Journal of the Korean Society of Radiology (대한영상의학회지)

The Korean Society of Radiology (대한영상의학회)
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Usefulness of Corticomedullary-Phase CT Urography in Patients with Suspected Acute Renal Colic Visiting the Emergency Department

응급실을 방문하는 급성신산통이 의심되는 환자에서 요로조영술 컴퓨터단층촬영의 피질-수질기의 유용성

  • Seokyoung Lee (Departments of Radiology, Korea University Guro Hospital, Korea University College of Medicine) ;
  • Yang Shin Park (Departments of Radiology, Korea University Guro Hospital, Korea University College of Medicine) ;
  • Bitna Park (Departments of Radiology, Korea University Guro Hospital, Korea University College of Medicine) ;
  • Jongmee Lee (Departments of Radiology, Korea University Guro Hospital, Korea University College of Medicine) ;
  • Jae Woong Choi (Departments of Radiology, Korea University Guro Hospital, Korea University College of Medicine) ;
  • Kyeong Ah Kim (Departments of Radiology, Korea University Guro Hospital, Korea University College of Medicine) ;
  • Chang Hee Lee (Departments of Radiology, Korea University Guro Hospital, Korea University College of Medicine)
  • 이석영 (고려대학교 의과대학 구로병원 영상의학과) ;
  • 박양신 (고려대학교 의과대학 구로병원 영상의학과) ;
  • 박빛나 (고려대학교 의과대학 구로병원 영상의학과) ;
  • 이종미 (고려대학교 의과대학 구로병원 영상의학과) ;
  • 최재웅 (고려대학교 의과대학 구로병원 영상의학과) ;
  • 김경아 (고려대학교 의과대학 구로병원 영상의학과) ;
  • 이창희 (고려대학교 의과대학 구로병원 영상의학과)
  • Received : 2022.06.26
  • Accepted : 2022.10.02
  • Published : 2023.07.01
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Abstract

Purpose To evaluate the sensitivity of corticomedullary-phase imaging for detecting urinary stones in patients with renal colic who visited the emergency department. Materials and Methods This retrospective study included 253 patients with suspected renal colic from two tertiary hospitals in South Korea, who visited the emergency department and underwent CT urography. Two radiologists blinded to the clinical history independently reviewed the corticomedullary-phase images. The sensitivity for identifying urinary stones were evaluated for each reviewer. After the initial evaluation, the images were re-evaluated based on patient history. The sensitivity of re-evaluation were recorded. Results Of 253 patients, 150 (59%) had urinary stones. Among them, significant stones were observed in 138 patients (92%), and obstructive changes on CT in 124 patients (82.7%). For identifying significant urinary stones, the sensitivity was 98.6% (136/138) for both the reviewers. For identifying significant urinary stones with urinary obstruction, the sensitivity was 99.2% (123/124) for reviewer 1, and 100% (124/124) for reviewer 2. The sensitivity for identifying significant stones increased from 98.6% to 100% for reviewer 1, and from 98.6% to 99.3% for reviewer 2 in the re-evaluation session. Conclusion The corticomedullary-phase CT urography was sensitive for diagnosing urolithiasis in patients with acute renal colic who visited the emergency department.

목적 응급실의 급성신산통을 호소하는 환자에서 피질-수질기 요로조영술 컴퓨터 단층촬영(이하 CT)에서 요로결석 발견을 기존의 CT 요로조영술과 비교하였다. 대상과 방법 이 후향적 연구는 한국의 두 삼차 병원의 응급실에서 CT 요로조영술을 촬영한 253명의 요로결석이 의심된 환자를 대상으로 시행하였다. 임상 병력을 알지 못한채로 두 명의 영상의학과 의사가 독립적으로 CT 요로조영술의 피질-수질기를 판독하여 요로결석에 관한 정보를 기록하였다. 판독자들의 요로결석 발견에 대한 민감도를 측정하였다. 초기 평가 후, 임상 정보를 바탕으로 다시 피질-수질기를 판독하였고 민감도를 측정하였다. 결과 253명 중 150명(59%)이 요로결석이 있었고, 요로결석이 응급실 방문의 원인(의미 있는 요로결석)이었던 사람은 138명(92%)이었고, 요로 폐쇄로 인한 변화를 보인 환자는 124명 (82.7%)이었다. 의미 있는 요로결석에 대해서는 두 판독자의 민감도는 98.6% (136/138)이었다. 요로 폐쇄로 인한 변화가 동반되었을 때의 민감도는 판독자 1은 99.2% (123/124)였고 판독자 2는 100% (124/124)였다. 임상 정보를 바탕으로 다시 판독했을 때 의미 있는 요로결석 발견의 민감도는 판독자 1이 98.6%에서 100%, 판독자 2는 98.6%에서 99.3%로 증가하였다. 결론 CT 요로조영술의 피질-수질기는 급성신산통으로 응급실을 내원한 환자에서 요로결석을 진단하는데 민감하다.

Keywords

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