Variation in the radiologic and urologic interpretation of computed tomography in relation to upper urinary tract stones, at a national referral hospital

Abstract

Objective

To compare the discrepancy in computed tomography (CT) interpretations between urologists and radiologists in relation to urolithiasis and determine whether it can affect treatment.

Materials and methods

All the patients with a radiologic report of urolithiasis were analyzed, utilizing the Cohen’s kappa statistic and the Mann-Whitney U test, within the time frame of November 2017 to May 2018.

Results

A total of 142 patients, made up of 56.3% men and 43.7% women, with a mean age of 46 years, were included in the study. The main indication for CT was pain (74.6%), the most frequently ordered CT was a non-contrast scan (82.4%), and 36.6% of the studies were bilateral. Stone size, HU, and ectasia grade were not present in the radiologic reports at 8.6%, 17.3%, and 12.3%, respectively. Overall concordance for stone size was 20% when there was more than one stone, and 55% when there was a single stone (p£0.001). Concordance was 77% when stone size was classified according to the AUA (p£0.001).

Conclusions

There was considerable variation between the two specialties, emphasizing the need to utilize morphometry as a standardized method, thus obtaining a better, more accurate interpretation. It is important for the urologist to view the CT scan before deciding upon management. An estimated 31% of urologists rely solely on the report of the radiologist.