In vivo evaluation of the chemical composition of urinary stones using dual-energy CT

Giuseppina Manglaviti, Silvia Tresoldi, Chiara Stefania Guerrer, Giovanni Di Leo, Emanuele Montanari, Francesco Sardanelli, Gianpaolo Cornalba

Research output: Contribution to journalArticle

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Abstract

OBJECTIVE. The purpose of this article is to evaluate in vivo the chemical composition of urinary stones using dual-source and dual-energy CT, with crystallography as the reference standard. MATERIALS AND METHODS. Forty patients (mean [± SD] age, 49 ± 17 years) with known or suspected nephrolithiasis underwent unenhanced abdominal CT for urinary tract evaluation using a dual-energy technique (tube voltages, 140 and 80 kVp). For each stone 5 mm or larger in diameter, we evaluated the site, diameter, CT density, surface (smooth vs rough), and stone composition. Patients were treated with extracorporeal shock wave lithotripsy (n = 34), percutaneous nephrolithotomy (n = 4), or therapeutic ureterorenoscopy (n = 2). Collected stones underwent crystallography, and the agreement with the results of dual-energy CT was calculated with the Cohen kappa coefficient. The correlation among stone composition, diameter, and CT density was estimated using the Kruskal-Wallis test. RESULTS. Thirty-one patients had a single stone and nine had multiple stones, for a total of 49 stones. Forty-five stones were in the kidneys, and four were in the ureters; 23 had a smooth surface and 26 had a rough surface. The mean stone diameter was 12 ± 6 mm; mean CT density was 783 ± 274 HU. According to crystallography, stone composition was as follows: 33 were calcium oxalate, seven were cystine, four were uric acid, and five were of mixed composition. Dual-energy CT failed to identify four stones with mixed composition, resulting in substantial agreement between dual-energy CT and crystallography (Cohen κ = 0.684). Stone composition was not correlated with either stone diameter (p = 0.920) or stone CT density (p = 0.185). CONCLUSION. CT showed excellent accuracy in classifying urinary stone chemical composition, except for uric acid-hydroxyapatite mixed stones.

Original languageEnglish
JournalAmerican Journal of Roentgenology
Volume197
Issue number1
DOIs
Publication statusPublished - Jul 2011

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Urinary Calculi
Crystallography
Uric Acid
Percutaneous Nephrostomy
Nephrolithiasis
Calcium Oxalate
Cystine
Lithotripsy
Durapatite
Ureter
Urinary Tract
Kidney
Therapeutics

Keywords

  • Crystallography
  • Dual-energy CT
  • Dual-source CT
  • Kidney stones
  • Stone composition

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging

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In vivo evaluation of the chemical composition of urinary stones using dual-energy CT. / Manglaviti, Giuseppina; Tresoldi, Silvia; Guerrer, Chiara Stefania; Di Leo, Giovanni; Montanari, Emanuele; Sardanelli, Francesco; Cornalba, Gianpaolo.

In: American Journal of Roentgenology, Vol. 197, No. 1, 07.2011.

Research output: Contribution to journalArticle

Manglaviti, Giuseppina ; Tresoldi, Silvia ; Guerrer, Chiara Stefania ; Di Leo, Giovanni ; Montanari, Emanuele ; Sardanelli, Francesco ; Cornalba, Gianpaolo. / In vivo evaluation of the chemical composition of urinary stones using dual-energy CT. In: American Journal of Roentgenology. 2011 ; Vol. 197, No. 1.
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abstract = "OBJECTIVE. The purpose of this article is to evaluate in vivo the chemical composition of urinary stones using dual-source and dual-energy CT, with crystallography as the reference standard. MATERIALS AND METHODS. Forty patients (mean [± SD] age, 49 ± 17 years) with known or suspected nephrolithiasis underwent unenhanced abdominal CT for urinary tract evaluation using a dual-energy technique (tube voltages, 140 and 80 kVp). For each stone 5 mm or larger in diameter, we evaluated the site, diameter, CT density, surface (smooth vs rough), and stone composition. Patients were treated with extracorporeal shock wave lithotripsy (n = 34), percutaneous nephrolithotomy (n = 4), or therapeutic ureterorenoscopy (n = 2). Collected stones underwent crystallography, and the agreement with the results of dual-energy CT was calculated with the Cohen kappa coefficient. The correlation among stone composition, diameter, and CT density was estimated using the Kruskal-Wallis test. RESULTS. Thirty-one patients had a single stone and nine had multiple stones, for a total of 49 stones. Forty-five stones were in the kidneys, and four were in the ureters; 23 had a smooth surface and 26 had a rough surface. The mean stone diameter was 12 ± 6 mm; mean CT density was 783 ± 274 HU. According to crystallography, stone composition was as follows: 33 were calcium oxalate, seven were cystine, four were uric acid, and five were of mixed composition. Dual-energy CT failed to identify four stones with mixed composition, resulting in substantial agreement between dual-energy CT and crystallography (Cohen κ = 0.684). Stone composition was not correlated with either stone diameter (p = 0.920) or stone CT density (p = 0.185). CONCLUSION. CT showed excellent accuracy in classifying urinary stone chemical composition, except for uric acid-hydroxyapatite mixed stones.",
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AU - Manglaviti, Giuseppina

AU - Tresoldi, Silvia

AU - Guerrer, Chiara Stefania

AU - Di Leo, Giovanni

AU - Montanari, Emanuele

AU - Sardanelli, Francesco

AU - Cornalba, Gianpaolo

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N2 - OBJECTIVE. The purpose of this article is to evaluate in vivo the chemical composition of urinary stones using dual-source and dual-energy CT, with crystallography as the reference standard. MATERIALS AND METHODS. Forty patients (mean [± SD] age, 49 ± 17 years) with known or suspected nephrolithiasis underwent unenhanced abdominal CT for urinary tract evaluation using a dual-energy technique (tube voltages, 140 and 80 kVp). For each stone 5 mm or larger in diameter, we evaluated the site, diameter, CT density, surface (smooth vs rough), and stone composition. Patients were treated with extracorporeal shock wave lithotripsy (n = 34), percutaneous nephrolithotomy (n = 4), or therapeutic ureterorenoscopy (n = 2). Collected stones underwent crystallography, and the agreement with the results of dual-energy CT was calculated with the Cohen kappa coefficient. The correlation among stone composition, diameter, and CT density was estimated using the Kruskal-Wallis test. RESULTS. Thirty-one patients had a single stone and nine had multiple stones, for a total of 49 stones. Forty-five stones were in the kidneys, and four were in the ureters; 23 had a smooth surface and 26 had a rough surface. The mean stone diameter was 12 ± 6 mm; mean CT density was 783 ± 274 HU. According to crystallography, stone composition was as follows: 33 were calcium oxalate, seven were cystine, four were uric acid, and five were of mixed composition. Dual-energy CT failed to identify four stones with mixed composition, resulting in substantial agreement between dual-energy CT and crystallography (Cohen κ = 0.684). Stone composition was not correlated with either stone diameter (p = 0.920) or stone CT density (p = 0.185). CONCLUSION. CT showed excellent accuracy in classifying urinary stone chemical composition, except for uric acid-hydroxyapatite mixed stones.

AB - OBJECTIVE. The purpose of this article is to evaluate in vivo the chemical composition of urinary stones using dual-source and dual-energy CT, with crystallography as the reference standard. MATERIALS AND METHODS. Forty patients (mean [± SD] age, 49 ± 17 years) with known or suspected nephrolithiasis underwent unenhanced abdominal CT for urinary tract evaluation using a dual-energy technique (tube voltages, 140 and 80 kVp). For each stone 5 mm or larger in diameter, we evaluated the site, diameter, CT density, surface (smooth vs rough), and stone composition. Patients were treated with extracorporeal shock wave lithotripsy (n = 34), percutaneous nephrolithotomy (n = 4), or therapeutic ureterorenoscopy (n = 2). Collected stones underwent crystallography, and the agreement with the results of dual-energy CT was calculated with the Cohen kappa coefficient. The correlation among stone composition, diameter, and CT density was estimated using the Kruskal-Wallis test. RESULTS. Thirty-one patients had a single stone and nine had multiple stones, for a total of 49 stones. Forty-five stones were in the kidneys, and four were in the ureters; 23 had a smooth surface and 26 had a rough surface. The mean stone diameter was 12 ± 6 mm; mean CT density was 783 ± 274 HU. According to crystallography, stone composition was as follows: 33 were calcium oxalate, seven were cystine, four were uric acid, and five were of mixed composition. Dual-energy CT failed to identify four stones with mixed composition, resulting in substantial agreement between dual-energy CT and crystallography (Cohen κ = 0.684). Stone composition was not correlated with either stone diameter (p = 0.920) or stone CT density (p = 0.185). CONCLUSION. CT showed excellent accuracy in classifying urinary stone chemical composition, except for uric acid-hydroxyapatite mixed stones.

KW - Crystallography

KW - Dual-energy CT

KW - Dual-source CT

KW - Kidney stones

KW - Stone composition

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