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Using Helical CT to Predict Stone Fragility in Shock Wave Lithotripsy (SWL).

James C Williams1, Chad A Zarse1, Molly E Jackson1

  • 1Department of Anatomy and Cell Biology, Indiana University School of Medicine, Indianapolis, IN 46202, USA.

AIP Conference Proceedings
|May 12, 2018
PubMed
Summary

Computed tomography (CT) can predict urinary stone fragility to shock wave lithotripsy (SWL) by analyzing stone structure, not just CT number. Examining stone internal features offers a more accurate method for predicting SWL success.

Keywords:
43.40.Ng81.70.Tx87.54.HkHounsfield unitcomputed tomographykidney stonesmicro CTshock wave lithotripsy

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Area of Science:

  • Urology
  • Medical Imaging
  • Biophysics

Background:

  • Urinary stone response to shock wave lithotripsy (SWL) varies significantly, even for stones of the same mineral composition.
  • Current methods to predict SWL success often rely on computed tomography (CT) stone number (Hounsfield units), but this is influenced by scan resolution and stone size.
  • Existing studies correlating CT number with SWL failure are limited by unaddressed confounding factors like stone size.

Purpose of the Study:

  • To investigate whether analyzing the internal structure of urinary stones using CT imaging can better predict their fragility to SWL compared to traditional CT number measurements.
  • To evaluate the potential of micro-CT imaging to reveal structural characteristics of calcium oxalate monohydrate (COM) stones that correlate with SWL outcomes.

Main Methods:

  • Review of studies linking stone CT number (Hounsfield units) to SWL outcomes, highlighting limitations due to stone size and CT resolution.
  • Preliminary analysis of calcium oxalate monohydrate (COM) stones using micro-CT to assess internal structures such as voids and apatite regions.
  • Comparison of shock wave requirements for complete fragmentation between COM stones with heterogeneous structures and those with homogeneous structures.

Main Results:

  • Stone CT number (Hounsfield units) is an unreliable predictor of SWL success due to its dependence on factors like stone size and CT slice width.
  • Calcium oxalate monohydrate (COM) stones exhibiting internal structural variations (e.g., voids, apatite inclusions) fragmented significantly faster than homogeneous COM stones.
  • Stones with observable internal structure required approximately half the number of shock waves for complete fragmentation compared to structurally uniform stones.

Conclusions:

  • Urinary stone structure, as visualized by CT, is a more promising predictor of SWL fragility than simple CT number values.
  • Utilizing CT to assess stone internal morphology offers a novel approach to enhance the prediction of SWL treatment success.
  • Further clinical studies are warranted to validate the correlation between CT-observed stone structure and in vivo SWL stone fragility.