In-vivo or in-vitro stone attenuation: what is more valuable for the prediction of renal stone composition in non-contrast-enhanced abdominal computed tomography?

Abstract

Objectives To compare the efficacy of in-vivo and in-vitro stone attenuation in the prediction of stone composition using non-contrast-enhanced abdominal computed tomography (NCCT).

Methods This study included a total of 104 patients with renal stones who received percutaneous nephrolithotomy treatment for renal stones between December 2016 and December 2019 and underwent NCCT before the procedure. Preoperative (in-vivo) and postoperative (in-vitro) kidney stone attenuations were compared using the NCCT images of the patients. Renal stone fragments were analysed with the infrared spectrophotometer method.

Results The mean age of the 104 patients was 49.5 (interquartile range: 37–61) years. According to the receiver operating characteristics analysis, the cut-off values for the prediction of uric acid stones were determined to be 556 HU for the in-vivo and 774 HU for the in-vitro attenuation measurement. Sensitivity and specificity were 100% and 96.6%, respectively, for the in-vivo and 90.9 and 91%, respectively, for the in-vitro images. The cut-off values for the prediction of calcium stones were determined to be 824 HU and 1065 HU for the in-vivo and in-vitro attenuation measurements, respectively. Sensitivity and specificity were 97.3 and 96% for the in-vivo and 96 and 96% for the in-vitro images.

Conclusions In-vivo stone attenuation measurement in NCCT was slightly superior to in-vitro measurement due to the reduction in the composition and size of the stone. Our findings show that NCCT in-vivo stone attenuation might differentiate uric acid and calcium stones from the other stone types.

Zusammenfassung

Ziele Vergleich der Wirksamkeit der In-vivo- und In-vitro-Steinabschwächung bei der Vorhersage der Steinzusammensetzung unter Verwendung von nicht kontrastverstärkter Computertomografie des Abdomens (NCCT).

Methoden Insgesamt 104 Patienten mit Nierensteinen, die zwischen Dezember 2016 und Dezember 2019 eine perkutane Nephrolithotomie-Behandlung wegen Nierensteinen erhielten und sich vor dem Eingriff einer NCCT unterzogen, wurden in die Studie aufgenommen. Präoperative (in vivo) und postoperative (in vitro) Nierensteinschwächungen wurden anhand der NCCT-Bilder der Patienten verglichen. Nierensteinfragmente wurden mit dem Infrarotspektrophotometer-Verfahren analysiert.

Ergebnisse Das Durchschnittsalter der 104 Patienten betrug 49,5 (Interquartilsabstand: 37–61) Jahre. Gemäß der Receiver Operating Characteristics Analysis wurden die Cut-Off-Werte für die Vorhersage von Harnsäuresteinen mit 556 HU bzw. 774 HU für die In-vivo- bzw. In-vitro-Dämpfungsmessung ermittelt. Sensitivität und Spezifität betrugen 100 bzw. 96,6% für die In-vivo- und 90,9 bzw. 91% für die In-vitro-Bilder. Die Cut-off-Werte für die Vorhersage von Kalziumsteinen wurden mit 824 HU und 1065 HU für die In-vivo- bzw. In-vitro-Abschwächungsmessungen bestimmt. Sensitivität und Spezifität betrugen 97,3 und 96% für die In-vivo- und 96 und 96% für die In-vitro-Bilder.

Schlussfolgerungen Die In-vivo-Steinabschwächungsmessung im NCCT war der In-vitro-Messung aufgrund der Verringerung der Zusammensetzung und Größe des Steins etwas überlegen. Unsere Ergebnisse zeigen, dass die NCCT-In-vivo-Steinabschwächung Harnsäure- und Kalziumsteine von den anderen Steintypen unterscheiden könnte.

Schlüsselwörter

in vivo - in vitro - Steindämpfung - Steinzusammensetzung - perkutane Nephrolithotomie

Keywords

stone attenuation - stone composition - percutaneous nephrolithotomy - in-vivo - in-vitro

Publication History

Received: 05 August 2022

Accepted: 24 October 2022

Article published online:
26 January 2023

• References

• 1 Imamoglu C, Buyukbayraktar FG, Gok A. et al. Characterization Of Kidney Stones With Imaging Modalities: Twinkling Artifact In Color Doppler Ultrasound And Density In Non-Contrast-Enhanced CT. The Journal of Tepecik Education and Research Hospital 2016; 26: 120-126
• 2 Park S, Pearle MS. Pathophysiology and management of calcium stones. Urologic Clinics of North America 2007; 34: 323-334 DOI: 10.1016/j.ucl.2007.04.009. (PMID: 17678983)
• 3 Ljunghall S, Åkerstrom G. Urate metabolism in primary hyperparathyroidism. Urologia internationalis 1982; 37: 73-78 DOI: 10.1159/000280800. (PMID: 7112764)
• 4 Marchini GS, Sarkissian C, Tian D. et al. Gout. stone composition and urinary stone risk: a matched case comparative study. The Journal of urology 2013; 189: 1334-1339 DOI: 10.1016/j.juro.2012.09.102. (PMID: 23022002)
• 5 Cho ST, Jung SI, Myung SC. et al. Correlation of metabolic syndrome with urinary stone composition. International Journal of Urology 2013; 20: 208-213 DOI: 10.1111/j.1442-2042.2012.03131.x. (PMID: 23020870)
• 6 Gonzalez RD, Whiting BM, Canales BK. The history of kidney stone dissolution therapy: 50 years of optimism and frustration with renacidin. Journal of endourology 2012; 26: 110-118 DOI: 10.1089/end.2011.0380. (PMID: 21999455)
• 7 Bazyar H, Ahmadi A, Javid AZ. et al. The association between dietary intakes and stone formation in patients with urinary stones in Shiraz. Medical journal of the Islamic Republic of Iran 2019; 33: 8-8
• 8 Bres-Niewada E, Dybowski B, Radziszewski P. Predicting stone composition before treatment–can it really drive clinical decisions?. Central European journal of urology 2014; 67: 392 DOI: 10.5173/ceju.2014.04.art15. (PMID: 25667761)
• 9 VellaMCaramia M, Maltese M. et al. ESWL prediction of outcome and failure prevention. Urologia internationalis 2007; 79 (Suppl. 01) 47-50 DOI: 10.1159/000104441. (PMID: 17726352)
• 10 Gok A, Polat H, Cift A. et al. The hounsfield unit value calculated with the aid of non-contrast computed tomography and its effect on the outcome of percutaneous nephrolithotomy. Urolithiasis 2015; 43: 277-281 DOI: 10.1007/s00240-015-0766-4. (PMID: 25820292)
• 11 Desai M, Symons SJ. Percutaneous nephrolithotomy. In: Rao NP, Preminger GM, Kavanagh JP. Urinary Tract Stone Disease. London: Springer; 2010: 481-495
• 12 Turk C, Neisius A, Petrik A. et al. EAU Guidelines on Urolithiasis. European Association of Urology. Edn. presented at the EAU Annual Congress Amsterdam 2020. EAU Guidelines Office, Arnhem, The Netherlands. Accessed January 01, 2001 at: https://uroweb.org/guideline/urolithiasis/
• 13 Hidas G, Eliahou R, Duvdevani M. et al. Determination of renal stone composition with dual-energy CT: in vivo analysis and comparison with x-ray diffraction. Radiology 2010; 257: 394-401 DOI: 10.1148/radiol.10100249. (PMID: 20807846)
• 14 Patel SR, Haleblian G, Zabbo A. et al. Hounsfield units on computed tomography predict calcium stone subtype composition. Urologia internationalis 2009; 83: 175-180 DOI: 10.1159/000230020. (PMID: 19752613)
• 15 Zarse CA, McAteer JA, Tann M. et al. 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 2004; 63: 828-833 DOI: 10.1016/j.urology.2003.11.038. (PMID: 15134957)
• 16 Demehri S, Kalra MK, Rybicki FJ. et al. Quantification of urinary stone volume: attenuation threshold-based CT method–a technical note. Radiology 2011; 258: 915-922 DOI: 10.1148/radiol.10100333. (PMID: 21339353)
• 17 Saw KC, McAteer JA, Monga AG. et al. Helical CT of urinary calculi: effect of stone composition, stone size, and scan collimation. American Journal of Roentgenology 2000; 175: 329-332 DOI: 10.2214/ajr.175.2.1750329. (PMID: 10915668)
• 18 Knoll T, Schubert AB, Fahlenkamp D. et al. Urolithiasis through the ages: data on more than 200,000 urinary stone analyses. The Journal of urology 2011; 185: 1304-1311 DOI: 10.1016/j.juro.2010.11.073. (PMID: 21334658)
• 19 Leusmann DB, Blaschke R, Schmandt W. Results of 5035 stone analyses: a contribution to epidemiology of urinary stone disease. Scandinavian journal of urology and nephrology 1990; 24: 205-210 DOI: 10.3109/00365599009180859. (PMID: 2237297)
• 20 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. Abdominal Radiology 2019; 44: 1027-1032 DOI: 10.1007/s00261-018-1787-6. (PMID: 30259102)
• 21 Mostafavi MR, Ernst RD, Saltzman B. Accurate determination of chemical composition of urinary calculi by spiral computerized tomography. The Journal of urology 1998; 159: 673-675 (PMID: 9474123)
• 22 Best SL, Sivalingam S, Penniston KL. et al. Radiographic and laboratory data (“the Megaprofile”) can accurately guide medical management in the absence of stone analysis. Journal of endourology 2015; 29: 357-361 DOI: 10.1089/end.2014.0160. (PMID: 25025627)
• 23 Kuwahara M, Kageyama S, Kurosu S. et al. Computed tomography and composition of renal calculi. Urological research 1984; 12: 111-113 DOI: 10.1007/BF00257175. (PMID: 6740833)
• 24 Lidén M. A new method for predicting uric acid composition in urinary stones using routine single-energy CT. Urolithiasis 2018; 46: 325-332 DOI: 10.1007/s00240-017-0994-x. (PMID: 28660283)
• 25 Kulkarni NM, Eisner BH, Pinho DF. et al. Determination of renal stone composition in phantom and patients using single-source dual-energy computed tomography. Journal of computer assisted tomography 2013; 37: 37-45 DOI: 10.1097/RCT.0b013e3182720f66. (PMID: 23321831)
• 26 Motley G, Dalrymple N, Keesling C. et al. Hounsfield unit density in the determination of urinary stone composition. Urology 2001; 58: 170-173 DOI: 10.1016/s0090-4295(01)01115-3. (PMID: 11489691)
• 27 Torricelli FCM, Marchini GS, De S. et al. Predicting urinary stone composition based on single-energy noncontrast computed tomography: the challenge of cystine. Urology 2014; 83: 1258-1264 DOI: 10.1016/j.urology.2013.12.066. (PMID: 24726314)
• 28 Marchini GS, Gebreselassie S, Liu X. et al. Absolute Hounsfield unit measurement on non-contrast computed tomography cannot accurately predict struvite stone composition. Journal of endourology 2013; 27: 162-167