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Kimura K, Yamamoto T, Tsuchiya J, Yoshida S, Yanai S, Onishi I, Fujii Y, Tateishi U. A diagnostic approach of various urethral diseases using multimodal imaging findings: comprehensive overview. Abdom Radiol (NY) 2024:10.1007/s00261-024-04435-0. [PMID: 38896251 DOI: 10.1007/s00261-024-04435-0] [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: 04/29/2024] [Revised: 06/05/2024] [Accepted: 06/06/2024] [Indexed: 06/21/2024]
Abstract
In clinical practice, urethral diseases are not as frequent as conditions affecting other components of the urinary system. Radiological imaging tests, such as retrograde urethrography, CT, MRI, and PET/CT, along with patient history, are crucial for accurately assessing relatively rare urethral lesions. This article aimed to provide a comprehensive overview of urethral lesions, from traumatic changes to neoplasms, and discuss the multimodal imaging findings of various urethral lesions that radiologists should know. To this end, the normal imaging anatomy of the urethra and a step-by-step approach that can be used in clinical practice have been presented to help in the systematic understanding of urethral lesions.
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Affiliation(s)
- Koichiro Kimura
- Department of Diagnostic Radiology, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-Ku, Tokyo, 113-8510, Japan.
| | - Tatsuya Yamamoto
- Department of Diagnostic Imaging, Cancer Institute Hospital of JFCR, Tokyo, Japan
| | - Junichi Tsuchiya
- Department of Diagnostic Radiology, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-Ku, Tokyo, 113-8510, Japan
| | - Soichiro Yoshida
- Department of Urology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Shuichi Yanai
- Department of Radiology, Fraternity Memorial Hospital, Tokyo, Japan
| | - Iichiro Onishi
- Department of Pathology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Yasuhisa Fujii
- Department of Urology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Ukihide Tateishi
- Department of Diagnostic Radiology, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-Ku, Tokyo, 113-8510, Japan
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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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Abstract
Computed tomography (CT) of the abdomen is usually appropriate for the initial imaging of many urinary tract diseases, due to its wide availability, fast scanning and acquisition of thin slices and isotropic data, that allow the creation of multiplanar reformatted and three-dimensional reconstructed images of excellent anatomic details. Non-enhanced CT remains the standard imaging modality for assessing renal colic. The technique allows the detection of nearly all types of urinary calculi and the estimation of stone burden. CT is the primary diagnostic tool for the characterization of an indeterminate renal mass, including both cystic and solid tumors. It is also the modality of choice for staging a primary renal tumor. Urolithiasis and urinary tract malignancies represent the main urogenic causes of hematuria. CT urography (CTU) improves the visualization of both the upper and lower urinary tract and is recommended for the investigation of gross hematuria and microscopic hematuria, in patients with predisposing factors for urologic malignancies. CTU is highly accurate in the detection and staging of upper tract urothelial malignancies. CT represents the most commonly used technique for the detection and staging of bladder carcinoma and the diagnostic efficacy of CT staging improves with more advanced disease. Nevertheless, it has limited accuracy in differentiating non-muscle invasive bladder carcinoma from muscle-invasive bladder carcinoma. In this review, clinical indications and the optimal imaging technique for CT of the urinary tract is reviewed. The CT features of common urologic diseases, including ureterolithiasis, renal tumors and urothelial carcinomas are discussed.
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Rawal N, Maldjian P. Urachal Remnant Calcification: A Rare Cause of Calcification Within the Urinary Bladder. Cureus 2022; 14:e29443. [DOI: 10.7759/cureus.29443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/22/2022] [Indexed: 11/05/2022] Open
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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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Bhawani SS, Jehangir M, Masood M, Dar SA, Syed SN. Dual-Energy Multidetector Computed Tomography: A Highly Accurate Non-Invasive Tool
for in Vivo Determination of Chemical Composition of Renal Calculi. GALICIAN MEDICAL JOURNAL 2021. [DOI: 10.21802/gmj.2021.3.4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Introduction. Computed tomography is more accurate than excretory urography in
evaluation of renal stones due to its high sensitivity and temporal resolution; it
permits sub-millimetric evaluation of the size and site of calculi but cannot evaluate
their chemical composition. Dual-energy computed tomography allows evaluating the
chemical composition of urinary calculi using simultaneous image acquisition at two
different energy levels.
The objective of the research was to determine renal stone
composition using dual-energy multidetector computed tomography, and its correlation
with post-extraction chemical analysis of stones.
Materials and Methods. This
prospective study was conducted in the Department of Radiodiagnosis and Imaging from
September 2017 to March 2019. A total of 50 patients with urolithiasis at the age of
18-70 years were included in the study. Dual-energy computed tomography ratios of
various stones were noted, and preoperative composition of calculi was given based on
their colour and dual-energy computed tomography ratio. These results were compared with
the post-extraction chemical analysis of stones (using Fourier infrared transform
spectroscopy as the standard comparative method.)
Results. The most common type of
calculi in our study population was calcium oxalate stones (78%) followed by uric acid
stones (12%), cystine stones (6%) and hydroxyapatite stones (4%). The dual-energy ratio
of calcium oxalate, uric acid, cystine and hydroxyapatite stones ranged from 1.38-1.59,
0.94-1.08, and 1.20-1.28 and 1.52-1.57, respectively, with the mean dual-energy ratio of
1.43, 1.01, 1.25 and 1.55, respectively. Dual-energy computed tomography was found to be
100% sensitive and specific for differentiating uric acid stones from non‑uric acid
stones. The sensitivity and specificity in differentiating calcium oxalate calculus from
non‑calcium oxalate calculus was 97.5% and 90.9%, respectively, with 96% accuracy and
kappa value of 0.883 suggesting strong agreement.
Conclusions. Dual-energy computed
tomography is highly sensitive and accurate in distinguishing between various types of
renal calculi. It has vital role in management as uric acid calculi are amenable to drug
treatment, while most of non-uric acid calculi require surgical intervention.
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Can obstructive urolithiasis be safely excluded on contrast CT? A retrospective analysis of contrast-enhanced and noncontrast CT. Am J Emerg Med 2021; 47:70-73. [PMID: 33774453 DOI: 10.1016/j.ajem.2021.03.059] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Revised: 03/03/2021] [Accepted: 03/17/2021] [Indexed: 11/20/2022] Open
Abstract
PURPOSE The aim of this study was to determine if contrast-enhanced CT can safely exclude obstructive urolithiasis in patients with flank plain. We performed a retrospective cohort analysis to compare the negative predictive values of contrast-enhanced and non-contrast CTs for the detection of obstructing urolithiasis. METHODS Through report analysis, we identified all non-contrast and contrast-enhanced CT examinations of the abdomen and pelvis performed on adult patients in the emergency department at a single, multi-site academic medical institution in 2017 with an indication of flank pain. The prevalence of obstructive urolithiasis in each group was calculated. We subsequently analyzed 200 consecutive studies from each of these groups (reported negative for obstructive urolithiasis) for negative predictive value calculation. Follow up abdominal imaging within 7 days from original presentation was used as a reference standard for analysis. RESULTS In the noncontrast group, 1 study out of 200 was false negative (negative predictive value = 99.5%). In the contrast-enhanced group, there were no false negatives (negative predictive value = 100%). The prevalence of obstructive urolithiasis was 44.0% (351/797) in the noncontrast group and 18.7% (86/459) in the contrast-enhanced group. CONCLUSION Our results suggest that contrast-enhanced CT can safely exclude obstructing ureteral calculi in the setting of acute flank pain. This finding is of clinical relevance given the inherent benefit of IV contrast in diagnosing abdominopelvic pathology.
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Unenhanced MRI of the Abdomen and Pelvis in the Comprehensive Evaluation of Acute Atraumatic Abdominal Pain in Children. AJR Am J Roentgenol 2020; 215:1218-1228. [PMID: 32901563 DOI: 10.2214/ajr.19.22577] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE. The purpose of this study is to show the utility of rapid unenhanced MRI in the comprehensive assessment of acute atraumatic abdominal pain in children, including appendicitis and alternate diagnoses, and to review the MRI features of common acute abdominal and pelvic conditions in a large, single-institution cohort. CONCLUSION. Rapid unenhanced MRI is an excellent option for the initial, comprehensive evaluation of acute abdominal emergencies in pediatric patients because it can diagnose the full range of presenting abnormalities, including causes of abdominal pain warranting surgical and nonsurgical management.
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Wildman-Tobriner B, Ehieli WL, Dixon AX, Allen BC. Computed tomography of the acute abdomen. APPLIED RADIOLOGY 2019. [DOI: 10.37549/ar2618] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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Odenrick A, Kartalis N, Voulgarakis N, Morsbach F, Loizou L. The role of contrast-enhanced computed tomography to detect renal stones. Abdom Radiol (NY) 2019; 44:652-660. [PMID: 30225609 DOI: 10.1007/s00261-018-1778-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
PURPOSE To investigate the detectability of renal stones in corticomedullary and nephrographic phases on contrast-enhanced computed tomography (CT). METHODS All consecutive patients between January 2012 and February 2016 undergoing CT of the kidneys according to our department's standard four-phase protocol and having at least one stone in the NC-phase (NCP) were included. Fifty patients with altogether 136 stones were eligible. Two radiologists in consensus evaluated the NCP from each examination and documented the number, location, and size of stones. Three abdominal radiologists blinded to the findings of the NCP reviewed independently the corticomedullary and nephrographic phases on two different occasions. They reported the number and location of stones in each kidney. For the inter-observer agreement the intra-class correlation coefficient (ICC) was estimated. The detection rate of renal stones was calculated for the three radiologists and compared between the two contrast-enhanced phases and the results were analyzed with concern to the size of the stones. RESULTS The ICC was 0.86. There was no statistically significant difference between corticomedullary and nephrographic phases (p = 0.94). The detection rate for stones measuring 3-5 mm was 82-88% and 98% for stones ≥ 6 mm. CONCLUSION The detectability of renal stones ≥ 6 mm on contrast-enhanced CT is extremely high. This means that stones with a higher risk of not passing spontaneously can be safely diagnosed.
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Affiliation(s)
- Alice Odenrick
- Division of Radiology, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, 14186, Stockholm, Sweden.
- Department of Abdominal Radiology, Karolinska University Hospital, Huddinge, 14186, Stockholm, Sweden.
| | - Nikolaos Kartalis
- Division of Radiology, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, 14186, Stockholm, Sweden
- Department of Abdominal Radiology, Karolinska University Hospital, Huddinge, 14186, Stockholm, Sweden
| | - Nikolaos Voulgarakis
- Division of Radiology, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, 14186, Stockholm, Sweden
- Department of Abdominal Radiology, Karolinska University Hospital, Huddinge, 14186, Stockholm, Sweden
| | - Fabian Morsbach
- Division of Radiology, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, 14186, Stockholm, Sweden
- Department of Abdominal Radiology, Karolinska University Hospital, Huddinge, 14186, Stockholm, Sweden
| | - Louiza Loizou
- Division of Radiology, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, 14186, Stockholm, Sweden
- Department of Abdominal Radiology, Karolinska University Hospital, Huddinge, 14186, Stockholm, Sweden
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Diamand R, Idrissi-Kaitouni M, Coppens E, Roumeguère T, Legrand F. [Evaluation of stone size before flexible ureteroscopy: Which measurement is best?]. Prog Urol 2017; 28:62-70. [PMID: 29102376 DOI: 10.1016/j.purol.2017.09.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Revised: 08/28/2017] [Accepted: 09/26/2017] [Indexed: 10/18/2022]
Abstract
PURPOSE To retrospectively assess the clinical utility in ureteroscopy (URS) planning of radiological parameters as predictor of stone-free status after a single flexible ureteroscopy. MATERIAL Sixty-seven patients with renal stones treated by flexible URS were retrospectively evaluated. To assess the clinical utility of radiological parameters, relationships between stone-free (SF) status and stone burden (maximal diameter, calculated area, calculated volume, cumulative diameter, and tridimentionnal volume [V3D]) were analyzed using the area under the receiver operating characteristics curve and logistic regression. RESULTS Maximal diameter (AUC=0.75), calculated area (AUC 0.79), calculated volume (AUC=0.79), cumulative diameter (AUC=0.80) and tridimensional volume (AUC=0.82) revealed ability to predict SF status after URS. CONCLUSION Stone burden evaluation is critical in predicting SF status after a single URS. Planar and volumetric measurements showed equal ability to predict SF status. V3D is more accurate but diameter measurement remains easier in clinical practice. LEVEL OF EVIDENCE 4.
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Affiliation(s)
- R Diamand
- Service d'urologie, cliniques universitaires de Bruxelles, hôpital Erasme-ULB, 808, route de Lennik, 1070 Bruxelles, Belgique
| | - M Idrissi-Kaitouni
- Service d'urologie, cliniques universitaires de Bruxelles, hôpital Erasme-ULB, 808, route de Lennik, 1070 Bruxelles, Belgique
| | - E Coppens
- Service de radiologie, cliniques universitaires de Bruxelles, hôpital Erasme-ULB, Bruxelles, Belgique
| | - T Roumeguère
- Service d'urologie, cliniques universitaires de Bruxelles, hôpital Erasme-ULB, 808, route de Lennik, 1070 Bruxelles, Belgique
| | - F Legrand
- Service d'urologie, cliniques universitaires de Bruxelles, hôpital Erasme-ULB, 808, route de Lennik, 1070 Bruxelles, Belgique.
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A new method for predicting uric acid composition in urinary stones using routine single-energy CT. Urolithiasis 2017; 46:325-332. [PMID: 28660283 PMCID: PMC6061464 DOI: 10.1007/s00240-017-0994-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Accepted: 06/15/2017] [Indexed: 10/31/2022]
Abstract
Urinary stones composed of uric acid can be treated medically. Prediction of uric acid stone type is, therefore, desirable when a urinary stone is diagnosed with unenhanced CT. The purpose of the present study was to describe single-energy thin slice quantitative CT parameters of urinary stones correlated to chemical stone type and to develop a method to distinguish pure uric acid stones (UA) from other stones (non-UA/Mix). Unenhanced thin slice single-energy CT images of 126 urinary stones (117 patients) with known chemical stone type were retrospectively included in the study. Among the included stones, 22 were UA and 104 were non-UA/Mix. The included CT images and Laplacian filtered images of the stones were quantitatively analyzed using operator-independent methods. A post hoc classification method for pure UA stones was created using a combination of cutoff values for the peak attenuation and peak point Laplacian. The stone types differed in most quantitative image characteristics including mean attenuation (p < 0.001), peak attenuation (p < 0.001), and peak point Laplacian (p < 0.001). The sensitivity for the post hoc-developed peak attenuation-peak point Laplacian method for classifying pure UA stones was 95% [21/22, 95% CI (77-100%)] and the specificity was 99% [103/104, 95% CI (95-100%)]. In conclusion, quantitative image analysis of thin slice routine single-energy CT images is promising for predicting pure UA content in urinary stones, with results comparable to double energy methods.
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Abstract
Nephrolithiasis (NL) is one of the most prevalent nontransmissible diseases in western countries. It is being associated with other frequent diseases, including osteoporosis, cardiovascular disease, hypertension, diabetes mellitus, through a putative common link with metabolic syndrome and insulin resistance or altered mineral metabolism. This review will focus on classification, physicochemical basis, risk factors, laboratory and imaging investigations, medical management.Classification as to stone composition includes calcium, uric acid (UA), cystine (Cys), infected, 2-8 dihydroxyadenine and rare NL. According to pathophysiology, NL is classified as primary, secondary to systemic diseases or drugs, caused by renal or metabolic hereditary disorders.A stone can only form in supersaturated environment, and this is sufficient in UA, Cys and infected NL, but not in Ca-NL, which results from the imbalance between supersaturation and inhibition. All types are characterized by derangements of peculiar risk factors. Laboratory investigations aim at identifying type of NL, underlying risk factors and state of saturation, and pathophysiology. This justifies a rationale therapy able to dissolve some types of stones and/or produce reduction in recurrence rate in others.Medical management includes alkali and allopurinol for UA nephrolithiasis (UA-NL), thiols and alkali in Cys-NL, dietary and pharmacological intervention for Ca-NL. Thiazides and alkaline citrate salts are the most widely used drugs in Ca-NL, where they proved efficient to prevent new stones. Other drugs have only been used in particular subsets.Proper medical management and modern urological approaches have already notably improved clinical outcomes. Future studies will further clarify mechanisms of NL with expected new and targeted therapeutic options.
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Berko NS, Dym RJ. Computed Tomographic Imaging of Renal and Ureteral Emergencies. Curr Probl Diagn Radiol 2015; 44:207-20. [DOI: 10.1067/j.cpradiol.2014.08.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2014] [Revised: 08/29/2014] [Accepted: 08/30/2014] [Indexed: 11/22/2022]
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Renal stones on portal venous phase contrast-enhanced CT: does intravenous contrast interfere with detection? ACTA ACUST UNITED AC 2015; 39:526-32. [PMID: 24504541 DOI: 10.1007/s00261-014-0082-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
PURPOSE To determine the sensitivity of portal venous phase contrast-enhanced CT for the detection of renal stones. METHODS This retrospective study included 97 CT examinations of the abdomen without and with intravenous contrast, including 85 (87.6%) examinations with at least one renal stone on the "gold standard" noncontrast images, as scored by a single radiologist. Three other radiologists each independently reviewed only the contrast-enhanced images from all 97 examinations and recorded all renal stones. Reviewer sensitivity for stones was categorized by stone diameter. Reviewer sensitivity and specificity for stone disease were also calculated on a per-kidney basis. RESULTS The 97 cases included a total of 238 stones ≥1 mm, with a mean (±SD) of 1.2 ± 1.9 stones per kidney and a stone diameter of 3.5 ± 3.0 mm. Pooling data for the three reviewers, sensitivity for all stones was 81%; sensitivity for stones ≥2, ≥3, ≥4, and ≥5 mm was 88%, 95%, 99%, and 98%, respectively. Sensitivity for stone disease on a per-kidney basis was 94% when considering all stones; when considering only stones ≥2, ≥3, and ≥4 mm, sensitivity was 96%, 99%, and 100%, respectively. Specificity for stone disease on a per-kidney basis was 98% overall, 99% when considering only stones ≥2 mm, and 100% when considering only stones ≥3 mm. CONCLUSION Contrast-enhanced CT is highly sensitive for the detection of renal stones ≥3 mm in diameter and less sensitive for smaller stones. In cases where the clinical diagnosis is uncertain and performance of a CT examination is being contemplated, intravenous contrast utilization would allow assessment for stone disease while also optimizing evaluation for other conditions.
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Solomon J, Samei E. A generic framework to simulate realistic lung, liver and renal pathologies in CT imaging. Phys Med Biol 2014; 59:6637-57. [PMID: 25325156 DOI: 10.1088/0031-9155/59/21/6637] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Realistic three-dimensional (3D) mathematical models of subtle lesions are essential for many computed tomography (CT) studies focused on performance evaluation and optimization. In this paper, we develop a generic mathematical framework that describes the 3D size, shape, contrast, and contrast-profile characteristics of a lesion, as well as a method to create lesion models based on CT data of real lesions. Further, we implemented a technique to insert the lesion models into CT images in order to create hybrid CT datasets. This framework was used to create a library of realistic lesion models and corresponding hybrid CT images. The goodness of fit of the models was assessed using the coefficient of determination (R(2)) and the visual appearance of the hybrid images was assessed with an observer study using images of both real and simulated lesions and receiver operator characteristic (ROC) analysis. The average R(2) of the lesion models was 0.80, implying that the models provide a good fit to real lesion data. The area under the ROC curve was 0.55, implying that the observers could not readily distinguish between real and simulated lesions. Therefore, we conclude that the lesion-modeling framework presented in this paper can be used to create realistic lesion models and hybrid CT images. These models could be instrumental in performance evaluation and optimization of novel CT systems.
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Affiliation(s)
- Justin Solomon
- Duke University Health System, Department of Radiology, 2424 Erwin Rd. Suite 302, Durham, NC 27705, USA
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Yildirim D, Ozturk O, Tutar O, Nurili F, Bozkurt H, Kayadibi H, Karaarslan E, Bakan S. A new method for computer-assisted detection, definition and differentiation of the urinary calculi. Ren Fail 2014; 36:1278-82. [PMID: 25019642 DOI: 10.3109/0886022x.2014.938577] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
PURPOSE Urinary stones are common and can be diagnosed with computed tomography (CT) easily. In this study, we aimed to specify the opacity characteristics of various types of calcified foci that develop through the urinary system by using an image analysis program. With this method, we try to differentiate the calculi from the non-calculous opacities and also we aimed to present how to identify the characteristic features of renal and ureteral calcules. MATERIALS AND METHODS We obtained the CT studies of the subjects (n = 48, mean age = 41 years) by using a dual source CT imaging system. We grouped the calculi detected in the dual-energy CT sections as renal (n = 40) or ureteric (n = 45) based on their locations. Other radio-opaque structures that were identified outside but within close proximity of the urinary tract were recorded as calculi "mimickers". We used ImageJ program for morphological analysis. All the acquired data were analyzed statistically. RESULTS According to thorough morphological parameters, there were statistically significant differences in the angle and Feret angle values between calculi and mimickers (p < 0.001). Multivariate logistical regression analysis showed that Minor Axis and Feret angle parameters can be used to distinguish between ureteric (p = 0.003) and kidney (p = 0.001) stones. CONCLUSIONS Computer-based morphologic parameters can be used simply to differentiate between calcular and noncalcular densities on CT and also between renal and ureteric stones.
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Affiliation(s)
- Duzgun Yildirim
- Department of Radiology, Centermed Advanced Imaging Center , Istanbul , Turkey
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Cakmakci E, Bayram A, Turkoglu OK, Ozal ST, Celebi I, Cakmakci S, Seker H, Aydin MZ, Aydin A, Kitirci G. Correlation between computerized tomography density measurements of urinary bladder and urinalysis results. Clin Imaging 2014; 38:283-6. [PMID: 24556331 DOI: 10.1016/j.clinimag.2014.01.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2013] [Revised: 12/27/2013] [Accepted: 01/06/2014] [Indexed: 11/28/2022]
Abstract
Our aim was to investigate whether there is a correlation between computerized tomography (CT) density measurements of the urinary bladder and urinalysis results. Patients were subdivided into three groups with respect to urinalysis results: Group 1, no leukocytes or erythrocytes detected in urine (n=25); Group 2, erythrocytes detected in urine (n=50); and Group 3, leukocytes and erythrocytes detected in urine (n=98). In CT sections, densitometric measurements had been performed from three zones on each section and groups were compared in terms of densitometry results. Our results indicate that density measurements of CT views form the urinary bladder may provide valuable data on hematuria and leukocyturia.
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Affiliation(s)
- Emin Cakmakci
- Department of Radiology, Kelkit Government Hospital, Gumushane, Turkey.
| | - Aysel Bayram
- Department of Radiology, Bafra Government Hospital, Samsun, Turkey
| | - Ozlem Kolcak Turkoglu
- Department of Radiology, Dr. Lutfu Kirdar Kartal Training and Research Hospital, Istanbul, Turkey
| | - Safiye Tokgoz Ozal
- Department of Radiology, Dr. Lutfu Kirdar Kartal Training and Research Hospital, Istanbul, Turkey
| | - Irfan Celebi
- Department of Radiology, Sisli Etfal Training and Research Hospital, Istanbul, Turkey
| | - Selma Cakmakci
- Department of Pediatrics, Division of Heamatology and Oncology, Dr. Abdurrahman Yurtaslan Ankara Oncology Training and Research Hospital, Ankara, Turkey
| | - Hulya Seker
- Department of Pediatrics, Kelkit Government Hospital, Gumushane, Turkey
| | - Mehmet Zeki Aydin
- Department of Internal Medicine, Kelkit Government Hospital, Gumushane, Turkey
| | - Alper Aydin
- Department of Radiology, Giresun Prof. Dr. Ilhan Ozdemir Government Hospital, Giresun, Turkey
| | - Gurcan Kitirci
- Department of Urology, Kelkit Government Hospital, Gumushane, Turkey
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