Determination of Renal Stone Composition in Phantom and Patients Using Single-Source Dual-Energy Computed Tomography

Kulkarni, Naveen M.; Eisner, Brian H.; Pinho, Daniella F.; Joshi, Mukta C.; Kambadakone, Avinash; Sahani, Dushyant V.

doi:10.1097/rct.0b013e3182720f66

Cited by 89 publications

(55 citation statements)

References 27 publications

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“…Using this approach, Kulkarni et al 11 showed that rapid kilovolt (peak) switching can help in the differentiation between different stone types both in vitro and in vivo.…”

Section: Y10mentioning

confidence: 99%

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Feasibility of Single-Source Dual-Energy Computed Tomography for Urinary Stone Characterization and Value of Iterative Reconstructions

Morsbach¹,

Wurnig²,

Müller³

et al. 2014

Investigative Radiology

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PURPOSE: The purposes of this study were to demonstrate the feasibility and accuracy of single-source dual-energy (DE) computed tomography (CT) with sequential data acquisition and a coregistration motion correction algorithm for urinary stone characterization and to evaluate the value of iterative reconstructions (IRs) in DE imaging. MATERIALS AND METHODS: Thirty-five urinary stones were placed in cylindrical phantoms with diameters of 30 and 40 cm. The phantoms were scanned on a 64-section CT machine with a single-source DE protocol consisting of 2 sequential acquisitions at 80 and 140 kilovolt (peak). The phantom was moved between the 80-and 140-kilovolt (peak) scans. Images were reconstructed with weighted filtered back projection (FBP) and with IR, and data were coregistered. Two independent and blinded readers assessed data sets for stone detection, overall image quality, and visibility of stones. Image noise and Hounsfield unit values of the stones were measured, and the DE index was calculated. In addition, the data sets were analyzed on color-coded images using the standard postprocessing software for differentiating uric acid-(UA) from non-UA-containing stones. RESULTS: The motion correction algorithm achieved a good coregistration of the 2 scans with different energy levels. Both readers detected all stones on all data sets with both reconstruction types. The overall image quality was rated significantly higher in IR images in the 40-cm phantom as compared with that in FBP images (P < 0.05), whereas no significant difference was found for the 30-cm phantom. Visibility of stones was rated significantly higher for both the 30-and 40-cm phantoms on IR as compared with that on FBP images, an effect that was pronounced for UA stones (P < 0.05). Noise was significantly reduced by up to 31% in the 40-cm phantom when using IR as compared with FBP (P < 0.001). The DE index was similar in the FBP and IR data sets for the 30-(P = 0.116) and 40-cm phantoms (P = 0.544), being significantly different between UA-containing stones, cystine, and struvite stones as well as stones of other compositions (P < 0.001). The postprocessing software classified all stones correctly as UA-or non-UA-containing stones on color-coded images. In the 40-cm phantom, false-positively colored voxels were found in the FBP data sets, which were not seen when using IR instead. CONCLUSIONS: Our study indicates that single-source dual-energy CT with sequential acquisitions at different energy levels and a coregistration motion correction algorithm is feasible and accurate for characterizing urinary stone composition on the basis of phantom evaluation. As compared with reconstructions with FBP, the use of IR in dual-energy CT reduces noise, improves overall image quality and visibility of stones particularly in large phantoms, and helps to avoid false classifications of urinary stones.

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“…Using this approach, Kulkarni et al 11 showed that rapid kilovolt (peak) switching can help in the differentiation between different stone types both in vitro and in vivo.…”

Section: Y10mentioning

confidence: 99%

“…11,12 The drawback of both of these techniques, however, is the requirement for dedicated CT machines that are capfable of dual-energy imaging. With a conventional single-source CT scanner, dual-energy CT is usually not feasible with adequate quality and performance.…”

Section: Y10mentioning

confidence: 99%

Feasibility of Single-Source Dual-Energy Computed Tomography for Urinary Stone Characterization and Value of Iterative Reconstructions

Morsbach¹,

Wurnig²,

Müller³

et al. 2014

Investigative Radiology

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“…These on-demand virtual monoE images can give us extra information and can improve the evaluation and characterization of lesions. Virtual monoE images can also reduce different artifact (metal, beam hardening, and blooming) [7][8][9][10][11]. No need for prospective patient selection, no rotation time limitations, full FOV, and no cross scatter are among the unique advantages of SDCT in comparison to the other spectral technologies.…”

mentioning

confidence: 99%

Assessment of 70-keV virtual monoenergetic spectral images in abdominal CT imaging: A comparison study to conventional polychromatic 120-kVp images

et al. 2017

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“…[8][9][10] Single and dual-energy CT scan imaging have demonstrated promising results in differentiating uric acid from calcium stones. 7,11,12 Wisenbaugh and colleagues studied 32 renal stones in vitro. When they attempted to differentiate uric acid and non-uric acid stones, they accurately distinguished 40% and 93% of non-uric acid stones using singleenergy and dual-energy CT scans, respectively.…”

Section: Discussionmentioning

confidence: 99%

Nomogram to predict uric acid kidney stones based on patient’s age, BMI and 24-hour urine profiles: a multi-center validation

Torricelli¹,

Brown²,

Berto³

et al. 2015

CUAJ

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Introduction: We performed a multicentre validation of a nomogram to predict uric acid kidney stones in two populations. Methods: We reviewed the kidney stone database of two institutions, searching for patients with kidney stones who had stone composition analysis and 24-hour urine collection from January 2010 to December 2013. A nomogram to predict uric acid kidneys stones based on patient age, body mass index (BMI), and 24-hour urine collection was tested. Receiver-operating curves (ROC) were performed. Results: We identified 445 patients, 355 from Cleveland, United States, and 90 from Sao Paulo, Brazil. Uric acid stone formers were 7.9% and 8.9%, respectively. Uric acid patients had a significantly higher age and BMI, as well as significant lower urinary calcium than calcium stone formers in both populations. Uric acid had significantly higher total points when scored according to the nomogram. ROC curves showed an area under the curve of 0.8 for Cleveland and 0.92 for Sao Paulo. The cutoff value that provided the highest sensitivity and specificity was 179 points and 192 for Cleveland and Sao Paulo, respectively. Using 180 points as a cutoff provided a sensitivity and specificity of 87.5% and 68% for Cleveland, and 100% and 42% for Sao Paulo. Higher cutoffs were associated with higher specificity. The main limitation of this study is that only patients from high volume hospitals with uric acid or calcium stones were included. Conclusion: Predicting uric acid kidneys stone based on a nomogram, which includes only demographic data and 24-hour urine parameters, is feasible with a high degree of accuracy.

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Determination of Renal Stone Composition in Phantom and Patients Using Single-Source Dual-Energy Computed Tomography

Cited by 89 publications

References 27 publications

Feasibility of Single-Source Dual-Energy Computed Tomography for Urinary Stone Characterization and Value of Iterative Reconstructions

Feasibility of Single-Source Dual-Energy Computed Tomography for Urinary Stone Characterization and Value of Iterative Reconstructions

Assessment of 70-keV virtual monoenergetic spectral images in abdominal CT imaging: A comparison study to conventional polychromatic 120-kVp images

Nomogram to predict uric acid kidney stones based on patient’s age, BMI and 24-hour urine profiles: a multi-center validation

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