RESULTS OF APPLICATION OF DUAL-ENERGY COMPUTED TOMOGRAPHY IN THE DIAGNOSIS OF UROLITHIASIS

Kapanadze L.B.1, Serova N.S.1, Rudenko V.I.1, Kuzmicheva G.M.2 Aleksandrova K.A.1, Novikov I.A.1

Purpose. To improve the diagnosis of urolithiasis using the latest technique – dual-energy computed tomography (DECT). Materials and methods. A prospective study of a group of 91 (100%) patients was conduct-ed at the department of radiology and urology at the Russian-Japanese Center in Sechenov University. All patients underwent a dual-energy CT scan to predict the chemical composi-tion of urinary stones "in vivo". All patients underwent surgical treatment after diagnostics: distance lithotripsy (DLT), percutaneous nephrolithotripsy (PHNLT), contact ureterolithotrip-sy (CULT). All the stones after operations were subjected to physico-chemical analysis (X-ray phase analysis, infrared spectroscopy) in order to verify the composition. Further, the diag-nostic value of the dual-energy computed tomography was assessed by comparing the DECT results with the physico-chemical analysis data. Results. Using DECT in the preoperative period, the following results were obtained: 40 patients had vevellit stones, 34 patients had Ca-containing stones without vevellit, 10 patients had stones with uric acid, in 7 patients stones were classified in the group of cys-tine/struvite. After verification studies in the postoperative period, the following urinary stone composition was determined: 42 stones – vevellit, 34 stones – Ca-containing stones without vevellit, 10 stones with uric acid, 5 stones – struvite stones. At the same time the following results were obtained incorrectly using DECT: 7 stones with vevellit from which 4 stones were postoperatively confermed to the group of Ca-containing stones without vevellit, 3 stones – struvite/cystine stones; 4 Ca-containing stones without vevellite were classified in the group of the vevellite; 2 struvite stones: 1 stone was incorrectly assigned to the group of uric acid, 1 stone – to the group of the vevellite; 1 stone uric acid was incorrectly assigned to the group of struvite stones. It should also be noted that 1 stone had a mixed composition (uric acid 70% + vevellit 23% + veddellite 7%), according to the results of DECT it was incor-rectly assigned to the group of stones from uric acid, at the same time the prevailing compo-nent was determined correctly. Conclusions. In order to predict the chemical composition of the stone "in vivo" with a high degree of reliability DECT in the preoperative period can differentiate not only the urate and Ca-containing stones, but also separately identify the stones in which vevellit is the predominant component. The detailed differentiation of Ca-containing stones, as well as of more rare stones, such as struvite and cystine, requires further studies with more signifi-cant groups of stones.

1 - I.M. Sechenov First Moscow State Medical University (Sechenov University). 2 - MIREA - Russian Technological University Moscow, Russia

 

Keywords:: multispiral computed tomography (MSCT), dual-energy computed tomography (DECT), uro-lithiasis, urinary stones, physico-chemical analysis.

 

Corresponding author: Kapanadze L.B. e-mail: Этот e-mail адрес защищен от спам-ботов, для его просмотра у Вас должен быть включен Javascript

 

For citation: Kapanadze L.B., Serova N.S., Rudenko V.I., Kuzmicheva G.M., Aleksandrova K.A., Novikov I.A. Results of application of dual-energy computed tomography in the diagnosis of urolithia-sis. REJR 2018; 8(2):94-104. DOI:10.21569/2222-7415-2018-8-2-94-104.

Received: 12.02.2018 Accepted: 16.03.2018