The utility of automated volume analysis of renal stones before and after shockwave lithotripsy treatment
Tóm tắt
This study aimed to evaluate the additional utility of an automated method of estimating volume for stones being treated with shockwave lithotripsy (SWL) using computed tomography (CT) images compared to manual measurement. Utility was assessed as the ability to accurately measure stone burden before and after SWL treatment, and whether stone volume is a better predictor of SWL outcome than stone diameter. 72 patients treated with SWL for a renal stone with available CT scans before and after treatment were included. Stone axes measurement and volume estimation using ellipsoid equations were compared to volume estimation using software using CT textural analysis (CTTA) of stone images. There was strong correlation (r > 0.8) between manual and CTTA estimated stone volume. CTTA measured stone volume showed the highest predictive value (r2 = 0.217) for successful SWL outcome on binary logistic regression analysis. Three cases that were originally classified as ‘stone-free with clinically insignificant residual fragments’ based on manual axis measurements actually had a larger stone volume based on CTTA estimation than the smallest fragments remaining for cases with an outcome of ‘not stone-free’. This study suggests objective measurement of total stone volume could improve estimation of stone burden before and after treatment. Current definitions of stone-free status based on manual measurements of residual fragment sizes are not accurate and may underestimate remaining stone burden after treatment. Future studies reporting on the efficacy of different stone treatments should consider using objective stone volume measurements based on CT image analysis as an outcome measure of stone-free state.
Tài liệu tham khảo
Türk C, Skolarikos A, Neisius A et al (2019) EAU guidelines on urolithiasis. European Association of Urology. https://uroweb.org/wp-content/uploads/EAU-Guidelines-on-Urolithiasis-2019.pdf. Accessed 11 Feb 2020
Assimos D, Krambeck A, Miller NL, Monga M, Murad MH, Nelson CP et al (2016) Surgical management of stones: American Urological Association/Endourological Society Guideline, Part I. J Urol 196:1153–1160. https://doi.org/10.1016/j.juro.2016.05.090
Assimos D, Krambeck A, Miller NL, Monga M, Murad MH, Nelson CP et al (2016) Surgical management of stones: American Urological Association/Endourological Society Guideline, Part II. J Urol 196:1161–1169. https://doi.org/10.1016/j.juro.2016.05.091
Guideline NICE (2019) Renal and ureteric stones: assessment and management: NICE (2019) renal and ureteric stones: assessment and management. BJU Int 123(2):220–232. https://doi.org/10.1111/bju.14654
Hyams ES, Bruhn A, Lipkin M, Shah O (2010) Heterogeneity in the reporting of disease characteristics and treatment outcomes in studies evaluating treatments for nephrolithiasis. J Endourol 24(9):1411–1414. https://doi.org/10.1089/end.2009.0645
Cui HW, Turney BW (2019) Variability and quality of outcome reporting in clinical trials of interventions for renal calculi. J Clin Urol 12(15):11
NICE guideline [NG118] (2020) Renal and ureteric stones: assessment and management. https://www.nice.org.uk/guidance/ng118. Accessed 11 Feb 2020
Streem SB, Yost A, Mascha E (1996) Clinical implications of clinically insignificant store fragments after extracorporeal shock wave lithotripsy. J Urol 155(4):1186–1190. https://doi.org/10.1016/S0022-5347(01)66208-6
Bandi G, Meiners RJ, Pickhardt PJ, Nakada SY (2009) Stone measurement by volumetric three-dimensional computed tomography for predicting the outcome after extracorporeal shock wave lithotripsy. BJU Int 103(4):524–528. https://doi.org/10.1111/j.1464-410X.2008.08069.x
Finch W, Johnston R, Shaida N, Winterbottom A, Wiseman O (2014) Measuring stone volume—three-dimensional software reconstruction or an ellipsoid algebra formula? BJU Int 113:610–614. https://doi.org/10.1111/bju.12456
McClinton S, Cameron S, Starr K, Thomas R, MacLennan G, McDonald A, Lam T, N’Dow J, Kilonzo M, Pickard R, Anson K (2018) TISU: extracorporeal shockwave lithotripsy, as first treatment option, compared with direct progression to ureteroscopic treatment, for ureteric stones: study protocol for a randomised controlled trial. Trials 19(1):1. https://doi.org/10.1186/s13063-018-2652-1
Sener NC, Bas O, Sener E, Zengin K, Ozturk U, Altunkol A, Evliyaoglu Y (2015) Asymptomatic lower pole small renal stones: shock wave lithotripsy, flexible ureteroscopy, or observation? A prospective randomized trial. Urology 85(1):33–37. https://doi.org/10.1016/j.urology.2014.08.023
Christiansen FE, Andreassen KH, Osther SS, Osther PJ (2016) Internal structure of kidney calculi as a predictor for shockwave lithotripsy success. J Endourol 30(3):324. https://doi.org/10.1089/end.2015.0616
Cui HW, Devlies W, Ravenscroft S, Heers H, Freidin AJ, Cleveland RO, Ganeshan B, Turney BW (2017) CT texture analysis of ex vivo renal stones predicts ease of fragmentation with shockwave lithotripsy. J Endourol 31(7):694–700. https://doi.org/10.1089/end.2017.0084
Ito H, Kawahara T, Terao H, Ogawa T, Yao M, Kubota Y, Matsuzaki J (2012) The most reliable preoperative assessment of renal stone burden as a predictor of stone-free status after flexible ureteroscopy with holmium laser lithotripsy: a single-center experience. Urology 80(3):524–528. https://doi.org/10.1016/j.urology.2012.04.001
Patel SR, Stanton P, Zelinski N, Borman EJ, Pozniak MA, Nakada SY, Pickhardt PJ (2011) Automated renal stone volume measurement by noncontrast computerized tomography is more reproducible than manual linear size measurement. J Urol 186(6):2275–2279. https://doi.org/10.1016/j.juro.2011.07.091
Yoshida S, Hayashi T, Morozumi M, Osada H, Honda N, Yamada T (2007) Three-dimensional assessment of urinary stone on non-contrast helical computed tomography as the predictor of stonestreet formation after extracorporeal shock wave lithotripsy for stones smaller than 20 mm. Int J Urol 14(7):665–667. https://doi.org/10.1111/j.1442-2042.2007.01767.x
Cui HW, Silva MD, Mills AW, North BV, Turney BW (2019) Predicting shockwave lithotripsy outcome for urolithiasis using clinical and stone computed tomography texture analysis variables. Sci Rep 9(1):14674. https://doi.org/10.1038/s41598-019-51026-x
Cohen TD, Preminger GM (1997) Management of calyceal calculi. Urol Clin N Am 24(1):81–96. https://doi.org/10.1016/s0094-0143(05)70356-6
Abdel-Khalek M, Sheir KZ, Mokhtar AA, Eraky I, Kenawy M, Bazeed M (2004) Prediction of success rate after extracorporeal shock-wave lithotripsy of renal stones. A multivariate analysis model. Scand J Urol Nephrol 38(2):161–167. https://doi.org/10.1080/00365590310022626
Lalak NJ, Moussa SA, Smith G, Tolley DA (2002) The Dornier Compact Delta lithotripter: the first 500 renal calculi. J Endourol 16(1):3–7. https://doi.org/10.1089/089277902753483637
Sorensen CM, Chandhoke PS (2002) Is lower pole calyceal anatomy predictive of extracorporeal shock wave lithotripsy success for primary lower pole kidney stones? J Urol 168(6):2377–2382. https://doi.org/10.1097/01.ju.0000036354.52323.c1
Guler Y, Erbin A, Kafkasli A, Ozmerdiven G (2020) Factors affecting success in the treatment of proximal ureteral stones larger than 1 cm with extracorporeal shockwave lithotripsy in adult patients. Urolithiasis. https://doi.org/10.1007/s00240-020-01186-7
Chaussy CG, Tiselius HG (2018) How can and should we optimize extracorporeal shockwave lithotripsy? Urolithiasis 46(1):3–17. https://doi.org/10.1007/s00240-017-1020-z
Olcott EW, Sommer FG, Napel S (1997) Accuracy of detection and measurement of renal calculi: in vitro comparison of three-dimensional spiral CT, radiography, and nephrotomography. Radiology 204(1):19–25. https://doi.org/10.1148/radiology.204.1.9205217
Khaitan A, Gupta NP, Hemal AK, Dogra PN, Seth A, Aron M (2002) Post-ESWL, clinically insignificant residual stones: reality or myth? Urology 59(1):20–24. https://doi.org/10.1016/s0090-4295(01)01494-7
Chew BH, Brotherhood HL, Sur RL, Wang AQ, Knudsen BE, Yong C, Marien T, Miller NL, Krambeck AE, Charchenko C, Humphreys MR (2016) Natural history, complications and re-intervention rates of asymptomatic residual stone fragments after ureteroscopy: a report from the EDGE research consortium. J Urol 195(4 Pt 1):982–986. https://doi.org/10.1016/j.juro.2015.11.009
Osman MM, Alfano Y, Kamp S, Haecker A, Alken P, Michel MS, Knoll T (2005) 5-year-follow-up of patients with clinically insignificant residual fragments after extracorporeal shockwave lithotripsy. Eur Urol 47(6):860–864. https://doi.org/10.1016/j.eururo.2005.01.005
Pullar B, Lunter C, Collie J, Shah S, Shah N, Hayek S, Wiseman OJ (2017) Do renal stones that fail lithotripsy require treatment? Urolithiasis 45(6):597–601. https://doi.org/10.1007/s00240-017-0973-2