Value of non-contrast CT examination of the urinary tract (stone protocol) in the detection of incidental findings and its impact upon the management

Abstract

Background: Urolithiasis is one of the most common urinary tract diseases  worldwide, with a wide range of affected age groups. Non-contrast CT examination of the urinary tract is the gold-standard examination for detection and characterization of urinary tract stones, with great impact upon the choice of method of management. Aside from detection of stones, non-contrast CT examination of the abdomen and pelvis also offers a valuable overlook upon the other abdominal organs, pathologies of which may simulate a stone disease, or accompany stone disease and can be detected incidentally, which may shift management plan dramatically.

Aim of work: To demonstrate the use of non-contrast CT examinations (stone  protocol) in the detection of abdominal pathologies other than stones, whether or not simulating the clinical picture of urolithiasis, and its impact upon patient management.

Patients and methods: Assessment of the non-contrast examinations of the urinary tract of patients referred for suspected stone urolithiasis recording any incidental finding and follow-up of the impact of these incidental findings upon the management delivered to the patient.

Results: A total of 719 examinations were performed, of which 334 had urinary tract stones only, 211 had incidental finding beside urinary tract stones, 170 had an incidental finding with no urinary tract stones, and four patients had neither stones nor incidental findings. A total number of 381 patients had incidental findings, 198 (47%) of which had an impact upon the management.

Conclusion: Non-contrast CT examination of the urinary tract (stone protocol) is a valuable tool in the detection of incidental findings which may simulate, or coincide with urolithiasis and it has a significant impact upon the management of the patients.

Keywords: Stone protocol; CT; Urolithiasis; Incidental; Urinary tract stones