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Asian Journal of Urology, 2023, 10(1): 39-49    doi: 10.1016/j.ajur.2022.03.015
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Diagnostic value ultrasound signs of stones less than or equal to 10 mm and clinico-radiological variants of ureteric colic
Denis V. Krakhotkina*(),Volodymyr A. Chernylovskyib,Kemal Saricac,Arman Tsaturyand,Evangelos Liatsikosdef,Jurijus Makeviciusg,Nikolay Yu Iglovikovh,Dmitry N. Pikhovkini
a Central District Hospital, Outpatient Clinic, Sadovaya Lane 23, Kamenolomni, Rostov Region, Russia
b Private Urological Practice, Dnipro, Ukraine
c Department of Urology, Biruni University Hospital, Instanbul, Turkey
d Department of Urology, University Hospital of Patras, Patras, Greece
e Department of Urology, Medical University of Vienna, Vienna, Austria
f Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
g Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
h Department and Clinic of Urology, S.M. Kirov Military Medical Academy of the Ministry of Defense of the Russian Federation, St. Petersburg, Russia
i Central District Hospital, Department of Surgery, Lenina Avenue 28, Aksay, Rostov Region, Russia
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Abstract: 

Objective: To determine the diagnostic value of ultrasound signs of urinary stones less than or equal to 10 mm and to determine clinico-radiological variants of ureteric colic.

Methods: A total of 455 ultrasound investigations were performed in patients referring to emergency department with urolithiasis and symptoms suspected of ureteric colic between January 2021 and May 2021. In addition to microscopic evaluation of urine sediment to detect different crystals and non-contrast spiral computed tomography to detect stones, B-mode and color Doppler sonography was performed to assess the presence of acoustic shadow (AS) and twinkle artifacts (TA) as possible signs of stone(s) in ureter.

Results: While the sensitivity and specificity of AS and TA were higher than 90% in patients with stones greater than 5 mm; positive prognostic values of these parameters were found to be extremely low for stones with sizes of 1-3 mm with specificity and sensitivity values not exceeding 53%. The sensitivity and specificity of AS and TA in the upper and lower ureters were higher for stones greater than or equal to 5 than for compared to those less than 5 mm. At the same time, the diagnostic values of TA and AS for middle ureter stones were very limited. The most prevalent clinico-radiological variants of ureteric colic were types I, III, and V being observed in 39%, 28% and 21% cases, respectively.

Conclusion: Our results demonstrate that TA and AS parameters seem to have a very low sensitivity and specificity in the diagnosis of urinary stones less than 5 mm. The diagnostic value of TA and AS increase significantly in stones greater than or equal to 5 mm. Therefore, clinicians need to be very careful for overestimating the diagnostic values of TA and AS for stones less than 5 mm and non-contrast spiral computed tomography must be the method of choice for patients presenting to emergency department with ureteric colic.
Key words:  Ureteric colic    Urolithiasis    Ultrasound    Twinkle artifact    Non-contrast computed tomography
收稿日期:  2021-12-13      修回日期:  2022-02-13      接受日期:  2022-03-22      出版日期:  2023-01-20      发布日期:  2023-02-06      整期出版日期:  2023-01-20
引用本文:    
. [J]. Asian Journal of Urology, 2023, 10(1): 39-49.
Denis V. Krakhotkin,Volodymyr A. Chernylovskyi,Kemal Sarica,Arman Tsaturyan,Evangelos Liatsikos,Jurijus Makevicius,Nikolay Yu Iglovikov,Dmitry N. Pikhovkin. Diagnostic value ultrasound signs of stones less than or equal to 10 mm and clinico-radiological variants of ureteric colic. Asian Journal of Urology, 2023, 10(1): 39-49.
链接本文:  
http://www.ajurology.com/CN/10.1016/j.ajur.2022.03.015  或          http://www.ajurology.com/CN/Y2023/V10/I1/39
Characteristic Value
Age, mean±SD, year 32.7±17.9
Body mass index, mean±SD, kg/m2 27.8±3.9
Gender, n (%)
Male 278 (61.1)
Female 177 (38.9)
Comorbidity, n (%) 52 (100)
Type 2 diabetes mellitus 18 (34.6)
Obesitya 15 (28.8)
Osteoporosis 5 (9.6)
Arterial hypertension 7 (13.5)
Dyslipidemia 4 (7.7)
Gout 3 (5.8)
The side of ureteric colic, n (%)
Right 207 (45.5)
Left 245 (53.8)
Bilateral 3 (0.7)
Stone localization, n (%)
Upper ureter 171 (37.6)
Middle ureter 152 (33.4)
Lower ureter 112 (24.6)
Multifocal 20 (4.4)
Stone size, n (%)
1 mm 16 (3.5)
2 mm 21 (4.6)
3 mm 33 (7.3)
4 mm 44 (9.7)
5 mm 60 (13.2)
6 mm 51 (11.2)
7 mm 57 (12.5)
8 mm 52 (11.4)
9 mm 62 (13.6)
10 mm 59 (13.0)
  
Characteristic Stone size (mm)
1 2 3 4 5 6 7 8 9 10
Acoustic shadow
Sensitivity 0.0 (0.0-84.2) 33.3 (0.8-90.6) 52.9 (27.8-77.0) 52.5 (44.9-59.9) 91.7 (87.4-94.9) 95.1 (91.5-97.5) 98.2 (95.5-99.5) 99.1 (96.8-99.9) 100.0 (98.4-100.0) 100.0 (98.4-100.0)
Specificity 49.8 (45.1-54.5) 49.9 (45.2-54.6) 50.1 (45.3-54.9) 51.7 (45.5-57.7) 92.4 (88.1-95.5) 94.3 (90.5-96.6) 97.8 (94.9-99.2) 98.7 (96.2-99.7) 98.7 (96.2-99.7) 100.0 (98.3-10.00)
PPV 0.0 (0.0-0.0) 0.4 (0.1-2.1) 3.9 (2.5-6.1) 5.4 (4.5-6.4) 92.5 (88.6-95.1) 94.3 (90.7-96.6) 97.8 (94.9-99.1) 98.7 (96.1-99.6) 98.7 (96.1-99.6) 99.5 (97.6-99.9)
NPV 99.1 (99.0-99.2) 99.1 (98.1-99.6) 96.5 (94.2-97.8) 95.4 (94.5-96.1) 91.6 (87.7-94.4) 95.2 (91.7-97.2) 98.2 (95.5-99.3) 99.1 (96.6-99.8) 100.0 (98.7-100.0) 100.0 (98.3-100.0)
Accuracy 49.6 (44.9-54.3) 49.8 (45.1-54.5) 50.2 (45.5-54.9) 51.7 (47.0-56.4) 92.0 (89.2-94.4) 94.7 (92.3-96.6) 98.0 (96.2-99.1) 98.9 (97.5-99.6) 99.3 (98.1-99.8) 99.7 (98.8-99.9)
Twinkle artifact
Sensitivity 0.0 (0.0-97.5) 47.1 (22.9-72.2) 52.8 (35.5-69.6) 85.7 (80.0-90.2) 89.4 (84.6-93.1) 93.3 (89.2-96.2) 94.6 (90.8-97.2) 96.4 (93.1-98.5) 98.7 (96.2-99.7) 99.1 (96.9-99.9)
Specificity 49.9 (45.2-54.6) 49.9 (45.1-54.7) 51.1 (46.2-55.9) 77.1 (71.5-82.1) 89.0 (84.2-92.8) 91.8 (87.5-95.0) 92.7(88.6-95.7) 95.6 (92.1-97.9) 98.2 (95.6-99.5) 99.5 (97.6-99.9)
PPV 0.0 (0.0-0.0) 3.5 (2.1-5.7) 8.4 (6.2-11.2) 74.0 (69.3-78.2) 88.9 (84.8-92.1) 91.6 (87.7-94.4) 92.5 (88.7-95.1) 95.6 (92.2-97.6) 98.2 (95.5-99.3) 99.5 (96.9-99.9)
NPV 99.6 (99.5-99.6) 96.0 (93.9-97.4) 92.7 (89.9-94.8) 87.6 (83.3-90.9) 89.4 (85.2-92.5) 93.4 (89.7-95.9) 94.7 (91.2-96.9) 96.5 (93.3-98.2) 98.7 (96.0-99.6) 99.1 (96.6-99.8)
Accuracy 49.8 (45.1-54.5) 49.8 (45.1-54.5) 51.2 (46.5-55.8) 80.8 (76.9-84.3) 89.2 (85.9-91.9) 92.5 (89.7-94.8) 93.6 (90.9-95.7) 96.0 (93.8-97.6) 98.5 (96.6-99.4) 99.3 (98.1-99.8)
  
  
Variable VAS 8-10 Maximum extension of the renal pelvis
OR 95 % CI p-Value OR 95 % CI p-Value
Twinkle artifact in US 1.018 0.966-1.073 0.032 0.024 0.002-0.259 0.021
Acoustic shadow in US 0.916 0.857-0.978 0.010 5.310 1.711-16.48 0.024
Kidney stone
≥5 mm 0.864 0.764-0.976 0.020 0.083 0.059-19.65 0.308
<5 mm 1.084 0.930-1.263 0.307 2.846 0.908-8.922 0.059
Ureter stone
<5 mm 1.065 0.917-1.237 0.409 1.249 0.976-1.600 0.077
≥5 mm 1.157 1.012-1.323 0.036 0.841 0.720-0.983 0.029
Microhematuria 0.973 0.930-1.018 0.237 1.497 1.212-1.850 0.014
Macrohematuria 1.000 0.996-1.004 0.972 0.975 0.952-0.998 0.043
Calcium oxalate dihydrate 0.859 0.754-0.978 0.023 0.913 0.730-1.141 0.041
Triple phosphate (NH4MgPO4) and calcium phosphates 0.949 0.824-1.092 0.463 1.412 0.288-6.932 0.647
Amorphous urates 1.185 1.029-1.365 0.020 0.586 0.341-1.005 0.069
  
Part of ureter Diagnostic value of acoustic shadow Diagnostic value of twinkle artifact
Upper ureter -
Sensitivity
<5 mm: 0%-57.8%;
≥5 mm: 91.7%-99.7%
-
Specificity
<5 mm: 48.9%-53.7%;
≥5 mm: 93.4%-99.8%
-
Positive prognostic value
<5 mm: 0%-5.4%;
≥5 mm: 92.5%-99.8%
-
Negative prognostic value
<5 mm: 98.1%-99.6%;
≥5 mm: 98.7%-99.7%
-
Accuracy
<5 mm: 48.2%-52.9%;
≥5 mm: 92.9%-99.8%		 -
Sensitivity
<5 mm: 0%-86.8%;
≥5 mm: 97.8%-99.9%
-
Specificity
<5 mm: 45.4%-69.9%;
≥5 mm: 96.4%-99.8%
-
Positive prognostic value
<5 mm: 0%-75.4%;
≥5 mm: 97.5%-99.9%
-
Negative prognostic value
<5 mm: 98.7%-99.8%;
≥5 mm: 99.1%-99.9%
-
Accuracy
<5 mm: 46.1%-72.9%;
≥5 mm: 97.9%-99.9%
Middle ureter -
Sensitivity
<5 mm: 0%-37.8%;
≥5 mm: 45.6%-53.2%
-
Specificity
<5 mm: 37.9%-48.7%;
≥5 mm: 41.4%-51.8%
-
Positive prognostic value
<5 mm: 0%-4.8%;
≥5 mm: 43.5%-50.8%
-
Negative prognostic value
<5 mm: 98.7%-99.8%;
≥5 mm: 99.1%-99.9%
-
Accuracy
<5 mm: 0%-39.8%;
≥5 mm: 35.9-49.8%		 -
Sensitivity
<5 mm: 0%-47.8%;
≥5 mm: 48.9%-65.7%
-
Specificity
<5 mm: 48.9%-53.7%;
≥5 mm: 49.4%-59.8%
-
Positive prognostic value
<5 mm: 0%-25.4%;
≥5 mm: 44.6%-62.4%
-
Negative prognostic value
<5 mm: 99.2%-99.9%;
≥5 mm: 98.9%-99.9%
-
Accuracy
<5 mm: 48.2%-60.9%;
≥5 mm: 50.9%-63.5%
Lower ureter -
Sensitivity
<5 mm: 0%-53.8%;
≥5 mm: 95.6-99.9%
-
Specificity
<5 mm: 45.8%-54.5%;
≥5 mm: 94.8%-99.9%
-
Positive prognostic value
<5 mm: 0%-4.6%;
≥5 mm 96.5%-99.9%
-
Negative prognostic value
<5 mm 98.7%-99.8%;
≥5 mm: 99.1%-99.8%
-
Accuracy
<5 mm: 45.3%-50.8%;
≥5 mm: 95.4%-99.9%		 -
Sensitivity
<5 mm: 0%-79.8%;
≥5 mm: 91.7%-99.7%
-
Specificity
<5 mm: 44.9%-63.7%;
≥5 mm: 97.9%-99.9%
-
Positive prognostic value
<5 mm: 0%-5.1%;
≥5 mm: 96.5%-99.9%
-
Negative prognostic value
<5 mm: 99.3%-99.8%;
≥5 mm: 99.3%-99.9%
-
Accuracy
<5 mm: 46.3%-59.8%;
≥5 mm: 96.9%-99.9%
  
  
  
  
  
  
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