Clinical utility of computed tomography Hounsfield characterization for percutaneous nephrolithotomy: a cross-sectional study

BMC Urology

Research Article

Alberto Trinchieri¹  Fabrizio Longo²  Andrea Gallioli²  Elisa De Lorenzis²  Luca Boeri²  Stefano Paolo Zanetti²  Emanuele Montanari²  Maurizio Delor³ 

[1] Department of Urology, Ospedale Alessandro Manzoni Lecco, Via dell’Eremo 9/11, 23900, Lecco, Italy;Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Department of Urology, University of Milan, Via della Commenda 15, 20122, Milan, Italy;Istituto Europeo di Oncologia, Department of Urology, University of Milan, Via Giuseppe Ripamonti 435, 20141, Milan, Italy;

关键词: Hounsfield;    Kidney stone;    Percutaneous nephrolithotomy;    Computed tomography;   

DOI  :  10.1186/s12894-017-0296-1

 received in 2017-07-26, accepted in 2017-11-10,  发布年份 2017

来源: Springer

【 摘 要 】

BackgroundComputed Tomography (CT) is considered the gold-standard for the pre-operative evaluation of urolithiasis. However, no Hounsfield (HU) variable capable of differentiating stone types has been clearly identified. The aim of this study is to assess the predictive value of HU parameters on CT for determining stone composition and outcomes in percutaneous nephrolithotomy (PCNL).MethodsSeventy seven consecutive cases of PCNL between 2011 and 2016 were divided into 4 groups: 40 (52%) calcium, 26 (34%) uric acid, 5 (6%) struvite and 6 (8%) cystine stones. All images were reviewed by a single urologist using abdomen/bone windows to evaluate: stone volume, core (HUC), periphery HU and their absolute difference. HU density (HUD) was defined as the ratio between mean HU and the stone’s largest diameter. ROC curves assessed the predictive power of HU for determining stone composition/stone-free rate (SFR).ResultsNo differences were found based on the viewing window (abdomen vs bone). Struvite stones had values halfway between hyperdense (calcium) and low-density (cystine/uric acid) calculi for all parameters except HUD, which was the lowest. All HU variables for medium-high density stones were greater than low-density stones (p < 0.001). HUC differentiated the two groups (cut-off 825 HU; specificity 90.6%, sensitivity 88.9%). HUD distinguished calcium from struvite (mean ± SD 51 ± 16 and 28 ± 12 respectively; p = 0.02) with high sensitivity (82.5%) and specificity (80%) at a cut-off of 35 HU/mm. Multivariate analysis revealed HUD ≥ 38.5 HU/mm to be an independent predictor of SFR (OR = 3.1, p = 0.03). No relationship was found between HU values and complication rate.ConclusionsHU parameters help predict stone composition to select patients for oral chemolysis. HUD is an independent predictor of residual fragments after PCNL and may be fundamental to categorize it, driving the imaging choice at follow-up.

【 授权许可】

CC BY   
© The Author(s). 2017