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Abstract
PURPOSE OF REVIEW Radiological imaging techniques and applications are constantly advancing. This review will examine modern imaging techniques in the diagnosis of urolithiasis and applications for surgical planning. RECENT FINDINGS The diagnosis of urolithiasis may be done via plain film X-ray, ultrasound (US), or contrast tomography (CT) scan. US should be applied in the workup of flank pain in emergency rooms and may reduce unnecessary radiation exposure. Low dose and ultra-low-dose CT remain the diagnostic standard for most populations but remain underutilized. Single and dual-energy CT provide three-dimensional imaging that can predict stone-specific parameters that help clinicians predict stone passage likelihood, identify ideal management techniques, and possibly reduce complications. Machine learning has been increasingly applied to 3-D imaging to support clinicians in these prognostications and treatment selection. SUMMARY The diagnosis and management of urolithiasis are increasingly personalized. Patient and stone characteristics will support clinicians in treatment decision, surgical planning, and counseling.
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Pourvaziri A, Parakh A, Cao J, Locascio J, Eisner B, Sahani D, Kambadakone A. Comparison of Four Dual-Energy CT Scanner Technologies for Determining Renal Stone Composition: A Phantom Approach. Radiology 2022; 304:580-589. [PMID: 35638928 DOI: 10.1148/radiol.210822] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background Studies have investigated the value of various dual-energy CT (DECT) technologies for determining renal stone composition. However, sparse multivendor comparison data exist. Purpose To compare the performance of four DECT technologies in determining renal stone composition at standard- and low-dose acquisitions. Materials and Methods This was an in vitro phantom study. Seventy-one urinary stones (size: 2.7-14.1 mm) of known chemical composition (51 calcium, four struvite, four cystine, and 12 urate) were placed in a custom-made cylindrical phantom. Consecutive scans with manufacturer-recommended protocols and dose-optimized institutional protocols (up to 80% reduction in volumetric CT dose index) were obtained with rapid kilovolt peak switching DECT (rsDECT) (n = 2), dual-source DECT (n = 2), twin-beam DECT (tbDECT) (n = 1), and dual-layer detector-based CT (dlDECT) (n = 1) scanners. The image data sets were analyzed using effective atomic number and dual-energy ratio indexes of maximally available and comparable spectra. The performance of each combination of scanner technology, method, and acquisition was assessed. Logistic regression models were used to calculate the area under the receiver operating characteristic curve (AUC). Results After image analysis, all scanners except tbDECT had an AUC greater than 0.95 in at least one acquisition in distinguishing urate from other stones. All DECT techniques were able to help differentiate calcium oxalate monohydrate stones with moderate accuracy (AUC: 0.70-0.83), and brushite was differentiated from urate with AUC greater than 0.99. There was no correlation between performance and acquisition with dose-optimized and/or vendor-recommended settings. Conclusion All four dual-energy CT (DECT) technologies enabled accurate determination of stone composition at standard- and low-dose acquisitions; however, performance varied based on the scanner parameters, DECT technique, and stone type. © RSNA, 2022 Online supplemental material is available for this article. See also the editorial by Ringl and Apfaltrer in this issue.
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Affiliation(s)
- Ali Pourvaziri
- From the Department of Radiology (A. Pourvaziri, J.C., A.K.), Harvard Catalyst Biostatistics Consulting Unit (J.L.), and Department of Urology (D.S.), Massachusetts General Hospital, 55 Fruit St, Boston, MA 02114; Department of Radiology, Brigham and Women's Hospital, Boston, Mass (A. Parakh); and Department of Radiology, University of Washington, Seattle, Wash (B.E.)
| | - Anushri Parakh
- From the Department of Radiology (A. Pourvaziri, J.C., A.K.), Harvard Catalyst Biostatistics Consulting Unit (J.L.), and Department of Urology (D.S.), Massachusetts General Hospital, 55 Fruit St, Boston, MA 02114; Department of Radiology, Brigham and Women's Hospital, Boston, Mass (A. Parakh); and Department of Radiology, University of Washington, Seattle, Wash (B.E.)
| | - Jinjin Cao
- From the Department of Radiology (A. Pourvaziri, J.C., A.K.), Harvard Catalyst Biostatistics Consulting Unit (J.L.), and Department of Urology (D.S.), Massachusetts General Hospital, 55 Fruit St, Boston, MA 02114; Department of Radiology, Brigham and Women's Hospital, Boston, Mass (A. Parakh); and Department of Radiology, University of Washington, Seattle, Wash (B.E.)
| | - Joseph Locascio
- From the Department of Radiology (A. Pourvaziri, J.C., A.K.), Harvard Catalyst Biostatistics Consulting Unit (J.L.), and Department of Urology (D.S.), Massachusetts General Hospital, 55 Fruit St, Boston, MA 02114; Department of Radiology, Brigham and Women's Hospital, Boston, Mass (A. Parakh); and Department of Radiology, University of Washington, Seattle, Wash (B.E.)
| | - Brian Eisner
- From the Department of Radiology (A. Pourvaziri, J.C., A.K.), Harvard Catalyst Biostatistics Consulting Unit (J.L.), and Department of Urology (D.S.), Massachusetts General Hospital, 55 Fruit St, Boston, MA 02114; Department of Radiology, Brigham and Women's Hospital, Boston, Mass (A. Parakh); and Department of Radiology, University of Washington, Seattle, Wash (B.E.)
| | - Dushyant Sahani
- From the Department of Radiology (A. Pourvaziri, J.C., A.K.), Harvard Catalyst Biostatistics Consulting Unit (J.L.), and Department of Urology (D.S.), Massachusetts General Hospital, 55 Fruit St, Boston, MA 02114; Department of Radiology, Brigham and Women's Hospital, Boston, Mass (A. Parakh); and Department of Radiology, University of Washington, Seattle, Wash (B.E.)
| | - Avinash Kambadakone
- From the Department of Radiology (A. Pourvaziri, J.C., A.K.), Harvard Catalyst Biostatistics Consulting Unit (J.L.), and Department of Urology (D.S.), Massachusetts General Hospital, 55 Fruit St, Boston, MA 02114; Department of Radiology, Brigham and Women's Hospital, Boston, Mass (A. Parakh); and Department of Radiology, University of Washington, Seattle, Wash (B.E.)
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Chen HW, Chen YC, Lee JT, Yang FM, Kao CY, Chou YH, Chu TY, Juan YS, Wu WJ. Prediction of the Uric Acid Component in Nephrolithiasis Using Simple Clinical Information about Metabolic Disorder and Obesity: A Machine Learning-Based Model. Nutrients 2022; 14:nu14091829. [PMID: 35565794 PMCID: PMC9103478 DOI: 10.3390/nu14091829] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 04/25/2022] [Accepted: 04/26/2022] [Indexed: 02/04/2023] Open
Abstract
There is a great need for a diagnostic tool using simple clinical information collected from patients to diagnose uric acid (UA) stones in nephrolithiasis. We built a predictive model making use of machine learning (ML) methodologies entering simple parameters easily obtained at the initial clinical visit. Socio-demographic, health, and clinical data from two cohorts (A and B), both diagnosed with nephrolithiasis, one between 2012 and 2016 and the other between June and December 2020, were collected before nephrolithiasis treatment. A ML-based model for predicting UA stones in nephrolithiasis was developed using eight simple parameters-sex, age, gout, diabetes mellitus, body mass index, estimated glomerular filtration rate, bacteriuria, and urine pH. Data from Cohort A were used for model training and validation (ratio 3:2), while data from Cohort B were used only for validation. One hundred and forty-six (13.3%) out of 1098 patients in Cohort A and 3 (4.23%) out of 71 patients in Cohort B had pure UA stones. For Cohort A, our model achieved a validation AUC (area under ROC curve) of 0.842, with 0.8475 sensitivity and 0.748 specificity. For Cohort B, our model achieved 0.936 AUC, with 1.0 sensitivity, and 0.912 specificity. This ML-based model provides a convenient and reliable method for diagnosing urolithiasis. Using only eight readily available clinical parameters, including information about metabolic disorder and obesity, it distinguished pure uric acid stones from other stones before treatment.
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Affiliation(s)
- Hao-Wei Chen
- Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, 100, Shih-Chuan 1st Road, Kaohsiung 80708, Taiwan; (H.-W.C.); (Y.-C.C.); (Y.-H.C.); (Y.-S.J.)
- Department of Urology, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung, 80145, Taiwan
- Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 80708, Taiwan
| | - Yu-Chen Chen
- Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, 100, Shih-Chuan 1st Road, Kaohsiung 80708, Taiwan; (H.-W.C.); (Y.-C.C.); (Y.-H.C.); (Y.-S.J.)
- Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 80708, Taiwan
| | - Jung-Ting Lee
- Si Wan College, National Sun-Yat Sen University, Kaohsiung 80424, Taiwan;
| | - Frances M. Yang
- School of Nursing, University of Kansas, Kansas City, KS 66160, USA;
| | - Chung-Yao Kao
- Department of Electrical Engineering, National Sun-Yat Sen University, Kaohsiung 80424, Taiwan;
| | - Yii-Her Chou
- Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, 100, Shih-Chuan 1st Road, Kaohsiung 80708, Taiwan; (H.-W.C.); (Y.-C.C.); (Y.-H.C.); (Y.-S.J.)
- Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 80708, Taiwan
| | - Ting-Yin Chu
- Department of Business Management, National Sun Yat-Sen University, Kaohsiung 80424, Taiwan;
| | - Yung-Shun Juan
- Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, 100, Shih-Chuan 1st Road, Kaohsiung 80708, Taiwan; (H.-W.C.); (Y.-C.C.); (Y.-H.C.); (Y.-S.J.)
- Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 80708, Taiwan
| | - Wen-Jeng Wu
- Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, 100, Shih-Chuan 1st Road, Kaohsiung 80708, Taiwan; (H.-W.C.); (Y.-C.C.); (Y.-H.C.); (Y.-S.J.)
- Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 80708, Taiwan
- Correspondence:
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Appel E, Thomas C, Steuwe A, Schaarschmidt BM, Brook OR, Aissa J, Hennenlotter J, Antoch G, Boos J. Evaluation of split-filter dual-energy CT for characterization of urinary stones. Br J Radiol 2021; 94:20210084. [PMID: 33989046 PMCID: PMC8553179 DOI: 10.1259/bjr.20210084] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 03/22/2021] [Accepted: 04/26/2021] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVE To assess accuracy of dual-energy computed tomography (DECT) to differentiate uric acid from calcium urinary stones in dual-energy split filter vs sequential-spiral vs dual-source acquisition. METHODS Thirty-four urinary stones (volume 89.0 ± 77.4 mm³; 17 calcium stones, 17 uric acid stones) were scanned in a water-filled phantom using a split-filter equipped CT scanner (SOMATOM Definition Edge, Siemens Healthineers, Forchheim, Germany) in split-filter mode at 120 kVp and sequential-spiral mode at 80 and 140 kVp. Additional DE scans were acquired at 80 and 140 kVp (tin filter) with a dual-source CT scanner (SOMATOM Definition FLASH, Siemens Healthineers). Scans were performed with a CTDIvol of 7.3 mGy in all protocols. Urinary stone categorization was based on dual energy ratio (DER) using an automated 3D segmentation. As reference standard, infrared spectroscopy was used to determine urinary stone composition. RESULTS All three DECT techniques significantly differentiated between uric acid and calcium stones by attenuation values and DERs (p < 0.001 for all). Split-filter DECT provided higher DERs for uric acid stones, when compared with dual-source and sequential-spiral DECT, and lower DERs for calcified stones when compared with dual-source DECT (p < 0.001 for both), leading to a decreased accuracy for material differentiation. CONCLUSION Split-filter DECT, sequential-spiral DECT and dual-source DECT all allow for the acquisition of DER to classify urinary stones. ADVANCES IN KNOWLEDGE Split-filter DECT enables the differentiation between uric acid and calcium stones despite decreased spectral separation when compared with dual-source and dual-spiral DECT.
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Affiliation(s)
- Elisabeth Appel
- Department of Diagnostic and Interventional Radiology, Medical Faculty, University Dusseldorf, Moorenstrasse 5, D-40225, Düsseldorf, Germany
| | - Christoph Thomas
- Radiologicum Krefeld, Oberdießemer Straße 96, 47805 Krefeld, Germany
| | - Andrea Steuwe
- Department of Diagnostic and Interventional Radiology, Medical Faculty, University Dusseldorf, Moorenstrasse 5, D-40225, Düsseldorf, Germany
| | - Benedikt M Schaarschmidt
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University of Duisburg-Essen, D-45147, Essen, Germany
| | - Olga R Brook
- Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Ave, Boston, MA, USA
| | - Joel Aissa
- RIO - Radiologie Institut Oberhausen, Mülheimer Str. 87, 46045 Oberhausen, Germany
| | - Jörg Hennenlotter
- Department of Urology, University Hospital Tübingen, Tübingen, Germany
| | - Gerald Antoch
- Department of Diagnostic and Interventional Radiology, Medical Faculty, University Dusseldorf, Moorenstrasse 5, D-40225, Düsseldorf, Germany
| | - Johannes Boos
- Radiologie Münster MVZ, Von-Steuben-Str. 10a, 48143 Münster, Germany
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Adam SZ, Rabinowich A, Kessner R, Blachar A. Spectral CT of the abdomen: Where are we now? Insights Imaging 2021; 12:138. [PMID: 34580788 PMCID: PMC8476679 DOI: 10.1186/s13244-021-01082-7] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Accepted: 08/16/2021] [Indexed: 12/14/2022] Open
Abstract
Spectral CT adds a new dimension to radiological evaluation, beyond assessment of anatomical abnormalities. Spectral data allows for detection of specific materials, improves image quality while at the same time reducing radiation doses and contrast media doses, and decreases the need for follow up evaluation of indeterminate lesions. We review the different acquisition techniques of spectral images, mainly dual-source, rapid kV switching and dual-layer detector, and discuss the main spectral results available. We also discuss the use of spectral imaging in abdominal pathologies, emphasizing the strengths and pitfalls of the technique and its main applications in general and in specific organs.
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Affiliation(s)
- Sharon Z Adam
- Department of Diagnostic Radiology, Tel Aviv Sourasky Medical Center, 6 Weizmann St., 6423906, Tel Aviv, Israel. .,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Aviad Rabinowich
- Department of Diagnostic Radiology, Tel Aviv Sourasky Medical Center, 6 Weizmann St., 6423906, Tel Aviv, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Rivka Kessner
- Department of Diagnostic Radiology, Tel Aviv Sourasky Medical Center, 6 Weizmann St., 6423906, Tel Aviv, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Arye Blachar
- Department of Diagnostic Radiology, Tel Aviv Sourasky Medical Center, 6 Weizmann St., 6423906, Tel Aviv, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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Mussmann B, Hardy M, Jung H, Ding M, Osther PJ, Graumann O. Can Dual Energy CT with Fast kV-Switching Determine Renal Stone Composition Accurately? Acad Radiol 2021; 28:333-338. [PMID: 32217056 DOI: 10.1016/j.acra.2020.02.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 02/04/2020] [Accepted: 02/04/2020] [Indexed: 11/29/2022]
Abstract
RATIONALE AND OBJECTIVES To determine whether a single source computed tomography (CT) system utilizing fast kV switching and low dose settings can characterize (diameter and chemical composition) renal stones accurately when compared infrared spectroscopy. MATERIALS AND METHODS The chemical composition of 15 renal stones was determined using Fourier transform infrared spectroscopy. The stones were inserted into a porcine kidney and placed within a water tank for CT scanning using both fast kV switching dual energy and standard protocols. Effective atomic number of each stone was measured using scanner software. Stone diameter measurements were repeated twice to determine intra-rater variation and compared to actual stone diameter as measured by micro CT. RESULTS The chemical composition of three stones (one calcium phosphate and two carbonite apatite) could not be determined using the scanner software. The composition of 10/12 remaining stones was correctly identified using dual energy computed tomography (83% absolute agreement; k = 0.69). No statistical difference (p = 0.051) was noted in the mean stone diameter as measured by clinical CT and micro CT. CONCLUSION Dual energy computed tomography using fast kV switching may potentially be developed as a low dose clinical tool for identifying and classifying renal stones in vivo supporting clinical decision-making.
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Affiliation(s)
- Bo Mussmann
- Department of Radiology, Odense University Hospital, Denmark, Sdr. Boulevard 29, 5000 Odense C, Denmark; Research and Innovation Unit of Radiology, University of Southern Denmark, Odense, Denmark; Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway.
| | - Maryann Hardy
- Research and Innovation Unit of Radiology, University of Southern Denmark, Odense, Denmark; Faculty of Health Studies, University of Bradford, Bradford, UK
| | - Helene Jung
- Urological Research Center, Department of Urology, Lillebaelt Hospital, Vejle, Denmark
| | - Ming Ding
- Department of Orthopaedic surgery and traumatology, Odense University Hospital, Odense, Denmark; Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Palle J Osther
- Urological Research Center, Department of Urology, Lillebaelt Hospital, Vejle, Denmark
| | - Ole Graumann
- Department of Radiology, Odense University Hospital, Denmark, Sdr. Boulevard 29, 5000 Odense C, Denmark; Research and Innovation Unit of Radiology, University of Southern Denmark, Odense, Denmark
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Abstract
PURPOSE OF REVIEW Conventional CT imaging is an excellent tool for the diagnosis of nephrolithiasis however is limited in its ability to detect stone composition. Dual-energy CT (DECT) scans have demonstrated promise in overcoming this limitation. We review the current utility of DECT in nephrolithiasis. RECENT FINDINGS DECT is superior to conventional CT in differentiating uric acid stones from non-uric acid stones, with numerous studies reporting sensitivities and specificities approaching > 95%. Dose reduction protocols incorporating low-dose CT scans are commonly used, providing significantly lower effective radiation doses compared to conventional CT. DECT remains an effective diagnostic tool in patients with large body habitus. DECT can accurately detect uric acid stones, which can help guide which stones may be suitable to medical dissolution. Further studies evaluating the effectiveness of DECT in guiding management of patients with nephrolithiasis can help to promote its widespread use.
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Cannella R, Shahait M, Furlan A, Zhang F, Bigley JD, Averch TD, Borhani AA. Efficacy of single-source rapid kV-switching dual-energy CT for characterization of non-uric acid renal stones: a prospective ex vivo study using anthropomorphic phantom. Abdom Radiol (NY) 2020; 45:1092-1099. [PMID: 31385007 DOI: 10.1007/s00261-019-02164-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
PURPOSE To investigate the accuracy of rapid kV-switching single-source dual-energy computed tomography (rsDECT) for prediction of classes of non-uric-acid stones. MATERIALS AND METHODS Non-uric-acid renal stones retrieved via percutaneous nephrolithotomy were prospectively collected between January 2017 and February 2018 in a single institution. Only stones ≥ 5 mm and with pure composition (i.e., ≥ 80% composed of one component) were included. Stone composition was determined using Fourier Transform Infrared Spectroscopy. The stones were scanned in 32-cm-wide anthropomorphic whole-body phantom using rsDECT. The effective atomic number (Zeff), the attenuation at 40 keV (HU40), 70 keV (HU70), and 140 keV (HU140) virtual monochromatic sets of images as well as the ratios between the attenuations were calculated. Values of stone classes were compared using ANOVA and Mann-Whitney U test. Receiver operating curves and area under curve (AUC) were calculated. A p value < 0.05 was considered statistically significant. RESULTS The final study sample included 31 stones from 31 patients consisting of 25 (81%) calcium-based, 4 (13%) cystine, and 2 (6%) struvite pure stones. The mean size of the stones was 9.9 ± 2.4 mm. The mean Zeff of the stones was 12.01 ± 0.54 for calcium-based, 11.10 ± 0.68 for struvite, and 10.23 ± 0.75 for cystine stones (p < 0.001). Zeff had the best efficacy to separate different classes of stones. The calculated AUC was 0.947 for Zeff; 0.833 for HU40; 0.880 for HU70; and 0.893 for HU140. CONCLUSION Zeff derived from rsDECT has superior performance to HU and attenuation ratios for separation of different classes of non-uric-acid stones.
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Affiliation(s)
- Roberto Cannella
- Division of Abdominal Imaging, Department of Radiology, University of Pittsburgh, UPMC Presbyterian, 200 Lothrop Street, Pittsburgh, PA, 15213, USA
- Section of Radiology - BiND, University Hospital "Paolo Giaccone", Via del Vespro 129, 90127, Palermo, Italy
| | - Mohammed Shahait
- Department of Urology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Alessandro Furlan
- Division of Abdominal Imaging, Department of Radiology, University of Pittsburgh, UPMC Presbyterian, 200 Lothrop Street, Pittsburgh, PA, 15213, USA
| | - Feng Zhang
- Department of Radiology, St. Joseph's Medical Center, Stockton, CA, USA
| | - Joel D Bigley
- Department of Urology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Timothy D Averch
- Department of Radiology, Palmetto Health-Health-University of South Carolina Medical Group, Columbia, SC, USA
| | - Amir A Borhani
- Division of Abdominal Imaging, Department of Radiology, University of Pittsburgh, UPMC Presbyterian, 200 Lothrop Street, Pittsburgh, PA, 15213, USA.
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Abstract
PURPOSE OF REVIEW Radiological imaging techniques are a fast developing field in medicine. Therefore, the purpose of this review was to identify and discuss the latest changes of modern imaging techniques in the management of urinary stone disease. RECENT FINDINGS The introduction of iterative image reconstruction enables low-dose and ultra-low-dose (ULD) protocols. Although current guidelines recommend their utilization in nonobese patients recent studies indicate that low-dose imaging may be feasible in obese (<30 kg/m) but not in bariatric patients. Use of dual energy computed tomography (CT) technologies should balance between additional information and radiation dose aspects. If available on a dose neutral basis, dual energy imaging and analysis should be performed. Current guidelines recommend measuring the largest diameter for clinical decision making; however, recent studies suggest a benefit from measuring the volume based on multiplanar reformation. Quantitative imaging is still an experimental approach. SUMMARY The use of low-dose and even ULD CT protocols should be diagnostic standard, even in obese patients. If dual energy imaging is available, it should be limited to specific clinical questions. The stone volume should be reported in addition to the largest diameter for treatment decision and a more valid comparability of upcoming studies.
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Große Hokamp N, Lennartz S, Salem J, Pinto Dos Santos D, Heidenreich A, Maintz D, Haneder S. Dose independent characterization of renal stones by means of dual energy computed tomography and machine learning: an ex-vivo study. Eur Radiol 2019; 30:1397-1404. [PMID: 31773296 DOI: 10.1007/s00330-019-06455-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Revised: 07/26/2019] [Accepted: 09/12/2019] [Indexed: 12/17/2022]
Abstract
OBJECTIVES To predict the main component of pure and mixed kidney stones using dual-energy computed tomography and machine learning. METHODS 200 kidney stones with a known composition as determined by infrared spectroscopy were examined using a non-anthropomorphic phantom on a spectral detector computed tomography scanner. Stones were of either pure (monocrystalline, n = 116) or compound (dicrystalline, n = 84) composition. Image acquisition was repeated twice using both, normal and low-dose protocols, respectively (ND/LD). Conventional images and low and high keV virtual monoenergetic images were reconstructed. Stones were semi-automatically segmented. A shallow neural network was trained using data from ND1 acquisition split into training (70%), testing (15%) and validation-datasets (15%). Performance for ND2 and both LD acquisitions was tested. Accuracy on a per-voxel and a per-stone basis was calculated. RESULTS Main components were: Whewellite (n = 80), weddellite (n = 21), Ca-phosphate (n = 39), cysteine (n = 20), struvite (n = 13), uric acid (n = 18) and xanthine stones (n = 9). Stone size ranged from 3 to 18 mm. Overall accuracy for predicting the main component on a per-voxel basis attained by ND testing dataset was 91.1%. On independently tested acquisitions, accuracy was 87.1-90.4%. CONCLUSIONS Even in compound stones, the main component can be reliably determined using dual energy CT and machine learning, irrespective of dose protocol. KEY POINTS • Spectral Detector Dual Energy CT and Machine Learning allow for an accurate prediction of stone composition. • Ex-vivo study demonstrates the dose independent assessment of pure and compound stones. • Lowest accuracy is reported for compound stones with struvite as main component.
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Affiliation(s)
- Nils Große Hokamp
- Faculty of Medicine and University Hospital Cologne, Institute for Diagnostic and Interventional Radiology, University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany.
| | - Simon Lennartz
- Faculty of Medicine and University Hospital Cologne, Institute for Diagnostic and Interventional Radiology, University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany
- Else Kröner Forschungskolleg Clonal Evolution in Cancer, University Hospital Cologne, Cologne, Germany
| | - Johannes Salem
- Faculty of Medicine and University Hospital Cologne, Department of Urology, University of Cologne, Cologne, Germany
| | - Daniel Pinto Dos Santos
- Faculty of Medicine and University Hospital Cologne, Institute for Diagnostic and Interventional Radiology, University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany
| | - Axel Heidenreich
- Faculty of Medicine and University Hospital Cologne, Department of Urology, University of Cologne, Cologne, Germany
| | - David Maintz
- Faculty of Medicine and University Hospital Cologne, Institute for Diagnostic and Interventional Radiology, University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany
| | - Stefan Haneder
- Faculty of Medicine and University Hospital Cologne, Institute for Diagnostic and Interventional Radiology, University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany
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Seitz C, Bach T, Bader M, Berg W, Knoll T, Neisius A, Netsch C, Nothacker M, Schmidt S, Schönthaler M, Siener R, Stein R, Straub M, Strohmaier W, Türk C, Volkmer B. Aktualisierung der S2k-Leitlinie zur Diagnostik, Therapie und Metaphylaxe der Urolithiasis (AWMF Registernummer 043-025). Urologe A 2019; 58:1304-1312. [DOI: 10.1007/s00120-019-01033-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Zusammenfassung
Die Zunahme des medizinischen Wissens, technische Neuerungen gemeinsam mit demographischem Wandel stellen eine Herausforderung an die Neukonzeption von Leitlinien und klinischen Studien dar. Die vorliegende S2k-Leitlinie, die sich ausschließlich mit Nieren- und Harnleitersteinen beschäftigt, soll die Behandlung von Harnsteinpatienten in Klinik und Praxis unterstützen, aber auch Patienteninformationen zur Urolithiasis geben. Die zunehmende interdisziplinäre Zusammenarbeit in der Steintherapie zeigt sich auch an der Anzahl beteiligter Fachgruppen und Arbeitsgemeinschaften in der Erstellung des neuen Leitlinienupdates. Die vorliegende, aus einem interdisziplinären Konsensusprozess hervorgegangene S2k-Leitlinie stellt die aktuellen Empfehlungen praxisnah dar und gibt Entscheidungshilfen für Diagnostik‑, Therapie- und Metaphylaxemaßnahmen auf Basis von Expertenmeinungen und verfügbaren Evidenzgrundlagen aus der Literatur.
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Magistro G, Bregenhorn P, Krauß B, Nörenberg D, D'Anastasi M, Graser A, Weinhold P, Strittmatter F, Stief CG, Staehler M. Optimized management of urolithiasis by coloured stent-stone contrast using dual-energy computed tomography (DECT). BMC Urol 2019; 19:29. [PMID: 31039768 PMCID: PMC6492318 DOI: 10.1186/s12894-019-0459-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Accepted: 04/12/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND We analysed in vitro the appearance of commonly used ureteral stents with dual-energy computed tomography (DECT) and we used these characteristics to optimize the differentiation between stents and adjacent stone. METHODS We analysed in vitro a selection of 36 different stents from 7 manufacturers. They were placed in a self-build phantom model and measured using the SOMATOM® Force Dual Source CT-Scanner (Siemens, Forchheim, Germany). Each sample was scanned at various tube potentials of 80 and 150 peak kilovoltage (kVp), 90 and 150 kVp and 100 and 150 kVp. The syngo Post-Processing Suite software program (Siemens, Forchheim, Germany) was used for differentiation based on a 3-material decomposition algorithm (UA, calcium, urine) according to our standard stone protocol. RESULTS Stents composed of polyurethane appeared blue and silicon-based stents were red on the image. The determined appearances were constant for various peak kilovoltage (kVp) values. The coloured stent-stone-contrast displayed on DECT improves monitoring, especially of small calculi adjacent to indwelling ureteral stents. CONCLUSION Both urinary calculi and ureteral stents can be accurately differentiated by a distinct appearance on DECT. For the management of urolithiasis patients can be monitored more easily and accurately using DECT if the stent shows a different colour than the adjacent stone.
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Affiliation(s)
- Giuseppe Magistro
- Department of Urology, Ludwig-Maximilians-University of Munich, Marchioninistrasse 15, 81377, Munich, Germany.
| | - Patrick Bregenhorn
- Department of Radiology, Ludwig-Maximilians-University of Munich, Munich, Germany
| | - Bernhard Krauß
- Siemens Healthcare GmbH, Research and Development, Forchheim, Germany
| | - Dominik Nörenberg
- Siemens Healthcare GmbH, Research and Development, Forchheim, Germany
| | - Melvin D'Anastasi
- Siemens Healthcare GmbH, Research and Development, Forchheim, Germany
| | - Anno Graser
- Gemeinschaftspraxis Radiologie München, Munich, Germany
| | - Philipp Weinhold
- Department of Urology, Ludwig-Maximilians-University of Munich, Marchioninistrasse 15, 81377, Munich, Germany
| | - Frank Strittmatter
- Department of Urology, Ludwig-Maximilians-University of Munich, Marchioninistrasse 15, 81377, Munich, Germany
| | - Christian G Stief
- Department of Urology, Ludwig-Maximilians-University of Munich, Marchioninistrasse 15, 81377, Munich, Germany
| | - Michael Staehler
- Department of Urology, Ludwig-Maximilians-University of Munich, Marchioninistrasse 15, 81377, Munich, Germany
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Abstract
Recent advances in computed tomography, X-ray-based imaging, and ultrasonography have improved the accuracy of urinary stone detection and differentiation of stone composition while minimizing radiation exposure. Dual-energy computed tomography and digital tomosynthesis show promise in predicting mineral composition to optimize medical and surgical therapy. Electromagnetic tracking may enhance the use of ultrasonography to achieve percutaneous renal access for nephrolithotomy. This article reviews innovations in imaging technology in the contemporary management of urinary stone disease.
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Pumberger M, Fuchs M, Engelhard N, Hermann KG, Putzier M, Makowski MR, Hamm B, Diekhoff T. Disk injury in patients with vertebral fractures-a prospective diagnostic accuracy study using dual-energy computed tomography. Eur Radiol 2019; 29:4495-4502. [PMID: 30649597 PMCID: PMC6610270 DOI: 10.1007/s00330-018-5963-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Revised: 11/25/2018] [Accepted: 12/06/2018] [Indexed: 12/19/2022]
Abstract
OBJECTIVES Using magnetic resonance imaging (MRI) as the standard of reference, we aimed to evaluate the diagnostic accuracy of dual-energy computed tomography (DECT) in assessing disk injuries in patients aged more than 50 years with vertebral fractures. METHODS This prospective study was approved by the local ethics committee (EA1/372/14), and all patients gave written informed consent. Patients with suspected fractures underwent spinal DECTs and MRIs. Three readers scored DECT collagen maps for the presence or absence of disk injuries and also scored MR images according to the Sander classification (0-3). Only disks at risk (target disks) were included in the analysis. Sensitivity and specificity were calculated. Fleiss's κ was used to evaluate interrater agreement. Attenuation, in Hounsfield units, was compared between affected and unaffected disks in DECT. RESULTS Analyzing 295 disks in 67 patients, DECT was both sensitive (0.85) and specific (0.75). Sensitivity varied with the severity of disk damage, as assessed using the Sander scale (grade 1, 0.80; 2, 0.85; and 3, 0.98). Fleiss's κ was 0.41 for MRI and 0.51 for DECT. In the DECT collagen maps, attenuation was lower in injured disks compared to that in normal disks (80.3 ± 35.2 vs. 97.9 ± 41.0, p < 0.001). CONCLUSIONS Compared to conventional CT, DECT collagen maps can yield more diagnostic information, allowing identification of disk injuries in elderly patients with vertebral fractures. KEY POINTS • Dual-energy computed tomography allows vertebral disk injuries to be detected in elderly patients with vertebral fractures. • Dual-energy computed tomography yields more diagnostic information about vertebral disks compared to conventional CT. • Dual-energy computed tomography can be used as an alternative imaging modality for patients unwilling or unable to undergo MRI.
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Affiliation(s)
- Matthias Pumberger
- Department of Spine Surgery, Center for Musculoskeletal Surgery, Charité - Universitätsmedizin Berlin, Campus Mitte, Humboldt-Universität zu Berlin, Freie Universität Berlin, Berlin, Germany
| | - Michael Fuchs
- Department of Spine Surgery, Center for Musculoskeletal Surgery, Charité - Universitätsmedizin Berlin, Campus Mitte, Humboldt-Universität zu Berlin, Freie Universität Berlin, Berlin, Germany.,Department of Orthopedic Surgery, University of Ulm, Ulm, Germany
| | - Nils Engelhard
- Department of Radiology, Charité - Universitätsmedizin Berlin, Campus Mitte, Humboldt-Universität zu Berlin, Freie Universität Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Kay Geert Hermann
- Department of Radiology, Charité - Universitätsmedizin Berlin, Campus Mitte, Humboldt-Universität zu Berlin, Freie Universität Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Michael Putzier
- Department of Spine Surgery, Center for Musculoskeletal Surgery, Charité - Universitätsmedizin Berlin, Campus Mitte, Humboldt-Universität zu Berlin, Freie Universität Berlin, Berlin, Germany
| | - Marcus R Makowski
- Department of Radiology, Charité - Universitätsmedizin Berlin, Campus Mitte, Humboldt-Universität zu Berlin, Freie Universität Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Bernd Hamm
- Department of Radiology, Charité - Universitätsmedizin Berlin, Campus Mitte, Humboldt-Universität zu Berlin, Freie Universität Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Torsten Diekhoff
- Department of Radiology, Charité - Universitätsmedizin Berlin, Campus Mitte, Humboldt-Universität zu Berlin, Freie Universität Berlin, Charitéplatz 1, 10117, Berlin, Germany.
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Ananthakrishnan L, Duan X, Xi Y, Lewis MA, Pearle MS, Antonelli JA, Goerne H, Kolitz EM, Abbara S, Lenkinski RE, Fielding JR, Leyendecker JR. Dual-layer spectral detector CT: non-inferiority assessment compared to dual-source dual-energy CT in discriminating uric acid from non-uric acid renal stones ex vivo. Abdom Radiol (NY) 2018; 43:3075-3081. [PMID: 29626256 DOI: 10.1007/s00261-018-1589-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
PURPOSE To assess the non-inferiority of dual-layer spectral detector CT (SDCT) compared to dual-source dual-energy CT (dsDECT) in discriminating uric acid (UA) from non-UA stones. METHODS Fifty-seven extracted urinary calculi were placed in a cylindrical phantom in a water bath and scanned on a SDCT scanner (IQon, Philips Healthcare) and second- and third-generation dsDECT scanners (Somatom Flash and Force, Siemens Healthcare) under matched scan parameters. For SDCT data, conventional images and virtual monoenergetic reconstructions were created. A customized 3D growing region segmentation tool was used to segment each stone on a pixel-by-pixel basis for statistical analysis. Median virtual monoenergetic ratios (VMRs) of 40/200, 62/92, and 62/100 for each stone were recorded. For dsDECT data, dual-energy ratio (DER) for each stone was recorded from vendor-specific postprocessing software (Syngo Via) using the Kidney Stones Application. The clinical reference standard of X-ray diffraction analysis was used to assess non-inferiority. Area under the receiver-operating characteristic curve (AUC) was used to assess diagnostic performance of detecting UA stones. RESULTS Six pure UA, 47 pure calcium-based, 1 pure cystine, and 3 mixed struvite stones were scanned. All pure UA stones were correctly separated from non-UA stones using SDCT and dsDECT (AUC = 1). For UA stones, median VMR was 0.95-0.99 and DER 1.00-1.02. For non-UA stones, median VMR was 1.4-4.1 and DER 1.39-1.69. CONCLUSION SDCT spectral reconstructions demonstrate similar performance to those of dsDECT in discriminating UA from non-UA stones in a phantom model.
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Nestler T, Nestler K, Neisius A, Isbarn H, Netsch C, Waldeck S, Schmelz HU, Ruf C. Diagnostic accuracy of third-generation dual-source dual-energy CT: a prospective trial and protocol for clinical implementation. World J Urol 2018; 37:735-741. [DOI: 10.1007/s00345-018-2430-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Accepted: 08/01/2018] [Indexed: 12/01/2022] Open
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17
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Diagnostic validity of dual-energy CT in determination of urolithiasis chemical composition: In vivo analysis. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2018. [DOI: 10.1016/j.ejrnm.2017.12.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Zhang GMY, Sun H, Shi B, Xu M, Xue HD, Jin ZY. Uric acid versus non-uric acid urinary stones: differentiation with single energy CT texture analysis. Clin Radiol 2018; 73:792-799. [PMID: 29793721 DOI: 10.1016/j.crad.2018.04.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Accepted: 04/17/2018] [Indexed: 02/03/2023]
Abstract
AIM To evaluate the accuracy of computed tomography (CT) texture analysis (TA) to differentiate uric acid (UA) stones from non-UA stones on unenhanced CT in patients with urinary calculi with ex vivo Fourier transform infrared spectroscopy (FTIR) as the reference standard. MATERIALS AND METHODS Fourteen patients with 18 UA stones and 31 patients with 32 non-UA stones were included. All the patients had preoperative CT evaluation and subsequent surgical removal of the stones. CTTA was performed on CT images using commercially available research software. Each texture feature was evaluated using the non-parametric Mann-Whitney test. Receiver operating characteristic (ROC) curves were created and the area under the ROC curve (AUC) was calculated for texture parameters that were significantly different. The features were used to train support vector machine (SVM) classifiers. Diagnostic accuracy was evaluated. RESULTS Compared to non-UA stones, UA stones had significantly lower mean, standard deviation and mean of positive pixels but higher kurtosis (p<0.001) on both unfiltered and filtered texture scales. There were no significant differences in entropy or skewness between UA and non-UA stones. The average SVM accuracy of texture features for differentiating UA from non-UA stones ranged from 88% to 92% (after 10-fold cross validation). A model incorporating standard deviation, skewness, and kurtosis from unfiltered texture scale images resulted in an AUC of 0.965±00.029 with a sensitivity of 94.4% and specificity of 93.7%. CONCLUSION CTTA can be used to accurately differentiate UA stones from non-UA stones in vivo using unenhanced CT images.
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Affiliation(s)
- G-M-Y Zhang
- Department of Radiology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences. Shuaifuyuan No.1, Wangfujing Street, Dongcheng District, Beijing 100730, China
| | - H Sun
- Department of Radiology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences. Shuaifuyuan No.1, Wangfujing Street, Dongcheng District, Beijing 100730, China.
| | - B Shi
- Department of Radiology, Shenzhen Sun Yat-Sen Cardiovascular Hospital, No. 1021 Dongmen Road North, Luohu District, Shenzhen 518001, China
| | - M Xu
- Siemens Healthcare Ltd, Beijing, China. No.7 Zhonghuan Nanlu, Chaoyang District, Beijing 100102, China
| | - H-D Xue
- Department of Radiology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences. Shuaifuyuan No.1, Wangfujing Street, Dongcheng District, Beijing 100730, China.
| | - Z-Y Jin
- Department of Radiology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences. Shuaifuyuan No.1, Wangfujing Street, Dongcheng District, Beijing 100730, China.
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Ganesan V, De S, Shkumat N, Marchini G, Monga M. Accurately Diagnosing Uric Acid Stones from Conventional Computerized Tomography Imaging: Development and Preliminary Assessment of a Pixel Mapping Software. J Urol 2017; 199:487-494. [PMID: 28923471 DOI: 10.1016/j.juro.2017.09.069] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/07/2017] [Indexed: 10/18/2022]
Abstract
PURPOSE Preoperative determination of uric acid stones from computerized tomography imaging would be of tremendous clinical use. We sought to design a software algorithm that could apply data from noncontrast computerized tomography to predict the presence of uric acid stones. MATERIALS AND METHODS Patients with pure uric acid and calcium oxalate stones were identified from our stone registry. Only stones greater than 4 mm which were clearly traceable from initial computerized tomography to final composition were included in analysis. A semiautomated computer algorithm was used to process image data. Average and maximum HU, eccentricity (deviation from a circle) and kurtosis (peakedness vs flatness) were automatically generated. These parameters were examined in several mathematical models to predict the presence of uric acid stones. RESULTS A total of 100 patients, of whom 52 had calcium oxalate and 48 had uric acid stones, were included in the final analysis. Uric acid stones were significantly larger (12.2 vs 9.0 mm, p = 0.03) but calcium oxalate stones had higher mean attenuation (457 vs 315 HU, p = 0.001) and maximum attenuation (918 vs 553 HU, p <0.001). Kurtosis was significantly higher in each axis for calcium oxalate stones (each p <0.001). A composite algorithm using attenuation distribution pattern, average attenuation and stone size had overall 89% sensitivity, 91% specificity, 91% positive predictive value and 89% negative predictive value to predict uric acid stones. CONCLUSIONS A combination of stone size, attenuation intensity and attenuation pattern from conventional computerized tomography can distinguish uric acid stones from calcium oxalate stones with high sensitivity and specificity.
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Affiliation(s)
- Vishnu Ganesan
- Lerner College of Medicine, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Shubha De
- Glickman Urological Kidney Institute, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Nicholas Shkumat
- Department of Diagnostic Imaging, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Giovanni Marchini
- Glickman Urological Kidney Institute, Cleveland Clinic Foundation, Cleveland, Ohio; Section of Endourology, Division of Urology, Hospital das Clínicas, University of São Paulo Medical School, São Paulo, Brazil
| | - Manoj Monga
- Glickman Urological Kidney Institute, Cleveland Clinic Foundation, Cleveland, Ohio.
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