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In vivo determination of urinary stone composition using dual energy computerized tomography with advanced post-acquisition processing.

Publication ,  Journal Article
Zilberman, DE; Ferrandino, MN; Preminger, GM; Paulson, EK; Lipkin, ME; Boll, DT
Published in: J Urol
December 2010

PURPOSE: We assessed whether dual energy computerized tomography with advanced post-image processing can accurately differentiate urinary calculi composition in vivo. MATERIALS AND METHODS: A total of 25 patients scheduled to undergo ureteroscopic/percutaneous nephrolithotomy were prospectively identified. Dual energy computerized tomography was performed using 64-slice multidetector computerized tomography. Novel post-processing (DECTSlope) used pixel by pixel analyses to generate data sets grayscale encoding ratios of relative differences in attenuation of low (DECT80 kVp) and high energy (DECT140 kVp) series. Surgical extraction and Fourier spectroscopy resulted in 82 calculi. Of these stones 51 showed minor admixtures (uric acid, ammonium urate, struvite, calcium oxalate monohydrate and brushite) and 31 were polycrystalline (mixtures of calcium oxalate monohydrate/dihydrate and calcium phosphate). Analyses identified stone clusters of equal composition and distinct attenuation descriptors on DECT140 kVp, DECT80 kVp and DECTSlope. Iterative cross-validation of the 3 dual energy computerized tomography data sets was used to identify characteristic attenuation limits for each stone type. RESULTS: Attenuatio profiles showed substantial overlap among various stones on DECT140 kVp (uric acid 427.3±168.1 HU, ammonium urate 429.9±99.7 HU, struvite 480.2±123.5 HU, calcium oxalate monohydrate 852.4±301.4 HU, brushite 863.7±180.1 HU and polycrystalline 858.1±210.5 HU) and on DECT80 kVp (uric acid 493.6±182.8 HU, ammonium urate 591.5±157.9 HU, struvite 712.4±173.9 HU, calcium oxalate monohydrate 1,240.5±494.7 HU, brushite 1,532.1±273.1 HU and polycrystalline 1,358.7±316.8 HU). Statistically spectral separation was not sufficient to characterize stones unambiguously based on DECT140 kVp/DECT80 kVp attenuation. Analysis of attenuation showed sufficient spectral separation on DECTSlope (uric acid 14.9±10.9 U, ammonium urate 56.1±1.8 U, struvite 42.7±1.4 U, calcium oxalate monohydrate 62.8±1.8 U and brushite 113.2±5.3 U). Polycrystalline stones (51.8±3.7 U) overlapped with struvite and ammonium urate stones. This overlap was resolved as all struvite/ammonium urate stones measured 900 HU or less and all polycrystalline stones measured more than 900 HU on DECT80 kVp. CONCLUSIONS: Dual energy computerized tomography with novel post-processing allows accurate discrimination among main subtypes of urinary calculi in vivo and, thus, may have implications in determining the optimum clinical treatment of urinary calculi from a noninvasive, preoperative radiological assessment.

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Published In

J Urol

DOI

EISSN

1527-3792

Publication Date

December 2010

Volume

184

Issue

6

Start / End Page

2354 / 2359

Location

United States

Related Subject Headings

  • Urology & Nephrology
  • Urinary Calculi
  • Tomography, X-Ray Computed
  • Prospective Studies
  • Middle Aged
  • Male
  • Image Processing, Computer-Assisted
  • Humans
  • Female
  • Aged
 

Citation

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Zilberman, D. E., Ferrandino, M. N., Preminger, G. M., Paulson, E. K., Lipkin, M. E., & Boll, D. T. (2010). In vivo determination of urinary stone composition using dual energy computerized tomography with advanced post-acquisition processing. J Urol, 184(6), 2354–2359. https://doi.org/10.1016/j.juro.2010.08.011
Zilberman, D. E., M. N. Ferrandino, G. M. Preminger, E. K. Paulson, M. E. Lipkin, and D. T. Boll. “In vivo determination of urinary stone composition using dual energy computerized tomography with advanced post-acquisition processing.J Urol 184, no. 6 (December 2010): 2354–59. https://doi.org/10.1016/j.juro.2010.08.011.
Zilberman DE, Ferrandino MN, Preminger GM, Paulson EK, Lipkin ME, Boll DT. In vivo determination of urinary stone composition using dual energy computerized tomography with advanced post-acquisition processing. J Urol. 2010 Dec;184(6):2354–9.
Zilberman, D. E., et al. “In vivo determination of urinary stone composition using dual energy computerized tomography with advanced post-acquisition processing.J Urol, vol. 184, no. 6, Dec. 2010, pp. 2354–59. Pubmed, doi:10.1016/j.juro.2010.08.011.
Zilberman DE, Ferrandino MN, Preminger GM, Paulson EK, Lipkin ME, Boll DT. In vivo determination of urinary stone composition using dual energy computerized tomography with advanced post-acquisition processing. J Urol. 2010 Dec;184(6):2354–2359.
Journal cover image

Published In

J Urol

DOI

EISSN

1527-3792

Publication Date

December 2010

Volume

184

Issue

6

Start / End Page

2354 / 2359

Location

United States

Related Subject Headings

  • Urology & Nephrology
  • Urinary Calculi
  • Tomography, X-Ray Computed
  • Prospective Studies
  • Middle Aged
  • Male
  • Image Processing, Computer-Assisted
  • Humans
  • Female
  • Aged