 2017
  10. 10.
    Masch WR, Cohan RH, Ellis JH et al (2016) Clinical effectiveness of prospectively reported sonographic twinkling artifact for the diagnosis of renal calculus in patients without known urolithiasis. AJR Am J Roentgenol 206:326–331CrossRefPubMedGoogle Scholar
  11. 11.
    Routh JC, Graham DA, Nelson CP (2010) Trends in imaging and surgical management of pediatric urolithiasis at American pediatric hospitals. J Urol 184:1816–1822CrossRefPubMedGoogle Scholar
  12. 12.
    Passerotti C, Chow JS, Silva A et al (2009) Ultrasound versus computerized tomography for evaluating urolithiasis. J Urol 182:1829–1834CrossRefPubMedGoogle Scholar
  13. 13.
    Winkel RR, Kalhauge A, Fredfeldt KE (2012) The usefulness of ultrasound colour-Doppler twinkling artefact for detecting urolithiasis compared with low dose nonenhanced computerized tomography. Ultrasound Med Biol 38:1180–1187CrossRefPubMedGoogle Scholar
  14. 14.
    Palmer JS, Donaher ER, O'Riordan MA et al (2005) Diagnosis of pediatric urolithiasis: role of ultrasound and computerized tomography. J Urol 174:1413–1416CrossRefPubMedGoogle Scholar
  15. 15.
    Jendeberg J, Geijer H, Alshamari M et al (2017) Size matters: the width and location of a ureteral stone accurately predict the chance of spontaneous passage. Eur Radiol 27:4775–4785CrossRefPubMedPubMedCentralGoogle Scholar
  16. 16.
    Uppot RN, Sahani DV, Hahn PF et al (2006) Effect of obesity on image quality: fifteen-year longitudinal study for evaluation of dictated radiology reports. Radiology 240:435–439CrossRefPubMedGoogle Scholar
  17. 17.
    Aytac SK, Ozcan H (1999) Effect of color Doppler system on the twinkling sign associated with urinary tract calculi. J Clin Ultrasound 27:433–439CrossRefPubMedGoogle Scholar
  18. 18.
    Turrin A, Minola P, Costa F et al (2007) Diagnostic value of colour Doppler twinkling artefact in sites negative for stones on B mode renal sonography. Urol Res 35:313–317CrossRefPubMedGoogle Scholar
  19. 19.
    Dillman JR, Kappil M, Weadock WJ et al (2011) Sonographic twinkling artifact for renal calculus detection: correlation with CT. Radiology 259:911–916CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Nathaniel P. Roberson
    • 1
  • Jonathan R. Dillman
    • 2
  • Sara M. O’Hara
    • 2
  • William R. DeFoorJr
    • 3
  • Pramod P. Reddy
    • 3
  • Richard M. Giordano
    • 2
  • Andrew T. Trout
    • 2
  1. 1.University of Cincinnati College of MedicineCincinnatiUSA
  2. 2.Department of RadiologyCincinnati Children’s Hospital Medical CenterCincinnatiUSA
  3. 3.Division of Pediatric UrologyCincinnati Children’s Hospital Medical CenterCincinnatiUSA

Personalised recommendations