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US for Detecting Renal Calculi with Nonenhanced CT as a Reference Standard¹

¹ From the Department of Radiology, University of New Mexico School of Medicine, University of New Mexico Health Sciences Center, 2211 Lomas Blvd, Albuquerque, NM 87131. Received February 14, 2001; revision requested March 20; revision received May 11; accepted July 5. Address correspondence to K.A.B.F. (e-mail: keirfowler@home.com).

PURPOSE: To determine the sensitivity and specificity of ultrasonography (US) for detecting parenchymal and renal pelvis calculi and to establish the accuracy of US for determining the size and number of calculi.

MATERIALS AND METHODS: A total of 123 US and computed tomographic (CT) examinations were compared retrospectively for the presence of renal calculi. The sensitivity of US was determined for individual calculi and at least one calculus per examination. Retrospective findings were compared with the original US interpretation. The sizes of calculi in longest axis were compared on US and CT images, and the US detection of calculi in the left and right kidneys was compared. The use of US for detecting the full extent of calculus burden was evaluated in patients with multiple calculi.

RESULTS: US depicted 24 of 101 calculi identified at CT, yielding a sensitivity of 24% and a specificity of 90%. There was no substantial difference for the detection of calculi in the right and left kidneys. The sensitivity of US for any calculi in a patient was 44%, equal to that of the original US interpretation. US enabled identification of 39% of patients with multiple calculi and demonstrated all calculi in 17% of these patients. The mean size of calculi detected with US was 7.1 mm ± 1.2 (95% CI); 73% of calculi not visualized at US were less than 3.0 mm in size. Calculus size based on US and CT measurements was concordant in 79% of cases and differed by a mean of 1.5 mm ± 0.7.

CONCLUSION: US is of limited value for detecting renal calculi.

Index terms: Kidney, calculi, 811.811, 813.811 • Kidney, CT, 81.12111, 81.12115 • Kidney, US, 81.1298

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