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Is hydronephrosis on ultrasound predictive of ureterolithiasis in patients with renal colic?
Troy Larson, BS1, Natalia Hernandez, MD2, Brian Eisner, MD2, Juliet Han, BS3, Vernon M. Pais, Jr., MD3, Kevan M. Sternberg, MD1.
1University of Vermont Medical Center, Burlington, VT, USA, 2Massachusetts General Hospital, Boston, MA, USA, 3Dartmouth–Hitchcock Medical Center, Lebanon, NH, USA.

Background
Renal ultrasound (US) is commonly used for the evaluation of acute renal colic. While US accurately identifies the presence of hydronephrosis, it is less sensitive than computerized tomography (CT) for the detection of ureterolithiasis. This study investigated whether or not the presence of hydronephrosis on US was associated with a ureteral stone in patients who underwent both US and CT during the evaluation of acute renal colic.
Methods
A retrospective chart review of 3 institutions was conducted of patients who were evaluated for renal colic with both renal US and CT in either the emergency department or outpatient setting between 2012 and 2015. Patients were included if US and CT were performed on the same day. The presence of ureterolithiasis, stone location, and concomitant hydronephrosis were reviewed and compared between imaging modalities.
Results
One hundred and forty-four (144) patients were evaluated with both US and CT on the same day, meeting inclusion criteria. Ureteral stones were present in 85 patients. US identified hydronephrosis in 89.8% of patients with reported hydronephrosis and identified a ureteral stone in 25.9% of all cases with a reported ureteral stone. CT identified hydronephrosis in 91.8% of patients with reported hydronephrosis and a ureteral stone in 98.8% of all cases with a reported ureteral stone. In 18 patients (12.5%), US and CT differed on the presence or absence of hydronephrosis. In 108 of the 144 (75.0%) patients, the presence or absence of hydronephrosis on US correctly predicted the presence or absence of a ureteral stone on CT (Table 1). Overall, hydronephrosis on ultrasound had a positive predictive value (PPV) of 0.77 for the presence of a ureteral stone and a negative predictive value (NPV) of 0.71 for the absence of a ureteral stone.
Hydronephrosis Present- CTHydronephrosis
Absent-CT
Ureteral Stone
Present-CT
Ureteral Stone
Absent-CT
Hydronephrosis
Present- US
N= 88/144
(61.1%)
80/144
(55.6%)
8/144
(5.6%)
68/144
(47.2%)
20/144
(13.9%)
Hydronephrosis
Absent- US
N= 56/144
(38.9%)
10/144
(6.9%)
46/144
(31.9%)
16/144
(11.1%)
40/144
(27.8%)

Conclusions
Hydronephrosis on ultrasound did not accurately predict the presence or absence of a ureteral stone on computed tomography in 25% of patients in this study. Ultrasound is an important tool in the evaluation of hydronephrosis associated with acute renal colic but patients may benefit from other studies to confirm the presence or absence of ureteral stones.


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