Christy Yoshida Gultom

03015049
• Urolithiasis is a common disease, estimated to affect 11% of
men and 7% of women in their lifetime
• Ureterolithiasis causes severe unilateral colicky flank pain
• The goals of imaging of urinary calculi are to determine the
presence of stones within the urinary tract, evaluate for
complications, estimate the likelihood of stone passage, confirm
stone passage, assess the stone burden, and evaluate disease
activity
• Intravenous urography (IVU) (excretory urography) provides
important physiologic information regarding the degree of
obstruction.
• IVU is less sensitive than CT, especially for small or
nonobstructing stones.
The ACR guidelines for evaluation of acute onset flank pain with
suspicion of urolithiasis include the following :

• Noncontrast computed tomography (NCCT) is the most accurate

technique for evaluating flank pain.
• Low-dose NCCT should be performed when evaluating for renal or
ureteral stones.
• If there is uncertainty about whether a calcific density represents a
ureteral stone or a phlebolith, intravenous contrast material can be
administered and excretory-phase images obtained for definitive
diagnosis.
• In pregnant patients with flank pain, ultrasonography is the best
initial study.
• Abdominal radiography combined with ultrasonography may be able
to diagnose most clinically significant stones and should be
considered, especially in young patients and those with known stone
disease.
• MRI could be considered to evaluate for hydronephrosis, although it is
less accurate for the direct visualization of renal and ureteral stones.
• often performed as a preliminary examination in patients with
abdominal pain possibly resulting from urinary calculi.
• Stones are often found at key points of narrowing such as the
ureteropelvic junction (UPJ), the ureterovesical junction (UVJ),
and the point at which the ureter crosses the iliac vessels.
Abdominal radiograph
shows calcification
filling the left collecting
system. This finding is
consistent with a
staghorn calculus. For its
size, the stone is
relatively lucent.
• is useful for confirming the exact location of a stone within the
urinary tract
• IVU depicts anatomic abnormalities such as dilated calyces,
calyceal diverticula, duplication, UPJ obstruction, retrocaval
ureter, and others that may predispose patients to stone
formation or alter therapy
• When a stone causes acute obstruction, an obstructive
nephrogram may be present. This may be prolonged and
hyperopaque, with increasing opacity over time.
• Other signs include delayed excretion, dilatation to the point of
obstruction, or blunting of the calyceal fornices. Immediately
after the passage of a stone, residual mild obstruction or
edema can be detected at the UVJ
Magnified scout
intravenous urogram
shows a large,
relatively lucent calculus
in the lower pole of the
right kidney
Intravenous urogram.
After the intravenous
injection, contrast
material in the
collecting system
obscures the calculus.
Scout intravenous
urogram shows a
smooth stone in the right
kidney.
Intravenous urogram
obtained 5 minutes
after the intravenous
injection. Contrast
material in the
collecting system
obscures the stone.
Scout intravenous
urogram shows a
smooth, dense, round
calculus in the left
kidney.
• CT is the most sensitive radiologic examination for the detection,
localization, and characterization of urinary calcifications.
• CT may depict the following :
1. Stones in the ureter
2. Enlarged kidneys
3. Hydronephrosis (83% sensitive, 94% specific)
4. Perinephric fluid (82% sensitive, 93% specific)
5. Ureteral dilatation (90% sensitive, 93% specific)
6. Soft-tissue rim sign
Axial nonenhanced CT
image at the level of
the kidneys shows
bilateral renal calculi,
right hydronephrosis,
and moderate
perinephric fluid.
Axial nonenhanced CT
image of the urinary
bladder demonstrates
an attenuating calculus
at the right
ureteropelvic junction.
• patients who undergo nonenhanced CT for possible urinary
stones receive intravenous contrast material for further
evaluation.
Contrast-enhanced CT
section reveals a dense
calculus in the right
kidney, but the
hydronephrosis has
resolved.
Axial contrast-enhanced
CT scan. The excretory
phase image through the
kidneys shows
extravasation of contrast
material in and near the
renal pelvis and
surrounding the proximal
ureter, which is opacified.
The finding is consistent
with fornix rupture.
• Stones are demonstrated as bright echogenic foci with posterior
acoustic shadowing.
• Stones are visualized fairly well with US in the kidneys and the
distal ureter at or near the UVJ, especially if dilatation is
present. US is good for the visualization of complications such as
hydronephrosis (or other signs of obstruction)
Renal sonogram
demonstrates an
echogenic shadowing
calculus in the renal
collecting system with
hydronephrosis.
Renal longitudinal
sonogram in a patient
with nephrocalcinosis
shows diffuse echogenic
shadowing calcifications
in the renal pyramids.