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We retrospectively included 341 consecutive patients with acute renal colic and a ureteral stone on NECT showing either a distal ureteral stone, a phlebolith or both. A 2.5-dimensional CNN (2.5D-CNN) model was used, where perpendicular axial, coronal and sagittal images through each calcification were used as input data for the CNN. The CNN was trained on 384 calcifications, and evaluated on an unseen dataset of 50 stones and 50 phleboliths. The CNN was compared to the assessment by seven radiologists who reviewed a local 5\u2009\u00d7\u20095\u2009\u00d7\u20095 cm image stack surrounding each calcification, and to a semi-quantitative method using cut-off values based on the attenuation and volume of the calcifications. The CNN differentiated stones and phleboliths with a sensitivity, specificity and accuracy of 94%, 90% and 92% and an AUC of 0.95. This was similar to a majority vote accuracy of 93% and significantly higher (<jats:italic>p<\/jats:italic>\u2009=\u20090.03) than the mean radiologist accuracy of 86%. The semi-quantitative method accuracy was 49%. In conclusion, the CNN differentiated ureteral stones from phleboliths with higher accuracy than the mean of seven radiologists\u2019 assessments using local features. However, more than local features are needed to reach optimal discrimination.<\/jats:p>","DOI":"10.1007\/s00240-020-01180-z","type":"journal-article","created":{"date-parts":[[2020,2,27]],"date-time":"2020-02-27T08:02:46Z","timestamp":1582790566000},"page":"41-49","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":46,"title":["Differentiation of distal ureteral stones and pelvic phleboliths using a convolutional neural network"],"prefix":"10.1007","volume":"49","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8949-119X","authenticated-orcid":false,"given":"Johan","family":"Jendeberg","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8351-3367","authenticated-orcid":false,"given":"Per","family":"Thunberg","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1346-1450","authenticated-orcid":false,"given":"Mats","family":"Lid\u00e9n","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2020,2,27]]},"reference":[{"key":"1180_CR1","doi-asserted-by":"publisher","first-page":"101","DOI":"10.2214\/ajr.178.1.1780101","volume":"178","author":"DM Coll","year":"2002","unstructured":"Coll DM, Varanelli MJ, Smith RC (2002) Relationship of spontaneous passage of ureteral calculi to stone size and location as revealed by unenhanced helical CT. 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The Regional Research Ethics Board approved the study protocol and waived the informed consent requirement.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval"}}]}}