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      Computed tomography window affects kidney stones measurements

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          ABSTRACT

          Objectives

          Measurements of stone features may vary according to the non-contrast computed tomography (NCCT) technique. Using magnified bone window is the most accurate method to measure urinary stones. Possible differences between stone measurements in different NCCT windows have not been evaluated in stones located in the kidney. The aim of this study is to compare measurements of kidney stone features between NCCT bone and soft tissue windows in patients submitted to retrograde intrarenal surgery (RIRS).

          Materials and Methods

          Preoperative and 90th postoperative day NCCT were performed in 92 consecutive symptomatic adult patients (115 renal units) with kidney stones between 5 mm to 20 mm (< 15 mm in the lower calyx) treated by RIRS. NCCT were evaluated in the magnified bone window and soft tissue window in three axes in a different time by a single radiologist blinded for the measurements of the NCCT other method.

          Results

          Stone largest size (7.92±3.81 vs. 9.13±4.08; mm), volume (435.5±472.7 vs. 683.1±665.0; mm3) and density (989.4±330.2 vs. 893.0±324.6; HU) differed between bone and soft-tissue windows, respectively (p<0.0001) 5.2% of the renal units (6/115) were reclassified from residual fragments > 2 mm on soft tissue window to 0-2 mm on bone window.

          Conclusion

          Kidney stone measurements vary according to NCCT window. Measurements in soft tissue window NCCT of stone diameter and volume are larger and stone density is lesser than in bone window. These differences may have impact on clinical decisions.

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          Most cited references30

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          Time to stone passage for observed ureteral calculi: a guide for patient education.

          O F Miller, C J Kane (1999)
          We analyze the natural history of stone passage in patients with ureterolithiasis, and define factors predictive of spontaneous passage. A total of 75 patients with ureteral calculi were prospectively followed for stone passage. Clinical data included patient gender and age, stone size and location, pain medication requirements and interval to stone passage. Of the 75 patients 13 (17%) required intervention and 62 (83%) were followed until spontaneous stone passage. Stones requiring intervention were not included in the time to passage analysis. Of the 75 patients 41 (55%) had ureteral stones 2 mm. or smaller with an average time to stone passage of 8.2 days and only 2 (4.8%) required intervention, 18 (24%) had stones between 2 and 4 mm. with an average time to stone passage of 12.2 days and 3 (17%) required intervention, and 16 had stones 4 mm. or greater with an average time to stone passage of 22.1 days and 8 required intervention. For 95% of stones to pass it took 31 days for those 2 mm, or less, 40 days for those 2 to 4 mm. and 39 days for those 4 to 6 mm. Multivariate analysis revealed that size, location and side were statistically related to stone passage interval (p = 0.012). Stones that were smaller, more distal and on the right side were more likely to pass spontaneously and required fewer interventions. Interval to stone passage is highly variable and dependent on stone size, location and side. Degree of pain, and patient gender and age had no bearing on the time to stone passage. Of ureteral stones 95% 2 to 4 mm. pass spontaneously but passage may take as long as 40 days. Intervention may be required in 50% of ureteral calculi greater than 5 mm.
          Article 0 comments Cited 69 times – based on 0 reviews     Review now
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            Diagnostic performance of low-dose CT for the detection of urolithiasis: a meta-analysis.

            Georg Bongartz, Tilo Niemann, Thilo Kollmann (2008)
            The objective of our study was to perform a meta-analysis to evaluate the diagnostic performance of low-dose CT for the diagnosis of urolithiasis (seven studies, 1,061 patients). The medical literature from 1995 to 2007 was searched using PubMed, Medline, and Cochrane Library databases for articles on studies that used low-dose CT (< 3 mSv dose applied for the entire CT examination) as a diagnostic test for the detection of urolithiasis. Prospective and retrospective studies were included if they separately reported the rate of true-positive, true-negative, false-positive, and false-negative diagnoses of urolithiasis from low-dose CT compared with the positive and negative rates of normal-dose CT or a combination of diagnostic tests. Two readers assessed the quality of the studies. The pooled sensitivity and specificity of low-dose CT for the diagnosis of urolithiasis were 0.966 (95% CI, 0.950-0.978) and 0.949 (95% CI, 0.920-0.970), respectively. The results of this meta-analysis suggest that a low-dose CT protocol can be used as the initial imaging technique in the workup of patients with suspected urolithiasis.
            Article 0 comments Cited 46 times – based on 0 reviews     Review now
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              Natural History, Complications and Re-Intervention Rates of Asymptomatic Residual Stone Fragments after Ureteroscopy: a Report from the EDGE Research Consortium.

              Ben H. Chew, Hilary Brotherhood, Roger Sur … (2016)
              Fragments 4 mm or smaller after ureteroscopy historically have been considered clinically insignificant but there is a reported 20% event rate on followup even with stones 4 mm or smaller. In this study we examine the natural history, complications and re-intervention rates of fragments after ureteroscopy.
              Article 0 comments Cited 41 times – based on 0 reviews     Review now
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                Author and article information

                Journal
                Journal ID (nlm-ta): Int Braz J Urol
                Journal ID (iso-abbrev): Int Braz J Urol
                Journal ID (publisher-id): ibju
                Title: International Brazilian Journal of Urology : official journal of the Brazilian Society of Urology
                Publisher: Sociedade Brasileira de Urologia
                ISSN (Print): 1677-5538
                ISSN (Electronic): 1677-6119
                Publication date (Electronic): 7 November 2019
                Publication date Collection: Sep-Dec 2019
                Volume: 45
                Issue: 5
                Pages: 948-955
                Affiliations
                [1 ] Departamento de Urologia do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, SP, Brasil;
                [2 ] Departamento de Radiologia do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, SP, Brasil;
                [3 ] Sorbonne Université, GRC n 20 Lithiase Renale, AP-HP, Hôpital Tenon, F-75020 Paris, France. University, Paris, France
                Author notes
                Correspondence address: Alexandre Danilovic, MD Av. Dr. Eneas de Carvalho Aguiar, nº 255, 7º andar, Sala 7175 São Paulo, SP, 05403-000, Brasil Telephone: +55 11 2661-8080 E-mail: alexandre.danilovic@ 123456hc.fm.usp.br

                CONFLICT OF INTEREST

                None declared.

                Author information
                http://orcid.org/0000-0002-6963-6117
                Article
                Publisher ID: S1677-5538.IBJU.2018.0819
                DOI: 10.1590/S1677-5538.IBJU.2018.0819
                PMC ID: 6844354
                PubMed ID: 31268643
                SO-VID: 9b24daae-1f27-4645-84aa-ad195f0182c9
                License:

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 28 November 2018
                Date accepted : 17 March 2019
                Page count
                Figures: 2, Tables: 2, Equations: 0, References: 33, Pages: 8
                Funding
                Funded by: Fapesp
                Award ID: 2014/05130-2
                Categories
                Subject: Original Article

                Keywords: kidney calculi,nephrolithiasis,patient outcome assessment
                Data availability:
                Keywords: kidney calculi, nephrolithiasis, patient outcome assessment

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