Ureterolithiasis: can clinical outcome be predicted with unenhanced helical CT?

Purpose: To evaluate the use of helical computed tomography (CT) without contrast material enhancement for prediction of a favorable outcome in ureterolithiasis.

Materials And Methods: CT studies were reviewed in 69 patients with a single ureteral stone not located at the ureteropelvic junction. CT findings (tissue rim sign, hydronephrosis, perinephric fat stranding, perinephric fluid collections, and thickening of renal fascia) were graded on a scale of 0-3. Stone diameter and renal parenchymal enlargement were also measured.

Results: Twenty-two patients had spontaneous passage, 12 did not respond to conservative treatment, and 35 were lost to follow-up. When the latter 35 patients were excluded, perinephric fat stranding (P = .044) and perinephric fluid collections (P = .021) were graded significantly higher in patients with spontaneous stone passage. Mean stone diameter was significantly larger (P < .001) in patients in whom conservative treatment failed (mean, 7.8 mm) than in patients with spontaneous stone passage (mean, 2.9 mm). The presence of a tissue rim sign and the grade of hydronephrosis, renal fascial thickening, and renal parenchymal enlargement were not significantly different between the two groups.

Conclusion: In addition to stone size, the degree of perinephric fat stranding and the presence of perinephric fluid collections are useful ancillary signs for help in predicting the likelihood of stone passage.