按照我的粗浅理解B超是看回声，密度高的回声有差异，理论上结石看得出来。CT是切面成像，但是那个有辐射，一个结石就要CT吗？非医疗专业，讲错勿喷。
我认真的查了一下uptodate
就肾石检测是这么说的：
“Ultrasound is less sensitive and demonstrates greater diagnostic variability than CT of the abdomen and pelvis without contrast for the diagnosis of nephrolithiasis. Ultrasound detects 24 to 57 percent of stones seen with CT [76,77]. Consequently, a CT is sometimes performed after a negative ultrasound to evaluate for a stone if the index of clinical suspicion remains high. Ultrasound is less accurate than CT at measuring stone size and defining ureteral location. Thus, a positive ultrasound often leads to a follow-up CT to enable treatment planning.
Ultrasound has been compared with standard-dose abdominopelvic CT for diagnostic performance and cumulative population-level radiation dose. A multicenter trial of 2759 emergency department patients clinically suspected to have nephrolithiasis were randomly assigned to initial imaging with a standard-dose, noncontrast CT, ultrasound performed by a radiologist, or ultrasound performed at the bedside by an emergency clinician [78]. After the initial imaging exam, subsequent evaluation and care was at the discretion of the treating clinicians. The key findings from this trial were as follows:
●The sensitivity of ultrasound for stone detection was 54 percent (if performed by an emergency clinician) and 57 percent (if performed by a radiologist). The sensitivity of CT was 88 percent. A CT scan was performed in 41 percent of patients who initially underwent ultrasound, whereas only 5 percent of patients who initially underwent CT subsequently underwent ultrasound.
●The cumulative radiation exposure after six months was approximately 70 percent higher with initial CT.
●The rate of important missed diagnoses resulting in complications, such as pyelonephritis with sepsis or diverticular abscess, were comparable between the two groups (0.5 percent with ultrasound versus 0.3 percent with CT). Serious adverse events and return visits to the emergency department after discharge were also similar.“
但是肾石CT都是non-contrast low radiation dose. 比一般的常规CT的辐射量小很多
“Ultrasound is less sensitive and demonstrates greater diagnostic variability than CT of the abdomen and pelvis without contrast for the diagnosis of nephrolithiasis. Ultrasound detects 24 to 57 percent of stones seen with CT [76,77]. Consequently, a CT is sometimes performed after a negative ultrasound to evaluate for a stone if the index of clinical suspicion remains high. Ultrasound is less accurate than CT at measuring stone size and defining ureteral location. Thus, a positive ultrasound often leads to a follow-up CT to enable treatment planning.
Ultrasound has been compared with standard-dose abdominopelvic CT for diagnostic performance and cumulative population-level radiation dose. A multicenter trial of 2759 emergency department patients clinically suspected to have nephrolithiasis were randomly assigned to initial imaging with a standard-dose, noncontrast CT, ultrasound performed by a radiologist, or ultrasound performed at the bedside by an emergency clinician [78]. After the initial imaging exam, subsequent evaluation and care was at the discretion of the treating clinicians. The key findings from this trial were as follows:
●The sensitivity of ultrasound for stone detection was 54 percent (if performed by an emergency clinician) and 57 percent (if performed by a radiologist). The sensitivity of CT was 88 percent. A CT scan was performed in 41 percent of patients who initially underwent ultrasound, whereas only 5 percent of patients who initially underwent CT subsequently underwent ultrasound.
●The cumulative radiation exposure after six months was approximately 70 percent higher with initial CT.
●The rate of important missed diagnoses resulting in complications, such as pyelonephritis with sepsis or diverticular abscess, were comparable between the two groups (0.5 percent with ultrasound versus 0.3 percent with CT). Serious adverse events and return visits to the emergency department after discharge were also similar.“
但是肾石CT都是non-contrast low radiation dose. 比一般的常规CT的辐射量小很多
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