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Low-Dose Versus Standard-Dose CT Protocol in Patients with Clinically Suspected Renal Colic

¹ Department of Radiology, University Hospital Geneva, 24 rue Micheli-du-Crest-14, Geneva 1211, Switzerland.
² Department of Internal Medicine, University Hospital Geneva, Geneva, Switzerland.
³ Urology Clinic, University Hospital Geneva, Geneva, Switzerland.

View larger version (149K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1A —42-year-old man with right flank pain. Upper abdomen axial low-dose CT image (120 kV, 30 mAs, pitch of 1.25, 5-mm collimation) (A) shows dilatation of pyelocaliceal system (asterisk) in enlarged right kidney and stranding of perirenal fat (arrow). Same findings are shown on standard-dose CT image (120 kV, 180 mAs, pitch of 1, 5-mm collimation) (B).

View larger version (134K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1B —42-year-old man with right flank pain. Upper abdomen axial low-dose CT image (120 kV, 30 mAs, pitch of 1.25, 5-mm collimation) (A) shows dilatation of pyelocaliceal system (asterisk) in enlarged right kidney and stranding of perirenal fat (arrow). Same findings are shown on standard-dose CT image (120 kV, 180 mAs, pitch of 1, 5-mm collimation) (B).

View larger version (118K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1C —42-year-old man with right flank pain. Low-dose CT scan shows calculus of 2 mm in distal aspect of right ureter (arrow) and surrounded by halo of soft-tissue attenuation (rim sign).

View larger version (108K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1D —42-year-old man with right flank pain. Size of calculus (arrow) is underestimated by < 1 mm when compared with conventional CT.

View larger version (142K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2A —Low-dose CT that was false-negative for ureteral stone in 43-year-old overweight patient (body mass index, 30) with intense left flank pain and hematuria. Axial low-dose CT image (120 kV, 30 mAs, pitch of 1.25, 5-mm collimation) (A) of upper abdomen shows enlargement of left kidney, dilatation of left pyelocaliceal system (asterisk), stranding of perirenal fat (arrowheads), and 6-mm calculus in pyramid (black arrow). Note also 10-mm renal stone in central aspect of right kidney (white arrow). Same findings are shown on standard-dose CT image (120 kV, 180 mAs, pitch of 1, 5-mm collimation) (B).

View larger version (122K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2B —Low-dose CT that was false-negative for ureteral stone in 43-year-old overweight patient (body mass index, 30) with intense left flank pain and hematuria. Axial low-dose CT image (120 kV, 30 mAs, pitch of 1.25, 5-mm collimation) (A) of upper abdomen shows enlargement of left kidney, dilatation of left pyelocaliceal system (asterisk), stranding of perirenal fat (arrowheads), and 6-mm calculus in pyramid (black arrow). Note also 10-mm renal stone in central aspect of right kidney (white arrow). Same findings are shown on standard-dose CT image (120 kV, 180 mAs, pitch of 1, 5-mm collimation) (B).

View larger version (172K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2C —Low-dose CT that was false-negative for ureteral stone in 43-year-old overweight patient (body mass index, 30) with intense left flank pain and hematuria. Axial low-dose CT image at pelvic level shows that multiple streak artifacts reduce quality of interpretation. No ureteral calculus has been reported at low-dose CT analysis.

View larger version (148K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2D —Low-dose CT that was false-negative for ureteral stone in 43-year-old overweight patient (body mass index, 30) with intense left flank pain and hematuria. Standard-dose CT image at same level as C shows 4.5-mm calculus (arrow) at left ureterovesical junction.

View larger version (147K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3A —41-year-old woman with suspected complicated renal colic (intense left flank pain and fever). Axial low-dose CT image (120 kV, 30 mAs, pitch of 1.25, 5-mm collimation) (A) shows wall irregularities of horizontal sigmoid colon (arrowheads) and infiltration of perisigmoid fatty tissue (asterisk), suggesting diverticulitis. Axial standard-dose CT image (120 kV, 180 mAs, pitch of 1, 5-mm collimation) (B) shows same findings as low-dose CT.

View larger version (127K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3B —41-year-old woman with suspected complicated renal colic (intense left flank pain and fever). Axial low-dose CT image (120 kV, 30 mAs, pitch of 1.25, 5-mm collimation) (A) shows wall irregularities of horizontal sigmoid colon (arrowheads) and infiltration of perisigmoid fatty tissue (asterisk), suggesting diverticulitis. Axial standard-dose CT image (120 kV, 180 mAs, pitch of 1, 5-mm collimation) (B) shows same findings as low-dose CT.

View larger version (137K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3C —41-year-old woman with suspected complicated renal colic (intense left flank pain and fever). Axial contrast-enhanced CT image with rectal opacification confirms diagnosis of sigmoid diverticulitis. Thickening of inflamed sigmoid part (arrowheads) is well shown. Two-centimeter collection with parietal enhancement, consistent with abscess (arrow), was overlooked on both low-dose CT and unenhanced standard-dose CT.

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