• Luís Ronan Marquez Ferreira de Souza, Suzan Menasce Goldman, Salomão Faintuch, Juliano Ferreira Faria, Daniel Bekhor, Dario Ariel Tiferes, Valdemar Ortiz, Peter Choyke, and Jacob Szejnfeld.
• Diagnostic Imaging Department, Universidade Federal de São Paulo - Escola Paulista de Medicina, São Paulo, Brazil. luisronan@gmail.com
• Sao Paulo Med J. 2007 Mar 1; 125 (2): 102107102-7.

Context And ObjectiveRecent studies have shown noncontrast computed tomography (NCT) to be more effective than ultrasound (US) for imaging acute ureterolithiasis. However, to our knowledge, there are few studies directly comparing these techniques in an emergency teaching hospital setting. The objectives of this study were to compare the diagnostic accuracy of US and NCT performed by senior radiology residents for diagnosing acute ureterolithiasis; and to assess interobserver agreement on tomography interpretations by residents and experienced abdominal radiologists.Design And SettingProspective study of 52 consecutive patients, who underwent both US and NCT within an interval of eight hours, at Hospital São Paulo.MethodsUS scans were performed by senior residents and read by experienced radiologists. NCT scan images were read by senior residents, and subsequently by three abdominal radiologists. The interobserver variability was assessed using the kappa statistic.ResultsUreteral calculi were found in 40 out of 52 patients (77%). US presented sensitivity of 22% and specificity of 100%. When collecting system dilatation was associated, US demonstrated 73% sensitivity, 82% specificity. The interobserver agreement in NCT analysis was very high with regard to identification of calculi, collecting system dilatation and stranding of perinephric fat.ConclusionsUS has limited value for identifying ureteral calculi in comparison with NCT, even when collecting system dilatation is present. Residents and abdominal radiologists demonstrated excellent agreement rates for ureteral calculi, identification of collecting system dilatation and stranding of perinephric fat on NCT.

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