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Spiral CT versus IVU for the evaluation of renal/Ureteric colic

Three Part Question

[In patients presenting to the Emergency department with features suggestive of ureteric colic,] is [spiral CT scan better than IVU] in the [detection of ureteric calculi?]

Clinical Scenario

A 45-year-old man presented to the emergency department with a history of sudden onset left-sided loin pain radiating to the left groin. Urinalysis revealed 2+ blood and nil else. Plain abdominal x ray did not reveal any radio-opaque calculus. You wonder whether a spiral computed tomography (CT) scan or intravenous urography (IVU) will be more appropriate for the further evaluation of the patient.

Search Strategy

OvidSP Medline 1966 to January week 3 2009
[{exp tomography, x ray computed/or exp tomography, spiral computed/or helical or CT or CAT or comput$} AND {exp urography/or OR exp ureteral obstruction/or exp contrast media/or exp Colic/or intravenous or intravenous}]. Limited to humans and the English language.

The Cochrane Library Issue 1 2009 [MeSH descriptor Tomography, X-Ray Computed explode all trees] AND [MeSH descriptor Urography explode all trees].

Search Outcome

Overall, 1081 papers were found, with only nine having direct relevance to the three-part question. One was a meta-analysis that included four of the other papers. This and the additional four papers are shown in the table.

Relevant Paper(s)

Author, date and country Patient group Study type (level of evidence) Outcomes Key results Study Weaknesses
Homer et al,
New Zealand
228 adults 123 had CT and 105 had IVU Gold standard (spontaneous stone passage, surgical retrieval or identification on retrograde pyelography) CT vs IVUProspective randomised diagnostic cohort Sensitivity100% vs 99%Indeterminate results considered positive in 18 patients in the IVU group. However, presence of stone confirmed in only 8 of these
Specificity100% vs 100%
Detection of alternative diagnosis27% vs 4%
Mendelson et al,
200 patients 102 had CT and 98 had IVU Gold standard (documented passage of calculus, patient reporting passage of calculus or surgical intervention). CT vs IVURandomised diagnostic cohort Detection of other pathologies6 vs 10Not controlled No follow up Retrospective
Worster et al,
Four diagnostic cohort studies Non-contrast helical CT vs IVU Meta-analysisPooled positive likelihood ratio23.15 (11.53–47.23) vs 9.32 (5.23–16.61) p = 0.046
Pooled negative likelihood ratio0.05 (0.02–0.15) vs 0.33 (0.23–0.48) p = 0.013
Pfister et al,
113 Patients 55 had CT 58 had IVU Gold standard (spontaneous passage, endoscopic retrieval or stone identification on retrograde pyelography) CT vs IVURandomised prospective trialSensitivity94.1% vs 94.2%No indication of how patients were randomly assigned Direct procedural costs in hospital perspective only analysed Both imaging modalities not applied to every patient. No details of follow up
Specificity85.2% vs 90.4%
Detection of other pathologies7% vs 5%
Wang et al,
82 Patients All had unenhanced CT and IVU on same day Composite gold standard (endoscopic evaluation, operative findings and pathology report) CT vs IVUDiagnostic cohortSensitivity98.5% vs 59.1%No documentation of radiation dose utilised Cost effectiveness assumed but not analysed
Specificity100% vs 100%
Detection of other diagnosis58% vs 0%


Most of the papers appraised showed that spiral CT has a better sensitivity and specificity than IVU. It also takes less time to perform and is better at revealing an alternative diagnosis, which may or may not be related to the patient’s symptoms. However spiral CT appears to be more expensive (although two studies showed no significant difference in costs from the hospital perspective) and is associated with a higher radiation dose than IVU. Furthermore, IVU is able to provide an idea of the functional status of the kidneys, whereas spiral CT has the advantage of being able to detect other pathologies.

Clinical Bottom Line

Spiral CT is more effective than IVU in the detection of renal or ureteric calculi.


  1. Homer JA, Davies-Payne DL, Peddinti BS Randomised prospective comparison of non-contrast enhanced helical CT and IVU in the diagnosis of acute ureteric colic. Australasian Radiology 2001;45:285-290
  2. Mendelson RM, Arnold-Reed DE, Kuan M et al. Renal colic: A prospective evaluation of non-enhanced spiral CT versus IVU Australasian Radiology. 2003;47:22-28
  3. Worster A, Preya I, Weaver B, et al. The accuracy of noncontrast helical computer tomography versus intravenous pyelography in the diagnosis of suspected urolithiasis. A meta-analysis. Emerg Med 2002;40:280–6.
  4. Pfister SA, Deckart A, Laschke S, et al. Unenhanced helical CT vs intravenous urography in patients acute flank pain: accuracy and economic impact. Eur Radiol 2003;13:2513–20.
  5. Wang J-H, Sha S-H, Huang S-S, et al. Prospective comparison of unenhanced spiral CT and IVU in the evaluation of acute renal colic. J Chinese Med Assoc 2008;71:30–6.