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Assessment of the Clinical Utility of the Rim and Comet-Tail Signs in Differentiating Ureteral Stones from Phleboliths

Amy Rochester Guest1, Richard H. Cohan1, Melvyn Korobkin1, Joel F. Platt1, Claudia C. Bundschu1, Isaac R. Francis1, Achamyeleh Gebramarium2 and Uwada M. Murray1

1 Department of Radiology, University of Michigan Hospital, Rm. B1D502G, University of Michigan Hospital, Ann Arbor, MI 48109-0030.
2 Department of Internal Medicine, University of Michigan Hospital, Ann Arbor, MI 48109-0030.



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  		Fig. 1. —CT scan of 48-year-old man shows distal left ureteral calculus surrounded by soft-tissue rim. Rim sign around ureteral calculus was noted to be "probably" or "definitely" present by all three reviewers.

 


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  		Fig. 2. —CT scan of 56-year-old man shows tail of soft-tissue attenuation (arrow) extending anterior to phlebolith in left hemipelvis. Comet-tail sign adjacent to ureteral calcification was noted to be "probably" or "definitely" present by all three reviewers.

 


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  		Fig. 3. —Interobserver variability in detection of rim sign. CT scan of 41-year-old man shows small amount of soft tissue surrounding more anterior of two pelvic calcifications (arrow). Radiologist one recorded rim sign as being "probably present," radiologist two as being "definitely absent," and resident as being "indeterminate" ("can't tell").

 


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  		Fig. 4. —Interobserver variability in detection of comet-tail sign. CT scan of 46-year-old woman shows small area of soft-tissue attenuation (arrow) immediately posterior to calcification in right hemipelvis. One senior radiologist described this as "probably showing" comet-tail sign and second senior radiologist as "probably not showing" comet-tail sign. Resident noted that comet-tail sign was "definitely absent."

 


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  		Fig. 5. —CT scan shows soft-tissue attenuation tail (arrow) extending toward distal left ureteral calculus in 68-year-old man that actually represents dilated distal left ureter. Comet-tail sign adjacent to ureteral calculus was described by all three reviewers.

 

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