Abstract
Although state-of-the-art CT provides accurate sub millimeter details of the size and location of renal stones, current routine clinical image analysis does not differentiate stone composition. This is particularly important in the case of uric acid (UA) stones (∼10% of cases), since urinary alkalinization can be prescribed to dissolve UA stones. Therefore, simple and reliable differentiation of UA vs. non-UA stone composition could potentially allow patients with UA stones to avoid invasive interventional urinary procedures for stone removal or external shock wave lithotripsy. This chapter describes a novel Dual-Energy CT (DECT) technique for renal stone differentiation, which is based on the difference in X-ray attenuation properties at high and low kV between UA- and non-UA-containing stones. The technique has been implemented on modern Dual-Source CT scanners which allow simultaneous Dual-Energy acquisition with high spatial resolution and immediate postprocessing using commercial algorithm available on the system. Principles of DECT imaging, acquisition parameters and postprocessing details are discussed. Diagnostic evaluation of three clinical cases is provided together with a summary of the results of all known validation studies performed both in vitro and in vivo. The reported accuracy and sensitivity of the UA vs. non-UA differentiation using DECT varied from 88 to 100%. Further improvement is expected with the second generation of Dual-Source scanners due to increased spectral separation.
This is a preview of subscription content, log in via an institution to check access.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
Alvarez RE, Macovski A (1976) Energy-selective reconstructions in X-ray computerized tomography. Phys Med Biol 21:733–744
Behrendt FF, Schmidt B, Plumhans C et al (2009) Image fusion in dual energy computed tomography: effect on contrast enhancement, signal-to-noise ratio and image quality in computed tomography angiography. Invest Radiol 44:1–6
Bellin MF, Renard-Penna R, Conort P et al (2004) Helical CT evaluation of the chemical composition of urinary tract calculi with a discriminant analysis of CT-attenuation values and density. Eur Radiol 14:2134–2140
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 250:813–820
Dillman JR, Caoili EM, Cohan RH (2007) Multi-detector CT urography: a one-stop renal and urinary tract imaging modality. Abdom Imaging 32:519–529
Evan AP, Willis LR, Lingeman JE et al (1998) Renal trauma and the risk of long-term complications in shock wave lithotripsy. Nephron 78:1–8
Graser A, Johnson TR, Bader M et al (2008) Dual energy CT characterization of urinary calculi: initial in vitro and clinical experience. Invest Radiol 43:112–119
Grosjean R, Sauer B, Guerra RM et al (2008) Characterization of human renal stones with MDCT: advantage of dual energy and limitations due to respiratory motion. Am J Roentgenol 190:720–728
National Institutes of Health (1990) National Kidney and Urological Diseases Advisory Board long range plan: window on the 21st century. In: NIH Publication 90–583. United States Department of Health and Human Services, Washington
Joseph P, Mandal AK, Singh SK et al (2002) Computerized tomography attenuation value of renal calculus: can it predict successful fragmentation of the calculus by extracorporeal shock wave lithotripsy? A preliminary study. J Urol 167:1968–1971
Lemann J Jr, Taylor AJ, Collier BD et al (1991) Kidney hematoma due to extracorporeal shock wave lithotripsy causing transient renin mediated hypertension. J Urol 145:1238–1241
Lingeman JE, Woods JR, Toth PD (1990) Blood pressure changes following extracorporeal shock wave lithotripsy and other forms of treatment for nephrolithiasis. JAMA 263:1789–1794
Matlaga BR, Kawamoto S, Fishman E (2008) Dual source computed tomography: a novel technique to determine stone composition. Urology 72:1164–1168
Mitcheson HD, Zamenhof RG, Bankoff MS et al (1983) Determination of the chemical composition of urinary calculi by computerized tomography. J Urol 130:814–819
Mostafavi MR, Ernst RD, Saltzman B (1998) Accurate determination of chemical composition of urinary calculi by spiral computerized tomography. J Urol 159:673–675
Motley G, Dalrymple N, Keesling C et al (2001) Hounsfield unit density in the determination of urinary stone composition. Urology 58:170–173
Nakada SY, Hoff DG, Attai S et al (2000) Determination of stone composition by noncontrast spiral computed tomography in the clinical setting. Urology 55:816–819
Pareek G, Armenakas NA, Fracchia JA (2003) Hounsfield units on computerized tomography predict stone-free rates after extracorporeal shock wave lithotripsy. J Urol 169:1679–1681
Pearle MS, Calhoun EA, Curhan GC (2005) Urologic diseases in America project: urolithiasis. J Urol 173:848–857
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 14:1441–1447
Primak AN, Ramirez Giraldo JC, Liu X et al (2009) Improved dual-energy material discrimination for dual-source CT by means of additional spectral filtration. Med Phys 36:1359–1369
Sheir KZ, Mansour O, Madbouly K et al (2005) Determination of the chemical composition of urinary calculi by noncontrast spiral computerized tomography. Urol Res 33:99–104
Stolzmann P, Scheffel H, Rentsch K et al (2008) Dual-energy computed tomography for the differentiation of uric acid stones: ex vivo performance evaluation. Urol Res 36:133–138
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. doi:10.1007/s00261-009-9569-9
Thomas C, Patschan O, Ketelsen D et al (2009) Dual-energy CT for the characterization of urinary calculi: In vitro and in vivo evaluation of a low-dose scanning protocol. Eur Radiol 19:1553–1559
Vrtiska TJ (2005) Quantitation of stone burden: imaging advances. Urol Res 33:398–402
Williams JC Jr, Saw KC, Monga AG et al (2001) Correction of helical CT attenuation values with wide beam collimation: in vitro test with urinary calculi. Acad Radiol 8:478–483
Williams JC Jr, Paterson RF, Kopecky KK et al (2002) High resolution detection of internal structure of renal calculi by helical computerized tomography. J Urol 167:322–326
Williams JC Jr, Kim SC, Zarse CA et al (2004) Progress in the use of helical CT for imaging urinary calculi. J Endourol 18:937–941
Yu L, Primak AN, Liu X et al (2009) Image quality optimization and evaluation of linearly mixed images in dual-source, dual-energy CT. Med Phys 36:1019–1024
Zarse CA, McAteer JA, Tann M et al (2004) Helical computed tomography accurately reports urinary stone composition using attenuation values: in vitro verification using high-resolution micro-computed tomography calibrated to Fourier transform infrared microspectroscopy. Urology 63:828–833
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2011 Springer-Verlag Berlin Heidelberg
About this chapter
Cite this chapter
Primak, A.N., Vrtiska, T.J., Qu, M., McCollough, C.H. (2011). Kidney Stones. In: Johnson, T., Fink, C., Schönberg, S., Reiser, M. (eds) Dual Energy CT in Clinical Practice. Medical Radiology(). Springer, Berlin, Heidelberg. https://doi.org/10.1007/174_2010_33
Download citation
DOI: https://doi.org/10.1007/174_2010_33
Published:
Publisher Name: Springer, Berlin, Heidelberg
Print ISBN: 978-3-642-01739-1
Online ISBN: 978-3-642-01740-7
eBook Packages: MedicineMedicine (R0)