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In Vivo, Percutaneous, Needle Based, Optical Coherence Tomography of Renal Masses

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In vivo determination of urinary stone composition using dual energy computerized tomography with advanced

D E Zilberman¹, M N Ferrandino, G M Preminger

¹Comprehensive Kidney Stone Center, Department of Radiology, Duke University Medical Center, Durham, North Carolina 27710, USA. dorit.zilberman@duke.edu

The Journal of Urology

|October 19, 2010

Summary

Dual energy CT with DECTSlope post-processing accurately differentiates urinary calculi subtypes in vivo. This noninvasive method aids in preoperative assessment for optimal treatment planning of kidney stones.

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Area of Science:

Radiology
Medical Imaging
Urology

Background:

Urinary calculi composition impacts treatment decisions.
Accurate in vivo stone characterization is crucial for effective management.
Current noninvasive methods have limitations in differentiating stone subtypes.

Purpose of the Study:

To evaluate the accuracy of dual-energy CT (DECT) with advanced post-processing (DECTSlope) in differentiating urinary calculi composition.
To assess the potential of DECT for noninvasive, preoperative radiological assessment of kidney stones.

Main Methods:

Prospective study of 25 patients undergoing stone removal.
Dual-energy CT (DECT) performed using 64-slice multidetector CT.
Novel DECTSlope post-processing analyzed attenuation ratios for stone characterization.
Fourier spectroscopy used for definitive stone composition analysis (82 calculi).

Main Results:

DECT140 kVp and DECT80 kVp showed significant overlap in attenuation profiles for different stone types.
DECTSlope provided sufficient spectral separation for differentiating uric acid, ammonium urate, struvite, calcium oxalate monohydrate, and brushite.
Polycrystalline stones overlapped with struvite/ammonium urate on DECTSlope but were distinguished using DECT80 kVp thresholds (>900 HU for polycrystalline).

Conclusions:

DECT with DECTSlope enables accurate in vivo discrimination of main urinary calculi subtypes.
This technique offers a noninvasive preoperative radiological assessment tool.
Findings may guide optimal clinical treatment selection for urinary calculi.