MP22-07 IN VIVO ASSESSMENT OF STONE FRAGILITY USING COMPUTED TOMOGRAPHY

Abstract

You have accessJournal of UrologyImaging/Radiology: Uroradiology II (MP22)1 Sep 2021MP22-07 IN VIVO ASSESSMENT OF STONE FRAGILITY USING COMPUTED TOMOGRAPHY Dane Klett, Aaron Potretzke, Andrea Ferrero, Tristan Juvet, Marcelino Rivera, John Knoedler, Jayse Weaver, John Lieske, Felicity Enders, and Cynthia McCollough Dane KlettDane Klett More articles by this author , Aaron PotretzkeAaron Potretzke More articles by this author , Andrea FerreroAndrea Ferrero More articles by this author , Tristan JuvetTristan Juvet More articles by this author , Marcelino RiveraMarcelino Rivera More articles by this author , John KnoedlerJohn Knoedler More articles by this author , Jayse WeaverJayse Weaver More articles by this author , John LieskeJohn Lieske More articles by this author , Felicity EndersFelicity Enders More articles by this author , and Cynthia McColloughCynthia McCollough More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002013.07AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Computed tomography (CT) is recommended for non-invasively imaging symptomatic urinary stones as it provides accurate submillimeter details of stone size and location within the urinary system. Previous ex vivo studies demonstrated routine dual-energy CT (DECT) stone protocols provide an accurate estimate of stone fragility by quantifying morphological features. The objective of this study was to validate the accuracy of a stone fragility model based on preoperative DECT to predict comminution time in patients undergoing percutaneous nephrolithotripsy (PCNL). METHODS: Patients received a DECT followed by PCNL using the ShockPulse SE ultrasonic lithotripter (Olympus). A quantitative model consisting of 7 DECT metrics, including stone volume, internal and surface morphology and stone composition, was developed using stones ex vivo stones and then applied in vivo to stone procedures. During the procedure, the time the ultrasonic lithotripter was actively engaged in stone breaking was measured. The observed and predicted comminution times for each stone were individually ranked from most to least fragile. Stone fragility classifications based on comminution time were then created: soft stones in the first quartile, hard stones in the last quartile and average stones in between. Postprocedure, the performing urologist subjectively assessed stone fragility, and was blinded to measured and estimated comminution times. RESULTS: A total of 11 stones from 10 patients were studied. With stones ranked by volume, the average ranking difference (predicted vs actual comminution time) was 1.8 with 4/11 having a ranking difference greater than 2. Using the stone fragility model, the average ranking difference was 0.7, with only one stone having a ranking difference greater than 2. The 3-class classification showed only 2 stones erroneously labeled using the predictive stone fragility model. The urologist's impression of stone fragility correlated well with comminution time-based classification. CONCLUSIONS: A predictive stone fragility model based on morphological and mineral characteristics of renal stones, as quantified on DECT, may accurately predict in vivo comminution time. Source of Funding: Grants DK100227 & EB028591 from the National Institute of Health © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e393-e393 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Dane Klett More articles by this author Aaron Potretzke More articles by this author Andrea Ferrero More articles by this author Tristan Juvet More articles by this author Marcelino Rivera More articles by this author John Knoedler More articles by this author Jayse Weaver More articles by this author John Lieske More articles by this author Felicity Enders More articles by this author Cynthia McCollough More articles by this author Expand All Advertisement Loading ...