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Wang M, Zhang Y, Tong H, Liu B, Chen J, Ma Q, Zhang Y. Comparison of ureteral stone measurements for predicting the efficacy of a single session of extracorporeal shockwave lithotripsy: one-, two-, and three-dimensional computed tomography measurements. Urolithiasis 2024; 52:43. [PMID: 38441706 DOI: 10.1007/s00240-024-01538-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Accepted: 01/28/2024] [Indexed: 03/07/2024]
Abstract
The objective of this study was to compare the value of one-, two- and three-dimensional computed tomography (CT) measurements for predicting the efficacy of a single session of extracorporeal shock wave lithotripsy (ESWL) in patients with a single ureteral stone. A total of 165 patients were included based on the inclusion and exclusion criteria. Different models were constructed using a combination of patients' clinical data and measurements obtained by manual sketching and automated extraction software. Multivariate logistic regression was used to develop the models. Receiver operating characteristic curves were used to assess the performance of the models. There was good interobserver agreement for all measurements in different dimensions (P < 0.001). We also found that hydronephrosis, the largest diameter, the largest area, volume, and mean CT value were significantly greater in the failure group than in the success group (P < 0.01). Furthermore, all sizes and CT measurement values were found to be independent predictors for predicting efficacy after one session of ESWL (P < 0.05). In addition, the multivariate logistic analysis showed that the area under the curve (AUC) for two-dimensional and three-dimensional measurements was superior to that of one-dimensional measurement (P < 0.01). However, when size alone was included as a measurable predictor, there was no significant difference in the AUC among the one-, two-, and three-dimensional measurements (P > 0.05). In summary, after adjusting for clinical data, two- and three-dimensional measurements combining ureteral stone size and CT values were found to be the best predictors of ESWL efficacy, and software-based three-dimensional measurements should be considered to avoid interobserver variability in clinical practice.
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Affiliation(s)
- Meng Wang
- Department of Ultrasound, The Second Affiliated Hospital of Soochow University, Suzhou, 215004, Jiangsu, China.
| | - Yueyue Zhang
- Department of Radiology, The Second Affiliated Hospital of Soochow University, Suzhou, 215004, Jiangsu, China
| | - Hua Tong
- Department of Urology, The Second Affiliated Hospital of Soochow University, Suzhou, 215004, Jiangsu, China
| | - Bin Liu
- Department of Urology, The Second Affiliated Hospital of Soochow University, Suzhou, 215004, Jiangsu, China
| | - Jueqi Chen
- Department of Urology, The Second Affiliated Hospital of Soochow University, Suzhou, 215004, Jiangsu, China
| | - Qi Ma
- Department of Ultrasound, The Second Affiliated Hospital of Soochow University, Suzhou, 215004, Jiangsu, China
| | - Yingchun Zhang
- Department of Ultrasound, The Second Affiliated Hospital of Soochow University, Suzhou, 215004, Jiangsu, China
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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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Steuwe A, Valentin B, Bethge OT, Ljimani A, Niegisch G, Antoch G, Aissa J. Influence of a Deep Learning Noise Reduction on the CT Values, Image Noise and Characterization of Kidney and Ureter Stones. Diagnostics (Basel) 2022; 12:diagnostics12071627. [PMID: 35885532 PMCID: PMC9317055 DOI: 10.3390/diagnostics12071627] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 06/20/2022] [Accepted: 07/01/2022] [Indexed: 12/25/2022] Open
Abstract
Deep-learning (DL) noise reduction techniques in computed tomography (CT) are expected to reduce the image noise while maintaining the clinically relevant information in reduced dose acquisitions. This study aimed to assess the size, attenuation, and objective image quality of reno-ureteric stones denoised using DL-software in comparison to traditionally reconstructed low-dose abdominal CT-images and evaluated its clinical impact. In this institutional review-board-approved retrospective study, 45 patients with renal and/or ureteral stones were included. All patients had undergone abdominal CT between August 2019 and October 2019. CT-images were reconstructed using the following three methods: filtered back-projection, iterative reconstruction, and PixelShine (DL-software) with both sharp and soft kernels. Stone size, CT attenuation, and objective image quality (signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR)) were evaluated and compared using Bonferroni-corrected Friedman tests. Objective image quality was measured in six regions-of-interest. Stone size ranged between 4.4 × 3.1−4.4 × 3.2 mm (sharp kernel) and 5.1 × 3.8−5.6 × 4.2 mm (soft kernel). Mean attenuation ranged between 704−717 Hounsfield Units (HU) (soft kernel) and 915−1047 HU (sharp kernel). Differences in measured stone sizes were ≤1.3 mm. DL-processed images resulted in significantly higher CNR and SNR values (p < 0.001) by decreasing image noise significantly (p < 0.001). DL-software significantly improved objective image quality while maintaining both correct stone size and CT-attenuation values. Therefore, the clinical impact of stone assessment in denoised image data sets remains unchanged. Through the relevant noise suppression, the software additionally offers the potential to further reduce radiation exposure.
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Affiliation(s)
- Andrea Steuwe
- Department of Diagnostic and Interventional Radiology, Medical Faculty, University Dusseldorf, D-40225 Dusseldorf, Germany; (B.V.); (O.T.B.); (A.L.); (G.A.); (J.A.)
- Correspondence: ; Tel.: +49-(0)-211-81-18897
| | - Birte Valentin
- Department of Diagnostic and Interventional Radiology, Medical Faculty, University Dusseldorf, D-40225 Dusseldorf, Germany; (B.V.); (O.T.B.); (A.L.); (G.A.); (J.A.)
| | - Oliver T. Bethge
- Department of Diagnostic and Interventional Radiology, Medical Faculty, University Dusseldorf, D-40225 Dusseldorf, Germany; (B.V.); (O.T.B.); (A.L.); (G.A.); (J.A.)
| | - Alexandra Ljimani
- Department of Diagnostic and Interventional Radiology, Medical Faculty, University Dusseldorf, D-40225 Dusseldorf, Germany; (B.V.); (O.T.B.); (A.L.); (G.A.); (J.A.)
| | - Günter Niegisch
- Department of Urology, Medical Faculty, University Dusseldorf, D-40225 Dusseldorf, Germany;
| | - Gerald Antoch
- Department of Diagnostic and Interventional Radiology, Medical Faculty, University Dusseldorf, D-40225 Dusseldorf, Germany; (B.V.); (O.T.B.); (A.L.); (G.A.); (J.A.)
| | - Joel Aissa
- Department of Diagnostic and Interventional Radiology, Medical Faculty, University Dusseldorf, D-40225 Dusseldorf, Germany; (B.V.); (O.T.B.); (A.L.); (G.A.); (J.A.)
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Danilovic A, Rocha BA, Marchini GS, Traxer O, Batagello C, Vicentini FC, Torricelli FCM, Srougi M, Nahas WC, Mazzucchi E. Computed tomography window affects kidney stones measurements. Int Braz J Urol 2019; 45:948-955. [PMID: 31268643 PMCID: PMC6844354 DOI: 10.1590/s1677-5538.ibju.2018.0819] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Accepted: 03/19/2019] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVES Measurements of stone features may vary according to the non-contrast computed tomography (NCCT) technique. Using magnified bone window is the most accurate method to measure urinary stones. Possible differences between stone measurements in different NCCT windows have not been evaluated in stones located in the kidney. The aim of this study is to compare measurements of kidney stone features between NCCT bone and soft tissue windows in patients submitted to retrograde intrarenal surgery (RIRS). MATERIALS AND METHODS Preoperative and 90th postoperative day NCCT were performed in 92 consecutive symptomatic adult patients (115 renal units) with kidney stones between 5 mm to 20 mm (< 15 mm in the lower calyx) treated by RIRS. NCCT were evaluated in the magnified bone window and soft tissue window in three axes in a different time by a single radiologist blinded for the measurements of the NCCT other method. RESULTS Stone largest size (7.92±3.81 vs. 9.13±4.08; mm), volume (435.5±472.7 vs. 683.1±665.0; mm3) and density (989.4±330.2 vs. 893.0±324.6; HU) differed between bone and soft-tissue windows, respectively (p<0.0001) 5.2% of the renal units (6/115) were reclassified from residual fragments > 2 mm on soft tissue window to 0-2 mm on bone window. CONCLUSION Kidney stone measurements vary according to NCCT window. Measurements in soft tissue window NCCT of stone diameter and volume are larger and stone density is lesser than in bone window. These differences may have impact on clinical decisions.
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Affiliation(s)
- Alexandre Danilovic
- Departamento de Urologia do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, SP, Brasil
| | - Bruno Aragão Rocha
- Departamento de Radiologia do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, SP, Brasil
| | - Giovanni Scala Marchini
- Departamento de Urologia do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, SP, Brasil
| | - Olivier Traxer
- Sorbonne Université, GRC n 20 Lithiase Renale, AP-HP, Hôpital Tenon, F-75020 Paris, France. University, Paris, France
| | - Carlos Batagello
- Departamento de Urologia do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, SP, Brasil
| | - Fabio Carvalho Vicentini
- Departamento de Urologia do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, SP, Brasil
| | | | - Miguel Srougi
- Departamento de Urologia do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, SP, Brasil
| | - William Carlos Nahas
- Departamento de Urologia do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, SP, Brasil
| | - Eduardo Mazzucchi
- Departamento de Urologia do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, SP, Brasil
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Umbach R, Müller JK, Wendt-Nordahl G, Knoll T, Jessen JP. In-vitro comparison of different slice thicknesses and kernel settings for measurement of urinary stone size by computed tomography. Urolithiasis 2019; 47:583-586. [PMID: 30649576 DOI: 10.1007/s00240-019-01109-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2018] [Accepted: 01/03/2019] [Indexed: 12/28/2022]
Abstract
Non-contrast enhanced computed tomography (NCCT) is widely used measuring stone size in patients with urolithiasis. We performed an evaluation of the accuracy of stone size measuring via NCCT. In an in-vitro study, we analyzed a total of 38 uric acid and 38 phantom stones. Within NCCT, we used different slice thicknesses (1.5 mm, 2.0 mm, and 3.0 mm) and kernel settings (bone and soft-tissue window). Maximal height, maximal length, and maximal width of each stone were measured on a picture archiving and communication system workstation. Blinded to these results, a second physician measured stone size in the same way using a caliper (real stone size). We used the Bland-Altman method for the analysis of agreement between the two measuring methods. The limit of agreement that was deemed clinical insignificant was ± 1.0 mm. All measurements via NCCT correlated significantly with the real stone size (p < 0.001). This was more pronounced for bone window and smaller slice thickness. Bland-Altman plots showed limits of agreement that exceeded the a priori defined level for all types of measurement with bone window and small slice thickness (1.5 mm) being better than soft-tissue window and large slice thickness (3.0 mm). We conclude that stone size measurement by NCCT with established settings is not exact. Stone size can easily be over- or underestimated by several millimeters. Using bone window and small slice thickness leads to more accurate results.
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Affiliation(s)
- Roland Umbach
- Department of Urology, Sindelfingen-Böblingen Medical Center, University of Tübingen, Arthur-Gruber-Straße 70, 71065, Sindelfingen, Germany.
| | - Jochen-Klaus Müller
- Department of Radiology, Sindelfingen-Böblingen Medical Center, University of Tübingen, Sindelfingen, Germany
| | - Gunnar Wendt-Nordahl
- Department of Urology, Sindelfingen-Böblingen Medical Center, University of Tübingen, Arthur-Gruber-Straße 70, 71065, Sindelfingen, Germany
| | - Thomas Knoll
- Department of Urology, Sindelfingen-Böblingen Medical Center, University of Tübingen, Arthur-Gruber-Straße 70, 71065, Sindelfingen, Germany
| | - Jan Peter Jessen
- Department of Urology, Sindelfingen-Böblingen Medical Center, University of Tübingen, Arthur-Gruber-Straße 70, 71065, Sindelfingen, Germany
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Soomro HU, Hammad Ather M, Salam B. Comparison of ureteric stone size, on bone window versus standard soft-tissue window settings, on multi-detector non-contrast computed tomography. Arab J Urol 2016; 14:198-202. [PMID: 27547460 PMCID: PMC4983159 DOI: 10.1016/j.aju.2016.06.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Revised: 06/14/2016] [Accepted: 06/25/2016] [Indexed: 01/04/2023] Open
Abstract
Objective To compare the difference in mean stone size, as measured on bone window vs standard soft-tissue window setting using multi-detector computed tomography (MDCT) in patients with a solitary ureteric stone. Patients and methods In all, 60 patients presenting to the emergency and outpatient departments of a University Hospital from May 2015 to October 2015 and fulfilling the inclusion criteria were included in the study. A 64-slice MDCT was used to assess the locations and size of the ureteric stones. A consultant radiologist independently analysed the MDCT scans of all the patients. The mean difference in stone size was calculated between both window settings in axial and coronal planes. Results The mean (SD) age of the patients was 37.13 (11.9) years. Males constituted ∼68% of the cohort and 32% were female. In all, 85% of the patients had left ureteric stones and 15% had right ureteric stones. The mean (SD) stone size, as measured on the soft-tissue window setting was 6.68 (2.01) mm, and on the bone window setting was 4.8 (1.9) mm. The mean (SD) difference in stone size between the two window settings was +1.85 (0.55) mm. The two means were compared using Student’s t-test, and the difference was found to be statistically significant (P < 0.05). Conclusion The stone size measured using the soft-tissue window setting on a MDCT is significantly different from the measurement on the bone window setting.
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Affiliation(s)
- Hussam Uddin Soomro
- Section of Urology, Department of Surgery, Aga Khan University, Karachi, Pakistan
| | - M Hammad Ather
- Section of Urology, Department of Surgery, Aga Khan University, Karachi, Pakistan
| | - Basit Salam
- Department of Radiology, Aga Khan University, Karachi, Pakistan
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