Noncontrast CT (NCCT) is the imaging study of choice for initial evaluation of patients with acute onset of flank pain and suspicion of stone disease without known prior stone disease. NCCT can reliably characterize the location and size of an offending ureteral calculus, identify complications, and diagnose alternative etiologies of abdominal pain. Although less sensitive in the detection of stones, ultrasound may have a role in evaluating for signs of obstruction. Radiography potentially has a role, although has been shown to be less sensitive than NCCT. For patients with known disease and recurrent symptoms of urolithiasis, NCCT remains the test of choice for evaluation. In pregnancy, given radiation concerns, ultrasound is recommended as the initial modality of choice with potential role for noncontrast MRI. In scenarios where stone disease suspected and initial NCCT is inconclusive, contrast-enhanced imaging, either with MRI or CT/CT urogram may be appropriate. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where peer reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation.
Journal of the American College of Radiology : JACR. 2023 Nov [Epub]
Expert Panel on Urological Imaging , Rajan T Gupta, Kevin Kalisz, Gaurav Khatri, Melanie P Caserta, Tara M Catanzano, Silvia D Chang, Alberto Diaz De Leon, John L Gore, Refky Nicola, Anand M Prabhakar, Stephen J Savage, Kevin P Shah, Venkateswar R Surabhi, Myles T Taffel, Jonathan H Valente, Don C Yoo, Paul Nikolaidis
Duke University Medical Center, Durham, North Carolina. Electronic address: ., Research Author, Duke University Medical Center, Durham, North Carolina., Panel Chair, University of Texas Southwestern Medical Center, Dallas, Texas., Mayo Clinic, Jacksonville, Florida., Baystate Health, Springfield, Massachusetts., University of British Columbia, Vancouver, British Columbia, Canada., The University of Texas MD Anderson Cancer Center, Houston, Texas., University of Washington, Seattle, Washington; American Urological Association., SUNY Upstate Medical University, Syracuse, New York., Massachusetts General Hospital, Boston, Massachusetts; Committee on Emergency Radiology-GSER., Medical University of South Carolina, Charleston, South Carolina; American Urological Association., Duke University Medical Center, Durham, North Carolina, Primary care physician., New York University Langone Medical Center, New York, New York., Rhode Island Hospital and Hasbro Children's Hospital, Providence, Rhode Island; American College of Emergency Physicians., Rhode Island Hospital/The Warren Alpert Medical School of Brown University, Providence, Rhode Island; Commission on Nuclear Medicine and Molecular Imaging., Specialty Chair, Northwestern University, Chicago, Illinois.