Abstract
Purpose
To prospectively examine the diagnostic performance of fast kilovoltage switching dual-energy computed tomography (DECT) in characterization of in vivo renal stone composition compared with postoperative stone analysis.
Methods
Consecutive consenting patients scheduled for endoscopic kidney stone surgery in a tertiary referral hospital from June 2015 to January 2016 were enrolled. Patients were preoperatively scanned with single-source, fast kilovoltage switching DECT. Stone compositions were determined regarding the effective atomic number measurements. Results of the stone compositions from DECT were compared to postoperative infrared spectroscopy stone analysis as the standard reference.
Results
For the 39 patients enrolled in the study, DECT was able to detect uric acid stone with sensitivity of 88.9% and specificity of 100%. There was 100% positive predictive value, 96.8% negative predictive value, and 97.4% accuracy. For non-contrast CT scan, sensitivity was 88.9%, specificity was 96.7%, positive predictive value was 88.9%, negative predictive value was 96.7%, and accuracy was 94.8%. Of the 39 samples examined, 21 (54%) were single composition, whereas 18 (46%) were combined. Single composition stones were correctly characterized by DECT in 100% (8/8) for uric acid. Whereas the result of uric acid stone containing stone discrimination in mixed composition was not so good with Zeff alone, iodine imaging can compensated this fault.
Conclusions
DECT provides excellent accuracy in characterizing uric acid stone compositions. With the addition of iodine image, all of uric acid-containing stones can be determined by the DECT.
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References
Romero V, Akpinar H, Assimos DG (2010) Kidney stones: a global picture of prevalence, incidence, and associated risk factors. Rev Urol 12(2–3):e86–e96
Rule AD, Bergstralh EJ, Melton LJ 3rd, et al. (2009) Kidney stones and the risk for chronic kidney disease. Clin J Am Soc Nephrol 4(4):804–811
Johri N, Cooper B, Robertson W, et al. (2010) An update and practical guide to renal stone management. Nephron Clin Pract 116(3):c159–c171
Bultitude M, Smith D, Thomas K (2016) Contemporary management of stone disease: the new EAU urolithiasis guidelines for 2015. Eur Urol 69(3):483–484
Primak AN, Fletcher JG, Vrtiska TJ, et al. (2007) Noninvasive differentiation of uric acid versus non-uric acid kidney stones using dual-energy CT. Acad Radiol. 14(12):1441–1447
Flohr TG, McCollough CH, Bruder H, et al. (2006) First performance evaluation of a dual-source CT (DSCT) system. Eur Radiol. 16(2):256–268
Ferrandino MN, Pierre SA, Simmons WN, et al. (2010) Dual-energy computed tomography with advanced postimage acquisition data processing: improved determination of urinary stone composition. J Endourol 24(3):347–354
Graser A, Johnson TR, Bader M, et al. (2008) Dual energy CT characterization of urinary calculi: initial in vitro and clinical experience. Investig Radiol 43(2):112–119
Boll DT, Patil NA, Paulson EK, et al. (2009) Renal stone assessment with dual-energy multidetector CT and advanced postprocessing techniques: improved characterization of renal stone composition–pilot study. Radiology. 250(3):813–820
Li X, Zhao R, Liu B, Yu Y (2013) Gemstone spectral imaging dual-energy computed tomography: a novel technique to determine urinary stone composition. Urology. 81(4):727–730
Hidas G, Eliahou R, Duvdevani M, et al. (2010) Determination of renal stone composition with dual-energy CT: in vivo analysis and comparison with X-ray diffraction. Radiology. 257(2):394–401
Stolzmann P, Kozomara M, Chuck N, et al. (2009) In vivo identification of uric acid stones with dual-energy CT: diagnostic performance evaluation in patients. Abdom Imaging. 35(5):629–635
Mansouri M, Aran S, Singh A, et al. (2015) Dual-energy computed tomography characterization of urinary calculi: basic principles, applications and concerns. Curr Probl Diagn Radiol 44(6):496–500
Krasnicki T, Podgorski P, Guzinski M, et al. (2012) Novel clinical applications of dual energy computed tomography. Adv Clin Exp Med 21(6):831–841
Sheir KZ, Mansour O, Madbouly K, et al. (2005) Determination of the chemical composition of urinary calculi by noncontrast computerized tompography. Urol Res. 33:99–104
Kaza RK, Platt JF, Cohan RH, et al. (2012) Dual-energy CT with single- and dual-source scanners: current applications in evaluating the genitourinary tract. Radiographics. 32(2):353–369
Gucuk A, Uyeturk U (2014) Usefulness of hounsfield unit and density in the assessment and treatment of urinary stones. World J Nephrol 3(4):282–286
Zilberman DE, Ferrandino MN, Preminger GM, et al. (2010) In vivo determination of urinary stone composition using dual energy computerized tomography with advanced post-acquisition processing. J Urol 184(6):2354–2359
Manglaviti G, Tresoldi S, Guerrer CS, et al. (2011) In vivo evaluation of the chemical composition of urinary stones using dual-energy CT. AJR 197(1):W76–W83
Kulkarni NM, Eisner BH, Pinho DF, et al. (2013) Determination of renal stone composition in phantom and patients using single-source dual-energy computed tomography. J Comput Assist Tomogr 37(1):37–45
Acknowledgments
The authors gratefully acknowledge Ms. Chulaluck Boonma and Mr. Weerachat Churawd for their assistances of the data analysis and research processes, respectively.
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Rompsaithong, U., Jongjitaree, K., Korpraphong, P. et al. Characterization of renal stone composition by using fast kilovoltage switching dual-energy computed tomography compared to laboratory stone analysis: a pilot study. Abdom Radiol 44, 1027–1032 (2019). https://doi.org/10.1007/s00261-018-1787-6
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DOI: https://doi.org/10.1007/s00261-018-1787-6