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Xu H, Liu B, Tang L. CT-based radiomics for predicting success of shock wave lithotripsy in ureteral stones larger than 1 cm. World J Urol 2024; 42:397. [PMID: 38985166 DOI: 10.1007/s00345-024-05111-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 03/05/2024] [Indexed: 07/11/2024] Open
Abstract
PURPOSE This study aims to investigate the predictive value of CT-based radiomics in determining the success of extracorporeal shock wave lithotripsy (SWL) treatment for ureteral stones larger than 10mm in adult patients. MATERIALS AND METHODS A total of 301 eligible patients (165/136 successful/unsuccessful) who underwent SWL were retrospectively evaluated and divided into a training cohort (n = 241) and a test cohort (n = 60) following an 8:2 ratio. Univariate analysis was performed to assess clinical characteristics for constructing a nomogram. Radiomics and conventional radiological characteristics of stones were evaluated. Following feature selection, radiomics and radiological models were constructed using logistic regression (LR), support vector machine (SVM), random forest (RF), K nearest neighbor (KNN), and XGBoost. The models' performance was compared using metrics such as the area under the receiver operating characteristic curve (AUC), precision, recall, accuracy, and F1 score. Finally, a nomogram was created incorporating the best image model signature and clinical predictors. RESULTS The SVM-based radiomics model showed superior predictive performance in both training and test cohorts (AUC: 0.956, 0.891, respectively). The nomogram, which combined SVM-based radiomics signature with proximal ureter diameter (PUD), demonstrated further improved predictive performance in the test cohort (AUC: 0.891 vs. 0.939, P = 0.166). CONCLUSIONS Integration of CT-derived radiomics and PUD showed excellent ability to predict SWL treatment success in patients with ureteral stones larger than 10mm, providing a promising approach for clinical decision-making.
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Affiliation(s)
- Huixin Xu
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, No. 300 Guangzhou Road, Nanjing, Jiangsu Province, China
| | - Bo Liu
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, No. 300 Guangzhou Road, Nanjing, Jiangsu Province, China
| | - Lijun Tang
- Department of Nuclear Medicine, The First Affiliated Hospital of Nanjing Medical University, No. 300 Guangzhou Road, Nanjing, Jiangsu Province, China.
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2
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Arikan Y, Eksi M, Sungur U, Yoldas M, Keskin MZ. Variation coefficient of stone density and renal cortical thickness: the parameters evaluating non-contrast computed tomography imaging for predict extracorporeal shock wave lithotripsy success. Urolithiasis 2024; 52:53. [PMID: 38564004 DOI: 10.1007/s00240-024-01561-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Accepted: 03/18/2024] [Indexed: 04/04/2024]
Abstract
The stone density (SD) is not the same in all parts of the stone due to the heterogeneous nature of the stone and the shock wave (SW) passes through tissues of many different densities until it reaches the stone. These factors affect the success of Extracorporeal Shock Wave Lithotripsy (ESWL). We aimed to evaluate the effect of the Variation Coefficient of Stone Density (VCSD) and Renal Cortical Tickness (RCT) on the success of ESWL. Between 2020 and 2023, 510 patients who underwent ESWL were divided into 2 groups treatment success (n:304) and treatment failure (n:206). Non-Contrast Computed Tomography (NCCT) imaging values of hydronephrosis degree of the kidney, stone location, stone volume (SV), stone-skin distance (SSD), SD, Standard deviation of Stone Density (SDSD), VCSD, RCT, Soft-Tissue Thickness (STT), Muscle Thickness (MT) were analyzed. VCSD value was obtained by dividing SDSD by SD. Along the SW, tissues were divided into three components: kidney (renal cortex), muscle and other soft tissues. RCT, MT and SSD were measured at three different angles (0°, 45°, and 90°) and these 3 lengths were averaged. In univariate analysis, Body Mass Index (BMI), SV, SD, VCSD, SSD, RCT and STT were demonstrated to affect ESWL success. In multivariate analysis, low BMI, SV, SD, RCT and large VCSD were significant independent predictors of ESWL success. Among these parameters, VCSD had the highest prediction accuracy, followed by SD, SV, RCT and BMI, respectively. This study demonstrated that VCSD value and RCT are predictive parameters in determining the treatment of patients with urinary calculi and selecting suitable ESWL candidates.
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Affiliation(s)
- Yusuf Arikan
- Department of Urology, Izmir Tepecik Training and Research Hospital, Izmir, Turkey.
| | - Mithat Eksi
- Department of Urology, University of Health Sciences, Istanbul Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - Ubeyd Sungur
- Department of Urology, University of Health Sciences, Istanbul Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - Mehmet Yoldas
- Department of Urology, Izmir Tepecik Training and Research Hospital, Izmir, Turkey
| | - Mehmet Zeynel Keskin
- Department of Urology, Izmir Tepecik Training and Research Hospital, Izmir, Turkey
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3
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Rodriguez-Alvarez JS, Khooblall P, Brar H, Fedrigon D, Gutierrez-Aceves J, Monga M, De S. Endoscopic Stone Composition Identification: Is Accuracy Improved by Stone Appearance During Laser Lithotripsy? Urology 2023; 182:67-72. [PMID: 37802193 DOI: 10.1016/j.urology.2023.09.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 09/05/2023] [Accepted: 09/23/2023] [Indexed: 10/08/2023]
Abstract
OBJECTIVE To evaluate if videos during laser lithotripsy increase accuracy and confidence of stone identification by urologists compared to still pictures. METHODS We obtained representative pictures and videos of 4 major stone types from 8 different patients during ureteroscopy with holmium laser lithotripsy. A REDCap survey was created and emailed to members of the Endourological Society. The survey included a picture followed by the corresponding video of each stone undergoing laser lithotripsy and additional clinical information. Each picture and video included multiple-choice questions about stone composition and response confidence level. Accuracy, confidence levels, and rates of rectification (change from incorrect to correct answer) or confounding (correct to incorrect) after watching videos were analyzed. RESULTS One hundred eighty-seven urologists responded to the survey. The accuracy rate of stone identification with pictures was 43.8% vs 46.1% with videos (P = .27). Accuracy for individual stones was low and highly variable. Video only improved accuracy for 1 cystine stone. After viewing videos, participants were more likely to rectify vs confound their answers. Urologists were more likely to be confident with videos than pictures alone (65.4% vs 53.7%, respectively; P <.001); however, confident answers were not more likely to yield accurate predictions with videos vs still pictures. CONCLUSION Stone identification by urologists is marginally improved with videos vs pictures alone. Overall, accuracy in stone identification is low irrespective of confidence level, picture, and lithotripsy video visualization. Urologists should be cautious in using endoscopic stone appearance to direct metabolic management.
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Affiliation(s)
| | - Prajit Khooblall
- Cleveland Clinic Glickman Urological & Kidney Institute, Cleveland, OH
| | | | | | | | - Manoj Monga
- University of California San Diego, San Diego, CA
| | - Smita De
- Cleveland Clinic Glickman Urological & Kidney Institute, Cleveland, OH
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4
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Leyendecker P, Roustan FR, Meria P, Almeras C. 2022 Recommendations of the AFU Lithiasis Committee: Diagnosis. Prog Urol 2023; 33:782-790. [PMID: 37918979 DOI: 10.1016/j.purol.2023.08.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 07/27/2023] [Accepted: 08/01/2023] [Indexed: 11/04/2023]
Abstract
The choice of imaging modality is guided by the clinical presentation and the context (acute or not). Although ultrasound is safe (no radiation) and easily available, non-contrast-enhanced CT has become the gold standard in the diagnostic strategy for patients with acute flank pain because of its sensitivity (93.1%) and specificity (96.6%). It also allows determining the stone size, volume and density, visualizing their internal structure, and assessing their distance from the skin and the adjacent anatomy. All these parameters can influence the stone management and the choice of intervention modality. METHODOLOGY: These recommendations were developed using two methods: the Clinical Practice Recommendations method (CPR) and the ADAPTE method, depending on whether the issue was considered in the EAU recommendations (https://uroweb.org/guidelines/urolithiasis [EAU Guidelines on urolithiasis. 2022]) and their adaptability to the French context.
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Affiliation(s)
- P Leyendecker
- Service de radiologie B, nouvel hôpital Civil, hôpitaux universitaires de Strasbourg, groupe d'imagerie médicale MIM, AFR-SIGU, Strasbourg, France
| | | | - P Meria
- Service d'urologie, hôpital Saint-Louis, AP-HP-centre université Paris Cité, Paris, France
| | - C Almeras
- UroSud, clinique La Croix du Sud, Quint-Fonsegrives, France.
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5
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Sudhir Pillai P, Hsieh SS, Vercnocke AJ, Potretzke AM, Koo K, McCollough CH, Ferrero A. In Vivo Prediction of Kidney Stone Fragility Using Radiomics-Based Regression Models. J Endourol 2023; 37:443-452. [PMID: 36205579 PMCID: PMC10066766 DOI: 10.1089/end.2022.0483] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Introduction: The surgical technique for urinary stone removal is partly influenced by its fragility, as prognosticated by the clinician. This feasibility study aims to develop a linear regression model from CT-based radiomic markers to predict kidney stone comminution time in vivo with two ultrasonic lithotrites. Materials and Methods: Patients identified by urologists at our institution as eligible candidates for percutaneous nephrolithotomy were prospectively enrolled. The active engagement time of the lithotrite in breaking the stone during surgery denoted the comminution time of each stone. The comminution rate was computed as the stone volume disintegrated per minute. Stones were grouped into three fragility classes (fragile, moderate, hard), based on inverse of the comminution rates with respect to the mean. Multivariable linear regression models were trained with radiomic features extracted from clinical CT images to predict comminution times in vivo. The model with the least root mean squared error (RMSE) on comminution times and the fewest misclassification of fragility was finally selected. Results: Twenty-eight patients with 31 stones in total were included in this study. Stones in the cohort averaged 1557 (±2472) mm3 in volume and 5.3 (±7.4) minutes in comminution time. Ten stones had nonmoderate fragility. Linear regression of stone volume alone predicted comminution time with an RMSE of 6.8 minutes and missed all 10 stones with nonmoderate fragility. A fragility model that included stone volume, internal morphology, shape-based radiomics, and device type improved RMSE to below 3.3 minutes and correctly classified 20/21 moderate and 6/10 nonmoderate stones. Conclusions: CT metrics-based fragility models may provide information to surgeons regarding kidney stone fragility and facilitate the selection of stone removal procedures.
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Affiliation(s)
| | - Scott S. Hsieh
- Department of Radiology and Mayo Clinic, Rochester, Minnesota, USA
| | | | | | - Kevin Koo
- Department of Urology, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Andrea Ferrero
- Department of Radiology and Mayo Clinic, Rochester, Minnesota, USA
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Jeong JY, Cho KS, Kim DH, Jun DY, Moon YJ, Lee JY. A New Parameter for Calcium Oxalate Stones: Impact of Linear Calculus Density on Non-Contrast Computed Tomography. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:medicina59020267. [PMID: 36837469 PMCID: PMC9962263 DOI: 10.3390/medicina59020267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/25/2022] [Revised: 01/24/2023] [Accepted: 01/27/2023] [Indexed: 01/31/2023]
Abstract
Background and Objectives: Non-contrast computed tomography (NCCT) is widely used to evaluate urolithiasis. The NCCT attenuation, measured in Hounsfield units (HU), has been evaluated to predict stone characteristics. We propose a novel parameter, linear calculus density (LCD), and analyze variables from NCCT imaging to predict calcium oxalate (CaOx) stones, which are common and challenging to fragment. Materials and Methods: We retrospectively reviewed the medical records of patients with urolithiasis between 2014 and 2017. Among those, 790 patients were included. Based on the NCCT pre-treatment, the maximal stone length (MSL), mean stone density (MSD), and stone heterogeneity index (SHI) were obtained. In addition, the variation coefficient of stone density (VCSD = SHI/MSD × 100) and linear calculus density (LCD = VCSD/MSL) were calculated. In accordance with the stone analysis, the patients were divided into two groups (CaOx and non-CaOx groups). The logistic regression model and receiver operating characteristic (ROC) curve were used for predictive modeling. Results: In the CaOx group, the SHI, VCSD, and LCD were more significant than in the non-CaOx group (all p < 0.001). SHI (OR 1.002, 95% CI 1.001-1.004, p < 0.001), VCSD (OR 1.028, 95% CI 1.016-1.041, p < 0.001), and LCD (OR 1.352, 95% CI 1.270-1.444, p < 0.001) were significant independent factors for CaOx stones in the logistic regression models. The areas under the ROC curve for predicting CaOx stones were 0.586 for SHI, 0.66 for VCSD, and 0.739 for LCD, with a cut-point of 2.25. Conclusions: LCD can be a useful new parameter to provide additional information to help discriminate CaOx stones before treatment.
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Affiliation(s)
- Jae Yong Jeong
- Department of Urology, Severance Hospital, Urological Science Institute, Yonsei University College of Medicine, Seoul 03722, Republic of Korea
| | - Kang Su Cho
- Department of Urology, Prostate Cancer Center, Gangnam Severance Hospital, Urological Science Institute, Yonsei University College of Medicine, Seoul 06273, Republic of Korea
| | - Dae Ho Kim
- Department of Urology, Prostate Cancer Center, Gangnam Severance Hospital, Urological Science Institute, Yonsei University College of Medicine, Seoul 06273, Republic of Korea
| | - Dae Young Jun
- Department of Urology, Severance Hospital, Urological Science Institute, Yonsei University College of Medicine, Seoul 03722, Republic of Korea
| | - Young Joon Moon
- Department of Urology, Severance Hospital, Urological Science Institute, Yonsei University College of Medicine, Seoul 03722, Republic of Korea
| | - Joo Yong Lee
- Department of Urology, Severance Hospital, Urological Science Institute, Yonsei University College of Medicine, Seoul 03722, Republic of Korea
- Center of Evidence-Based Medicine, Institute of Convergence Science, Yonsei University, Seoul 03722, Republic of Korea
- Correspondence: ; Tel.: +82-2-2228-2320; Fax: +82-2-312-2538
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7
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Akouris PP, Chmiel JA, Stuivenberg GA, Kiattiburut W, Bjazevic J, Razvi H, Grohe B, Goldberg HA, Burton JP, Al KF. Osteopontin phosphopeptide mitigates calcium oxalate stone formation in a Drosophila melanogaster model. Urolithiasis 2022; 51:19. [PMID: 36547746 DOI: 10.1007/s00240-022-01395-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 12/12/2022] [Indexed: 12/24/2022]
Abstract
Kidney stone disease affects nearly one in ten individuals and places a significant economic strain on global healthcare systems. Despite the high frequency of stones within the population, effective preventative strategies are lacking and disease prevalence continues to rise. Osteopontin (OPN) is a urinary protein that can inhibit the formation of renal calculi in vitro. However, the efficacy of OPN in vivo has yet to be determined. Using an established Drosophila melanogaster model of calcium oxalate urolithiasis, we demonstrated that a 16-residue synthetic OPN phosphopeptide effectively reduced stone burden in vivo. Oral supplementation with this peptide altered crystal morphology of calcium oxalate monohydrate (COM) in a similar manner to previous in vitro studies, and the presence of the OPN phosphopeptide during COM formation and adhesion significantly reduced crystal attachment to mammalian kidney cells. Altogether, this study is the first to show that an OPN phosphopeptide can directly mitigate calcium oxalate urolithiasis formation in vivo by modulating crystal morphology. These findings suggest that OPN supplementation is a promising therapeutic approach and may be clinically useful in the management of urolithiasis in humans.
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Affiliation(s)
- Polycronis P Akouris
- Canadian Centre for Human Microbiome and Probiotics, London, ON, Canada
- Department of Microbiology and Immunology, Western University, London, ON, Canada
| | - John A Chmiel
- Canadian Centre for Human Microbiome and Probiotics, London, ON, Canada
- Department of Microbiology and Immunology, Western University, London, ON, Canada
| | - Gerrit A Stuivenberg
- Canadian Centre for Human Microbiome and Probiotics, London, ON, Canada
- Department of Microbiology and Immunology, Western University, London, ON, Canada
| | - Wongsakorn Kiattiburut
- Canadian Centre for Human Microbiome and Probiotics, London, ON, Canada
- Department of Microbiology and Immunology, Western University, London, ON, Canada
| | - Jennifer Bjazevic
- Division of Urology, Department of Surgery, Western University, London, ON, Canada
| | - Hassan Razvi
- Division of Urology, Department of Surgery, Western University, London, ON, Canada
| | - Bernd Grohe
- Canadian Centre for Human Microbiome and Probiotics, London, ON, Canada
| | - Harvey A Goldberg
- Department of Biochemistry, Western University, London, ON, Canada
- School of Dentistry, Western University, London, ON, Canada
| | - Jeremy P Burton
- Canadian Centre for Human Microbiome and Probiotics, London, ON, Canada
- Department of Microbiology and Immunology, Western University, London, ON, Canada
- Division of Urology, Department of Surgery, Western University, London, ON, Canada
| | - Kait F Al
- Canadian Centre for Human Microbiome and Probiotics, London, ON, Canada.
- Department of Microbiology and Immunology, Western University, London, ON, Canada.
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8
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Henderickx MMEL, Stoots SJM, de Bruin DM, Wijkstra H, Freund JE, Wiseman O, Ploumidis A, Skolarikos A, Somani BK, Sener TE, Emiliani E, Dragos L, Villa L, Talso M, Daudon M, Traxer O, Kronenberg P, Doizi S, Tailly T, Tefik T, Hendriks N, Beerlage HP, Baard J, Kamphuis GM. How reliable is endoscopic stone recognition? A comparison between visual stone identification and formal stone analysis. J Endourol 2022; 36:1362-1370. [PMID: 35651279 DOI: 10.1089/end.2022.0217] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVE To assess the diagnostic accuracy and intra-observer agreement of endoscopic stone recognition compared with formal stone analysis. INTRODUCTION Stone analysis is a corner stone in the prevention of stone recurrence. Although X-ray diffraction and infrared spectroscopy are the recommended techniques for reliable formal stone analysis, this is not always possible, and the process takes time and is costly. Endoscopic stone recognition could be an alternative as it would give immediate information on stone composition. MATERIAL AND METHODS Fifteen endourologists predicted stone composition based on 100 videos from ureterorenoscopy. Diagnostic accuracy was evaluated by comparing the prediction from visual assessment with stone analysis by X-ray diffraction. After 30 days, the videos were reviewed again in a random order to assess intra-observer agreement. RESULTS The median diagnostic accuracy for calcium oxalate monohydrate was of 54% in questionnaire 1 (Q1) and 59% in questionnaire 2 (Q2), whereas calcium oxalate dihydrate had a median diagnostic accuracy of 75% in Q1 and 50% in Q2. The diagnostic accuracy for calcium hydroxyphosphate was 10% in Q1 and 13% in Q2. The median diagnostic accuracy for calcium hydrogen phosphate dihydrate and calcium magnesium phosphate was 0% in both questionnaires. The median diagnostic accuracy for magnesium ammonium phosphate was in 20% in Q1 and 40% in Q2. The median diagnostic accuracy for uric acid was 22% in both questionnaires. Finally, there was a diagnostic accuracy of 60% in Q1 and 80% in Q2 for cystine. The intra-observer agreement ranged between 45-72%. CONCLUSION Diagnostic accuracy of endoscopic stone recognition is limited and intra-observer agreement is below the threshold of acceptable agreement.
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Affiliation(s)
- Michaël M E L Henderickx
- Amsterdam UMC Locatie Meibergdreef, 26066, Department of Urology, Amsterdam, North Holland, Netherlands;
| | - Simone J M Stoots
- Amsterdam UMC Locatie Meibergdreef, 26066, Department of Urology, Amsterdam, North Holland, Netherlands;
| | - D Martijn de Bruin
- Amsterdam UMC Locatie Meibergdreef, 26066, Biomedical Engineering & Physics, Amsterdam, North Holland, Netherlands.,Amsterdam UMC Locatie Meibergdreef, 26066, Department of Urology, Amsterdam, North Holland, Netherlands;
| | - Hessel Wijkstra
- Amsterdam UMC Locatie Meibergdreef, 26066, Department of Urology, Amsterdam, North Holland, Netherlands.,Eindhoven University of Technology, 3169, Department of Electrical Engineering, Eindhoven, Noord-Brabant, Netherlands;
| | - Jan Erik Freund
- Amsterdam UMC Locatie Meibergdreef, 26066, Department of Pathology, Amsterdam, North Holland, Netherlands;
| | - Oliver Wiseman
- Cambridge University Hospitals NHS Foundation Trust, Urology, 14 Herons Close, Cambridge, Cambridgeshire, United Kingdom of Great Britain and Northern Ireland, CB1 8NS;
| | | | - Andreas Skolarikos
- University of Athens, 2nd Department of Urology, 6 LASKAREOS ST, NEA ZOI PERISTERI, Athens, Greece, 12137;
| | - Bhaskar K Somani
- University Hospitals Southampton NHS Trust, Urology, Southampton, United Kingdom of Great Britain and Northern Ireland;
| | - Tarik Emre Sener
- Marmara University School of Medicine, Urology, Fevzi Çakmak Mah. Muhsin Yazıcıoğlu Cad. No: 10 Üst Kaynarca / Pendik / İSTANBUL, Istanbul, Turkey, 34890;
| | | | - Laurian Dragos
- Cambridge University Hospitals NHS Foundation Trust, 2153, Department of Urology, Cambridge, Cambridgeshire, United Kingdom of Great Britain and Northern Ireland;
| | - Luca Villa
- Università Vita-Salute San Raffaele, Urology, Via Olgettina, 60, Milan, Italy, 20132;
| | - Michele Talso
- ASST Fatebenefratelli Sacco, 472674, Urology - Ospedale Luigi Sacco University Hospital, Milano, Italy;
| | - Michel Daudon
- Hôpital Tenon, 55705, Department of Urology, Paris, Île-de-France, France.,Sorbonne Universite, 27063, GRC n°20, Groupe de Recherche Clinique sur la Lithiase Urinaire, Paris, Île-de-France, France;
| | - Olivier Traxer
- Hopital Tenon, 55705, Department of Urology, Paris, Île-de-France, France.,Sorbonne Universite, 27063, GRC n°20, Groupe de Recherche Clinique sur la Lithiase Urinaire, Paris, Île-de-France, France;
| | - Peter Kronenberg
- Hospital CUF Descobertas, 162265, Department of Urology , Lisboa, Lisboa, Portugal;
| | - Steeve Doizi
- Hopital Tenon, 55705, Department of Urology, Paris, Île-de-France, France.,Sorbonne Universite, 27063, GRC n°20, Groupe de Recherche Clinique sur la Lithiase Urinaire, Paris, Île-de-France, France;
| | | | - Tzevat Tefik
- Istanbul University Istanbul Faculty of Medicine, 64041, Department of Urology, Istanbul, Istanbul, Turkey;
| | - Nora Hendriks
- Amsterdam UMC Locatie AMC, 26066, Department of Urology, Amsterdam, Netherlands;
| | - Harrie P Beerlage
- Amsterdam UMC Locatie Meibergdreef, 26066, Department of Urology, Amsterdam, North Holland, Netherlands;
| | - Joyce Baard
- Amsterdam UMC Locatie Meibergdreef, 26066, Department of Urology, Amsterdam, North Holland, Netherlands;
| | - Guido M Kamphuis
- Amsterdam UMC Locatie Meibergdreef, 26066, Department of Urology, Amsterdam, North Holland, Netherlands;
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9
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Variables measured on three-dimensional computed tomography are preferred for predicting the outcomes of shock wave lithotripsy. World J Urol 2021; 40:569-575. [PMID: 34687343 DOI: 10.1007/s00345-021-03861-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 10/07/2021] [Indexed: 10/20/2022] Open
Abstract
PURPOSE Shock wave lithotripsy (SWL) is used to treat upper urinary tract stones. Recently, some volume analyzers have enabled preoperative assessment using three-dimensional computed tomography (3D-CT). We evaluated the efficacy of 3D-CT variables for predicting the outcomes of SWL. METHODS The study population included 193 patients who underwent SWL between November 2014 and August 2020. In addition to conventional two-dimensional computed tomography (2D-CT) assessments, 3D-CT assessments of targeted stones were retrospectively performed, and stone size and stone density (SD) were measured. The successful and unsuccessful treatment groups were compared and risk factors for an unsuccessful first SWL session were investigated. The predictive accuracy of variables measured on 3D-CT was evaluated by receiver operating characteristic curves and multivariate analyses. RESULTS The success rate of the first SWL session was 73.1%. Stone volume, mean SD and highest SD on 3D-CT were significantly higher in the unsuccessful group than in the successful group. Stone volume showed a higher area under the curve (AUC) than the estimated volumetric stone burden and stone diameter, which were measured on 2D-CT (0.729, 0.683, and 0.672, respectively). The AUCs of the mean SD and highest SD on 3D-CT were higher than those on 2D-CT (0.699, 0.680, 0.617, and 0.627, respectively). Multivariate analyses identified stone volume (≥ 0.29 ml), mean SD on 3D-CT (≥ 421 HU), and absence of hydronephrosis as independent predictive factors for unsuccessful SWL. CONCLUSION 3D-CT variables were promising predictors of the outcomes of SWL. Preoperative 3D-CT assessment is helpful for selecting favorable patients for SWL.
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10
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Implementation of a Technique Based on Hounsfield Units and Hounsfield Density to Determine Kidney Stone Composition. ACTA ACUST UNITED AC 2021; 7:606-613. [PMID: 34698253 PMCID: PMC8544724 DOI: 10.3390/tomography7040051] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2021] [Revised: 09/21/2021] [Accepted: 09/29/2021] [Indexed: 11/28/2022]
Abstract
Hounsfield units (HU) are a measure of radiodensity, related to the density of a tissue and the composition of kidney stones. Hounsfield density is what is related to the composition of kidney stones. In the standard acquisition method, these measures are arbitrary and dependent on the operator. This study describes the implementation of a technique based on the HU and Hounsfield density to predict the stone compositions of patients with nephrolithiasis. By conventional percutaneous nephrolithotomy, thirty kidney stone samples corresponding to the cortex, middle, and nucleus were obtained. The HU were obtained by CT scanning with a systematic grid. Hounsfield density was calculated as the HU value divided by the stone’s greatest diameter (HU/mm). With that method and after analyzing the samples by IR-spectroscopy, anhydrous uric acid and ammonium magnesium phosphate were identified as the compounds of kidney stones. Additionally, anhydrous uric acid, magnesium ammonium phosphate, and calcium oxalate monohydrate were identified via Hounsfield density calculation. The study identified HU ranges for stone compounds using a systematic technique that avoids bias in its analysis. In addition, this work could contribute to the timely diagnosis and development of personalized therapies for patients with this pathology.
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11
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Correlative investigation between routine clinical parameters of dual-energy computed tomography and the outcomes of extracorporeal shock wave lithotripsy in children with urolithiasis: a retrospective study. Abdom Radiol (NY) 2021; 46:4881-4887. [PMID: 34114086 DOI: 10.1007/s00261-021-03162-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 05/28/2021] [Accepted: 06/01/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE To evaluate the associations of DECT parameters with extracorporeal shock wave lithotripsy (ESWL) outcomes in pediatric patients. METHODS A retrospective study of consecutive patients with calculi who underwent ESWL and DECT in our hospital was performed in 2011-2019. The primary outcome was DECT imaging's correlation with ESWL outcomes. The secondary outcome was to determine DECT parameters independently predicting ESWL outcomes, including stone-free (SF) and residual stone (RS) statuses. RESULTS The study included 207 patients. The mean CT attenuations at 140 kVp, 80 kVp, and 120 kVp and effective atomic number (Zeff) were significantly correlated with stone free (SF) and residual stone (RS) (P < 0.05). Areas under the curves (AUCs) of CT attenuations at 120 kVp, 80 kVp, 140 kVp, and dual-energy index (DEI) were 0.784 (95% CI 0.672-0.897), 0.780 (95% CI 0.677-0.884), 0.766 (95% CI 0.658-0.885), and 0.709 (95% CI 0.578-0.840) (all P < 0.05). With cutoffs of 882.5, 1330.5, 1042.5, and 0.103 for CT attenuations at 140 kVp, 80 kVp, 120 kVp, and DEI, respectively, sensitivities and specificities were 75.0% and 31.1%, 83.3% and 31.8%, 80.3% and 31.1%, and 58.3% and 44.7%, respectively. CONCLUSION Our results demonstrated that the parameters of DECT could be used to predict ESWL outcomes (especially the SF status) in children with urolithiasis. ESWL success can be accurately predicted by DECT, and it is hard to predict ESWL failure.
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Elbaset MA, Taha DE, Anas M, Abouelkheir RT, Edwan M, Abdullateef M, Ashour R, Osman Y, Sheir KZ. Optimization of shockwave lithotripsy use for single medium sized hard renal stone with stone density ≥ 1000 HU. A prospective study. World J Urol 2021; 40:243-250. [PMID: 34392391 DOI: 10.1007/s00345-021-03807-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 08/04/2021] [Indexed: 11/28/2022] Open
Abstract
PURPOSE To identify shock wave lithotripsy (SWL) success predictors in hard renal stones (average stone density ≥ 1000 HU). MATERIALS We prospectively evaluated patients who underwent SWL for hard renal stones between April 2018 and December 2020. Radiological parameters were identified, e.g., stone site, size, the average density in addition to stone core and shell mean density, and renal cortical thickness (RKT). SWL sessions were performed using Doli-S lithotripter till a maximum of 3-4 sessions with 2-4 weeks interval. Initial response to SWL included stone fragmentation and decreased stone size after the first SWL. Treatment success was considered if complete clearance of renal stones occurred or in case of clinically insignificant residual fragments ≤ 4 mm after 12 weeks follow up by NCCT. RESULTS Out of 1878 patients who underwent SWL, the study included 157 patients with hard renal stones. Treatment overall success was found in 92 patients (58.6%) where 69 patients (43.9%) had complete stone clearance. On multivariate analysis, stone shell density < 901 HU, maximum stone size < 1 cm, RKT > 1.95 cm and initial treatment response were associated with increased the success rate after SWL for hard renal stones (P = 0.0001, 0.009, < 0.0001 and < 0.0001, respectively). CONCLUSION In hard renal stones, treatment overall success was found in 58.6% where complete stone clearance was found in 43.9%. Stone outer shell fragility, lower stone size, increased RKT and initial response to SWL were associated with a higher success rate at 12-week follow-up.
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Affiliation(s)
- M A Elbaset
- Urology Department, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt.
| | - Diaa-Eldin Taha
- Urology Department, KafrELshiekh University, Kafr Al Sheikh, Egypt
| | - Marwan Anas
- Urology Department, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt
| | - Rasha T Abouelkheir
- Radiology Department, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt
| | - Mohamed Edwan
- Urology Department, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt
| | - Muhamad Abdullateef
- Urology Department, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt
| | - Rawdy Ashour
- Urology Department, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt
| | - Yasser Osman
- Urology Department, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt
| | - K Z Sheir
- Urology Department, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt
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Williams JC, Lingeman JE, Daudon M, Bazin D. Using micro computed tomographic imaging for analyzing kidney stones. ACTA ACUST UNITED AC 2021; 24. [PMID: 34321982 DOI: 10.5802/crchim.89] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Stone analysis is a critical part of the clinical characterization of urolithiasis. This article reviews the strengths and limitations of micro CT in the analysis of stones. Using micro CT alone in a series of 757 stone specimens, micro CT identified the 458 majority calcium oxalate specimens with a sensitivity of 99.6% and specificity of 95.3%. Micro CT alone was also successful in identifying majority apatite, brushite, uric acid, and struvite stones. For some minor minerals-such as apatite in calcium oxalate or calcium salts in uric acid stones-micro CT enables the detection of minute quantities well below 1%. The addition of a standard for calibrating X-ray attenuation values improves the ability of micro CT to identify common stone minerals. The three-dimensional nature of micro CT also allows for the visualization of surface features in stones, which is valuable for the study of stone formation.
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Affiliation(s)
- James C Williams
- Department of Anatomy, Cell Biology & Physiology, Indiana University School of Medicine, Indianapolis, Indiana (USA)
| | - James E Lingeman
- Department of Urology, Indiana University School of Medicine, Indianapolis, Indiana (USA)
| | - Michel Daudon
- UMR S1155, INSERM/UPMC, 4 Rue de la Chine, 75970 Paris Cedex 20, France.,AP-HP, Hôpital Tenon, Explorations fonctionnelles multidisciplinaires, 4 Rue de la Chine, 75970 Paris Cedex 20, France
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Kim DS, Moon SK, Lee SH. Histogram of kidney stones on non-contrast computed tomography to predict successful stone dusting during retrograde intrarenal surgery. World J Urol 2021; 39:3563-3569. [PMID: 33733297 DOI: 10.1007/s00345-021-03659-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Accepted: 03/06/2021] [Indexed: 12/23/2022] Open
Abstract
PURPOSE To predict successful dusting of kidney stones during retrograde intrarenal surgery (RIRS) using stone density parameters and histograms measured with non-contrast computed tomography imaging. METHODS Medical records of 49 patients who underwent retrograde intrarenal surgery between January 2018 and January 2019 at Kyung Hee University Hospital were reviewed, and the data of 55 stones were evaluated. Patient age, sex, mean stone density, the highest and lowest measured Hounsfield unit (HU), standard deviation and range of the measured HUs, volume of the most measured HU, and success of dusting were evaluated. Histograms of the measured HUs were created and cutoff values for successful dusting were analyzed. RESULTS Thirty-two stones were successfully dusted during surgery. Dusted stones had a wider range of HU and higher standard deviation. The volume of the most measured HU was smaller in the dusted stones. Successful dusting could be predicted when the volume of the most measured HU was < 8.9 mm3, with range ≥ 853, or when the volume of the most measured HU was < 8.9 mm3, with range < 853, and the mean stone density was < 355. The histograms of HUs of the dusted stones were wide and rugged, while those of dusting failed stones were narrow and peaked. CONCLUSION Evaluation of stone HU histograms showed differences in distribution and proportion. This will help predict surgical outcomes and prepare for intraoperative complications.
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Affiliation(s)
- Dong Soo Kim
- Department of Urology, School of Medicine, Kyung Hee University, Kyung Hee University Medical Center, 23, Kyung Hee Dae-ro, Dongdaemun-gu, Seoul, 02447, Republic of Korea
| | - Sung Kyoung Moon
- Department of Radiology, School of Medicine, Kyung Hee University, Seoul, 02447, Republic of Korea
| | - Sang Hyub Lee
- Department of Urology, School of Medicine, Kyung Hee University, Kyung Hee University Medical Center, 23, Kyung Hee Dae-ro, Dongdaemun-gu, Seoul, 02447, Republic of Korea.
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Endoscopic identification of urinary stone composition: A study of South Eastern Group for Urolithiasis Research (SEGUR 2). Actas Urol Esp 2021; 45:154-159. [PMID: 32854978 DOI: 10.1016/j.acuro.2020.01.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Accepted: 01/24/2020] [Indexed: 11/21/2022]
Abstract
INTRODUCTION AND OBJECTIVES To assess the surgeon's ability to evaluate the composition of the stone by observation of endoscopic images. MATERIALS AND METHODS A series of 20 video clips of endoscopic treatments of urinary stones of which was also available the result of infrared spectroscopy was uploaded to a YouTube site accessible only to members of the South Eastern Group for Urolithiasis Research (SEGUR) who were asked to identify the composition of the stones. RESULTS A total of 32 clinicians from 9 different countries participated in the study. The average number of correct detections of participants was 7.81 ± 2.68 (range 1-12). Overall accuracy was 39% (250 out of 640 predictions). Calcium oxalate dihydrate stones have been correctly detected in 69.8%, calcium oxalate monohydrate in 41.8%, uric acid in 33.3%, calcium oxalate/uric acid in 34.3% and cystine in 78.1%. Precision rates for struvite (15.6%), calcium phosphate (0%) and mixed calcium oxalate/calcium phosphate (9.3%) were quite low. CONCLUSIONS Observation of the stone during the endoscopic procedure was not reliable to identify the composition of most stones although it gave some information allowing to identify with a good sensitivity calcium oxalate dihydrate and cystine stones. Nevertheless, photo or video reporting of the intact stone and its internal structure could should be encouraged to implement results of still mandatory post-operative stone analysis. Endourologists should improve their ability of visual identification of the different types of stones.
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Oestreich MC, Vernooij RW, Sathianathen NJ, Hwang EC, Kuntz GM, Koziarz A, Scales CD, Dahm P. Alpha-blockers after shock wave lithotripsy for renal or ureteral stones in adults. Cochrane Database Syst Rev 2020; 11:CD013393. [PMID: 33179245 PMCID: PMC8092672 DOI: 10.1002/14651858.cd013393.pub2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND Shock wave lithotripsy (SWL) is a widely used method to treat renal and ureteral stone. It fragments stones into smaller pieces that are then able to pass spontaneously down the ureter and into the bladder. Alpha-blockers may assist in promoting the passage of stone fragments, but their effectiveness remains uncertain. OBJECTIVES: To assess the effects of alpha-blockers as adjuvant medical expulsive therapy plus usual care compared to placebo and usual care or usual care alone in adults undergoing shock wave lithotripsy for renal or ureteral stones. SEARCH METHODS We performed a comprehensive literature search of the Cochrane Library, the Cochrane Database of Systematic Reviews, MEDLINE, Embase, several clinical trial registries and grey literature for published and unpublished studies irrespective of language. The date of the most recent search was 27 February 2020. SELECTION CRITERIA We included randomized controlled trials of adults undergoing SWL. Participants in the intervention group had to have received an alpha-blocker as adjuvant medical expulsive therapy plus usual care. For the comparator group, we considered studies in which participants received placebo. DATA COLLECTION AND ANALYSIS Two review authors independently selected studies for inclusion/exclusion, and performed data abstraction and risk of bias assessment. We conducted meta-analysis for the identified dichotomous and continuous outcomes using RevManWeb according to Cochrane methods using a random-effects model. We judged the certainty of evidence on a per outcome basis using GRADE. MAIN RESULTS We included 40 studies with 4793 participants randomized to usual care and an alpha-blocker versus usual care alone. Only four studies were placebo controlled. The mean age of participants was 28.6 to 56.8 years and the mean stone size prior to SWL was 7.1 mm to 13.2 mm. The most widely used alpha-blocker was tamsulosin; others were silodosin, doxazosin, terazosin and alfuzosin. Alpha-blockers may improve clearance of stone fragments after SWL (risk ratio (RR) 1.16, 95% confidence interval (CI) 1.09 to 1.23; I² = 78%; studies = 36; participants = 4084; low certainty evidence). Based on the stone clearance rate of 69.3% observed in the control arm, an alpha-blocker may increase stone clearance to 80.4%. This corresponds to 111 more (62 more to 159 more) participants per 1000 clearing their stone fragments. Alpha-blockers may reduce the need for auxiliary treatments after SWL (RR 0.67, 95% CI 0.45 to 1.00; I² = 16%; studies = 12; participants = 1251; low certainty evidence), but also includes the possibility of no effect. Based on a rate of auxiliary treatments in the usual care arm of 9.7%, alpha-blockers may reduce the rate to 6.5%. This corresponds 32 fewer (53 fewer to 0 fewer) participants per 1000 undergoing auxiliary treatments. Alpha-blockers may reduce major adverse events (RR 0.60, 95% CI 0.46 to 0.80; I² = 0%; studies = 7; participants = 747; low certainty evidence). Major adverse events occurred in 25.8% of participants in the usual care group; alpha-blockers would reduce this to 15.5%. This corresponds to 103 fewer (139 fewer to 52 fewer) major adverse events per 1000 with alpha-blocker treatment. None of the reported major adverse events appeared drug-related; most were emergency room visits or rehospitalizations. Alpha-blockers may reduce stone clearance time in days (mean difference (MD) -3.74, 95% CI -5.25 to -2.23; I² = 86%; studies = 14; participants = 1790; low certainty evidence). We found no evidence for the outcome of quality of life. For those outcomes for which we were able to perform subgroup analyses, we found no evidence of interaction with stone location, stone size or type of alpha-blocker. We were unable to conduct an analysis by lithotripter type. The results were also largely unchanged when the analyses were limited to placebo controlled studies and those in which participants explicitly only received a single SWL session. AUTHORS' CONCLUSIONS Based on low certainty evidence, adjuvant alpha-blocker therapy following SWL in addition to usual care may result in improved stone clearance, less need for auxiliary treatments, fewer major adverse events and a reduced stone clearance time compared to usual care alone. We did not find evidence for quality of life. The low certainty of evidence means that our confidence in the effect estimate is limited; the true effect may be substantially different from the estimate of the effect.
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Affiliation(s)
- Makinna C Oestreich
- University of Minnesota Medical School, University of Minnesota, Minneapolis, Minnesota, USA
| | - Robin Wm Vernooij
- Department of Nephrology and Hypertension, University Medical Center Utrecht, Utrecht, Netherlands
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | | | - Eu Chang Hwang
- Department of Urology, Chonnam National University Medical School, Chonnam National University Hwasun Hospital, Hwasun, Korea, South
- Institute of Evidence Based Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea, South
| | - Gretchen M Kuntz
- Borland Health Sciences Library, University of Florida-Jacksonville, Jacksonville, Florida, USA
| | - Alex Koziarz
- Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Charles D Scales
- Department of Urology, Duke University School of Medicine, Durham, North Carolina, USA
| | - Philipp Dahm
- Urology Section, Minneapolis VA Health Care System, Minneapolis, Minnesota, USA
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Adel Atta M, Abdeldaeim HM, Hashad MME, Shabaan MS. Colour-coded density-gradients stone mapping: A novel reporting system for stone density on non-contrast computed tomography and its clinical applications. Arab J Urol 2020; 18:247-251. [PMID: 33312736 PMCID: PMC7717598 DOI: 10.1080/2090598x.2020.1784601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/29/2022] Open
Abstract
Objective To presents a novel clinically oriented system to report stone attenuation on non-contrast computed tomography (NCCT) using colour-coded density-gradients stone mapping and its clinical applications. Patients and methods This study was performed on 50 patients with 63 stones. All patients had a recent history of failed shockwave lithotripsy (SWL) or failed dissolution therapy by alkalinisation of urine for radiolucent stones. A multi-detector NCCT examination of the abdomen and pelvis was performed in all patients. The stones were isolated and displayed in 'Volume Rendering Technique' using four-colour encoding. Results Eight patients with failed dissolution therapy for radiolucent stones showed an outer layer of >500 Hounsfield units (HU) or a heterogeneous composition. A total of 42 patients with failed SWL had mean attenuations of <1000 HU on NCCT. Subsequent colour-coded stone mapping showed a dense core in all stones (>1000 HU) that failed to be clearly demonstrated by the mean HU alone. Conclusion The initial use of a colour-coded density-gradients stone mapping reporting system for stone density on NCCT is useful for explaining failure of SWL or failure of dissolution therapy for radiolucent stones in selected cases.Abbreviations: HU: Hounsfield units; MSD: mean stone density; NCCT: non-contrast computed tomography; PCNL: percutaneous nephrolithotomy; SWL: shockwave lithotripsy; VRT: Volume Rendering Technique.
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Karve PM, Duddu R, Tierney J, Dei K, Hsi R, Byram B. On the Effects of Constitutive Properties and Roughness of a Hard Inclusion in Soft Tissue on B-mode Images. ULTRASONIC IMAGING 2020; 42:159-176. [PMID: 32362201 DOI: 10.1177/0161734620917306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
We perform finite element modeling of pulse-echo ultrasound of a hard inclusion in a soft tissue to gain a better understanding of B-mode image brightness characteristics. We simulate a pressure wave emitted by an ultrasound transducer through the inclusion-tissue medium by prescribing suitable boundary conditions, and collect the scattered wave response to simulate the behavior of the transducer array used for pulse-echo ultrasound. We form B-mode images from simulated channel data using standard delay and sum beamforming. We establish the accuracy of the finite element model by comparing the point spread function with that obtained from Field II ultrasound simulation program. We also demonstrate qualitative validation by comparing the brightness characteristics of rough and smooth surfaced circular inclusions with experimental images of a cylindrical metal tool immersed in a water tank. We next conduct simulation studies to evaluate changes in B-mode image brightness intensity and contrast related to different constitutive properties, namely, compressibility of the inclusion, impedance contrast between the host and inclusion, and surface roughness of the inclusion. We find that the intensity observed behind a hard inclusion in the axial direction is strongly affected by the compressibility and roughness of the inclusion. Also, the perceived width of the stone based on the intensity is greater for rougher stones. Our study indicates that imaging of compressible inclusions may benefit from targeted B-mode image forming algorithms. Our modeling framework can potentially be useful in differentiating hard inclusions from surrounding parenchyma, and for classifying kidney stones or gallstones.
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Affiliation(s)
- Pranav M Karve
- Department of Civil and Environmental Engineering, Vanderbilt University, Nashville, TN, USA
| | - Ravindra Duddu
- Department of Civil and Environmental Engineering, Vanderbilt University, Nashville, TN, USA
| | - Jaime Tierney
- Department of Biomedical Engineering, Vanderbilt University, Nashville, TN, USA
| | - Kazuyuki Dei
- Department of Biomedical Engineering, Vanderbilt University, Nashville, TN, USA
| | - Ryan Hsi
- Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Brett Byram
- Department of Biomedical Engineering, Vanderbilt University, Nashville, TN, USA
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Cui HW, Silva MD, Mills AW, North BV, Turney BW. Predicting shockwave lithotripsy outcome for urolithiasis using clinical and stone computed tomography texture analysis variables. Sci Rep 2019; 9:14674. [PMID: 31604986 PMCID: PMC6788981 DOI: 10.1038/s41598-019-51026-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Accepted: 08/14/2019] [Indexed: 11/09/2022] Open
Abstract
We aimed to develop and evaluate a statistical model, which included known pre-treatment factors and new computed tomography texture analysis (CTTA) variables, for its ability to predict the likelihood of a successful outcome after extracorporeal shockwave lithotripsy (SWL) treatment for renal and ureteric stones. Up to half of patients undergoing SWL may fail treatment. Better prediction of which cases will likely succeed SWL will help patients to make an informed decision on the most effective treatment modality for their stone. 19 pre-treatment factors for SWL success, including 6 CTTA variables, were collected from 459 SWL cases at a single centre. Univariate and multivariable analyses were performed by independent statisticians to predict the probability of a stone free (both with and without residual fragments) outcome after SWL. A multivariable model had an overall accuracy of 66% on Receiver Operator Curve (ROC) analysis to predict for successful SWL outcome. The variables most frequently chosen for the model were those which represented stone size. Although previous studies have suggested SWL can be reliably predicted using pre-treatment factors and that analysis of CT stone images may improve outcome prediction, the results from this study have not produced a useful model for SWL outcome prediction.
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Affiliation(s)
- Helen W Cui
- Oxford Stone Group, Nuffield Department of Surgical Sciences, University of Oxford, Oxford, United Kingdom.
| | | | | | | | - Benjamin W Turney
- Oxford Stone Group, Nuffield Department of Surgical Sciences, University of Oxford, Oxford, United Kingdom
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Oestreich MC, Sathianathen NJ, Hwang EC, Vernooij RWM, Kuntz GM, Scales CD, Dahm P. Alpha-blockers after shock wave lithotripsy for renal or ureteral stones in adults. Hippokratia 2019. [DOI: 10.1002/14651858.cd013393] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Makinna C Oestreich
- University of Minnesota; University of Minnesota Medical School; Minneapolis Minnesota USA
| | | | - Eu Chang Hwang
- Chonnam National University Medical School, Chonnam National University Hwasun Hospital; Department of Urology; Hwasun Korea, South
- Yonsei University Wonju College of Medicine; Institute of Evidence Based Medicine; Wonju Korea, South
| | - Robin WM Vernooij
- University Medical Center Utrecht; Department of Nephrology and Hypertension; Utrecht Netherlands
- University Medical Center Utrecht, Utrecht University; Julius Center for Health Sciences and Primary Care; Utrecht Netherlands
| | - Gretchen M Kuntz
- University of Florida-Jacksonville; Borland Health Sciences Library; 653-1 West Eight St. 2nd FL LRC Jacksonville Florida USA 32209
| | - Charles D Scales
- Duke University School of Medicine; Department of Urology; Durham North Carolina USA
| | - Philipp Dahm
- Minneapolis VA Health Care System; Urology Section; One Veterans Drive Mail Code 112D Minneapolis Minnesota USA 55417
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Talso M, Tefik T, Mantica G, Rodriguez Socarras M, Kartalas Goumas I, Somani BK, Esperto F. Extracorporeal shockwave lithotripsy: current knowledge and future perspectives. MINERVA UROL NEFROL 2019; 71:365-372. [DOI: 10.23736/s0393-2249.19.03415-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Pishchalnikov YA, Behnke-Parks WM, Schmidmayer K, Maeda K, Colonius T, Kenny TW, Laser DJ. High-speed video microscopy and numerical modeling of bubble dynamics near a surface of urinary stone. THE JOURNAL OF THE ACOUSTICAL SOCIETY OF AMERICA 2019; 146:516. [PMID: 31370610 PMCID: PMC6660306 DOI: 10.1121/1.5116693] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Revised: 06/21/2019] [Accepted: 06/26/2019] [Indexed: 05/09/2023]
Abstract
Ultra-high-speed video microscopy and numerical modeling were used to assess the dynamics of microbubbles at the surface of urinary stones. Lipid-shell microbubbles designed to accumulate on stone surfaces were driven by bursts of ultrasound in the sub-MHz range with pressure amplitudes on the order of 1 MPa. Microbubbles were observed to undergo repeated cycles of expansion and violent collapse. At maximum expansion, the microbubbles' cross-section resembled an ellipse truncated by the stone. Approximating the bubble shape as an oblate spheroid, this study modeled the collapse by solving the multicomponent Euler equations with a two-dimensional-axisymmetric code with adaptive mesh refinement for fine resolution of the gas-liquid interface. Modeled bubble collapse and high-speed video microscopy showed a distinctive circumferential pinching during the collapse. In the numerical model, this pinching was associated with bidirectional microjetting normal to the rigid surface and toroidal collapse of the bubble. Modeled pressure spikes had amplitudes two-to-three orders of magnitude greater than that of the driving wave. Micro-computed tomography was used to study surface erosion and formation of microcracks from the action of microbubbles. This study suggests that engineered microbubbles enable stone-treatment modalities with driving pressures significantly lower than those required without the microbubbles.
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Affiliation(s)
- Yuri A Pishchalnikov
- Applaud Medical, Incorporated, 953 Indiana Street, San Francisco, California 94107, USA
| | | | - Kevin Schmidmayer
- Division of Engineering and Applied Science, California Institute of Technology, Pasadena, California 91125, USA
| | - Kazuki Maeda
- Division of Engineering and Applied Science, California Institute of Technology, Pasadena, California 91125, USA
| | - Tim Colonius
- Division of Engineering and Applied Science, California Institute of Technology, Pasadena, California 91125, USA
| | - Thomas W Kenny
- Department of Mechanical Engineering, Stanford University, Stanford, California 94305, USA
| | - Daniel J Laser
- Applaud Medical, Incorporated, 953 Indiana Street, San Francisco, California 94107, USA
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Moen T, Ferrero A, McCollough C. Robustness of Textural Features to Predict Stone Fragility Across Computed Tomography Acquisition and Reconstruction Parameters. Acad Radiol 2019; 26:885-892. [PMID: 30287145 DOI: 10.1016/j.acra.2018.08.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Revised: 08/06/2018] [Accepted: 08/10/2018] [Indexed: 11/27/2022]
Abstract
RATIONALE AND OBJECTIVES Previous studies have demonstrated that quantitative relationships exist between stone fragility at lithotripsy and morphological features extracted from computed tomography (CT) scans. The goal of this study was to determine if variations in scanner model, patient size, radiation dose, or reconstruction parameters impact the accuracy of the prediction of renal stone fragility in an in vitro model. MATERIALS AND METHODS Sixty-seven kidney stones were scanned using routine single and dual energy stone protocols, mimicking average, and large patient habitus. Low dose scans were also performed. Each scan was reconstructed with routine protocol parameters, and with thinner (0.6 mm) or thicker (3 mm) images, two different reconstruction kernels, and iterative reconstruction at two strengths. Fragility of each stone was measured in a controlled ex vivo experiment. A single predictive model was developed from a reference CT protocol configuration and applied to data from each CT acquisition and reconstruction parameter tested to obtain estimated stone comminution times. RESULTS None of the investigated protocols showed a significant variation in the accuracy of stone fragility classification, except for the ones with the most aggressive iterative reconstruction and/or with thicker images. In these protocols, a number of stone fragility assessments changed from fragile to hard (or vice versa), compared to their ground truth measurement. CONCLUSION Prediction accuracy of stone fragility models developed from CT data is robust to expected variations in CT stone protocols used for quantification tasks. This finding facilitates their future adoption to different clinical practices.
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Manzoor MAP, Agrawal AK, Singh B, Mujeeburahiman M, Rekha PD. Morphological characteristics and microstructure of kidney stones using synchrotron radiation μCT reveal the mechanism of crystal growth and aggregation in mixed stones. PLoS One 2019; 14:e0214003. [PMID: 30901364 PMCID: PMC6430423 DOI: 10.1371/journal.pone.0214003] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Accepted: 03/05/2019] [Indexed: 11/19/2022] Open
Abstract
Understanding the mechanisms of kidney stone formation, development patterns and associated pathological features are gaining importance due to an increase in the prevalence of the disease and diversity in the presentation of the stone composition. Based on the microstructural characteristics of kidney stones, it may be possible to explain the differences in the pathogenesis of pure and mixed types of stones. In this study, the microstructure and distribution of mineral components of kidney stones of different mineralogy (pure and mixed types) were analyzed. The intact stones removed from patients were investigated using synchrotron radiation X-ray computed microtomography (SR-μCT) and the tomography slice images were reconstructed representing the density and structure distribution at various elevation planes. Infrared (IR) spectroscopes, X-ray diffraction (XRD) and scanning electron microscopy (SEM) were used to confirm the bulk mineral composition in the thin section stones. Observations revealed differences in the micro-morphology of the kidney stones with similar composition in the internal 3-D structure. Calcium oxalate monohydrate stones showed well-organised layering patterns, while uric acid stones showed lower absorption signals with homogenous inner structure. Distinct mineral phases in the mixed types were identified based on the differential absorption rates. The 3-D quantitative analysis of internal porosity and spatial variation between nine different types of stones were compared. The diversity among the microstructure of similar and different types of stones shows that the stone formation is complex and may be governed by both physiological and micro-environmental factors. These factors may predispose a few towards crystal aggregation and stone growth, while, in others the crystals may not establish stable attachment and/or growth.
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Affiliation(s)
- Muhammed A. P. Manzoor
- Yenepoya Research Centre, Yenepoya (Deemed to be University), Mangalore, Karnataka, India
- Department of Urology, Yenepoya Medical College, Yenepoya (Deemed to be University), Mangalore, Karnataka, India
| | - Ashish K. Agrawal
- Technical Physics Division, Bhabha Atomic Research Centre, Indore-Mumbai, India
| | - Balwant Singh
- Technical Physics Division, Bhabha Atomic Research Centre, Indore-Mumbai, India
| | - M. Mujeeburahiman
- Department of Urology, Yenepoya Medical College, Yenepoya (Deemed to be University), Mangalore, Karnataka, India
| | - Punchappady-Devasya Rekha
- Yenepoya Research Centre, Yenepoya (Deemed to be University), Mangalore, Karnataka, India
- * E-mail: ,
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Liu R, Su W, Chen X, Yin W, Gong J, Lu J. Quantification and differentiation of composition of mixed pancreatic duct stones using single-source dual-energy CT: an ex vivo study. Abdom Radiol (NY) 2019; 44:984-991. [PMID: 30474724 DOI: 10.1007/s00261-018-1837-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
PURPOSE To evaluate the feasibility of using single-source dual-energy CT (SS DECT) to quantify and differentiate calcium carbonate (CA) and non-calcium carbonate (NCA) components of pancreatic duct stones (PDS) with mixed composition. MATERIALS AND METHODS A total of 12 PDS harvested from general surgery department in our hospital were analyzed with micro-CT as a reference standard for CA and NCA composition. These stones were placed in a TOS water phantom of 35 cm diameter to simulate standard adult body size. High- and low-energy image sets were acquired from SS DECT scans with high/low tube potential pairs of 80 kVp/140 kVp. All the image sets were imported into an in-house software for further post-processing. CT number ratio (CTR), defined as the ratio of the CT number at 80 kVp to 140 kVp was calculated for each pixel of the images. Threshold was preset between 1.00 and 1.25 to classify CA and NCA components. Pixels in PDS with CTR higher than the threshold were classified as CA, and those with CTR lower than the threshold were classified as NCA. The percentages of CA and NCA for each stone were determined by calculating the number of CA and NCA pixels. Finally, the minimal, maximal and root-mean-square errors (RMSE) of composition measured by SS DECT under each threshold were calculated by referring to the composition data from micro-CT. The optimal threshold was determined with the minimal RMSE. A paired t test was used to compare the stone composition determined by DECT with micro-CT. RESULTS The optimal CTR threshold was 1.16, with RMSE of 6.0%. The minimum and maximum absolute errors were 0.22% and 11.35%, respectively. Paired t test showed no significant difference between DECT and micro-CT for characterizing CA and NCA composition (p = 0.414). CONCLUSION SS DECT is a potential approach for quantifying and differentiating CA and NCA components in PDS with mixed composition.
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Affiliation(s)
- Ri Liu
- Department of Radiology, Changhai Hospital Affiliated to the Naval Military Medical University, Changhai Road 168, Yangpu District, Shanghai, 200433, People's Republic of China
| | - Weiwei Su
- Department of Nuclear Medicine, Changhai Hospital Affiliated to the Naval Military Medical University, Changhai Road 168, Yangpu District, Shanghai, 200433, People's Republic of China
| | - Xingbiao Chen
- Clinical Science, Philips Healthcare, No 718 Lingshi Road, JingAn District, Shanghai, 201100, People's Republic of China
| | - Wei Yin
- Department of Radiology, Changhai Hospital Affiliated to the Naval Military Medical University, Changhai Road 168, Yangpu District, Shanghai, 200433, People's Republic of China
| | - Jing Gong
- Department of Radiology, Changhai Hospital Affiliated to the Naval Military Medical University, Changhai Road 168, Yangpu District, Shanghai, 200433, People's Republic of China.
| | - Jianping Lu
- Department of Radiology, Changhai Hospital Affiliated to the Naval Military Medical University, Changhai Road 168, Yangpu District, Shanghai, 200433, People's Republic of China.
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Talso M, Emiliani E, Froio S, Gallioli A, Forzenigo L, Pradere B, Traxer O, Somani BK, Montanari E. Low-dose CT scan in stone detection for stone treatment follow-up: is there a relation between stone composition and radiation delivery? Study on a porcine-kidney model. MINERVA UROL NEFROL 2018; 71:63-71. [PMID: 30547905 DOI: 10.23736/s0393-2249.18.03265-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Non-contrast CT scan (NCCT) is becoming the standard imaging modality in urinary stone disease. Radiation dose remains an issue, especially for those patients who may need to undergo several CT scans for this indication during their lifetime. Low-dose and ultra-low-dose protocols exist, but there is limited data on the relationship between the minimum radiation dose capable of detecting stone fragments and stone composition. METHODS Seven different kinds of human kidney stone were selected. Fragments of 1, 2, 4 and 7 mm were obtained for each stone. Four fragments of the same material were placed in a porcine kidney. A CT scan was then used to scan the kidney at decreasing dosages of 140, 70, 30, 15 and 7mAs. The scans were repeated for each type of stone. Images were reviewed by two radiologists independently with the intent of identifying the stone composition and providing information on its position, dimensions and Hounsfield units (HU). RESULTS All types of stone were visible at all settings. Only the 1-mm uric-acid fragment was not detected by both radiologists at 7 and 15 mAs. Dose Length product (DLP) decreased with the reduction in mAs. In terms of HU a statistically significant difference was observed between calcium-based and non-calcium-based stones. Stone dimensions and HU were not affected by the reductions in mAs. CONCLUSIONS Ultra-low-dose CT has a good detection rate for all kinds of stone, even when the fragment size is small. Only small uric acid fragments need higher energy settings in order to be detected. When the stone composition is known after surgery for urolithiasis, the most appropriate CT scan setting could be suggested by the urologist during their follow-up.
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Affiliation(s)
- Michele Talso
- Urology Department, Fondazione IRCSS Ca' Granda, Ospedale Maggiore Policlinico, University of Milan, Milan, Italy - .,Urology Department, ASST Vimercate Hospital, Vimercate, Monza Brianza, Italy -
| | - Estenan Emiliani
- Urology Department, Fundación Puigvert, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - Sara Froio
- Intensive Care Unit, ASST Santi Paolo e Carlo, University of Milan, Milan, Italy
| | - Andrea Gallioli
- Urology Department, Fondazione IRCSS Ca' Granda, Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Laura Forzenigo
- Radiology Department, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Benjamin Pradere
- Urology Department, Tenon Hospital, Sorbonne University, Paris, France
| | - Olivier Traxer
- Urology Department, Tenon Hospital, Sorbonne University, Paris, France
| | - Bhaskar K Somani
- Urology Department, University Hospital Southampton NHS Trust, Southampton, UK
| | - Emanuele Montanari
- Urology Department, Fondazione IRCSS Ca' Granda, Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
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Noncontrast Computed Tomography Parameters for Predicting Shock Wave Lithotripsy Outcome in Upper Urinary Tract Stone Cases. BIOMED RESEARCH INTERNATIONAL 2018; 2018:9253952. [PMID: 30627582 PMCID: PMC6304629 DOI: 10.1155/2018/9253952] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Revised: 11/07/2018] [Accepted: 11/13/2018] [Indexed: 11/17/2022]
Abstract
Kidney stones are a major public health concern with continuously increasing worldwide prevalence. Shock wave lithotripsy (SWL) is the first line treatment choice for upper urinary tract calculi with ureteroscopy and has advantages of safety and noninvasiveness, but the treatment success rate of SWL is lower than that of other therapies. It is therefore important to identify predictive factors for SWL outcome and select a suitable treatment choice for patients with upper urinary tract calculi. In recent years, computed tomography (CT) has become the gold standard for diagnosis of upper urinary tract calculi. Several factors based on CT images, including skin-to-stone distance, mean stone density, stone heterogeneity index, and variation coefficient of stone density, have been reported to be useful for predicting SWL outcome. In addition, a new method of analysis, CT texture analysis, is reportedly useful for predicting SWL outcomes. This review aims to summarize CT parameters for predicting the outcome of shock wave lithotripsy in stone cases in the upper urinary tract.
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Single extracorporeal shock-wave lithotripsy for proximal ureter stones: Can CT texture analysis technique help predict the therapeutic effect? Eur J Radiol 2018; 107:84-89. [PMID: 30292278 DOI: 10.1016/j.ejrad.2018.08.018] [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] [Received: 07/11/2018] [Revised: 08/13/2018] [Accepted: 08/21/2018] [Indexed: 01/08/2023]
Abstract
PURPOSE To explore whether the computed tomography texture analysis (CTTA) technique can help predict the curative effects of a single extracorporeal shock-wave lithotripsy (ESWL) for proximal ureteral stones. MATERIALS AND METHODS In all, 100 patients with proximal ureteral stone underwent non-enhanced multi-detector computed tomography (MDCT) before ESWL. The patients were divided into success and failure groups. Success of ESWL was defined as the patients being stone-free or having residual stone fragments of ≤2 mm. Traditional characteristics, such as stone size, body mass index (BMI), and skin-to-stone distance (SSD), and CTTA metrics, such as the mean Hounsfield unit (HU) density, entropy, kurtosis, and skewness, were analyzed and compared between two groups by univariate and multivariate logistic regression analyses. Receiver operating characteristic (ROC) curves were generated to determine Youden index-based cutoff values. RESULT Failure of stone removal was observed in 36 patients (36%). Stone height, stone cross-sectional diameter, largest cross-sectional area, stone volume, stone density (mean HU), and CTTA metrics (kurtosis and entropy) were the significant independent predictors of ESWL success on univariate analysis (p < 0.05). On multivariate analysis, mean HU, skewness, and kurtosis were shown to be significant predictors of ESWL success (p < 0.05). In subgroup analysis based on the cutoff value of mean stone density (HU = 857), the only significant independent factor associated with both subgroups was kurtosis (p < 0.05). CONCLUSIONS As a quantitative analysis method, CTTA may be helpful in selecting appropriate ESWL patients. High kurtosis and low mean HU values simultaneously indicate a relatively higher ESWL success rate.
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Accuracy of Ex Vivo Semiautomatic Segmentation of Urinary Stone Size in Computed Tomography Compared With Manual Size Estimation in Radiographic Correlation. Urology 2018; 123:70-75. [PMID: 30076939 DOI: 10.1016/j.urology.2018.06.044] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Revised: 05/06/2018] [Accepted: 06/12/2018] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To evaluate the accuracy of semiautomated segmentation of urinary stone size in computed tomography (CT) compared with manual measurement. MATERIALS AND METHODS A total of 103 patients (32f, 71m ; mean age 52 years±18 that were diagnosed with urolithiasis and collected stones received standardized ex vivo CT-scans and radiography of the stones. Stone size was segmented semiautomatically using commercial software (syngo.via, Siemens, Germany) and compared with manual caliper measurement on digital radiography. RESULTS Mean size was 4.4 mm in CT and 4.6 mm in radiography. Depending on number of stones analyzed per patient, estimation of stone size showed moderate to excellent correlation for both methods. There was no significant difference in overall size measurement. CONCLUSION Semiautomatic segmentation of urinary stone size in CT is possible and reduces measurement errors, allowing more precise estimation especially for smaller concrements. Neighboring stones may hamper segmentation of stone size.
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Advanced non-contrasted computed tomography post-processing by CT-Calculometry (CT-CM) outperforms established predictors for the outcome of shock wave lithotripsy. World J Urol 2018; 36:2073-2080. [PMID: 29845319 DOI: 10.1007/s00345-018-2348-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2018] [Accepted: 05/18/2018] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVES To evaluate the predictive value of advanced non-contrasted computed tomography (NCCT) post-processing using novel CT-calculometry (CT-CM) parameters compared to established predictors of success of shock wave lithotripsy (SWL) for urinary calculi. MATERIALS AND METHODS NCCT post-processing was retrospectively performed in 312 patients suffering from upper tract urinary calculi who were treated by SWL. Established predictors such as skin to stone distance, body mass index, stone diameter or mean stone attenuation values were assessed. Precise stone size and shape metrics, 3-D greyscale measurements and homogeneity parameters such as skewness and kurtosis, were analysed using CT-CM. Predictive values for SWL outcome were analysed using logistic regression and receiver operating characteristics (ROC) statistics. RESULTS Overall success rate (stone disintegration and no re-intervention needed) of SWL was 59% (184 patients). CT-CM metrics mainly outperformed established predictors. According to ROC analyses, stone volume and surface area performed better than established stone diameter, mean 3D attenuation value was a stronger predictor than established mean attenuation value, and parameters skewness and kurtosis performed better than recently emerged variation coefficient of stone density. Moreover, prediction of SWL outcome with 80% probability to be correct would be possible in a clearly higher number of patients (up to fivefold) using CT-CM-derived parameters. CONCLUSIONS Advanced NCCT post-processing by CT-CM provides novel parameters that seem to outperform established predictors of SWL response. Implementation of these parameters into clinical routine might reduce SWL failure rates.
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Lee JS, Cho KS, Lee SH, Yoon YE, Kang DH, Jeong WS, Jung HD, Kwon JK, Lee JY. Stone heterogeneity index on single-energy noncontrast computed tomography can be a positive predictor of urinary stone composition. PLoS One 2018; 13:e0193945. [PMID: 29649219 PMCID: PMC5896902 DOI: 10.1371/journal.pone.0193945] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Accepted: 02/05/2018] [Indexed: 01/09/2023] Open
Abstract
The aim of this study was to investigate the correlation between stone composition and single-energy noncontrast computed tomography (NCCT) parameters, including stone heterogeneity index (SHI) and mean stone density (MSD), in patients with urinary calculi. We retrospectively reviewed medical records of 255 patients who underwent operations or procedures for urinary stones or had spontaneous stone passage between December 2014 and October 2015. Among these, 214 patients with urinary calculi who underwent NCCT and stone composition analyses were included in the study. Maximal stone length (MSL), mean stone density (MSD), and stone heterogeneity index (SHI) were determined on pretreatment NCCT. The mean MSD (454.68±177.80 HU) and SHI (115.82±96.31 HU) of uric acid stones were lower than those of all other types. Based on post hoc tests, MSD was lower for uric acid stones than for the other types (vs. CaOx: P<0.001; vs. infection stones: P<0.001). SHI was lower for uric acid stones than for the other types (vs. CaOx: P<0.001; vs. infection stones: P<0.001) Receiver operating characteristic curves of uric acid stones for MSD and SHI demonstrated that SHI (cut-off value: 140.4 HU) was superior to MSD (cut-off value: 572.3 HU) in predicting uric acid stones (P<0.001).
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Affiliation(s)
- Jong Soo Lee
- Department of Urology, Severance Hospital, Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Kang Su Cho
- Department of Urology, Gangnam Severance Hospital, Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Seung Hwan Lee
- Department of Urology, Severance Hospital, Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Young Eun Yoon
- Department of Urology, Hanyang University College of Medicine, Seoul, Korea
| | - Dong Hyuk Kang
- Department of Urology, Inha University School of Medicine, Incheon, Korea
| | - Won Sik Jeong
- Department of Urology, Kwangju Christian Hospital, Gwangju, Korea
| | - Hae Do Jung
- Department of Urology, Yongin Severance Hospital, Yonsei University Health System, Yongin, Korea
| | - Jong Kyou Kwon
- Department of Urology, Severance Check-Up, Yonsei University Health System, Seoul, Korea
| | - Joo Yong Lee
- Department of Urology, Severance Hospital, Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
- * E-mail:
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Abstract
OBJECTIVE To determine whether dual-energy CT (DECT) could accurately differentiate the composition of common canine uroliths in a phantom model. SAMPLE 30 canine uroliths with pure compositions. PROCEDURES Each urolith was composed of ≥ 70% struvite (n = 10), urate (8), cystine (5), calcium oxalate (4), or brushite (3) as determined by standard laboratory methods performed at the Canadian Veterinary Urolith Centre. Uroliths were suspended in an agar phantom, and DECT was performed at low (80 kV) and high (140 kV) energies. The ability of low- and high-energy CT numbers, DECT number, and DECT ratio to distinguish uroliths on the basis of composition was assessed with multivariate ANOVA. RESULTS No single DECT measure differentiated all urolith types. The DECT ratio differentiated urate uroliths from all other types of uroliths. The DECT and low-energy CT numbers were able to differentiate between 8 and 7 pairs of urolith types, respectively. CONCLUSIONS AND CLINICAL RELEVANCE Results indicated that DECT was unable to differentiate common types of canine uroliths in an in vitro model; therefore, it is unlikely to be clinically useful for determining urolith composition in vivo. Given that the primary reasons for determining urolith composition in vivo are to predict response to shock wave lithotripsy and develop a treatment plan, future research should focus on the correlation between DECT measurements and urolith fragility rather than urolith composition.
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Cui HW, Devlies W, Ravenscroft S, Heers H, Freidin AJ, Cleveland RO, Ganeshan B, Turney BW. CT Texture Analysis of Ex Vivo Renal Stones Predicts Ease of Fragmentation with Shockwave Lithotripsy. J Endourol 2017; 31:694-700. [DOI: 10.1089/end.2017.0084] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Helen W. Cui
- Oxford Stone Group, University of Oxford, Oxford, United Kingdom
| | | | - Samuel Ravenscroft
- Division of Medical Sciences, University of Oxford, Oxford, United Kingdom
| | - Hendrik Heers
- Oxford Stone Group, University of Oxford, Oxford, United Kingdom
- Department of Urology and Paediatric Urology, Philipps-Universität Marburg, Marburg, Germany
| | - Andrew J. Freidin
- Kennedy Institute of Rheumatology, University of Oxford, Oxford, United Kingdom
| | - Robin O. Cleveland
- Department of Engineering Science, Institute of Biomedical Engineering, University of Oxford, Oxford, United Kingdom
| | - Balaji Ganeshan
- Division of Medicine, Institute of Nuclear Medicine, University College London, London, United Kingdom
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Abou-Elela A. Epidemiology, pathophysiology, and management of uric acid urolithiasis: A narrative review. J Adv Res 2017; 8:513-527. [PMID: 28748117 PMCID: PMC5512151 DOI: 10.1016/j.jare.2017.04.005] [Citation(s) in RCA: 64] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Revised: 04/16/2017] [Accepted: 04/25/2017] [Indexed: 12/31/2022] Open
Abstract
An in-depth comprehension of the epidemiology as well as pathophysiology of uric acid urolithiasis is important for the identification, treatment, and prophylaxis of calculi in these patients. Persistently low urinary pH, hyperuricosuria, and low urinary volume are the most important factors in pathogenesis of uric acid urolithiasis. Other various causes of calculus formation comprises of chronic diarrhea, renal hyperuricosuria, insulin resistance, primary gout, extra purine in the diet, neoplastic syndromes, and congenital hyperuricemia. Non-contrast-enhanced computed tomography is the radiologic modality of choice for early assessment of patients with renal colic. Excluding situations where there is acute obstruction, rising blood chemistry, severe infection, or unresolved pain, the initial management ought to be medical dissolution by oral chemolysis since this method has proved to be effective in most of the cases.
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Affiliation(s)
- A Abou-Elela
- Department Of Urology, Faculty Of Medicine, Cairo University, Kasr Al Ainy St., P.O. 11553, Cairo 11562, Egypt
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Yamashita S, Kohjimoto Y, Iguchi T, Nishizawa S, Iba A, Kikkawa K, Hara I. Variation Coefficient of Stone Density: A Novel Predictor of the Outcome of Extracorporeal Shockwave Lithotripsy. J Endourol 2017; 31:384-390. [DOI: 10.1089/end.2016.0719] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
| | - Yasuo Kohjimoto
- Department of Urology, Wakayama Medical University, Wakayama, Japan
| | - Takashi Iguchi
- Department of Urology, Wakayama Medical University, Wakayama, Japan
| | | | - Akinori Iba
- Department of Urology, Wakayama Medical University, Wakayama, Japan
| | - Kazuro Kikkawa
- Department of Urology, Wakayama Medical University, Wakayama, Japan
| | - Isao Hara
- Department of Urology, Wakayama Medical University, Wakayama, Japan
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37
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Urolithiasis: evaluation, dietary factors, and medical management: an update of the 2014 SIU-ICUD international consultation on stone disease. World J Urol 2017; 35:1331-1340. [DOI: 10.1007/s00345-017-2000-1] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Accepted: 01/02/2017] [Indexed: 01/13/2023] Open
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Ferrero A, Montoya JC, Vaughan LE, Huang AE, McKeag IO, Enders FT, Williams JC, McCollough CH. Quantitative Prediction of Stone Fragility From Routine Dual Energy CT: Ex vivo proof of Feasibility. Acad Radiol 2016; 23:1545-1552. [PMID: 27717761 DOI: 10.1016/j.acra.2016.07.016] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2016] [Revised: 06/20/2016] [Accepted: 07/06/2016] [Indexed: 11/19/2022]
Abstract
RATIONALE AND OBJECTIVES Previous studies have demonstrated a qualitative relationship between stone fragility and internal stone morphology. The goal of this study was to quantify morphologic features from dual-energy computed tomography (CT) images and assess their relationship to stone fragility. MATERIALS AND METHODS Thirty-three calcified urinary stones were scanned with micro-CT. Next, they were placed within torso-shaped water phantoms and scanned with the dual-energy CT stone composition protocol in routine use at our institution. Mixed low- and high-energy images were used to measure volume, surface roughness, and 12 metrics describing internal morphology for each stone. The ratios of low- to high-energy CT numbers were also measured. Subsequent to imaging, stone fragility was measured by disintegrating each stone in a controlled ex vivo experiment using an ultrasonic lithotripter and recording the time to comminution. A multivariable linear regression model was developed to predict time to comminution. RESULTS The average stone volume was 300 mm3 (range: 134-674 mm3). The average comminution time measured ex vivo was 32 seconds (range: 7-115 seconds). Stone volume, dual-energy CT number ratio, and surface roughness were found to have the best combined predictive ability to estimate comminution time (adjusted R2 = 0.58). The predictive ability of mixed dual-energy CT images, without use of the dual-energy CT number ratio, to estimate comminution time was slightly inferior, with an adjusted R2 of 0.54. CONCLUSIONS Dual-energy CT number ratios, volume, and morphologic metrics may provide a method for predicting stone fragility, as measured by time to comminution from ultrasonic lithotripsy.
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Affiliation(s)
- Andrea Ferrero
- Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905
| | - Juan C Montoya
- Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905
| | - Lisa E Vaughan
- Department of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota
| | - Alice E Huang
- Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905
| | - Ian O McKeag
- Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905
| | - Felicity T Enders
- Department of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota
| | - James C Williams
- Department of Anatomy and Cell Biology, Indiana University School of Medicine, Indianapolis, Indiana
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Christiansen FE, Andreassen KH, Osther SS, Osther PJS. Internal Structure of Kidney Calculi as a Predictor for Shockwave Lithotripsy Success. J Endourol 2015; 30:323-6. [PMID: 26537971 DOI: 10.1089/end.2015.0616] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION The internal structure of renal calculi can be determined on CT using bone windows and may be classified as homogeneous or inhomogeneous with void regions. In vitro studies have shown homogeneous stones to be less responsive to extracorporeal shockwave lithotripsy (SWL). The objective was to evaluate whether the internal morphology of calculi defined by CT bone window influences SWL outcome in vivo. MATERIALS AND METHODS One hundred eleven patients with solitary renal calculi treated with SWL were included. Treatment data were registered prospectively and follow-up data were collected retrospectively. All patients had noncontrast computed tomography (NCCT) performed before SWL and at 3-month follow-up. The stones were categorized as homogeneous or inhomogeneous. At follow-up, the patient's stone status was registered. Stone-free status was defined as no evidence of calculi on NCCT. Treatment was considered successful if the patient was either stone free or had clinically insignificant residual fragments. RESULTS Using simple logistic regression, the odds for being stone free 3 months post-SWL were significantly reduced in the patients with inhomogeneous stones compared with patients with homogeneous stones (odds ratio 0.43 [95% confidence interval 0.20, 0.92; p < 0.05]). However, when adjusting for stone size by multiple logistic regression, including stone size (area) as a covariate, this difference became insignificant. CONCLUSION The internal structure of kidney stones did not predict the outcome of SWL in vivo.
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Affiliation(s)
- Frederikke Eichner Christiansen
- Department of Urology, Urological Research Center, Lillebaelt Hospital, University of Southern Denmark , Fredericia, Denmark
| | - Kim Hovgaard Andreassen
- Department of Urology, Urological Research Center, Lillebaelt Hospital, University of Southern Denmark , Fredericia, Denmark
| | - Susanne Sloth Osther
- Department of Urology, Urological Research Center, Lillebaelt Hospital, University of Southern Denmark , Fredericia, Denmark
| | - Palle Joern Sloth Osther
- Department of Urology, Urological Research Center, Lillebaelt Hospital, University of Southern Denmark , Fredericia, Denmark
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Kawahara T, Miyamoto H, Ito H, Terao H, Kakizoe M, Kato Y, Ishiguro H, Uemura H, Yao M, Matsuzaki J. Predicting the mineral composition of ureteral stone using non-contrast computed tomography. Urolithiasis 2015; 44:231-9. [PMID: 26427864 DOI: 10.1007/s00240-015-0823-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2015] [Accepted: 09/08/2015] [Indexed: 10/23/2022]
Abstract
We investigated the correlation between computed tomography (CT) density of ureteral stones and their mineral composition. A total of 346 patients who underwent ureteroscopic lithotripsy for calculi all fragments of which were acquired at a single institution from 2009 to 2011 were analyzed. The maximum and mean CT densities were measured preoperatively. A mineral analysis revealed calcium oxalate in 203 (58.7 %), mixed calcium oxalate and calcium phosphate in 78 (23.0 %), calcium phosphate in 18 (5.2 %), uric acid in 8 (2.3 %), struvite in 3 (0.9 %), and cysteine in 5 (1.4 %). The mean Hounsfield units (HUs) of the CT density were 1046 HUs in calcium oxalate, 1101 HUs in mixed calcium oxalate and calcium phosphate, 835 HUs in calcium phosphate, 549 HUs in uric acid, 729 HUs in struvite, and 698 HUs in cystine. The HUs in calcium oxalate were significantly higher than those in uric acid (p < 0.01) and struvite (p < 0.01). Those in monohydrate stones were significantly higher, compared with dehydrate stones (p < 0.05). We analyzed the largest number of stones than each published study to correlate their mineral composition and CT density. Calcium component stones showed significantly higher CT densities than other types.
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Affiliation(s)
- Takashi Kawahara
- Department of Pathology and Laboratory Medicine, University of Rochester Medical Center, Rochester, NY, USA. .,Department of Urology, Yokohama City University Graduate School of Medicine, 3-9, Fukuura, Kanazawa-ku, Yokohama, Kanagawa, Japan. .,Department of Urology, Ohguchi Higashi General Hospital, Yokohama, Kanagawa, Japan.
| | - Hiroshi Miyamoto
- Department of Pathology and Laboratory Medicine, University of Rochester Medical Center, Rochester, NY, USA
| | - Hiroki Ito
- Department of Urology, Yokohama City University Graduate School of Medicine, 3-9, Fukuura, Kanazawa-ku, Yokohama, Kanagawa, Japan.,Department of Urology, Ohguchi Higashi General Hospital, Yokohama, Kanagawa, Japan
| | - Hideyuki Terao
- Department of Urology, Ohguchi Higashi General Hospital, Yokohama, Kanagawa, Japan
| | - Manabu Kakizoe
- Department of Urology, Ohguchi Higashi General Hospital, Yokohama, Kanagawa, Japan
| | - Yoshitake Kato
- Department of Urology, Ohguchi Higashi General Hospital, Yokohama, Kanagawa, Japan
| | - Hitoshi Ishiguro
- Department of Pathology and Laboratory Medicine, University of Rochester Medical Center, Rochester, NY, USA
| | - Hiroji Uemura
- Department of Urology, Yokohama City University Graduate School of Medicine, 3-9, Fukuura, Kanazawa-ku, Yokohama, Kanagawa, Japan
| | - Masahiro Yao
- Department of Urology, Yokohama City University Graduate School of Medicine, 3-9, Fukuura, Kanazawa-ku, Yokohama, Kanagawa, Japan
| | - Junichi Matsuzaki
- Department of Urology, Ohguchi Higashi General Hospital, Yokohama, Kanagawa, Japan
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Andrabi Y, Patino M, Das CJ, Eisner B, Sahani DV, Kambadakone A. Advances in CT imaging for urolithiasis. Indian J Urol 2015; 31:185-93. [PMID: 26166961 PMCID: PMC4495492 DOI: 10.4103/0970-1591.156924] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Urolithiasis is a common disease with increasing prevalence worldwide and a lifetime-estimated recurrence risk of over 50%. Imaging plays a critical role in the initial diagnosis, follow-up and urological management of urinary tract stone disease. Unenhanced helical computed tomography (CT) is highly sensitive (>95%) and specific (>96%) in the diagnosis of urolithiasis and is the imaging investigation of choice for the initial assessment of patients with suspected urolithiasis. The emergence of multi-detector CT (MDCT) and technological innovations in CT such as dual-energy CT (DECT) has widened the scope of MDCT in the stone disease management from initial diagnosis to encompass treatment planning and monitoring of treatment success. DECT has been shown to enhance pre-treatment characterization of stone composition in comparison with conventional MDCT and is being increasingly used. Although CT-related radiation dose exposure remains a valid concern, the use of low-dose MDCT protocols and integration of newer iterative reconstruction algorithms into routine CT practice has resulted in a substantial decrease in ionizing radiation exposure. In this review article, our intent is to discuss the role of MDCT in the diagnosis and post-treatment evaluation of urolithiasis and review the impact of emerging CT technologies such as dual energy in clinical practice.
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Affiliation(s)
- Yasir Andrabi
- Department of Radiology, Division of Abdominal Imaging and Intervention Radiology, Massachusetts General Hospital, Boston, MA, USA
| | - Manuel Patino
- Department of Radiology, Division of Abdominal Imaging and Intervention Radiology, Massachusetts General Hospital, Boston, MA, USA
| | - Chandan J Das
- Department of Radiology, All India Institute of Medical Sciences, New Delhi, India
| | - Brian Eisner
- Department of Urology, Massachusetts General Hospital, Boston, MA, USA
| | - Dushyant V Sahani
- Department of Radiology, Division of Abdominal Imaging and Intervention Radiology, Massachusetts General Hospital, Boston, MA, USA
| | - Avinash Kambadakone
- Department of Radiology, Division of Abdominal Imaging and Intervention Radiology, Massachusetts General Hospital, Boston, MA, USA
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Wang X, Krambeck AE, Williams JC, Tang X, Rule AD, Zhao F, Bergstralh E, Haskic Z, Edeh S, Holmes DR, Herrera Hernandez LP, Lieske JC. Distinguishing characteristics of idiopathic calcium oxalate kidney stone formers with low amounts of Randall's plaque. Clin J Am Soc Nephrol 2014; 9:1757-63. [PMID: 25092598 DOI: 10.2215/cjn.01490214] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Overgrowth of calcium oxalate on Randall's plaque is a mechanism of stone formation among idiopathic calcium oxalate stone-formers (ICSFs). It is less clear how stones form when there is little or no plaque. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS Participants were a consecutive cohort of ICSFs who underwent percutaneous nephroscopic papillary mapping in the kidney or kidneys containing symptomatic stones and a papillary tip biopsy from a representative calyx during a stone removal procedure between 2009 and 2013. The distribution of Randall's plaque coverage was analyzed and used to divide ICSFs into those with a high (≥5%; mean, 10.5%; n=10) versus low (<5%; mean, 1.5%; n=32) amount of plaque coverage per papilla. Demographic and laboratory features were compared between these two groups. RESULTS Low-plaque stone formers tended to be obese (50% versus 10%; P=0.03) and have a history of urinary tract infection (34% versus 0%; P=0.04). They were less likely to have multiple prior stone events (22% versus 80%; P=0.002) and had a lower mean 24-hour urine calcium excretion (187±86 mg versus 291±99 mg; P<0.01). Morphologically, stones from patients with low amounts of plaque lacked a calcium phosphate core by microcomputed tomography. Papillary biopsies from low plaque stone-formers revealed less interstitial and basement membrane punctate crystallization. CONCLUSIONS These findings suggest that other pathways independent of Randall's plaque may contribute to stone pathogenesis among a subgroup of ICSFs who harbor low amounts of plaque.
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Affiliation(s)
- Xiangling Wang
- Division of Nephrology and Hypertension, Department of Medicine
| | | | | | - Xiaojing Tang
- Division of Nephrology and Hypertension, Department of Medicine
| | - Andrew D Rule
- Division of Nephrology and Hypertension, Department of Medicine
| | - Fang Zhao
- Division of Nephrology and Hypertension, Department of Medicine
| | | | - Zejfa Haskic
- Division of Nephrology and Hypertension, Department of Medicine
| | - Samuel Edeh
- Division of Nephrology and Hypertension, Department of Medicine
| | - David R Holmes
- Department of Physiology and Biomedical Engineering, and
| | | | - John C Lieske
- Division of Nephrology and Hypertension, Department of Medicine, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota; and
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Zhou XJ, Zhang J, Zhang C, Xu CG. In vitro dissolution of calcium oxalate stones with ethylenediaminetetraacetic acid and snake venom thrombin-like enzyme. Urol Int 2013; 92:349-55. [PMID: 24246673 DOI: 10.1159/000353096] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2012] [Accepted: 05/05/2013] [Indexed: 11/19/2022]
Abstract
OBJECTIVE The aim of this study was to determine the feasibility of using snake venom thrombin-like enzyme (SVTLE) and/or ethylenediaminetetraacetic acid (EDTA) to dissolve calcium oxalate stones in vitro. METHODS Seven calcium oxalate stones were incubated with various chemolytic agents [EDTA, Tris-HCl/EDTA (TE) buffer or SVTLE diluted in TE buffer]. The pH, calcium concentration, stone weight and stone surface integrity were recorded, as well as related pathological changes to bladder mucosae. RESULTS Compared to all other solutions, those containing SVTLE and buffered EDTA had higher concentrations of mobilized calcium and caused significantly more stone weight loss, stone fragility and gaps in the calcium crystals. Also, there were no adverse pathological effects on rabbit bladder mucosae from any of the solutions. CONCLUSIONS The data indicate that buffered EDTA and SVTLE can be used to dissolve calcium oxalate stones and, at the concentrations used here, do not damage tissue.
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Affiliation(s)
- Xiang-Jun Zhou
- Department of Urology, Renmin Hospital of Wuhan University, Wuhan, PR China
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Garg M, Singh V, Sankhwar SN. Re: El-Assmy et al.: kidney stone size and Hounsfield units predict successful shockwave lithotripsy in children (Urology 2013;81:880-884). Urology 2013; 82:255. [PMID: 23806399 DOI: 10.1016/j.urology.2013.02.055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2013] [Revised: 02/24/2013] [Accepted: 02/26/2013] [Indexed: 11/17/2022]
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El-Assmy A, El-Nahas AR, Awad BA, Sheir KZ, Abou-El-Ghar ME. Reply by the authors. Urology 2013; 82:255-6. [PMID: 23806398 DOI: 10.1016/j.urology.2013.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2013] [Revised: 03/06/2013] [Accepted: 03/07/2013] [Indexed: 10/26/2022]
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Anastasiadis A, Onal B, Modi P, Turna B, Duvdevani M, Timoney A, Wolf JS, De La Rosette J. Impact of stone density on outcomes in percutaneous nephrolithotomy (PCNL): an analysis of the clinical research office of the endourological society (CROES) pcnl global study database. Scand J Urol 2013; 47:509-14. [PMID: 23781902 DOI: 10.3109/21681805.2013.803261] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVE This study aimed to explore the relationship between stone density and outcomes of percutaneous nephrolithotomy (PCNL) using the Clinical Research Office of the Endourological Society (CROES) PCNL Global Study database. MATERIAL AND METHODS Patients undergoing PCNL treatment were assigned to a low stone density [LSD, ≤ 1000 Hounsfield units (HU)] or high stone density (HSD, > 1000 HU) group based on the radiological density of the primary renal stone. Preoperative characteristics and outcomes were compared in the two groups. RESULTS Retreatment for residual stones was more frequent in the LSD group. The overall stone-free rate achieved was higher in the HSD group (79.3% vs 74.8%, p = 0.113). By univariate regression analysis, the probability of achieving a stone-free outcome peaked at approximately 1250 HU. Below or above this density resulted in lower treatment success, particularly at very low HU values. With increasing radiological stone density, operating time decreased to a minimum at approximately 1000 HU, then increased with further increase in stone density. Multivariate non-linear regression analysis showed a similar relationship between the probability of a stone-free outcome and stone density. Higher treatment success rates were found with low stone burden, pelvic stone location and use of pneumatic lithotripsy. CONCLUSIONS Very low and high stone densities are associated with lower rates of treatment success and longer operating time in PCNL. Preoperative assessment of stone density may help in the selection of treatment modality for patients with renal stones.
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Duan X, Qu M, Wang J, Trevathan J, Vrtiska T, Williams JC, Krambeck A, Lieske J, McCollough C. Differentiation of calcium oxalate monohydrate and calcium oxalate dihydrate stones using quantitative morphological information from micro-computerized and clinical computerized tomography. J Urol 2013; 189:2350-6. [PMID: 23142201 PMCID: PMC3966517 DOI: 10.1016/j.juro.2012.11.004] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/01/2012] [Indexed: 11/24/2022]
Abstract
PURPOSE We differentiated calcium oxalate monohydrate and calcium oxalate dihydrate kidney stones using micro and clinical computerized tomography images. MATERIALS AND METHODS A total of 22 calcium oxalate monohydrate and 15 calcium oxalate dihydrate human kidney stones were scanned using a commercial micro-computerized tomography scanner with a pixel size of 7 to 23 μm. Under an institutional review board approved protocol, image data on 10 calcium oxalate monohydrate and 9 calcium oxalate dihydrate stones greater than 5 mm were retrieved from a total of 80 patients who underwent clinical dual energy computerized tomography for clinical indications and had stones available for infrared spectroscopic compositional analysis. Micro and clinical computerized tomography images were processed using in-house software, which quantified stone surface morphology with curvature based calculations. A shape index was generated as a quantitative shape metric to differentiate calcium oxalate monohydrate from calcium oxalate dihydrate stones. Statistical tests were used to test the performance of the shape index. RESULTS On micro-computerized tomography images the shape index of calcium oxalate monohydrate and calcium oxalate dihydrate stones significantly differed (ROC curve AUC 0.92, p <0.0001). At the optimal cutoff sensitivity was 0.93 and specificity was 0.91. On clinical computerized tomography images a significant morphological difference was also detected (p = 0.007). AUC, sensitivity and specificity were 0.90, 1 and 0.73, respectively. CONCLUSIONS On micro and clinical computerized tomography images a morphological difference was detectable in calcium oxalate monohydrate and calcium oxalate dihydrate stones larger than 5 mm. The shape index is a highly promising method that can distinguish calcium oxalate monohydrate and calcium oxalate dihydrate stones with reasonable accuracy.
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Affiliation(s)
- Xinhui Duan
- Departments of Radiology (XD, MQ, JW, JT, TV, CM), Urology (AK), Internal Medicine (JL) and Laboratory Medicine and Pathology (JL), Mayo Clinic, Rochester and Department of Physics, Gustavus Adolphus College (JT), St. Peter, Minnesota, and Department of Anatomy and Cell Biology, Indiana University School of Medicine (JCW), Indianapolis, Indiana
| | - Mingliang Qu
- Departments of Radiology (XD, MQ, JW, JT, TV, CM), Urology (AK), Internal Medicine (JL) and Laboratory Medicine and Pathology (JL), Mayo Clinic, Rochester and Department of Physics, Gustavus Adolphus College (JT), St. Peter, Minnesota, and Department of Anatomy and Cell Biology, Indiana University School of Medicine (JCW), Indianapolis, Indiana
| | | | - James Trevathan
- Departments of Radiology (XD, MQ, JW, JT, TV, CM), Urology (AK), Internal Medicine (JL) and Laboratory Medicine and Pathology (JL), Mayo Clinic, Rochester and Department of Physics, Gustavus Adolphus College (JT), St. Peter, Minnesota, and Department of Anatomy and Cell Biology, Indiana University School of Medicine (JCW), Indianapolis, Indiana
| | - Terri Vrtiska
- Departments of Radiology (XD, MQ, JW, JT, TV, CM), Urology (AK), Internal Medicine (JL) and Laboratory Medicine and Pathology (JL), Mayo Clinic, Rochester and Department of Physics, Gustavus Adolphus College (JT), St. Peter, Minnesota, and Department of Anatomy and Cell Biology, Indiana University School of Medicine (JCW), Indianapolis, Indiana
| | - James C. Williams
- Departments of Radiology (XD, MQ, JW, JT, TV, CM), Urology (AK), Internal Medicine (JL) and Laboratory Medicine and Pathology (JL), Mayo Clinic, Rochester and Department of Physics, Gustavus Adolphus College (JT), St. Peter, Minnesota, and Department of Anatomy and Cell Biology, Indiana University School of Medicine (JCW), Indianapolis, Indiana
| | - Amy Krambeck
- Departments of Radiology (XD, MQ, JW, JT, TV, CM), Urology (AK), Internal Medicine (JL) and Laboratory Medicine and Pathology (JL), Mayo Clinic, Rochester and Department of Physics, Gustavus Adolphus College (JT), St. Peter, Minnesota, and Department of Anatomy and Cell Biology, Indiana University School of Medicine (JCW), Indianapolis, Indiana
| | - John Lieske
- Departments of Radiology (XD, MQ, JW, JT, TV, CM), Urology (AK), Internal Medicine (JL) and Laboratory Medicine and Pathology (JL), Mayo Clinic, Rochester and Department of Physics, Gustavus Adolphus College (JT), St. Peter, Minnesota, and Department of Anatomy and Cell Biology, Indiana University School of Medicine (JCW), Indianapolis, Indiana
| | - Cynthia McCollough
- Departments of Radiology (XD, MQ, JW, JT, TV, CM), Urology (AK), Internal Medicine (JL) and Laboratory Medicine and Pathology (JL), Mayo Clinic, Rochester and Department of Physics, Gustavus Adolphus College (JT), St. Peter, Minnesota, and Department of Anatomy and Cell Biology, Indiana University School of Medicine (JCW), Indianapolis, Indiana
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Yassin A, Pedrosa I, Kearney M, Genega E, Rofsky NM, Lenkinski RE. In vitro MR imaging of renal stones with an ultra-short echo time magnetic resonance imaging sequence. Acad Radiol 2012; 19:1566-72. [PMID: 22959582 DOI: 10.1016/j.acra.2012.07.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2012] [Revised: 07/12/2012] [Accepted: 07/20/2012] [Indexed: 11/19/2022]
Abstract
OBJECTIVES To characterize the magnetic resonance (MR) relaxation times (ie, T1 and T2 relaxation times) of a variety of kidney stone specimens using an ultra-short echo time (UTE) sequence and to correlate these values to their size and composition based on chemical analysis. MATERIALS AND METHODS This was an institutional review board-approved, Health Insurance Portability and Accountability Act-compliant study with waiver of informed consent. Between April 2009 and September 2009, stones from 36 patients underwent 1.5T MR imaging with two UTE pulse sequences to measure: 1) T2 relaxation times (repetition time [TR] = 1 second and multiple echo times [TEs] ranging from 0.1 ms up to 2 ms); 2) T1 relaxation times (TE = 0.1 ms and multiple TRs ranging from 500 ms to 2.5 seconds). A tube containing a solution of water and hydroxyapatite crystals near the stones served as reference standard. Results were compared to previous data obtained from experiments measuring the T1 and T2 of pure calcium oxalate and hydroxyapatite crystals suspended in water. Stones were submitted for chemical analysis. The stone size and composition was correlated to the relaxation time, and signal intensity. RESULTS The average stone size was 0.86 cm (range 0.1-3.3 cm). Twenty-one stones were visible by MR. The average size of MR-visible stones was 1.1 cm (range 0.15-3.3 cm) compared to 0.46 cm (range 0.1-0.9) for nonvisible stones. The mean T1 and T2 of MR-visible stones were 950 ms (range 138-3000 ms) and 3.12 ms (range 0.27-12 ms), respectively. The T1 (mean 1143, range 740-1583) and T1 (mean 8.31, range 4.6-12) values of calcium phosphate were longer than that for other stone compositions T1 (mean 953, range 138-3000) and T2 (mean 2.58, range 0.27-5.8; P < .05). CONCLUSIONS The T1- and T2-relaxation times of kidney stones are variable and depend on their composition and the size of the stones. UTE MR allows for visualization of renal stones in vitro.
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Affiliation(s)
- Aya Yassin
- Department of Radiology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
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49
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Williams JC, Hameed T, Jackson ME, Aftab S, Gambaro A, Pishchalnikov YA, Lingeman JE, McAteer JA. Fragility of brushite stones in shock wave lithotripsy: absence of correlation with computerized tomography visible structure. J Urol 2012; 188:996-1001. [PMID: 22819106 PMCID: PMC3418465 DOI: 10.1016/j.juro.2012.04.097] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2011] [Indexed: 10/28/2022]
Abstract
PURPOSE Brushite stones were imaged in vitro and then broken with shock wave lithotripsy to assess whether stone fragility correlates with internal stone structure visible on helical computerized tomography. MATERIALS AND METHODS A total of 52 brushite calculi were scanned by micro computerized tomography, weighed, hydrated and placed in a radiological phantom. Stones were scanned using a Philips® Brilliance iCT 256 system and images were evaluated for the visibility of internal structural features. The calculi were then treated with shock wave lithotripsy in vitro. The number of shock waves needed to break each stone to completion was recorded. RESULTS The number of shock waves needed to break each stone normalized to stone weight did not differ by HU value (p = 0.84) or by computerized tomography visible structures that could be identified consistently by all observers (p = 0.053). Stone fragility correlated highly with stone density and brushite content (each p <0.001). Calculi of almost pure brushite required the most shock waves to break. When all observations of computerized tomography visible structures were used for analysis by logistic fit, computerized tomography visible structure predicted increased stone fragility with an overall area under the ROC curve of 0.64. CONCLUSIONS The shock wave lithotripsy fragility of brushite stones did not correlate with internal structure discernible on helical computerized tomography. However, fragility did correlate with stone density and increasing brushite mineral content, consistent with clinical experience with patients with brushite calculi. Thus, current diagnostic computerized tomography technology does not provide a means to predict when brushite stones will break well using shock wave lithotripsy.
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Affiliation(s)
- James C. Williams
- Department of Anatomy and Cell Biology, Indiana University School of Medicine, Indianapolis, IN 46202, USA
| | - Tariq Hameed
- Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, IN 46202, USA
| | - Molly E. Jackson
- Department of Anatomy and Cell Biology, Indiana University School of Medicine, Indianapolis, IN 46202, USA
| | - Syed Aftab
- Department of Anatomy and Cell Biology, Indiana University School of Medicine, Indianapolis, IN 46202, USA
| | - Alessia Gambaro
- Department of Anatomy and Cell Biology, Indiana University School of Medicine, Indianapolis, IN 46202, USA
| | - Yuri A. Pishchalnikov
- Department of Anatomy and Cell Biology, Indiana University School of Medicine, Indianapolis, IN 46202, USA
| | | | - James A. McAteer
- Department of Anatomy and Cell Biology, Indiana University School of Medicine, Indianapolis, IN 46202, USA
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Ito H, Kawahara T, Terao H, Ogawa T, Yao M, Kubota Y, Matsuzaki J. Predictive Value of Attenuation Coefficients Measured as Hounsfield Units on Noncontrast Computed Tomography During Flexible Ureteroscopy with Holmium Laser Lithotripsy: A Single-Center Experience. J Endourol 2012; 26:1125-30. [DOI: 10.1089/end.2012.0154] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Affiliation(s)
- Hiroki Ito
- Department of Urology, Ohguchi East General Hospital, Yokohama, Japan
- Department of Urology, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Takashi Kawahara
- Department of Urology, Ohguchi East General Hospital, Yokohama, Japan
- Department of Urology, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Hideyuki Terao
- Department of Urology, Ohguchi East General Hospital, Yokohama, Japan
| | - Takehiko Ogawa
- Department of Urology, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Masahiro Yao
- Department of Urology, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Yoshinobu Kubota
- Department of Urology, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Junichi Matsuzaki
- Department of Urology, Ohguchi East General Hospital, Yokohama, Japan
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