Comparison of Diagnostic Accuracy of Colour Doppler Twinkling Artefact with Computed Tomography of the Kidney, Ureters, and Bladder in Detection of Nephrolithiasis in Emergency Setup–Point of Care Ultrasonography

Authors

  • Rabia Tariq Department of Radiology, Combined Military Hospital, Lahore/National University of Medical Sciences (NUMS) Pakistan
  • Syed Farrukh Nadeem Department of Radiology, Combined Military Hospital, Lahore/National University of Medical Sciences (NUMS) Pakistan
  • Hasham Bin Tahir Department of Medicine, Combined Military Hospital, Lahore/National University of Medical Sciences (NUMS) Pakistan
  • Ali Zul Hasnain Department of Radiology, Combined Military Hospital, Lahore/National University of Medical Sciences (NUMS) Pakistan
  • Ammara Iftikhar Department of Radiology, Combined Military Hospital, Lahore/National University of Medical Sciences (NUMS) Pakistan
  • Waleed Khan Department of Medicine, Combined Military Hospital, Malir/National University of Medical Sciences (NUMS) Pakistan

DOI:

https://doi.org/10.51253/pafmj.v74i1.10304

Keywords:

Diagnostic imaging tomography, X-Ray computed ultrasonography, Doppler, Color ultrasonography, Artifacts

Abstract

Objective: To Compare the Diagnostic Accuracy of the Colour Doppler twinkling artefact with Computed Tomography of the Kidney, ureters, and bladder in the detection of Nephrolithiasis - Point of Care Ultrasonography.

Study Design: Comparative prospective study.

Place and Duration of Study: Department of Diagnostic Radiology, Combined Military Hospital, Pakistan, from Jan 2023 to
Apr 2023.

Methodology: A total of 370 patients referred from hospital emergency for evaluation of renal colic of the age group 18-65 years were evaluated. Greyscale ultrasound and Colour Doppler TA were performed at the emergency department as a pointof-care ultrasonography. All patients were subsequently referred for Computed Tomography of the Kidney, ureters.

Results: Diagnostic yield of Colours Doppler TA was comparable to CT KUB and slightly greater GSU. The sensitivity,
Specificity, Positive predictive value, Negative predictive value and Accuracy for TA and GSU was 99.33%, 92.01%, 96.92%,
83.64%,92.97% and 89.63%, 88.0%, 95.28%,75.86% 89.19% respectively. The mean time required for GSU / Colour Doppler TA diagnosis was 39.32 ± 9.36 Minutes and 27.87 ± 15.45 hours for CT KUB.

Conclusion: The diagnostic yield of colour Doppler twinkling artefact is comparable to Computed Tomography of the kidney, ureters, and bladder in diagnosing acute renal colic. It is a reliable alternative to GSU and CT-KUB in emergency setups as a point-of-care ultrasonography.

Downloads

Download data is not yet available.

References

Bibi A, Aamir M, Riaz M, Haroon ZH, Kirmani SI, Javaid H.

Assessment of Frequency and Composition of Renal Stones in a

Reference Laboratory of Pakistan. Pak Armed Forces Med J 2023;

(2): 341-344. https://doi.org/10.51253/pafmj.v73i2.6798.

Chen Z, Prosperi M, Bird VY. Prevalence of kidney stones in the

USA: the National Health and Nutrition Evaluation Survey. J

Clin Urol 2019; 12(4): 296-302.

https://doi.org/10.1177/2051415818813820.

Bashir A, Zuberi SK, Musharraf B, Khan H, Ather MH,

Musharraf MB, et al. Perception of dietary influences on renal

stone formation among the general population. Cureus 2022;

(6). https://doi.org/ 10.7759/cureus.26024.

Roberson D, Sperling C, Shah A, Ziemba J. Economic

considerations in the management of nephrolithiasis. Curr Urol

Rep 2020; 21: 1-9. https://doi.org/10.1007/s11934-020-00971-6.

Ang AJ, Sharma AA, Sharma A. Nephrolithiasis: approach to

diagnosis and management. Indian J Pediatr 2020; 87(9): 716-725.

https://doi.org/10.1007/s12098-020-03424-7.

Mehra S. Role of dual-energy computed tomography in

urolithiasis. Journal of Gastrointestinal and Abdominal

Radiology 2022; 5(02): 121-126.

https://doi.org/10.1055/s-0042-1749108.

Gupta A, Li S, Ji G, Xiong H, Peng J, Huang J, et al. The Role of

Imaging in Diagnosis of Urolithiasis and Nephrolithiasis—A

Literature Review Article. Yangtze Med 2019; 3(4): 301-12.

https://doi.org/10.4236/ym.2019.34029.

Alao D. Non-contrast CT KUB still has a central role in the

management of patients suspected of nephrolithiasis. Emerg

Med J 2021; 38(2): 164.

https://doi.org/10.1136/emermed-2020-210697.

Ali A, Akram F, Hussain S, Janan Z, Gillani SY. Non-contrast

enhanced multi-slice ct-kub in renal colic: Spectrum of

abnormalities detected on ct kub and assessment of referral

patterns. J Ayub Med Coll Abbottabad 2019; 31(3): 415-417.

Brisbane W, Bailey MR, Sorensen MD. An overview of kidney

stone imaging techniques. Nat Rev Urol 2016; 13(11): 654-662.

https://doi.org/10.1038/nrurol.2016.154.

Javed M. Diagnostic accuracy of trans-abdominal

ultrasonography in urolithiasis, keeping CT KUB as gold

standard. J Islamabad Med Dent Coll 2018; 7(3): 204-207.

Teichman JM. Acute renal colic from ureteral calculus. N Engl J

Med 2004; 350(7): 684-693.

https://doi.org/10.1056/NEJMcp030813.

Hanafi MQ, Fakhrizadeh A, Jaafaezadeh E. An investigation into

the clinical accuracy of twinkling artifacts in patients with

urolithiasis smaller than 5 mm in comparison with computed

tomography scanning. J Family Med Prim Care 2019; 8(2): 401.

https://doi.org/10.4103/jfmpc.jfmpc_300_18.

Liu N, Zhang Y, Shan K, Yang R, Zhang X. Sonographic

twinkling artifact for diagnosis of acute ureteral calculus. J Urol

; 38: 489-95. https://doi.org/10.1007/s00345-019-02773-z.

Hamm M, Knöpfle E, Wartenberg S, Wawroschek F,

Weckermann D, Harzmann R, et al. Low dose unenhanced

helical computerized tomography for the evaluation of acute

flank pain. J Urol 2002; 167(4): 1687-1691.

https://doi.org/10.1016/S0022-5347(05)65178-6.

Kim BS, Hwang IK, Choi YW, Namkung S, Kim HC, Hwang

WC, et al. Low-dose and standard-dose unenhanced helical

computed tomography for the assessment of acute renal colic:

prospective comparative study. Acta Radiologica 2005; 46(7):

-763. https://doi.org/10.1080/02841850500216004.

Poletti PA, Platon A, Rutschmann OT, Schmidlin FR, Iselin CE,

Becker CD, et al. Low-dose versus standard-dose CT protocol in

patients with clinically suspected renal colic. AJR Am Roentgen

; 188(4): 927-933.

Sen V, Imamoglu C, Kucukturkmen I, Degirmenci T, Bozkurt IH,

Yonguc T, et al. Can doppler ultrasonography twinkling artifact

be used as an alternative imaging modality to non-contrastenhanced computed tomography in patients with ureteral

stones? A prospective clinical study. Urolithiasis 2017; 45(2): 215-

https://doi.org/10.1007/s00240-016-0891-8.

Abdel-Gawad M, Kadasne RD, Elsobky E, Ali-El-Dein B, Monga

M. A Prospective comparative study of color doppler ultrasound

with twinkling and noncontrast computerized tomography for

the evaluation of acute renal colic. J Urol 2016; 196(3): 757-762.

https://doi.org/10.1016/j.juro.2016.03.175.

Mitterberger M, Aigner F, Pallwein L, Pinggera GM, Neururer R,

Rehder P, et al. Sonographic detection of renal and ureteral

stones: value of the twinkling sign. International Braz J Urol

; 35: 532-535.

https://doi.org/10.1590/S1677-55382009000500004.

Abid A, Butt RW, Abbas HB, Niazi M, Alam S, Shakil H.

Diagnostic accuracy of colour doppler ultrasound using

twinkling artefact for the diagnosis of renal and ureteric calculi

keeping non enhanced CT KUB as gold standard. Pak Armed

Forces Med J 2021; 71(2): 522-525

Downloads

Published

28-02-2024

Issue

Section

Original Articles

How to Cite

1.
Tariq R, Nadeem SF, Tahir HB, Hasnain AZ, Iftikhar A, Khan W. Comparison of Diagnostic Accuracy of Colour Doppler Twinkling Artefact with Computed Tomography of the Kidney, Ureters, and Bladder in Detection of Nephrolithiasis in Emergency Setup–Point of Care Ultrasonography. Pak Armed Forces Med J [Internet]. 2024 Feb. 28 [cited 2024 Nov. 22];74(1):104-7. Available from: https://pafmj.org/PAFMJ/article/view/10304