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Imaging strategies for patients with suspicion of uncomplicated colic pain: diagnostic accuracy and management assessment

  • Emergency Radiology
  • Published:
European Radiology Aims and scope Submit manuscript

Abstract

Objective

Compare different imaging scenarios in the diagnosis of uncomplicated renal colic due to urolithiasis (URCU).

Materials and methods

A total of 206 prospectively included patients had been admitted with suspected URCU and had undergone abdominal plain film (APF), US and unenhanced CT after clinical STONE score evaluation. CT was the reference standard. We assessed sensitivity (Se), specificity (Spe) and Youden index for colic pain diagnosis, percentage of patients managed by urologic treatment with stone identified, percentage of alternative diagnoses (AD) and exposure to radiation, according to single imaging approaches, strategies driven by patient characteristics and conditional imaging strategies after APF and US.

Results

One hundred (48.5%) patients had a final diagnosis of URCU and 19 underwent urologic treatment. The conditional strategy, i.e. CT in patients who had no stone identified at US, had a perfect sensitivity and specificity. This enabled diagnosis of all stones requiring urology management while decreasing the number of CT exams by 22%. The strategy whereby CT was used when there was neither direct or indirect APF + US finding of colic pain nor alternative diagnoses in patients with a STONE score ≥ 10 had a sensitivity of 0.95 and a specificity of 0.99, identified 84% of stones managed by urologic treatment and decreased the number of CT examinations by 76%.

Conclusion

In patients with clinical findings consistent with URCU, the use of ultrasound as first-line imaging modality, with CT restricted to patients with negative US and a STONE score ≥ 10, led to a sensitivity and specificity of above 95%, identified 84% of stones requiring urological management and reduced the number of CT scans needed by fourfold.

Key Points

• For diagnosis, the use of APF + US as first-line imaging, with CT restricted to patients with both a normal APF + US and a STONE score ≥ 10, provides both a sensitivity and specificity superior or equal to 95% and reduces the number of CT scans necessary by fourfold.

• For management, the use of APF + US as first-line imaging, with CT restricted to patients with both a normal APF + US and a STONE score ≥ 10, maintains a 84% stone identification rate in urology-treated patients.

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Abbreviations

AD:

Alternative diagnosis

APF:

Abdominal plain film

Se:

Sensitivity

Spe:

Specificity

URCU:

Uncomplicated renal colic due to urolithiasis

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Funding

This study has received funding by Montpellier University Hospital Centre.

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Authors and Affiliations

  1. Department of Medical Imaging, Montpellier University Hospital, Lapeyronie Hospital, 191, Avenue du Doyen Gaston Giraud, 34295, Montpellier Cedex 5, France

    Claire Faget, Ingrid Millet, Cécile Verheyden, Fernanda Curros-Doyon & Patrice Taourel

  2. Department of Emergency, Montpellier University Hospital, Lapeyronie Hospital, Montpellier, France

    Mustapha Sebbane

  3. Department of Urology and Renal Transplantation, Montpellier University Hospital, Lapeyronie Hospital, Montpellier, France

    Rodolphe Thuret

  4. Department of Biostatistics and Medical Information, Montpellier University Hospital, Lapeyronie Hospital, Montpellier, France

    Nicolas Molinari

Authors
  1. Claire Faget
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  2. Ingrid Millet
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  3. Mustapha Sebbane
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  4. Rodolphe Thuret
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  6. Fernanda Curros-Doyon
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  8. Patrice Taourel
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Correspondence to Patrice Taourel.

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Guarantor

The scientific guarantor of this publication is Pr. Patrice TAOUREL.

Conflict of interest

The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.

Statistics and biometry

One of the authors has significant statistical expertise.

Informed consent

Written informed consent was obtained from all subjects (patients) in this study.

Ethical approval

Institutional Review Board approval was obtained by the Institutional Review Board named “Comité de Protection des personnes Sud méditerranée V” (Registry Identifier: ID-RCB 2015-A01981-48, reference 16.013).

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• prospective

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• performed at one institution

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Faget, C., Millet, I., Sebbane, M. et al. Imaging strategies for patients with suspicion of uncomplicated colic pain: diagnostic accuracy and management assessment. Eur Radiol 31, 2983–2993 (2021). https://doi.org/10.1007/s00330-020-07264-z

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  • DOI: https://doi.org/10.1007/s00330-020-07264-z

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