| Advantages | Disadvantages |
Ultrasound kidneys and bladder | - No ionizing radiation; lower cumulative radiation dose in patients undergoing repeated imaging
- Reliably detects hydronephrosis
| - Low to moderate sensitivity and wide variability in diagnostic performance; detects 24 to 57% of stones seen with CT[1,2]
- Inaccurate stone size measurements and ureteral localization for treatment planning
- Likely nondiagnostic in patients with large body habitus (males >285 lb, females >250 lb), or those with end-stage kidney disease
|
Noncontrast CT abdomen and pelvis | - Highest diagnostic accuracy; pooled sensitivity 0.97 and specificity 0.95 for low-dose examination[3]
- Reliably detects hydronephrosis
- Accurate stone size measurements and ureteral localization for treatment planning
| - Ionizing radiation; effective dose 2 to 3 mSv with low-dose and 10 to 12 mSv with standard-dose examination
- Rarely, a second set of images after intravenous contrast are needed for definitive diagnosis of urolithiasis*
|
Abdomen radiograph | - Accurate stone size measurements and ureteral localization for treatment planning
| - Low to moderate sensitivity and wide variability in diagnostic performance; detects 29 to 59% of stones seen with CT[4,5]
- Does not detect hydronephrosis
- Ionizing radiation; effective dose 0.8 mSv with each view
|
MRI abdomen and pelvis | - No ionizing radiation
- Reliably detects hydronephrosis
- Accurately localizes the site of ureteral obstruction for treatment planning
| - Very low sensitivity as stones are nearly invisible
- Inaccurate stone size measurements for treatment planning
- Requires patient lie still in enclosed scanner for 10 to 20 minutes
|
Intravenous pyelography (IVP) | - Reliably detects hydronephrosis
- Accurate stone size measurements and ureteral localization for treatment planning
| - Diagnostic performance not quantified; less accurate than CT
- Ionizing radiation; effective dose 3 mSv
- Intravenous contrast required
|