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Galtung KF, Lauritzen PM, Sandbæk G, Bay D, Baco E, Rud E. Urinary stone assessment in a single-phase may replace the unenhanced and multiphase computed tomography protocol in painless visible haematuria. Scand J Urol 2024; 59:147-155. [PMID: 39268780 DOI: 10.2340/sju.v59.40679] [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: 04/30/2024] [Accepted: 08/27/2024] [Indexed: 09/15/2024]
Abstract
OBJECTIVE Painless visible haematuria (VH) necessitates a computed tomography (CT) usually consisting of one unenhanced and two to three contrast enhanced acquisitions to detect urinary tract stones and malignancy. Recently, we demonstrated that a single nephrographic phase (NP) CT sufficed in detecting malignancy in patients with painless VH. Now, we aim to evaluate the diagnostic performance of single NP CT in stone detection and size measurements in the same cohort. MATERIAL AND METHODS "A Prospective Trial for Examining Haematuria using Computed Tomography" (PROTEHCT) was a single-center prospective diagnostic study in patients with painless VH between September 2019 and June 2021. All underwent four-phase CT (reference standard) from which a single NP CT (experimental) was extracted. Two randomised readers independently assessed the experimental CT for urinary stones and size. Statistical analysis included diagnostic accuracies and inter-reader agreement (kappa) of experimental CT, and size correlation (Spearman's ρ) between experimental CT and reference standard. RESULTS In 308 included patients (median age: 68 years, 250 males), urinary stones (median size 5 mm) were diagnosed in 21%. The per-patient experimental CT sensitivity was 86% (97% for stones ≥ 5 mm), specificity was 98% and accuracy was 96%. The experimental CT sensitivity for detecting kidney stones was 78% (89% for stones ≥ 5 mm), and 100% for bladder and ureteral stones. No missed stone required active treatment. The inter-reader agreement was almost perfect (96%, k = 0.85). The correlation in stone size was very strong (ρ = 0.91). Conclusions: A single NP CT is sufficient in detecting and measuring urinary stones in patients with painless VH.
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Affiliation(s)
- Kristina Flor Galtung
- Department of Radiology, Oslo University Hospital, Oslo, Norway; Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.
| | - Peter Mæhre Lauritzen
- Department of Radiology, Oslo University Hospital, Oslo, Norway; Department of Life Sciences and Health, Faculty of Health Science, Oslo Metropolitan University, Oslo, Norway
| | - Gunnar Sandbæk
- Department of Radiology, Oslo University Hospital, Oslo, Norway; Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Dag Bay
- Department of Radiology, Oslo University Hospital, Oslo, Norway
| | - Eduard Baco
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway; Department of Urology, Oslo University Hospital, Oslo, Norway
| | - Erik Rud
- Department of Radiology, Oslo University Hospital, Oslo, Norway
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Ahmed F, Abbas S, Athar A, Shahzad T, Khan WA, Alharbi M, Khan MA, Ahmed A. Identification of kidney stones in KUB X-ray images using VGG16 empowered with explainable artificial intelligence. Sci Rep 2024; 14:6173. [PMID: 38486010 PMCID: PMC10940612 DOI: 10.1038/s41598-024-56478-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Accepted: 03/06/2024] [Indexed: 03/18/2024] Open
Abstract
A kidney stone is a solid formation that can lead to kidney failure, severe pain, and reduced quality of life from urinary system blockages. While medical experts can interpret kidney-ureter-bladder (KUB) X-ray images, specific images pose challenges for human detection, requiring significant analysis time. Consequently, developing a detection system becomes crucial for accurately classifying KUB X-ray images. This article applies a transfer learning (TL) model with a pre-trained VGG16 empowered with explainable artificial intelligence (XAI) to establish a system that takes KUB X-ray images and accurately categorizes them as kidney stones or normal cases. The findings demonstrate that the model achieves a testing accuracy of 97.41% in identifying kidney stones or normal KUB X-rays in the dataset used. VGG16 model delivers highly accurate predictions but lacks fairness and explainability in their decision-making process. This study incorporates the Layer-Wise Relevance Propagation (LRP) technique, an explainable artificial intelligence (XAI) technique, to enhance the transparency and effectiveness of the model to address this concern. The XAI technique, specifically LRP, increases the model's fairness and transparency, facilitating human comprehension of the predictions. Consequently, XAI can play an important role in assisting doctors with the accurate identification of kidney stones, thereby facilitating the execution of effective treatment strategies.
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Affiliation(s)
- Fahad Ahmed
- School of Computer Science, National College of Business Administration and Economics, Lahore, 54000, Pakistan
| | - Sagheer Abbas
- Department of Computer Sciences, Bahria University, Lahore Campus, Lahore, 54000, Pakistan
| | - Atifa Athar
- Department of Computer Science, Comsats University Islamabad, Lahore Campus, Lahore, 54000, Pakistan
| | - Tariq Shahzad
- Department of Computer Sciences, COMSATS University Islamabad, Sahiwal Campus, Sahiwal, 57000, Pakistan
| | - Wasim Ahmad Khan
- School of Computer Science, National College of Business Administration and Economics, Lahore, 54000, Pakistan
| | - Meshal Alharbi
- Department of Computer Science, College of Computer Engineering and Sciences, Prince Sattam Bin Abdulaziz University, 11942, Alkharj, Saudi Arabia
| | - Muhammad Adnan Khan
- School of Computing, Skyline University College, University City Sharjah, 1797, Sharjah, UAE.
- Department of Software, Faculty of Artificial Intelligence and Software, Gachon University, Seongnam-si, 13120, Republic of Korea.
- Riphah School of Computing and Innovation, Faculty of Computing, Riphah International University, Lahore Campus, Lahore, 54000, Pakistan.
| | - Arfan Ahmed
- AI Center for Precision Health, Weill Cornell Medicine-Qatar, Doha, Qatar.
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3
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González-Enguita C, Garcia-Giménez R, Garcia-Guinea J, Correcher V. Spectral characterization of renal calculi collected from population in downtown Madrid (Spain). SPECTROCHIMICA ACTA. PART A, MOLECULAR AND BIOMOLECULAR SPECTROSCOPY 2024; 304:123395. [PMID: 37716040 DOI: 10.1016/j.saa.2023.123395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 08/18/2023] [Accepted: 09/09/2023] [Indexed: 09/18/2023]
Abstract
This paper reports on a comprehensive approach to characterize a set of kidney stones through various analytical techniques including ESEM-EDS, XRD, Raman, and CL spectroscopy, linked to an assessment of the patient's lifestyle and dietary habits. The use of these techniques can provide valuable insights into the underlying causes of stone formation and guide strategies for prevention and treatment. ESEM-EDS and XRD are commonly used techniques for kidney stone characterization due to their complementary nature, enabling the identification of a wide range of renal calculi. However, these techniques may not be sensitive enough to determine the detailed composition of the samples. In such cases, Raman and CL techniques can be used to provide more precise information about the chemical and structural composition of the stones. Raman spectroscopy, for example, can identify molecular phases observed under an optical microscope characterizing chemical compositions through vibrational modes associated with specific bonds. The CL spectral emission within the 250-850 nm range can also yield valuable information about the mineral phases, including the identification of structural crystallinity, hydrated molecules, Ca-OH bonds, and oxygen defects. By correlating spectral analyses with patient habits, this study identifies potential exogenous factors contributing to stone formation, including excess protein consumption, urinary bacterial infections, and oxalate-rich diets. This comprehensive approach provides a more complete understanding of the composition of kidney stones helping to personalized prevention and treatment strategies.
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Affiliation(s)
- C González-Enguita
- Hospital Univ. Fundación Jiménez Díaz, Av. Reyes Católicos 2, 28040 Madrid, Spain
| | - R Garcia-Giménez
- Dpto. Geología y Geoquímica. Fac. Ciencias, Univ. Autónoma, 28049 Madrid, Spain
| | - J Garcia-Guinea
- Museo Nacional de Ciencias Naturales (CSIC), c/José Gutierrez Abascal 2, Madrid 28006, Spain
| | - V Correcher
- CIEMAT, Av. Complutense 40, Madrid 28040, Spain.
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4
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González-Enguita C, Bueno-Serrano G, López de Alda-González A, García-Giménez R. Environmental Conditions as Determinants of Kidney Stone Formation. ACS APPLIED BIO MATERIALS 2023; 6:5030-5036. [PMID: 37913796 PMCID: PMC10863387 DOI: 10.1021/acsabm.3c00722] [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: 08/30/2023] [Revised: 10/20/2023] [Accepted: 10/23/2023] [Indexed: 11/03/2023]
Abstract
Urolithiasis is a disease characterized by the presence of stones in the urinary tract, whether in the kidneys, ureters, or bladder. Its origin is multiple, and causes can be cited as hereditary, environmental, dietary, anatomical, metabolic, or infectious factors. A kidney stone is a biomaterial that originates inside the urinary tract, following the principles of crystalline growth, and in most cases, it cannot be eliminated naturally. In this work, 40 calculi from the Don Benito, Badajoz University Hospital are studied and compared with those collected in Madrid to establish differences between both populations with the same pathology and located in very different geographical areas. Analysis by cathodoluminescence offers information on the low crystallinity of the phases and their hydration states, as well as the importance of the bonds with the Ca cation in all of the structures, which, in turn, is related to environmental and social factors of different population groups such as a high intake of proteins, medications, bacterial factors, or possible contamination with greenhouse gases, among other factors.
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Affiliation(s)
- Carmen González-Enguita
- Hospital
Universitario Fundación Jiménez Díaz, Avenida Reyes Católicos,
2, 28040 Madrid, Spain
| | - Gonzalo Bueno-Serrano
- Hospital
Universitario Fundación Jiménez Díaz, Avenida Reyes Católicos,
2, 28040 Madrid, Spain
| | | | - Rosario García-Giménez
- Departamento
de Geología y Geoquímica, Facultad de Ciencias, Universidad Autónoma, 28049 Madrid, Spain
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Gupta RT, Kalisz K, Khatri G, Caserta MP, Catanzano TM, Chang SD, De Leon AD, Gore JL, Nicola R, Prabhakar AM, Savage SJ, Shah KP, Surabhi VR, Taffel MT, Valente JH, Yoo DC, Nikolaidis P. ACR Appropriateness Criteria® Acute Onset Flank Pain-Suspicion of Stone Disease (Urolithiasis). J Am Coll Radiol 2023; 20:S315-S328. [PMID: 38040458 DOI: 10.1016/j.jacr.2023.08.020] [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: 08/15/2023] [Accepted: 08/22/2023] [Indexed: 12/03/2023]
Abstract
Noncontrast CT (NCCT) is the imaging study of choice for initial evaluation of patients with acute onset of flank pain and suspicion of stone disease without known prior stone disease. NCCT can reliably characterize the location and size of an offending ureteral calculus, identify complications, and diagnose alternative etiologies of abdominal pain. Although less sensitive in the detection of stones, ultrasound may have a role in evaluating for signs of obstruction. Radiography potentially has a role, although has been shown to be less sensitive than NCCT. For patients with known disease and recurrent symptoms of urolithiasis, NCCT remains the test of choice for evaluation. In pregnancy, given radiation concerns, ultrasound is recommended as the initial modality of choice with potential role for noncontrast MRI. In scenarios where stone disease suspected and initial NCCT is inconclusive, contrast-enhanced imaging, either with MRI or CT/CT urogram may be appropriate. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where peer reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation.
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Affiliation(s)
- Rajan T Gupta
- Duke University Medical Center, Durham, North Carolina.
| | - Kevin Kalisz
- Research Author, Duke University Medical Center, Durham, North Carolina
| | - Gaurav Khatri
- Panel Chair, University of Texas Southwestern Medical Center, Dallas, Texas
| | | | | | - Silvia D Chang
- University of British Columbia, Vancouver, British Columbia, Canada
| | | | - John L Gore
- University of Washington, Seattle, Washington; American Urological Association
| | - Refky Nicola
- SUNY Upstate Medical University, Syracuse, New York
| | - Anand M Prabhakar
- Massachusetts General Hospital, Boston, Massachusetts; Committee on Emergency Radiology-GSER
| | - Stephen J Savage
- Medical University of South Carolina, Charleston, South Carolina; American Urological Association
| | - Kevin P Shah
- Duke University Medical Center, Durham, North Carolina, Primary care physician
| | | | - Myles T Taffel
- New York University Langone Medical Center, New York, New York
| | - Jonathan H Valente
- Rhode Island Hospital and Hasbro Children's Hospital, Providence, Rhode Island; American College of Emergency Physicians
| | - Don C Yoo
- Rhode Island Hospital/The Warren Alpert Medical School of Brown University, Providence, Rhode Island; Commission on Nuclear Medicine and Molecular Imaging
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Lee S, Park YS, Park B, Lee J, Choi JW, Kim KA, Lee CH. Usefulness of Corticomedullary-Phase CT Urography in Patients with Suspected Acute Renal Colic Visiting the Emergency Department. JOURNAL OF THE KOREAN SOCIETY OF RADIOLOGY 2023; 84:923-933. [PMID: 37559807 PMCID: PMC10407065 DOI: 10.3348/jksr.2022.0098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Revised: 08/28/2022] [Accepted: 10/02/2022] [Indexed: 08/11/2023]
Abstract
PURPOSE To evaluate the sensitivity of corticomedullary-phase imaging for detecting urinary stones in patients with renal colic who visited the emergency department. MATERIALS AND METHODS This retrospective study included 253 patients with suspected renal colic from two tertiary hospitals in South Korea, who visited the emergency department and underwent CT urography. Two radiologists blinded to the clinical history independently reviewed the corticomedullary-phase images. The sensitivity for identifying urinary stones were evaluated for each reviewer. After the initial evaluation, the images were re-evaluated based on patient history. The sensitivity of re-evaluation were recorded. RESULTS Of 253 patients, 150 (59%) had urinary stones. Among them, significant stones were observed in 138 patients (92%), and obstructive changes on CT in 124 patients (82.7%). For identifying significant urinary stones, the sensitivity was 98.6% (136/138) for both the reviewers. For identifying significant urinary stones with urinary obstruction, the sensitivity was 99.2% (123/124) for reviewer 1, and 100% (124/124) for reviewer 2. The sensitivity for identifying significant stones increased from 98.6% to 100% for reviewer 1, and from 98.6% to 99.3% for reviewer 2 in the re-evaluation session. CONCLUSION The corticomedullary-phase CT urography was sensitive for diagnosing urolithiasis in patients with acute renal colic who visited the emergency department.
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A novel approach to classify urinary stones using dual-energy kidney, ureter and bladder (DEKUB) X-ray imaging. Appl Radiat Isot 2020; 164:109267. [DOI: 10.1016/j.apradiso.2020.109267] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2019] [Revised: 05/19/2020] [Accepted: 06/02/2020] [Indexed: 12/18/2022]
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8
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Teijido JT, Johnson T. Young woman with flank pain. J Am Coll Emerg Physicians Open 2020; 1:676-677. [PMID: 33000098 PMCID: PMC7493525 DOI: 10.1002/emp2.12149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 05/05/2020] [Accepted: 05/19/2020] [Indexed: 11/11/2022] Open
Affiliation(s)
- John Thomas Teijido
- Emergency Medicine Specialists S. C. Wauwatosa Wisconsin USA
- Ascension St. Louis Missouri USA
| | - Therese Johnson
- Emergency Medicine Specialists S. C. Wauwatosa Wisconsin USA
- Ascension St. Louis Missouri USA
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