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Patients with Acute Flank Pain: Comparison of MR Urography with Unenhanced Helical CT¹

¹ From the Departments of Clinical Radiology (M.S., R.L.V., K.P., S.K., A.M.) and Urology (A.H., M.A.O.), Kuopio University Hospital, Finland. Received January 17, 2001; revision requested March 6; final revision received October 9; accepted October 26. Supported by Kuopio University Hospital (EVO funding no. 5063508), the Radiological Society of Finland, and the Pehr Oscar Klingendahl Fund. Address correspondence to M.S., North-Karelian Central Hospital, Department of Radiology, Tikkamäentie 16, 80210 Joensuu, Finland (e-mail: mazen.sudah@pkshp.fi).

PURPOSE: To compare unenhanced helical computed tomography (CT) and magnetic resonance (MR) urography, by using T2-weighted and contrast material–enhanced T1-weighted imaging to examine patients with acute flank pain, with reference to excretory urography and final clinical diagnosis.

MATERIALS AND METHODS: Forty-nine patients underwent CT, MR urography (with T2-weighted and gadopentetate dimeglumine–enhanced T1-weighted sequences), and excretory urography. CT and MR urographic findings were evaluated separately and independently by two radiologists each (CT, observers A and B; MR urography, observers C and D) for the presence, cause, level, and degree of obstruction. The final conclusive diagnosis was based on the combination of excretory urographic, clinical, and interventional results.

RESULTS: At final diagnosis, 32 (65%) patients were found to have ureteral stones causing unilateral obstruction. In ureteral stone detection, the sensitivity and specificity of CT were 90.6% (29 of 32 patients) and 100.0% (17 of 17 patients), respectively (observer A) and 90.6% (29 of 32 patients) and 94.1% (16 of 17 patients), respectively (observer B), while those of MR urography were 93.8% (30 of 32 patients) and 100.0% (17 of 17 patients), respectively (observer C) and 100.0% (32 of 32 patients) and 100.0% (17 of 17 patients), respectively (observer D). Spearman correlation coefficients for stone size at CT were 0.76 (P < .001) and 0.75 (P < .001) and at MR urography, 0.49 (P = .005) and 0.51 (P = .004).

CONCLUSION: In routine clinical practice, CT is the modality of choice in the evaluation of patients with acute flank pain. MR urography is an accurate and suitable alternative imaging technique in selected patients.

© RSNA, 2002

Index terms: Computed tomography (CT), comparative studies • Computed tomography (CT), helical, 81.12115, 82.12115 • Genitourinary system, MR, 80.121411, 80.121412, 121413, 80.121415, 80.12149 • Magnetic resonance (MR), comparative studies • Ureter, calculi, 82.811 • Ureter, stenosis or obstruction, 82.811 • Urography, 80.1221

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