{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T01:29:31Z","timestamp":1760059771576,"version":"build-2065373602"},"reference-count":20,"publisher":"MDPI AG","issue":"14","license":[{"start":{"date-parts":[[2025,7,8]],"date-time":"2025-07-08T00:00:00Z","timestamp":1751932800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>Background\/Objectives: Non-enhanced computed tomography of the kidneys, ureters and bladder (NECT KUB) is the initial imaging modality for suspected nephroureterolithiasis. However, for alternative diagnoses, NECT may not be the ideal technique. Our institution changed the protocol for this cohort from NECT to intravenous contrast-enhanced CT (CECT) KUB. We aimed to retrospectively compare the rate of alternative diagnosis seen and the rates of calculus detection in CECT versus NECT KUB as a means of assessing performance. Our secondary aim was to compare the radiation dose between CECT and NECT KUB. Methods: Patients referred from the emergency department with suspected nephroureterolithiasis who underwent NECT and CECT KUB over two years were included. Key performance metrics included calculus detection rate, alternative findings, and negative studies. The metrics were compared between genders and age groups. Categorical variables were analysed using Chi-squared or Fisher\u2019s Exact Test and continuous with T-testing. Results: A total of 423 patients had CT KUB imaging (209 NECT, 214 CECT). The incidence of alternative findings in the NECT group was 23% and 40% in CECT (p &lt; 0.001). There were 48 findings (13 major, 11 moderate and 24 minor) in NECT studies and 85 findings (23 major, 43 moderate and 19 minor) in CECT (p &lt; 0.001). Major diagnoses ranged from acute emergencies to more indolent findings, including suspicious nodules\/masses. The calculus detection rate (NECT 56%, CECT 54%, p = 0.643) and negative studies (NECT 28%, CECT 22%, p = 0.168) did not significantly differ between protocols. CECT had a mean effective dose of 8.71 \u00b1 2.58 mSv representing 2.4 times the exposure of NECT (p &lt; 0.001). Conclusions: CECT is associated with a greater alternative diagnosis rate with similar calculus detection rates compared to NECT KUB, suggesting superior performance. However, CECT exposes patients to significantly greater levels of ionizing radiation.<\/jats:p>","DOI":"10.3390\/diagnostics15141731","type":"journal-article","created":{"date-parts":[[2025,7,8]],"date-time":"2025-07-08T07:31:57Z","timestamp":1751959917000},"page":"1731","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Performance of Computed Tomography of the Kidneys, Ureter and Bladder in Non-Calculus Diagnoses: A Comparative Review of Non-Enhanced with Intravenous Contrast-Enhanced Imaging"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9110-2579","authenticated-orcid":false,"given":"Alexander T.","family":"O\u2019Mahony","sequence":"first","affiliation":[{"name":"Department of Radiology, Cork University Hospital, T12DC4A Cork, Ireland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4073-9841","authenticated-orcid":false,"given":"Michael G.","family":"Waldron","sequence":"additional","affiliation":[{"name":"Department of Radiology, Cork University Hospital, T12DC4A Cork, Ireland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8906-2379","authenticated-orcid":false,"given":"David J.","family":"Ryan","sequence":"additional","affiliation":[{"name":"Department of Radiology, Cork University Hospital, T12DC4A Cork, Ireland"},{"name":"Department of Radiology, School of Medicine, Brookfield Health Complex, University College Cork, T12Ak54 Cork, Ireland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6584-8032","authenticated-orcid":false,"given":"Brian","family":"Carey","sequence":"additional","affiliation":[{"name":"Department of Radiology, Cork University Hospital, T12DC4A Cork, Ireland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sahil","family":"Shet","sequence":"additional","affiliation":[{"name":"Department of Radiology, School of Medicine, Brookfield Health Complex, University College Cork, T12Ak54 Cork, Ireland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6605-4576","authenticated-orcid":false,"given":"Eid","family":"Kakish","sequence":"additional","affiliation":[{"name":"Department of Radiology, School of Medicine, Brookfield Health Complex, University College Cork, T12Ak54 Cork, Ireland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Patrick","family":"O'Regan","sequence":"additional","affiliation":[{"name":"Department of Radiology, Cork University Hospital, T12DC4A Cork, Ireland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"David","family":"Glynn","sequence":"additional","affiliation":[{"name":"Department of Radiology, Cork University Hospital, T12DC4A Cork, Ireland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Josephine","family":"Barry","sequence":"additional","affiliation":[{"name":"Department of Radiology, Cork University Hospital, T12DC4A Cork, Ireland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Owen J.","family":"O'Connor","sequence":"additional","affiliation":[{"name":"Department of Radiology, Cork University Hospital, T12DC4A Cork, Ireland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michael M.","family":"Maher","sequence":"additional","affiliation":[{"name":"Department of Radiology, Cork University Hospital, T12DC4A Cork, Ireland"},{"name":"Department of Radiology, School of Medicine, Brookfield Health Complex, University College Cork, T12Ak54 Cork, Ireland"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,7,8]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"789","DOI":"10.1148\/radiology.194.3.7862980","article-title":"Acute flank pain: Comparison of non-contrast-enhanced CT and intravenous urography","volume":"194","author":"Smith","year":"1995","journal-title":"Radiology"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"53","DOI":"10.1016\/S0090-4295(00)00584-7","article-title":"Alternative or additional diagnoses on unenhanced helical computed tomography for suspected renal colic: Experience with 1000 consecutive examinations","volume":"56","author":"Katz","year":"2000","journal-title":"Urology"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"705","DOI":"10.1016\/j.crad.2017.05.009","article-title":"Making the best value of clinical radiology: iRefer Guidelines","volume":"72","author":"Remedios","year":"2017","journal-title":"Clin. Radiol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"58","DOI":"10.1177\/2051415817740492","article-title":"British Association of Urological Surgeons standards for management of acute ureteric colic","volume":"11","author":"Tsiotras","year":"2017","journal-title":"J. Clin. Urol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1756","DOI":"10.1007\/s00261-017-1376-0","article-title":"Renal cancer at unenhanced CT: Imaging features, detection rates, and outcomes","volume":"43","author":"Silverman","year":"2018","journal-title":"Abdom. Radiol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"2058460119849706","DOI":"10.1177\/2058460119849706","article-title":"T1a renal cell carcinoma on unenhanced CT: Analysis of detectability and imaging features","volume":"8","author":"Gobara","year":"2019","journal-title":"Acta Radiol. Open"},{"key":"ref_7","first-page":"168","article-title":"Imaging of pancreatic cancer: An overview","volume":"2","author":"Tummala","year":"2011","journal-title":"J. Gastrointest. Oncol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"S63","DOI":"10.1016\/j.jceh.2014.06.009","article-title":"Radiological Features of Hepatocellular Carcinoma","volume":"4","author":"Shah","year":"2014","journal-title":"J. Clin. Exp. Hepatol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"109","DOI":"10.1007\/s10140-014-1259-4","article-title":"Limited added utility of performing follow-up contrast-enhanced CT in patients undergoing initial non-enhanced CT for evaluation of flank pain in the emergency department","volume":"22","author":"Agarwal","year":"2015","journal-title":"Emerg. Radiol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"179","DOI":"10.1016\/j.ijsu.2016.06.047","article-title":"Management of alternative pathology detected using CT KUB in suspected ureteric colic","volume":"32","author":"Sarofim","year":"2016","journal-title":"Int. J. Surg."},{"key":"ref_11","first-page":"197","article-title":"Acute Renal Infarction: An Underdiagnosed Disorder","volume":"3","author":"Baig","year":"2012","journal-title":"J. Med. Cases"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"970","DOI":"10.1016\/j.crad.2007.04.016","article-title":"Unenhanced multidetector CT (CT KUB) in the initial imaging of suspected acute renal colic: Evaluating a new service","volume":"62","author":"Chowdhury","year":"2007","journal-title":"Clin. Radiol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1118","DOI":"10.1259\/bjr\/62994625","article-title":"Emergency department imaging protocol for suspected acute renal colic: Re-evaluating our service","volume":"85","author":"Patatas","year":"2012","journal-title":"Br. J. Radiol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"632","DOI":"10.1046\/j.1464-410x.2000.00605.x","article-title":"One year\u2019s clinical experience with unenhanced spiral computed tomography for the assessment of acute loin pain suggestive of renal colic","volume":"85","author":"Greenwell","year":"2000","journal-title":"BJU Int."},{"key":"ref_15","unstructured":"Shrimpton, P., Hillier, M., Meeson, S., and Golding, S. (2014). Doses from Computed Tomography (CT) Examinations in the UK\u20142011 Review, Public Health England."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"276","DOI":"10.1259\/bjr\/98067945","article-title":"Incidental findings in imaging diagnostic tests: A systematic review","volume":"83","author":"Lumbreras","year":"2010","journal-title":"Br. J. Radiol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.icrp.2011.10.001","article-title":"Conversion Coefficients for Radiological Protection Quantities for External Radiation Exposures","volume":"40","author":"Bolch","year":"2010","journal-title":"Ann. ICRP"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"149","DOI":"10.1016\/j.aju.2012.01.002","article-title":"Has the significance of incidental findings on unenhanced computed tomography for urolithiasis been overestimated? A retrospective review of over 800 patients","volume":"10","author":"Khan","year":"2012","journal-title":"Arab. J. Urol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"70","DOI":"10.1016\/j.ajem.2021.03.059","article-title":"Can obstructive urolithiasis be safely excluded on contrast CT? A retrospective analysis of contrast-enhanced and noncontrast CT","volume":"47","author":"Lei","year":"2021","journal-title":"Am. J. Emerg. Med."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"455","DOI":"10.1007\/s10140-018-1604-0","article-title":"Contrast-enhanced or noncontrast CT for renal colic: Utilizing urinalysis and patient history of urolithiasis to decide","volume":"25","author":"Desai","year":"2018","journal-title":"Emerg. Radiol."}],"container-title":["Diagnostics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-4418\/15\/14\/1731\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T18:06:23Z","timestamp":1760033183000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-4418\/15\/14\/1731"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,7,8]]},"references-count":20,"journal-issue":{"issue":"14","published-online":{"date-parts":[[2025,7]]}},"alternative-id":["diagnostics15141731"],"URL":"https:\/\/doi.org\/10.3390\/diagnostics15141731","relation":{},"ISSN":["2075-4418"],"issn-type":[{"type":"electronic","value":"2075-4418"}],"subject":[],"published":{"date-parts":[[2025,7,8]]}}}