Рентгенология & Радиология, 2011, XLХ 292-297

SPECT/CT in emergency treatment of renal colic patients
V. Hadzhiyska
V. Mladenov, V. Marianov, I. Kostadinova, T. Petrov, Sv. Dineva, Y. Asenov

The therapeutic approach in patients with renal colic is based on the information from clinical, laboratory and imaging methods. However, the presence of a urolith does not necessarily mean that the kidney is obstructed and requires emergency decompression. The aim of the study was to apply a new multimodal diagnostic method – single photon emission computed tomography/ computed tomography (SPECT/CT) in decision making for emergency intervention in patients with renal colic. Twenty patients (9 male, 11 female) with acute or prolonged renal colic (middle age – 46,5 years), were studied. All of them were examined with a new hybrid technology, including dynamic renal scintigraphy (DRS), single photon emission computed tomography (SPECT) and low dose computed tomography (CT). A diuretic test with furosemide was performed in patients with visual retention of activity during
the study (protocol F+20). By using the low dose CT urolithiasis was found in 15 (75%) of the patients. Among the 15 patients with positive helical CT findings, 70 were found to have obstruction by scintigraphy (30% – partially, 40% – completely), the remaining 30% did not have obstruction. The patients with complete obstruction required emergency decompression – endoscope procedure, surgery, as well as extracorporeal shock wave, whereas those with partial obstruction were treated conservatively. Patients without obstruction were only followed up. Outcome information from clinical follow up and imaging findings indicated that this therapeutic approach was successful. Our first experience in appliance of SPECT/CТ shows that this method provides complex functional and morphological information of urolithiasis and shortens the diagnostic process in patients with acute or prolonged renal colic.