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Unenhanced MDCT in Patients with Suspected Urinary Stone Disease: Do Coronal Reformations Improve Diagnostic Performance?

¹ Department of Radiology, Medical University of Vienna, General Hospital of Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria.
² Department of Radiology, University of Amsterdam, Amsterdam, The Netherlands.
³ Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands.
⁴ Department of Urology, Medical University of Vienna, Vienna, Austria.

OBJECTIVE. The objectives of our study were to assess whether coronal reformations improve the diagnostic performance of MDCT in patients with acute flank pain and suspected urinary stone disease; and to determine if performing such reformations from 3-mm-thick sections is sufficient or if it is necessary to perform reformations from thinner sections.

MATERIALS AND METHODS. We included 147 consecutive patients (72 women and 75 men; mean age ± SD, 58 ± 18.1 years) with suspected urinary stone disease who underwent unenhanced MDCT. Scans were obtained with a 4 x 1 mm collimation and were reconstructed with a section thickness of 1.25 and 3 mm. We compared the diagnostic yield of 3-mm axial sections with that of coronal reformations reconstructed from 1.25- and 3-mm axial sections. Imaging data were evaluated in random order by two radiologists. The significance of the difference between the axial sections and coronal multiplanar reformations (MPRs) was tested for the number, size, and location of uroliths and for the presence of alternative diagnoses. The time required for review by both observers was recorded.

RESULTS. We found uroliths in 72 patients. There was no difference between 3-mm axial sections and coronal reformations from 1.25-mm sections with regard to the number of detected stones (n = 264 for both protocols), whereas coronal reformations from 3-mm sections revealed significantly fewer calcifications (n = 255, p = 0.016). Coronal reformations did not improve the localization of calcifications. Review time, however, was significantly shorter for coronal reformations than for axial sections (p = 0.001); however, coronal reformations were less sensitive than axial sections for the detection of additional findings suggestive of alternative diagnoses in 16 (30%) of 53 patients.

CONCLUSION. Coronal reformations from MDCT do not improve urinary stone detection but may reduce evaluation time; however, there is the danger of missing additional findings. Coronal reformations reconstructed from thick (i.e., 3-5 mm) axial sections may result in reduced detection of small stones and should therefore be avoided.

Keywords: emergency radiology • kidney disease • MDCT technique • multiplanar reformations • renal stones • urinary stone disease • urinary system

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