Document Detail


Determination of renal stone composition with dual-energy CT: in vivo analysis and comparison with x-ray diffraction.
MedLine Citation:
PMID:  20807846     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
PURPOSE: To preoperatively assess the composition of urinary stones by using dual-energy computed tomography (CT), with postoperative in vitro x-ray diffraction analysis as the reference standard.
MATERIALS AND METHODS: Institutional review board approval was obtained, and all participants provided written informed consent. Twenty-seven patients aged 50-64 years with renal stones, who were scheduled for stone extraction with percutaneous nephrolithotomy (PCNL), preoperatively underwent nonenhanced single-source dual-energy multidetector CT with 2-mm section thickness, 1-mm increments, 140 kVp, and 250 mAs. Regions of interest were drawn on low- and high-energy images, and low- and high-energy attenuation ratios were calculated for each stone scanned in vivo. The attenuation ratios for the patients were compared with those for an in vitro stone library phantom model of 37 stones with known chemical compositions. After surgery, the extracted stones were analyzed by using x-ray diffraction. The results of in vivo multidetector CT and ex vivo chemical analysis were compared.
RESULTS: Dual-energy low- and high-energy attenuation ratios measured with the phantom were less than 1.1 for uric acid, 1.1-1.24 for cystine, and greater than 1.24 for calcified stones. Struvite stones had attenuation ratios that overlapped with calcified stone ratios and thus could not be assessed reliably. Four patients had mixed stones (<75% of a single component), and one patient had a struvite stone. Of 27 patients, 22 (82%) (exact confidence interval [CI]: 68%, 92%) received a correct diagnosis with dual-energy CT: all six (100%; exact CI: 54%, 100%) patients with uric acid stones, 15 (79%; exact CI: 62%, 95%) of the 19 patients with calcium stones, and the one (100%) patient with a cystine stone. The patient with a struvite stone did not receive a correct dual-energy CT-based diagnosis.
CONCLUSION: Dual-energy multidetector CT may enable accurate in vivo characterization of kidney stone composition.
Authors:
Guy Hidas; Ruth Eliahou; Mordechai Duvdevani; Phillipe Coulon; Laurent Lemaitre; Ofer N Gofrit; Dov Pode; Jacob Sosna
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Publication Detail:
Type:  Comparative Study; Journal Article     Date:  2010-08-31
Journal Detail:
Title:  Radiology     Volume:  257     ISSN:  1527-1315     ISO Abbreviation:  Radiology     Publication Date:  2010 Nov 
Date Detail:
Created Date:  2010-10-20     Completed Date:  2010-12-02     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0401260     Medline TA:  Radiology     Country:  United States    
Other Details:
Languages:  eng     Pagination:  394-401     Citation Subset:  AIM; IM    
Copyright Information:
© RSNA, 2010.
Affiliation:
Department of Urology, Hadassah Hebrew University Medical Center, POB 12000, Jerusalem, Israel.
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Female
Humans
Kidney Calculi / chemistry*,  radiography*,  surgery
Male
Middle Aged
Phantoms, Imaging
Prospective Studies
Reference Values
Tomography, X-Ray Computed / methods*
X-Ray Diffraction*

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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