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Abdominal Radiography After CT Reveals Urinary Calculi

A Method to Predict Usefulness of Abdominal Radiography on the Basis of Size and CT Attenuation of Calculi

¹ All authors: Department of Radiology, Wake Forest University School of Medicine, Medical Center Blvd., Winston-Salem, NC 27157-1088.

OBJECTIVE. The purpose of this study was to determine if the radiographic visibility of urinary tract calculi could be predicted on the basis of CT features.

MATERIALS AND METHODS. The images of 26 patients whose urinary tract calculi were revealed on unenhanced helical CT and who also underwent digital abdominal radiography were retrospectively reviewed. CT features studied included size and CT attenuation of the calculi. These CT findings were correlated with the ability to detect the same calculi with radiography.

RESULTS. Forty-nine urinary tract calculi were detected with unenhanced helical CT in 26 patients. Twenty-six (53%) calculi were visible on radiography. Most (79%) calculi larger than 5 mm were detectable with radiography (p < 0.01). One (8%) of 13 calculi with CT attenuation below 200 H was detectable on radiographs. Ninety-five percent (21/22) of calculi with CT attenuation exceeding 300 H were visible on radiographs (p < 0.0001). The one remaining calculus was obscured by overlying anatomy.

CONCLUSION. Radiographic surveillance of urinary tract calculi detected with CT may not be useful if the calculi have a CT attenuation below 200 H. Most calculi larger than 5 mm and nearly all calculi with a CT attenuation exceeding 300 H can be seen on abdominal radiographs.

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