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

Publikationsverlauf

Eingereicht: 05. August 2022

Angenommen: 24. Oktober 2022

Artikel online veröffentlicht:
26. Januar 2023

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