Üriner Sistem Taş Hastalığında Görüntüleme Yöntemleri
Özet
Ürolitiazis, üriner sistemde mineral ve tuzların kristalleşerek taş oluşturması durumudur. Bu hastalıkta doğru tanı, tedavi planlaması ve takip süreçlerinde radyolojik görüntüleme yöntemleri kritik bir rol oynamaktadır. Taşlar mineral içeriklerine göre kalsiyum, struvit, ürik asit ve sistin gibi türlere ayrılır ve X-ışını geçirgenlikleri değişkenlik gösterir. İlk değerlendirmede ucuz ve hızlı olan Direkt Üriner Sistem Grafisi (DÜSG) kullanılsa da sensitivitesinin düşüklüğü ve gaz süperpozisyonu gibi kısıtlamaları vardır. Kontrastsız Çok Dedektörlü Bilgisayarlı Tomografi (BT), yüksek duyarlılık ve özgüllük oranlarıyla (%95-100) akut yan ağrısı şüphesinde ilk basamak altın standart inceleme haline gelmiştir; tüm taş tiplerini, boyutlarını ve komplikasyonları net olarak ortaya koyar. Ancak BT’nin tekrarlayan dozlarda yüksek kümülatif radyasyon maruziyeti riski taşıması, dozu azaltılmış düşük ve ultra düşük doz BT protokollerinin yanı sıra radyasyon içermeyen Ultrasonografi (USG) kullanımını teşvik etmektedir. USG, özellikle radyasyondan kaçınılması gereken hamile ve çocuk hastalarda ilk tercih olup, hidronefroz tespitinde ve takibinde oldukça etkilidir. Ayrıca son teknolojik gelişmelerden olan Dual Enerji BT (DEBT), in-vivo ortamda taş bileşimini ve ürik asit taşlarını yüksek doğrulukla ayırt ederek tedavi algoritmasını doğrudan optimize etmektedir.
Urolithiasis refers to the formation of stones in the urinary system due to the crystallization of minerals and salts, and radiological imaging methods play a critical role in its accurate diagnosis, treatment planning, and follow-up processes. Stones are classified into various types such as calcium, struvit, uric acid, and cystine based on their mineral content, displaying varying degrees of X-ray opacity. Although Kidney-Ureter-Bladder (KUB) radiography is widely used as an inexpensive and rapid initial tool, it is limited by low sensitivity and bowel gas superimposition. Unenhanced Multi-Detector Computed Tomography (MDCT), with its exceptionally high sensitivity and specificity (95-100%), has become the first-line gold standard for investigating acute flank pain, clearly identifying all stone types, sizes, and associated complications. However, the risk of high cumulative radiation exposure from repetitive CT scans encourages the use of radiation-free Ultrasonography (USG) and low- or ultra-low-dose CT protocols. USG remains the primary modality for pregnant and pediatric populations where radiation must be avoided, and it is highly effective in detecting and monitoring hydronephrosis. Additionally, recent technological advances such as Dual-Energy CT (DECT) allow for the in-vivo characterization of stone composition and highly accurate differentiation of uric acid stones, directly optimizing the treatment algorithm.
Referanslar
GENÇTOY G. Tuz ve böbrek yetmezliği. Türkiye Klinikleri J Nephrol-Special Topics. 2017;10(2):73-83.
Smith RC, Levine J, Rosenfeld AT. Helical CT of urinary tract stones: epidemiology, origin, pathophysiology, diagnosis, and management. Radiologic clinics of north America. 1999;37(5):911-52.
Cheng PM, Moin P, Dunn MD, Boswell WD, Duddalwar VA. What the Radiologist Needs to Know About Urolithiasis: Part 1??? Pathogenesis, Types, Assessment, and Variant Anatomy. American Journal of Roentgenology. 2012;198(6):W540-W7.
Van Arsdalen KN. Pathogenesis of renal calculi. Urologic radiology. 1984;6(1):65-73.
Park S, Pearle MS. Pathophysiology and management of calcium stones. Urologic Clinics of North America. 2007;34(3):323-34.
Fishman MC. Medicine: Lippincott Williams & Wilkins; 2004.
Ekeruo WO, Tan YH, Young MD, Dahm P, Maloney ME, Mathias BJ, et al. Metabolic risk factors and the impact of medical therapy on the management of nephrolithiasis in obese patients. The Journal of urology. 2004;172(1):159-63.
Marchiñena PG, Peres NB, Liyo J, Ocantos J, Gonzalez M, Jurado A, et al. CT SCAN as a predictor of composition and fragility of urinary lithiasis treated with extracorporeal shock wave lithotripsy in vitro. Arch Esp Urol. 2009;62(3):215-22.
Kim SC, Burns EK, Lingeman JE, Paterson RF, McAteer JA, Williams JC. Cystine calculi: correlation of CT-visible structure, CT number, and stone morphology with fragmentation by shock wave lithotripsy. Urological research. 2007;35(6):319-24.
Cohen-Solal F, Abdelmoula J, Hoarau M, Jungers P, Lacour B, Daudon M. Urinary lithiasis of medical origin. Therapie. 2001;56(6):743-50.
Blake S, McNicholas M, Raptopoulos V. Nonopaque crystal deposition causing ureteric obstruction in patients with HIV undergoing indinavir therapy. AJR American journal of roentgenology. 1998;171(3):717-20.
Leusmann D. Whewellite, weddellite and company: where do all the strange names originate? BJU international. 2000;86(4):411-3.
Heidenreich A, Desgrandschamps F, Terrier F. Modern approach of diagnosis and management of acute flank pain: review of all imaging modalities. European urology. 2002;41(4):351-62.
McCarthy CJ, Baliyan V, Kordbacheh H, Sajjad Z, Sahani D, Kambadakone A. Radiology of renal stone disease. International Journal of Surgery. 2016;36:638-46.
Pfister S, Deckart A, Laschke S, Dellas S, Otto U, Buitrago C, et al. Unenhanced helical computed tomography vs intravenous urography in patients with acute flank pain: accuracy and economic impact in a randomized prospective trial. European radiology. 2003;13(11):2513-20.
Herek D. Üreter taşlı hastalarda düşük doz helikal BT incelemesi. 2005.
Gerst SR, Hricak H. 6 Radiology of the Urinary Tract. General Urology. 2008:58.
Ripollés T, Agramunt M, Errando J, Martínez MJ, Coronel B, Morales M. Suspected ureteral colic: plain film and sonography vs unenhanced helical CT. A prospective study in 66 patients. European radiology. 2004;14(1):129-36.
Daniels B, Gross CP, Molinaro A, Singh D, Luty S, Jessey R, et al. STONE PLUS: evaluation of emergency department patients with suspected renal colic, using a clinical prediction tool combined with point-of-care limited ultrasonography. Annals of emergency medicine. 2016;67(4):439-48.
Smith-Bindman R, Aubin C, Bailitz J, Bengiamin RN, Camargo Jr CA, Corbo J, et al. Ultrasonography versus computed tomography for suspected nephrolithiasis. New England Journal of Medicine. 2014;371(12):1100-10.
Dillman JR, Kappil M, Weadock WJ, Rubin JM, Platt JF, DiPietro MA, et al. Sonographic twinkling artifact for renal calculus detection: correlation with CT. Radiology. 2011;259(3):911-6.
Andrabi Y, Patino M, Das CJ, Eisner B, Sahani DV, Kambadakone A. Advances in CT imaging for urolithiasis. Indian journal of urology: IJU: journal of the Urological Society of India. 2015;31(3):185.
Smith R, Coll D. Helical computed tomography in the diagnosis of ureteric colic. BJU international. 2000;86:33-41.
Katz SI, Saluja S, Brink JA, Forman HP. Radiation dose associated with unenhanced CT for suspected renal colic: impact of repetitive studies. American Journal of Roentgenology. 2006;186(4):1120-4.
Türk C, Knoll T, Petrik A, Sarica K, Skolarikos A, Straub M, et al. European association of urology. Guidelines on Urolithiaisis. 2012.
Stolzmann P, Kozomara M, Chuck N, Müntener M, Leschka S, Scheffel H, et al. In vivo identification of uric acid stones with dual-energy CT: diagnostic performance evaluation in patients. Abdominal imaging. 2010;35(5):629-35.
Vrtiska TJ, Takahashi N, Fletcher JG, Hartman RP, Yu L, Kawashima A. Genitourinary applications of dual-energy CT. AJR American journal of roentgenology. 2010;194(6):1434.
Kaza RK, Ananthakrishnan L, Kambadakone A, Platt JF. Update of dual-energy CT applications in the genitourinary tract. American journal of roentgenology. 2017;208(6):1185-92.
Moon J, Park B, Kim C, Park S. Evaluation of virtual unenhanced CT obtained from dual-energy CT urography for detecting urinary stones. The British Journal of Radiology. 2012;85(1014):e176-e81.
Takahashi N, Vrtiska TJ, Kawashima A, Hartman RP, Primak AN, Fletcher JG, et al. Detectability of urinary stones on virtual nonenhanced images generated at pyelographic-phase dual-energy CT. Radiology. 2010;256(1):184-90.
Lukasiewicz A, Bhargavan-Chatfield M, Coombs L, Ghita M, Weinreb J, Gunabushanam G, et al. Radiation dose index of renal colic protocol CT studies in the United States: a report from the American College of Radiology National Radiology Data Registry. Radiology. 2014;271(2):445-51.
Niemann T, Van Straten M, Resinger C, Bayer T, Bongartz G. Detection of urolithiasis using low-dose CT—A noise simulation study. European journal of radiology. 2011;80(2):213-8.
Xiang H, Chan M, Brown V, Huo YR, Chan L, Ridley L. Systematic review and meta‐analysis of the diagnostic accuracy of low‐dose computed tomography of the kidneys, ureters and bladder for urolithiasis. Journal of medical imaging and radiation oncology. 2017;61(5):582-90.
Lee CH, Goo JM, Ye HJ, Ye S-J, Park CM, Chun EJ, et al. Radiation dose modulation techniques in the multidetector CT era: from basics to practice. Radiographics. 2008;28(5):1451-9.
Cheng RZ, Shkolyar E, Chang TC, Spradling K, Ganesan C, Song S, et al. Ultra-low-dose CT: an effective follow-up imaging modality for ureterolithiasis. Journal of Endourology. 2020;34(2):139-44.
Primak AN, Fletcher JG, Vrtiska TJ, Dzyubak OP, Lieske JC, Jackson ME, et al. Noninvasive differentiation of uric acid versus non–uric acid kidney stones using dual-energy CT. Academic radiology. 2007;14(12):1441-7.
Müllhaupt G, Engeler DS, Schmid H-P, Abt D. How do stone attenuation and skin-to-stone distance in computed tomography influence the performance of shock wave lithotripsy in ureteral stone disease? BMC urology. 2015;15(1):1-8.
Sternberg KM, Eisner B, Larson T, Hernandez N, Han J, Pais VM. Ultrasonography significantly overestimates stone size when compared to low-dose, noncontrast computed tomography. Urology. 2016;95:67-71.
Gupta M, Lee MW. Treatment of stones associated with complex or anomalous renal anatomy. Urologic Clinics of North America. 2007;34(3):431-41.
Güner E, Çolakoğlu Y, Soytaş M, HUSEYNOV C, TAŞÇI Aİ. Calculi in the Ureter That Has an Ectopic Insertion to the Prostatic Urethra: A Rare Case Report. The New Journal of Urology.14(2):137-40.
Karabulut İ, YILMAZ AH, Mahmut K, Erdem K, Bedir F, Demirdöğen ŞO. Effectivenes of retrograd intrarenal surgery at stones of calix diverticulum. Yeni Üroloji Dergisi.12(3):26-8.
White WM, Johnson EB, Zite NB, Beddies J, Krambeck AE, Hyams E, et al. Predictive value of current imaging modalities for the detection of urolithiasis during pregnancy: a multicenter, longitudinal study. The Journal of urology. 2013;189(3):931-4.
Kalb B, Sharma P, Salman K, Ogan K, Pattaras JG, Martin DR. Acute abdominal pain: is there a potential role for MRI in the setting of the emergency department in a patient with renal calculi? Journal of Magnetic Resonance Imaging. 2010;32(5):1012-23.
Sternberg K, Greenfield SP, Williot P, Wan J. Pediatric stone disease: an evolving experience. The Journal of urology. 2005;174(4):1711-4.
Cody DD, Moxley DM, Krugh KT, O'Daniel JC, Wagner LK, Eftekhari F. Strategies for formulating appropriate MDCT techniques when imaging the chest, abdomen, and pelvis in pediatric patients. American Journal of Roentgenology. 2004;182(4):849-59.
Türk C, Knoll T, Petrik A, Sarica K, Straub M, Seitz C, editors. EAU guidelines on urolithiasis. European Association of Urology. EAU Annual Congress Amsterdam Arnhem, The Netherlands: EAU Guidelines Office https://uroweb org/guideline/urolithiasis/ Accessed November; 2020.
SCHWARTZ BF, SCHENKMAN N, ARMENAKAS NA, STOLLER ML. Imaging characteristics of indinavir calculi. The Journal of urology. 1999;161(4):1085-7.
Linsenmeyer MA, Linsenmeyer TA. Accuracy of bladder stone detection using abdominal x-ray after spinal cord injury. The journal of spinal cord medicine. 2004;27(5):438-42.
Salinawati B, Hing EY, Fam X, Zulfiqar M. Accuracy of ultrasound versus computed tomography urogram in detecting urinary tract calculi. The Medical journal of Malaysia. 2015;70(4):238-42.
Babjuk M, Oosterlinck W, Sylvester R, Kaasinen E, Böhle A, Palou J, et al. Guidelines on non-muscle-invasive bladder cancer (TaT1 and CIS). 2011.
ÖZBİLEN MH, YALÇIN MY, SÜELÖZGEN T, İLBEY YÖ. A Rare Case Report: Spontaneous Rupture of Renal Pelvis. İzmir Tepecik Eğitim Hastanesi Dergisi. 2021;31(1):114-6.
Tang X, Lieske JC. Acute and chronic kidney injury in nephrolithiasis. Current opinion in nephrology and hypertension. 2014;23(4):385.
Sigurjonsdottir VK, Runolfsdottir HL, Indridason OS, Palsson R, Edvardsson VO. Impact of nephrolithiasis on kidney function. BMC nephrology. 2015;16(1):1-7.
Jongyotha K, Sriphrapradang C. Squamous cell carcinoma of the renal pelvis as a result of long-standing staghorn calculi. Case reports in oncology. 2015;8(3):399-404.
