Üriner sistemde taş şüphesinde Spiral Bilgisayarlı Tomografi ne zaman kullanılmalı?

Year 2013, Volume: 20 Issue: 3, 85 - 92, 30.09.2013

Ömer Yılmaz , Hatice Ermiş Olcay Ciner Uğur Koşar

Abstract

Amaç: Çalışmanın amacı ön tanısı üriner sistemin taş hastalığı olan hastalarda ultrasonografi (US) duyarlılığını kontrastsız spiral Bilgisayarlı tomografi (BT) ile karşılaştırmaktır.
Gereç Yöntem: Çalışmaya 116 hasta dahil edildi. Hastalara spiral BT tetkinden önce tetkiki inceleyecek radyolog dışında başka bir radyolog tarafından üriner sistem US yapıldı. Spiral BT incelemeleri, Hitachi Pronto SE cihazında, kontrast madde verilmeden gerçekleştirildi. BT bulguları temel alınarak US sonuçlarının böbrekler, üreterler ve tüm üriner sistem taşları için duyarlılık, özgüllük, pozitif ve negatif öngörü değerleri hesaplandı.
Bulgular: Çalışmamıza dahil edilen 116 hastadan 78'inde BT ve US' da taş tesbit edildi. 78 hastanın 48'inde BT ile saptanabilen böbrek taşı ve 34'ünde üreter taşı mevcuttu. US ile 6 hastada böbrek taşını, 14 hastada üreter taşını tesbit edemedik. US'un böbrek taşı tanısında %87,5 duyarlılık, %95 özgüllük, %95 pozitif öngörü ve %87,5 negatif öngörü; üreter taşı tesbitinde %58 duyarlılık, %98 özgüllük, %94 pozitif tahmin ve %84 negatif öngörü değerine sahip olduğu bulundu.
Sonuç: Üriner sistemin taş hastalıklarında US'un böbrek taşını saptamadaki duyarlılığı oldukça yüksek olup üriner kolik vakaları çoğunlukla direkt grafi/US yardımı ile aydınlatabilmektedir. Ancak kliniği açıklanamayan semptomatik hastalarda; özellikle üreter taşı şüphesinde ve üriner sistem dışı patolojileri saptama açısından ek tetkik ihtiyacı doğmuşsa akla US'nun üreter taşını saptamadaki duyarlılığının düşük olduğu gelmeli ve düşük doz kontrastsız spiral BT ilk tercih edilecek yöntem olmalıdır.
Anahtar kelimeler: Üriner sistem taş hastalığı, Ultrasonografi, Spiral Bilgisayarlı Tomografi



In urinary tract for doubt of Stone, when spiral computer tomography should be used?

The aim: Purpose of study compares the sensitivity of ultrasonography (US) and the helical computed tomography (CT) without contrast for cases who have stone in urinary tract in the first diagnose.
The method: The research includes 116 cases. Before examination of helical CT, except radiologist, another radiologist abstracted the examination and did the urinary tract US. The examinations of helical CT in the equipment of Hitachi Pronto Se were happened without given contrast element. With the basic examinations of CT, the sensibility, the specificity, the first diagnose assets of positive and negative were figured out for US results in kidneys, ureter and urinary tract stones.
Results: In the research 78 out of 116 cases were found stone in CT and US. In 48 out of 78 cases, kidney stone was found with CT and there was urinary stone in 34 cases. With US, we couldn't find out kidney stone in 6 cases and couldn't find out urinary stone in 14 cases. In the diagnosis of US kidney stone, the sensitivity is found %87,5, the specificity is found %95 , the positive prevision is found %95 and the negative prevision is found %87,5; in the determination of urinary stone the sensitivity is found %58 , the specificity is found %98, the positive forecast is %94 and the negative prevision is found %84.
Conclusion: In urinary tract the stone illnesses, the sensitivity of US in the searching of kidney stone is really high and urinary colic cases can brighten with the help of direct graphy/US. But in the symptomatic cases whose their clinic can not be explained, especially in terms of stating in the doubt of urinary stone and except the pathology of urinary tract, if appendix examination is needed, it should be reminded that the sensitivity of urinary stone is low in determination and the low dose contrast helical CT should be preferred firstly.
Keywords: Urinary system stone disease, Ultrasonography, helical Computed Tomography

Keywords

Üriner sistem taþ hastalýðý, Ultrasonografi, Spiral Bilgisayarlý Tomografi

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