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Ultra-low-dose, low-dose, and standard-dose CT of the kidney, ureters, and bladder: is there a difference? Results from a systematic review of the literature

Ultra-low-dose, low-dose, and standard-dose CT of the kidney, ureters, and bladder: is there a difference? Results from a systematic review of the literature
Ultra-low-dose, low-dose, and standard-dose CT of the kidney, ureters, and bladder: is there a difference? Results from a systematic review of the literature

AIM: To investigate whether reducing the radiation dose of computed tomography (CT) of the kidney, ureters, and bladder (KUB) for acute renal colic impacts upon the specificity, sensitivity, and detection of urolithiasis.

MATERIALS AND METHODS: A systematic review of the literature over a 20-year period between 1995 and 2015 was conducted of all prospective studies in the English language reporting on adult patients who underwent CT KUB or non-contrast CT for renal colic or urolithiasis. Retrospective studies and those that included pregnant females, children, non-human test subjects, cadaveric use, and simulations were excluded. Data were collected using an Excel spreadsheet and ultra-low-dose (ULD CT) and low-dose CT KUB (LD CT) was defined as a radiation dose ≤1.9 and <3.5 mSv, respectively.

RESULTS: A total of 417 articles were identified, and after screening, seven articles (1,104 patients) were included in the present study with a male:female ratio of 3:2. Of the four studies with ULD CT for both males and females, the prevalence of urolithiasis ranged from 36% and 73%, with additional pathologies found in 12-15%. The effective radiation dose of ULD CT ranged from 0.5-1.9 mSv. Overall, ULD CT and LD CT had a sensitivity of 90-100% and a specificity of 86-100% across all studies.

CONCLUSIONS: ULD CT and LD CT are effective techniques and yield high sensitivity and specificity. Although they yield comparable results against standard-dose CT KUB in detecting alternative diagnoses, they may not be as effective in detecting stones <3 mm in size or in patients with a body mass index of >30 kg/m2; however, this should be the first-line investigation for the majority of renal colic patients in the modern era.

Adolescent, Adult, Aged, Aged, 80 and over, Child, Child, Preschool, Female, Humans, Infant, Infant, Newborn, Male, Middle Aged, Prevalence, Radiation Dosage, Radiation Exposure, Radiation Protection, Radiographic Image Enhancement, Reproducibility of Results, Sensitivity and Specificity, Tomography, X-Ray Computed, Urologic Diseases, Young Adult, Comparative Study, Journal Article, Meta-Analysis, Review
0009-9260
11-15
Rob, S.
af93125f-1704-4e4e-a1df-88aff6c54cab
Bryant, T.
0b33acf2-e052-4d9f-9d44-7f1d8a656374
Wilson, I.
5d8bafee-a4e5-47dc-9015-fce418434bf0
Somani, B.K.
ab5fd1ce-02df-4b88-b25e-8ece396335d9
Rob, S.
af93125f-1704-4e4e-a1df-88aff6c54cab
Bryant, T.
0b33acf2-e052-4d9f-9d44-7f1d8a656374
Wilson, I.
5d8bafee-a4e5-47dc-9015-fce418434bf0
Somani, B.K.
ab5fd1ce-02df-4b88-b25e-8ece396335d9

Rob, S., Bryant, T., Wilson, I. and Somani, B.K. (2017) Ultra-low-dose, low-dose, and standard-dose CT of the kidney, ureters, and bladder: is there a difference? Results from a systematic review of the literature. Clinical Radiology, 72 (1), 11-15. (doi:10.1016/j.crad.2016.10.005).

Record type: Review

Abstract

AIM: To investigate whether reducing the radiation dose of computed tomography (CT) of the kidney, ureters, and bladder (KUB) for acute renal colic impacts upon the specificity, sensitivity, and detection of urolithiasis.

MATERIALS AND METHODS: A systematic review of the literature over a 20-year period between 1995 and 2015 was conducted of all prospective studies in the English language reporting on adult patients who underwent CT KUB or non-contrast CT for renal colic or urolithiasis. Retrospective studies and those that included pregnant females, children, non-human test subjects, cadaveric use, and simulations were excluded. Data were collected using an Excel spreadsheet and ultra-low-dose (ULD CT) and low-dose CT KUB (LD CT) was defined as a radiation dose ≤1.9 and <3.5 mSv, respectively.

RESULTS: A total of 417 articles were identified, and after screening, seven articles (1,104 patients) were included in the present study with a male:female ratio of 3:2. Of the four studies with ULD CT for both males and females, the prevalence of urolithiasis ranged from 36% and 73%, with additional pathologies found in 12-15%. The effective radiation dose of ULD CT ranged from 0.5-1.9 mSv. Overall, ULD CT and LD CT had a sensitivity of 90-100% and a specificity of 86-100% across all studies.

CONCLUSIONS: ULD CT and LD CT are effective techniques and yield high sensitivity and specificity. Although they yield comparable results against standard-dose CT KUB in detecting alternative diagnoses, they may not be as effective in detecting stones <3 mm in size or in patients with a body mass index of >30 kg/m2; however, this should be the first-line investigation for the majority of renal colic patients in the modern era.

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More information

Accepted/In Press date: 6 October 2016
e-pub ahead of print date: 31 October 2016
Published date: January 2017
Keywords: Adolescent, Adult, Aged, Aged, 80 and over, Child, Child, Preschool, Female, Humans, Infant, Infant, Newborn, Male, Middle Aged, Prevalence, Radiation Dosage, Radiation Exposure, Radiation Protection, Radiographic Image Enhancement, Reproducibility of Results, Sensitivity and Specificity, Tomography, X-Ray Computed, Urologic Diseases, Young Adult, Comparative Study, Journal Article, Meta-Analysis, Review

Identifiers

Local EPrints ID: 419385
URI: http://eprints.soton.ac.uk/id/eprint/419385
ISSN: 0009-9260
PURE UUID: c5fbeca3-ef26-4153-8c3a-91a3090073b6

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Date deposited: 11 Apr 2018 16:30
Last modified: 06 Oct 2020 18:14

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Contributors

Author: S. Rob
Author: T. Bryant
Author: I. Wilson
Author: B.K. Somani

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