低剂量非增强螺旋CT、超声和KUB平片检查在肾绞痛诊断中的前瞻性比较

目的探讨低剂量非增强螺旋CT在急诊肾绞痛中的诊断价值。方法对123例急性腰腹部绞痛而怀疑泌尿系结石患者，根据体质量指数行低剂量非增强螺旋CT检查，并同时行泌尿系超声和KUB平片检查作对照。结果103例确诊为泌尿系结石，其中25例自行排出，45例体外碎石后排出，33例行输尿管镜碎石。低剂量非增强螺旋CT诊断泌尿系结石100例；超声诊断泌尿系结石77例；KUB诊断泌尿系结石68例，5例假阳性。低剂量非增强螺旋CT、超声和KUB的敏感度分别为1Do％、74．8％、66．1％，特异度分别为100％、100％、75％，阳性预测值分别为100％、100％、93．1％，阴性预测值分别为86．9％、43．5％、30．0％，约登指数分别为0．97、0．75、0．41。CT与超声组对比X^2＝21．23，P＝0．000，两种方法差别具有显著性。CT与KUB组对比X^2＝33．04，P＝0．000，两种方法差别具有显著性。结论低剂量非增强螺旋CT诊断泌尿系结石比超声和KUB具有更高的敏感度和特异度，且降低了患者的辐射剂量，可作为临床怀疑泌尿系结石、尤其是急性肾绞痛患者的常规检查方法。

Prospective comparison of low-dose nonenhanced helical computerized tomography,doppler ultrasonography and KUB flat for the diagnosis of renal colic

Objective To compare the value of low-dose noncontrast helical CT （NCHCT）, US and KUB in detecting u- rinary calculi. Methods A total of 123 patients with acute renal colic were evaluated with low-dose NCHCT, US and KUB for detection of urinary calculi. Results 103 patients were proved as urolithiasis, low-dose NCHCT revealed 100 calculi, US demonstrated 77 calculi, KUB demonstrated 68 calculi, and 5 were false positive. Sensitivity of low-dose NCHCT, US and KUB was 100%, 74.8%, 66. 1%, respectively, specificity of low-dose NCHCT, US and KUB was 100%, 100%, 750%, respectively. Positive predictive value was 100%, 100%, 93.1 % and negative predictive value was 86.90%, 43.5%, 30.0%, respectively. Youden index was 0.97, 0.75, 0.41, respectively. Differences in accuracy of low- dose NCHCT and US were statistically significant （X2 = 21.23, P =0. 000）, so were NCHCT and KUB （x2 = 33.04, P = 0. 000）. Conclusion Low-dose NCHCT is more accurate than US and KUB in detecting urinary calculi and the radiation dose is significantly decreased. Low-dose NCHCT is the imaging method of choice in the assessment of patients with acute renal colic.