Impact of dual energy characterization of urinary calculus on management

Single-energy CT predicts uric acid stones with accuracy comparable to dual-energy CT-prospective validation of a quantitative method

OBJECTIVES

To prospectively validate three quantitative single-energy CT (SE-CT) methods for classifying uric acid (UA) and non-uric acid (non-UA) stones.

METHODS

Between September 2018 and September 2019, 116 study participants were prospectively included in the study if they had at least one 3-20-mm urinary stone on an initial urinary tract SE-CT scan. An additional dual-energy CT (DE-CT) scan was performed, limited to the stone of interest. Additionally, to include a sufficient number of UA stones, eight participants with confirmed UA stone on DE-CT were retrospectively included. The SE-CT stone features used in the prediction models were (1) maximum attenuation (maxHU) and (2) the peak point Laplacian (ppLapl) calculated at the position in the stone with maxHU. Two prediction models were previously published methods (ppLapl-maxHU and maxHU) and the third was derived from the previous results based on the k-nearest neighbors (kNN) algorithm (kNN-ppLapl-maxHU). The three methods were evaluated on this new independent stone dataset. The reference standard was the CT vendor's DE-CT application for kidney stones.

RESULTS

Altogether 124 participants (59 ± 14 years, 91 men) with 106 non-UA and 37 UA stones were evaluated. For classification of UA and non-UA stones, the sensitivity, specificity, and accuracy were 100% (37/37), 97% (103/106), and 98% (140/143), respectively, for kNN-ppLapl-maxHU; 95% (35/37), 98% (104/106), and 97% (139/143) for ppLapl-maxHU; and 92% (34/37), 94% (100/106), and 94% (134/143) for maxHU.

CONCLUSION

A quantitative SE-CT method (kNN-ppLapl-maxHU) can classify UA stones with accuracy comparable to DE-CT.

KEY POINTS

• Single-energy CT is the first-line diagnostic tool for suspected renal colic. • A single-energy CT method based on the internal urinary stone attenuation distribution can classify urinary stones into uric acid and non-uric acid stones with high accuracy. • This immensely increases the availability of in vivo stone analysis.

Aggregation of Nanochemical Microcrystals in Urine Promotes the Formation of Urinary Calculi

With the increasing incidence and recurrence rate of urinary calculi, urinary calculi have become a serious health risk, and the research on urinary calculi has become the focus of public attention. At present, the research results on the formation mechanism of urinary calculi are not ideal, and there is no unified conclusion. In order to further study the influencing factors of the formation of urinary calculi and provide new ideas for the prevention and clinical treatment of urinary calculi, the influence of agglomeration of nanochemical microcrystals in urine on urinary calculi was studied in this paper. In this study, fresh morning urine was collected from 10 urological stone patients and 10 healthy controls without urological stone in the urology department of a hospital. After processing the experimental specimens, we first use flame atomic absorption spectrometry and alcian blue colorimetric method to detect the content of Ca2+ and citrate in the urine and then use the nanoparticle size analyzer to detect the microcrystals in the urine. Diameter, distribution, degree of aggregation and potential, and finally HRTEM observation to observe the morphology, chemical composition, and element composition of the nanocrystals. The results showed that the content of Ca2+ and lemon hydrochloric acid in the urine of the experimental group was lower than that of the control group. The particle size of the nanocrystals increased with the increase in the pore size of the membrane. The average particle size of the experimental group increased gradually from 163 ± 31 nm to 3219 ± 863 nm, while the average particle size of the control group increased from 183 ± 65 nm to 997 ± 522 nm. The mean value of the potential decreased with the increase in the pore size of the filter membrane. The change amplitude of the experimental group was 6.57 mV, while the change amplitude of the control group was only 1.75 mV. In the composition of nanocrystals, element O accounts for the most, accounting for 42.54% of all elements. This indicates that the aggregation of nanocrystals in urine will lead to the rapid increase in the size of nanocrystals, which will eventually lead to the formation of stones.

Dual-Energy Computed Tomography for Stone Type Assessment: A Pilot Study of Dual-Energy Computed Tomography with Five Indices

Purpose: To assess the efficacy of dual-energy CT (DECT) in predicting the composition of urinary stones with a single index (dual energy ratio [DER]) and five indices. Methods: Patients undergoing DECT before active urolithiasis treatment were prospectively enrolled in the study. Predictions of stone composition were made based on discriminant analysis with a single index (DER) and five indices (stone density at 80 and 135 kV, Zeff [the effective atomic number of the absorbent material] of the stone, DER, dual-energy index [DEI] and dual-energy difference [DED]). After extraction, stone composition was evaluated by means of physicochemical analyses (X-ray phase analysis, electron microscopy, wet chemistry techniques, and infrared spectroscopy). Results: A total of 91 patients were included. For calcium oxalate monohydrate (COM) stones, the sensitivity, specificity, and overall accuracy of DECT with one index (DER) were 83.3%, 89.8%, and 86.8%, respectively; for calcium oxalate dihydrate (COD) and calcium phosphate stones-88.2%, 92.9%, and 91.2%, respectively; for uric acid stones-0%, 98.8% and 97.8%, respectively; for struvite stones-60%, 95.3%, and 93.4%, respectively. Discriminant analysis with five indices yielded the following sensitivity, specificity, and overall accuracy: 95.2%, 89.8%, and 92.3% for COM stones, 85.3%, 96.4%, and 92.3% for COD stones, and 100% in all three categories for both uric acid and struvite stones. Conclusions: DECT is a promising tool for stone composition assessment. It allowed for evaluation of chemical composition of all stone types with specificity and accuracy ranging from 85% to 100%. Five DECT indices have shown much better diagnostic accuracy compared to a single DECT index.

Efficacy of single-source rapid kV-switching dual-energy CT for characterization of non-uric acid renal stones: a prospective ex vivo study using anthropomorphic phantom

PURPOSE

To investigate the accuracy of rapid kV-switching single-source dual-energy computed tomography (rsDECT) for prediction of classes of non-uric-acid stones.

MATERIALS AND METHODS

Non-uric-acid renal stones retrieved via percutaneous nephrolithotomy were prospectively collected between January 2017 and February 2018 in a single institution. Only stones ≥ 5 mm and with pure composition (i.e., ≥ 80% composed of one component) were included. Stone composition was determined using Fourier Transform Infrared Spectroscopy. The stones were scanned in 32-cm-wide anthropomorphic whole-body phantom using rsDECT. The effective atomic number (Zeff), the attenuation at 40 keV (HU40), 70 keV (HU70), and 140 keV (HU140) virtual monochromatic sets of images as well as the ratios between the attenuations were calculated. Values of stone classes were compared using ANOVA and Mann-Whitney U test. Receiver operating curves and area under curve (AUC) were calculated. A p value < 0.05 was considered statistically significant.

RESULTS

The final study sample included 31 stones from 31 patients consisting of 25 (81%) calcium-based, 4 (13%) cystine, and 2 (6%) struvite pure stones. The mean size of the stones was 9.9 ± 2.4 mm. The mean Zeff of the stones was 12.01 ± 0.54 for calcium-based, 11.10 ± 0.68 for struvite, and 10.23 ± 0.75 for cystine stones (p < 0.001). Zeff had the best efficacy to separate different classes of stones. The calculated AUC was 0.947 for Zeff; 0.833 for HU40; 0.880 for HU70; and 0.893 for HU140.

CONCLUSION

Zeff derived from rsDECT has superior performance to HU and attenuation ratios for separation of different classes of non-uric-acid stones.