Noncontrast helical computed tomography (CT) has recently been found to be superior to excretory urography (IVU) in the evaluation of patients with suspected ureterolithiasis. Noncontrast helical CT does not require the use of intravenous contrast material with its associated cost and risk of adverse reactions and can be completed within 5 min, in most cases. Noncontrast CT often detects extraurinary pathology responsible for the patient's symptoms. CT is also more sensitive than IVU in detecting the calculus, regardless of its size, location, and chemical composition. However, confidently differentiating ureteral calculi from phleboliths along the course of the ureter may, at times, be difficult. The "tissue-rim" sign, a rim of soft tissue attenuation around the suspicious calcification, is helpful in making this distinction. Noncontrast CT does not provide physiological information about renal function and the degree of obstruction. A pilot study has suggested a proportional relationship between the extent of perinephric edema and the degree of obstruction. The cost of the examination and the radiation dose delivered to the patient may be higher with CT. Despite these limitations, noncontrast helical CT has quickly become the imaging study of choice in evaluating patients with acute flank pain.
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