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DOI: 10.1055/s-2003-40426
Native Spiral-CT bei Urolithiasis: Indikation, Durchführung und Interpretation
Unenhanced Spiral CT in Urolithiasis: Indication, Performance and InterpretationPublication History
Publication Date:
08 July 2003 (online)
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Zusammenfassung
Die Computertomographie (CT) ohne Kontrastmittelgabe findet heute bei Patienten mit akutem Flankenschmerz zunehmend Verwendung zur Abklärung eines Konkrementes im harnableitenden System. Bezüglich ihrer Erkennungsrate von Konkrementen übertrifft die Nativ-CT andere Untersuchungsmethoden wie die konventionelle Röntgenaufnahme, den Ultraschall oder die intravenöse Urographie und ist auch in der Niedrigdosistechnik durchführbar. Nahezu sämtliche Konkremente, einschließlich jener aus Harnsäure, Xanthin und Cystin, können computertomographisch nachgewiesen werden. Neben einer Bestimmung der Konkrementgröße und -lokalisation kann mit der Nativ-CT zusätzlich eine Aussage über die Steinbeschaffenheit getroffen werden. Ferner sind auch sekundäre Zeichen einer Obstruktion wie eine Dilatation des Nierenbeckenkelchsystems oder perirenale Veränderungen nachweisbar. Wenn kein Konkrement nachweisbar ist, lassen sich mittels der Nativ-CT häufig auch andere Ursachen akuter Flankenschmerzen nachweisen oder ausschließen, wodurch eine zusätzlich Bildgebung und das weitere therapeutische Management in die richtige Richtung gelenkt werden.
Abstract
Unenhanced spiral computed tomography is now applied in the investigation of patients with acute flank pain to search for suspected urinary tract calculi. Spiral CT can depict urinary calculi more accurately than plain radiographs, sonography or excretory urography, and can be performed using a low dose protocol. Almost all urinary calculi, including calculi composed of uric acid, xanthine and cystine, can be detected. In addition to determining size and location of the stone, unenhanced helical CT can predict its composition. Furthermore, it reveals secondary signs of obstruction, such as dilatation of the renal collecting system and perinephric stranding. In the absence of urolithiasis, CT can frequently detect or exclude other causes of acute flank pain, thus guiding subsequent imaging and the therapeutic management.
Key words
Unenhanced helical CT - urolithiasis - kidney - urinary tract
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Dr. med. Harriet Thoeny
Institut für Diagnostische Radiologie Universitätsspital Bern
Freiburgstrasse 10
3010 Bern, Schweiz
Phone: 0041 31 632-2939
Fax: 0041 31 332-4873
Email: harriet.thoeny@insel.ch