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Published on: March 30, 2015
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.
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.
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