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© 2008 by the American Institute of Ultrasound in Medicine
J Ultrasound Med 27:1441-1450 • 0278-4297

Evaluation of Patients With Suspected Ureteral Calculi Using Sonography as an Initial Diagnostic Tool

How Can We Improve Diagnostic Accuracy?

Seong Jin Park, MD, PhD, Boem Ha Yi, MD, Hae Kyung Lee, MD, Young Ho Kim, MD, Gong Jo Kim, MD and Hyun Cheol Kim, MD

Departments of Radiology (S.J.P., B.H.Y., H.K.L.) and Urology (Y.H.K., G.J.K.), Soonchunhyang University Bucheon Hospital, Gyeonggi-do, Korea; and Department of Diagnostic Radiology, Kyung Hee University East West Neo Medicine Hospital, Seoul, Korea (H.C.K.).

Address correspondence to Seong Jin Park, MD, PhD, Department of Radiology, Soonchunhyang University Bucheon Hospital, 1174, Jung-dong, Wonmi-gu, Bucheon-si, Gyeonggi-do 420-021, Korea. E-mail address: indawn{at}hanafos.com

Objective. The purpose of this study was to evaluate the usefulness of sonography as an initial diagnostic tool in patients with suspected ureterolithiasis. Methods. We performed a prospective study of 318 patients with suspected ureteral stones over a 14-month period. All patients underwent sonography after fasting for 8 hours and bladder filling. If no cause of the flank pain was found by sonography, computed tomography or intravenous urography was performed immediately to confirm the absence of ureteral stones. Results. We found urolithiasis with sonography in 291 of 296 patients with confirmed urolithiasis. The 5 remaining cases were identified after non–contrast-enhanced computed tomography (n = 3), intravenous urography (n = 1), or the passage of a stone (n = 1, pregnant patient). We detected 313 calculi in the 291 patients with sonography as follows: 307 ureteral calculi in 285 patients, 5 urinary bladder calculi that were probably passed from the ureter in 5 patients, and 1 urethral calculus. The locations of the 313 calculi in the 291 patients with a sonographic diagnosis were as follows: 21 were in the ureteropelvic junction, 96 in the proximal half of the ureter, 69 in the distal half of the ureter, 121 in the ureterovesical junction, 5 in the urinary bladder, and 1 in the urethra. Hydronephrosis was seen in 200 of the 291 patients with calculi identified by sonography (68.7%). Twinkling artifacts helped confirm the presence of tiny calculi in 184 of the 214 calculi (86%). Conclusions. Sonography can be used as an initial diagnostic tool in patients with suspected ureterolithiasis.

Key Words: calculi • sonography • ureter

Abbreviations: CT, computed tomography • IVU, intravenous urography • UPJ, ureteropelvic junction • UVJ, ureterovesical junction

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Copyright © 2008 by the American Institute of Ultrasound in Medicine.