MRU Without IV Contrast There is no relevant literature documenting the additional benefit of MRU without IV contrast in a patient with known current stone disease, diagnosed on recent imaging with recurrent symptoms of stone disease. Radiography Abdomen and Pelvis If a stone was initially radiopaque on initial KUB and/or CT, a follow-up KUB could indicate whether a stone has migrated/changed in position. However, there is no relevant literature documenting the benefit of KUB in a patient with known current stone disease, diagnosed on recent imaging with recurrent symptoms of stone disease. Radiography Intravenous Urography With urinary tract opacification, IVU may confirm the ureteral location of a calculus, distinguishing from stone mimics such as an adjacent phlebolith or vascular calcification. However, there is no relevant literature specifically assessing its use/benefit in this clinical scenario. US Color Doppler Kidneys and Bladder Retroperitoneal There is no evidence to support the use of dedicated US color Doppler in the evaluation of patients with known current stone disease, diagnosed on recent imaging with recurrent symptoms of stone disease. This procedure is intended for evaluation of vasculature. US Kidneys and Bladder Retroperitoneal Using grayscale techniques, US demonstrates variable performance in the detection of renal calculi depending on the clinical scenario but is used to assess for associated complications such as hydronephrosis. In one study, using US to guide clinical decision-making for patients with known residual calculi is limited by low sensitivity and the inability to size the stone accurately, which can lead to inappropriate counseling for patients [36]. Variant 3: Pregnant patient. Acute onset flank pain. Suspicion of stone disease. Initial or follow-up imaging. Stones can be a source of abdominal pain in pregnant patients.
Acute Onset Flank Pain Suspicion of Stone Disease Urolithiasis . MRU Without IV Contrast There is no relevant literature documenting the additional benefit of MRU without IV contrast in a patient with known current stone disease, diagnosed on recent imaging with recurrent symptoms of stone disease. Radiography Abdomen and Pelvis If a stone was initially radiopaque on initial KUB and/or CT, a follow-up KUB could indicate whether a stone has migrated/changed in position. However, there is no relevant literature documenting the benefit of KUB in a patient with known current stone disease, diagnosed on recent imaging with recurrent symptoms of stone disease. Radiography Intravenous Urography With urinary tract opacification, IVU may confirm the ureteral location of a calculus, distinguishing from stone mimics such as an adjacent phlebolith or vascular calcification. However, there is no relevant literature specifically assessing its use/benefit in this clinical scenario. US Color Doppler Kidneys and Bladder Retroperitoneal There is no evidence to support the use of dedicated US color Doppler in the evaluation of patients with known current stone disease, diagnosed on recent imaging with recurrent symptoms of stone disease. This procedure is intended for evaluation of vasculature. US Kidneys and Bladder Retroperitoneal Using grayscale techniques, US demonstrates variable performance in the detection of renal calculi depending on the clinical scenario but is used to assess for associated complications such as hydronephrosis. In one study, using US to guide clinical decision-making for patients with known residual calculi is limited by low sensitivity and the inability to size the stone accurately, which can lead to inappropriate counseling for patients [36]. Variant 3: Pregnant patient. Acute onset flank pain. Suspicion of stone disease. Initial or follow-up imaging. Stones can be a source of abdominal pain in pregnant patients.