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Advanced non-contrasted computed tomography post-processing by CT-Calculometry (CT-CM) outperforms established predictors for the outcome of shock wave lithotripsy

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Abstract

Objectives

To evaluate the predictive value of advanced non-contrasted computed tomography (NCCT) post-processing using novel CT-calculometry (CT-CM) parameters compared to established predictors of success of shock wave lithotripsy (SWL) for urinary calculi.

Materials and Methods

NCCT post-processing was retrospectively performed in 312 patients suffering from upper tract urinary calculi who were treated by SWL. Established predictors such as skin to stone distance, body mass index, stone diameter or mean stone attenuation values were assessed. Precise stone size and shape metrics, 3-D greyscale measurements and homogeneity parameters such as skewness and kurtosis, were analysed using CT-CM. Predictive values for SWL outcome were analysed using logistic regression and receiver operating characteristics (ROC) statistics.

Results

Overall success rate (stone disintegration and no re-intervention needed) of SWL was 59% (184 patients). CT-CM metrics mainly outperformed established predictors. According to ROC analyses, stone volume and surface area performed better than established stone diameter, mean 3D attenuation value was a stronger predictor than established mean attenuation value, and parameters skewness and kurtosis performed better than recently emerged variation coefficient of stone density. Moreover, prediction of SWL outcome with 80% probability to be correct would be possible in a clearly higher number of patients (up to fivefold) using CT-CM-derived parameters.

Conclusions

Advanced NCCT post-processing by CT-CM provides novel parameters that seem to outperform established predictors of SWL response. Implementation of these parameters into clinical routine might reduce SWL failure rates.

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Authors and Affiliations

  1. Department of Urology, Kantonsspital St. Gallen, Rorschacherstrasse 95, 9007, St. Gallen, Switzerland

    J. Langenauer, P. Betschart, H. P. Schmid, D. S. Engeler, D. Abt & V. Zumstein

  2. Department of Radiology and Nuclear Medicine, Kantonsspital St. Gallen, Rorschacherstrasse 95, 9007, St. Gallen, Switzerland

    L. Hechelhammer

  3. Biostatistics, Clinical Trials Unit, Rorschacherstrasse 95, 9007, St. Gallen, Switzerland

    S. Güsewell

  4. Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany

    V. Zumstein

Authors
  1. J. Langenauer
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  2. P. Betschart
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  3. L. Hechelhammer
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  4. S. Güsewell
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  5. H. P. Schmid
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  6. D. S. Engeler
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  7. D. Abt
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  8. V. Zumstein
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Contributions

JL and PB data collection, manuscript writing, manuscript editing. LH data collection, manuscript editing. SG project development, statistical analysis, manuscript writing, manuscript editing HPS, DSE, DA project development, manuscript editing. VZ project development, data collection, manuscript writing, manuscript editing.

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Correspondence to V. Zumstein.

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The authors declare that they have no conflict of interest.

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General consent for data usage was obtained from all individual participants included in the study.

Ethical approval

All procedures performed in the study were in accordance with the ethical standards of the local research committee and with the 1964 Helsinki declaration and its later amendments.

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Langenauer, J., Betschart, P., Hechelhammer, L. et al. Advanced non-contrasted computed tomography post-processing by CT-Calculometry (CT-CM) outperforms established predictors for the outcome of shock wave lithotripsy. World J Urol 36, 2073–2080 (2018). https://doi.org/10.1007/s00345-018-2348-x

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  • DOI: https://doi.org/10.1007/s00345-018-2348-x

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