European Radiology

, Volume 29, Issue 12, pp 6953–6964 | Cite as

Increased urinary bladder volume improves the detectability of urinary stones at the ureterovesical junction in non-enhanced computed tomography (NECT)

  • Maxim AvanesovEmail author
  • Julja Togmat
  • Mehtap Solmaz
  • Michael Gerhard Kaul
  • Azien Laqmani
  • Helena Guerreiro
  • Sarah Keller
  • Lars Weisbach
  • Gerhard Adam
  • Jin Yamamura



To evaluate the influence of the urinary bladder volume on the detectability of urolithiasis at the ureterovesical junction (UVJ) using a low-dose CT (LD-CT) with iterative reconstruction (IR) and a standard-dose CT (SD-CT) without IR in a large cohort.


Four hundred patients (278 males (69.5%), mean 44.6 ± 14.7 years) with urolithiasis at the UVJ were investigated either by an LD-CT with IR (n = 289, 72%) or an SD-CT without IR (n = 111, 28%) protocol. The detectability of distal urolithiasis was assessed by a dichotomous assessment (definite or questionable) by two radiologists in consensus and by a quantitative analysis of the signal density distribution across a line drawn parallel to the distal ureter. Based on the resulting graph, minimum/maximum density values and mean/maximum upslopes and downslopes were derived and calculated automatically. In all patients, the total bladder volume was calculated by a slice-by-slice approach on axial CT images.


Patients with definite stones showed significantly higher urinary bladder volumes compared to patients with questionable stones in both LD-CT and SD-CT (p < 0.01). These results were independent of stones’ length and patients’ BMI values. Using cutoffs of 92 ml for LD-CT and 69 ml for SD-CT, high positive predictive values/accuracy rates of 96%/85% (LD-CT) and 98%/86% (SD-CT) were observed to identify definite urinary stones.


Urinary bladder volume has a significant impact on the detectability of distal urolithiasis. Moderate bladder filling by pre-CT hydration with subsequent CT scan at the time of high urge to void increases the detectability of urinary stones at the UVJ in clinical routine.

Key Points

• Urinary bladder volume significantly affects the detectability of distal urolithiasis

• Higher bladder volumes are associated with improved detectability of distal urinary stones

• Oral pre-CT hydration for urolithiasis is easily applicable and cost-effective


Urolithiasis Radiation dosage Image reconstruction Spiral CT Diagnostic imaging 



Body mass index


Computed tomography


Dual-source CT


Dose-length product


Hounsfield units


Interquartile range


Iterative reconstruction


Low-dose CT


Non-enhanced CT


Negative predictive value


Positive predictive value


Receiver operating curve analysis


Standard-dose CT


Transitional cell carcinoma


Ureterovesical junction



The authors state that this work has not received any funding.

Compliance with ethical standards


The scientific guarantor of this publication is Dr. Maxim Avanesov.

Conflict of interest

The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.

Statistics and biometry

One of the authors has significant statistical expertise.

Informed consent

Written informed consent was waived by the Institutional Review Board.

Ethical approval

Institutional Review Board approval was obtained.


• Retrospective

• Observational

• Performed at one institution


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Copyright information

© European Society of Radiology 2019

Authors and Affiliations

  • Maxim Avanesov
    • 1
    Email author
  • Julja Togmat
    • 1
  • Mehtap Solmaz
    • 1
  • Michael Gerhard Kaul
    • 1
  • Azien Laqmani
    • 1
  • Helena Guerreiro
    • 1
  • Sarah Keller
    • 1
    • 2
  • Lars Weisbach
    • 3
  • Gerhard Adam
    • 1
  • Jin Yamamura
    • 1
  1. 1.Department of Diagnostic and Interventional Radiology and Nuclear MedicineUniversity Medical Center Hamburg-EppendorfHamburgGermany
  2. 2.Department of RadiologyCharité – University Medicine BerlinBerlinGermany
  3. 3.Department of UrologyUniversity Medical Center Hamburg-EppendorfHamburgGermany

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