Performance of Computed Tomography of the Kidneys, Ureter and Bladder in Non-Calculus Diagnoses: A Comparative Review of Non-Enhanced with Intravenous Contrast-Enhanced Imaging
<b>Background/Objectives</b>: Non-enhanced computed tomography of the kidneys, ureters and bladder (NECT KUB) is the initial imaging modality for suspected nephroureterolithiasis. However, for alternative diagnoses, NECT may not be the ideal technique. Our institution changed the protoco...
Saved in:
| Main Authors: | , , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
MDPI AG
2025-07-01
|
| Series: | Diagnostics |
| Subjects: | |
| Online Access: | https://www.mdpi.com/2075-4418/15/14/1731 |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1849733340074082304 |
|---|---|
| author | Alexander T. O’Mahony Michael G. Waldron David J. Ryan Brian Carey Sahil Shet Eid Kakish Patrick O'Regan David Glynn Josephine Barry Owen J. O'Connor Michael M. Maher |
| author_facet | Alexander T. O’Mahony Michael G. Waldron David J. Ryan Brian Carey Sahil Shet Eid Kakish Patrick O'Regan David Glynn Josephine Barry Owen J. O'Connor Michael M. Maher |
| author_sort | Alexander T. O’Mahony |
| collection | DOAJ |
| description | <b>Background/Objectives</b>: Non-enhanced computed tomography of the kidneys, ureters and bladder (NECT KUB) is the initial imaging modality for suspected nephroureterolithiasis. However, for alternative diagnoses, NECT may not be the ideal technique. Our institution changed the protocol for this cohort from NECT to intravenous contrast-enhanced CT (CECT) KUB. We aimed to retrospectively compare the rate of alternative diagnosis seen and the rates of calculus detection in CECT versus NECT KUB as a means of assessing performance. Our secondary aim was to compare the radiation dose between CECT and NECT KUB. <b>Methods</b>: Patients referred from the emergency department with suspected nephroureterolithiasis who underwent NECT and CECT KUB over two years were included. Key performance metrics included calculus detection rate, alternative findings, and negative studies. The metrics were compared between genders and age groups. Categorical variables were analysed using Chi-squared or Fisher’s Exact Test and continuous with T-testing. <b>Results</b>: A total of 423 patients had CT KUB imaging (209 NECT, 214 CECT). The incidence of alternative findings in the NECT group was 23% and 40% in CECT (<i>p</i> < 0.001). There were 48 findings (13 major, 11 moderate and 24 minor) in NECT studies and 85 findings (23 major, 43 moderate and 19 minor) in CECT (<i>p</i> < 0.001). Major diagnoses ranged from acute emergencies to more indolent findings, including suspicious nodules/masses. The calculus detection rate (NECT 56%, CECT 54%, <i>p</i> = 0.643) and negative studies (NECT 28%, CECT 22%, <i>p</i> = 0.168) did not significantly differ between protocols. CECT had a mean effective dose of 8.71 ± 2.58 mSv representing 2.4 times the exposure of NECT (<i>p</i> < 0.001). <b>Conclusions</b>: CECT is associated with a greater alternative diagnosis rate with similar calculus detection rates compared to NECT KUB, suggesting superior performance. However, CECT exposes patients to significantly greater levels of ionizing radiation. |
| format | Article |
| id | doaj-art-2e8fe96c416247faa600fa75ef50ff5b |
| institution | DOAJ |
| issn | 2075-4418 |
| language | English |
| publishDate | 2025-07-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Diagnostics |
| spelling | doaj-art-2e8fe96c416247faa600fa75ef50ff5b2025-08-20T03:08:05ZengMDPI AGDiagnostics2075-44182025-07-011514173110.3390/diagnostics15141731Performance of Computed Tomography of the Kidneys, Ureter and Bladder in Non-Calculus Diagnoses: A Comparative Review of Non-Enhanced with Intravenous Contrast-Enhanced ImagingAlexander T. O’Mahony0Michael G. Waldron1David J. Ryan2Brian Carey3Sahil Shet4Eid Kakish5Patrick O'Regan6David Glynn7Josephine Barry8Owen J. O'Connor9Michael M. Maher10Department of Radiology, Cork University Hospital, T12DC4A Cork, IrelandDepartment of Radiology, Cork University Hospital, T12DC4A Cork, IrelandDepartment of Radiology, Cork University Hospital, T12DC4A Cork, IrelandDepartment of Radiology, Cork University Hospital, T12DC4A Cork, IrelandDepartment of Radiology, School of Medicine, Brookfield Health Complex, University College Cork, T12Ak54 Cork, IrelandDepartment of Radiology, School of Medicine, Brookfield Health Complex, University College Cork, T12Ak54 Cork, IrelandDepartment of Radiology, Cork University Hospital, T12DC4A Cork, IrelandDepartment of Radiology, Cork University Hospital, T12DC4A Cork, IrelandDepartment of Radiology, Cork University Hospital, T12DC4A Cork, IrelandDepartment of Radiology, Cork University Hospital, T12DC4A Cork, IrelandDepartment of Radiology, Cork University Hospital, T12DC4A Cork, Ireland<b>Background/Objectives</b>: Non-enhanced computed tomography of the kidneys, ureters and bladder (NECT KUB) is the initial imaging modality for suspected nephroureterolithiasis. However, for alternative diagnoses, NECT may not be the ideal technique. Our institution changed the protocol for this cohort from NECT to intravenous contrast-enhanced CT (CECT) KUB. We aimed to retrospectively compare the rate of alternative diagnosis seen and the rates of calculus detection in CECT versus NECT KUB as a means of assessing performance. Our secondary aim was to compare the radiation dose between CECT and NECT KUB. <b>Methods</b>: Patients referred from the emergency department with suspected nephroureterolithiasis who underwent NECT and CECT KUB over two years were included. Key performance metrics included calculus detection rate, alternative findings, and negative studies. The metrics were compared between genders and age groups. Categorical variables were analysed using Chi-squared or Fisher’s Exact Test and continuous with T-testing. <b>Results</b>: A total of 423 patients had CT KUB imaging (209 NECT, 214 CECT). The incidence of alternative findings in the NECT group was 23% and 40% in CECT (<i>p</i> < 0.001). There were 48 findings (13 major, 11 moderate and 24 minor) in NECT studies and 85 findings (23 major, 43 moderate and 19 minor) in CECT (<i>p</i> < 0.001). Major diagnoses ranged from acute emergencies to more indolent findings, including suspicious nodules/masses. The calculus detection rate (NECT 56%, CECT 54%, <i>p</i> = 0.643) and negative studies (NECT 28%, CECT 22%, <i>p</i> = 0.168) did not significantly differ between protocols. CECT had a mean effective dose of 8.71 ± 2.58 mSv representing 2.4 times the exposure of NECT (<i>p</i> < 0.001). <b>Conclusions</b>: CECT is associated with a greater alternative diagnosis rate with similar calculus detection rates compared to NECT KUB, suggesting superior performance. However, CECT exposes patients to significantly greater levels of ionizing radiation.https://www.mdpi.com/2075-4418/15/14/1731urinary calculinon-contrast enhanced CT KUBcontrast-enhanced CT KUBdiagnostic yieldeffective radiation dose |
| spellingShingle | Alexander T. O’Mahony Michael G. Waldron David J. Ryan Brian Carey Sahil Shet Eid Kakish Patrick O'Regan David Glynn Josephine Barry Owen J. O'Connor Michael M. Maher Performance of Computed Tomography of the Kidneys, Ureter and Bladder in Non-Calculus Diagnoses: A Comparative Review of Non-Enhanced with Intravenous Contrast-Enhanced Imaging Diagnostics urinary calculi non-contrast enhanced CT KUB contrast-enhanced CT KUB diagnostic yield effective radiation dose |
| title | Performance of Computed Tomography of the Kidneys, Ureter and Bladder in Non-Calculus Diagnoses: A Comparative Review of Non-Enhanced with Intravenous Contrast-Enhanced Imaging |
| title_full | Performance of Computed Tomography of the Kidneys, Ureter and Bladder in Non-Calculus Diagnoses: A Comparative Review of Non-Enhanced with Intravenous Contrast-Enhanced Imaging |
| title_fullStr | Performance of Computed Tomography of the Kidneys, Ureter and Bladder in Non-Calculus Diagnoses: A Comparative Review of Non-Enhanced with Intravenous Contrast-Enhanced Imaging |
| title_full_unstemmed | Performance of Computed Tomography of the Kidneys, Ureter and Bladder in Non-Calculus Diagnoses: A Comparative Review of Non-Enhanced with Intravenous Contrast-Enhanced Imaging |
| title_short | Performance of Computed Tomography of the Kidneys, Ureter and Bladder in Non-Calculus Diagnoses: A Comparative Review of Non-Enhanced with Intravenous Contrast-Enhanced Imaging |
| title_sort | performance of computed tomography of the kidneys ureter and bladder in non calculus diagnoses a comparative review of non enhanced with intravenous contrast enhanced imaging |
| topic | urinary calculi non-contrast enhanced CT KUB contrast-enhanced CT KUB diagnostic yield effective radiation dose |
| url | https://www.mdpi.com/2075-4418/15/14/1731 |
| work_keys_str_mv | AT alexandertomahony performanceofcomputedtomographyofthekidneysureterandbladderinnoncalculusdiagnosesacomparativereviewofnonenhancedwithintravenouscontrastenhancedimaging AT michaelgwaldron performanceofcomputedtomographyofthekidneysureterandbladderinnoncalculusdiagnosesacomparativereviewofnonenhancedwithintravenouscontrastenhancedimaging AT davidjryan performanceofcomputedtomographyofthekidneysureterandbladderinnoncalculusdiagnosesacomparativereviewofnonenhancedwithintravenouscontrastenhancedimaging AT briancarey performanceofcomputedtomographyofthekidneysureterandbladderinnoncalculusdiagnosesacomparativereviewofnonenhancedwithintravenouscontrastenhancedimaging AT sahilshet performanceofcomputedtomographyofthekidneysureterandbladderinnoncalculusdiagnosesacomparativereviewofnonenhancedwithintravenouscontrastenhancedimaging AT eidkakish performanceofcomputedtomographyofthekidneysureterandbladderinnoncalculusdiagnosesacomparativereviewofnonenhancedwithintravenouscontrastenhancedimaging AT patrickoregan performanceofcomputedtomographyofthekidneysureterandbladderinnoncalculusdiagnosesacomparativereviewofnonenhancedwithintravenouscontrastenhancedimaging AT davidglynn performanceofcomputedtomographyofthekidneysureterandbladderinnoncalculusdiagnosesacomparativereviewofnonenhancedwithintravenouscontrastenhancedimaging AT josephinebarry performanceofcomputedtomographyofthekidneysureterandbladderinnoncalculusdiagnosesacomparativereviewofnonenhancedwithintravenouscontrastenhancedimaging AT owenjoconnor performanceofcomputedtomographyofthekidneysureterandbladderinnoncalculusdiagnosesacomparativereviewofnonenhancedwithintravenouscontrastenhancedimaging AT michaelmmaher performanceofcomputedtomographyofthekidneysureterandbladderinnoncalculusdiagnosesacomparativereviewofnonenhancedwithintravenouscontrastenhancedimaging |