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E88 CT scan evaluation of renal papillary density in kidney
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FRIDAY 11 SEPTEMBER 2015 / EUROPEAN UROLOGY SUPPLEMENTS 14 (2015) 29–78
lithotripsy (ESWL) and to assess the suitability of this, or if we due to employ other techniques. To assess the ability of simple radiology, using the advances in digitalization and image processing, and CT in bone and soft window to classify four types stones of different composition. Materials and methods: We present an experimental, prospective and blind study with 308 urinary calculi from four hospitals. We rejected 115 lithiasis because they did not meet the inclusion criteria: Intact stones, larger than 0.5 cm. They must also be pure calcium oxalate monohydrate (COM), uric (UR), carbonate apatite (CA) or mixed calcium oxalate mono or dihydrate composition (OCMix). The remaining 193 were subjected to radiography and tomography (CT), valuing digitally gray attenuation presented by Adobe Photoshop® CS5 program, and attenuation in Hounsfield units (HU) with different techniques. Results: Medium gray values (GMDA) found in simple radiography were higher for CA (246), followed by OCMix (230.5), COM (228) and finally UR (160.5). The differences were significant for the comparison GMDA of OCMix and CA (p <0.005) and UR (p <0.002). OCM also showed differences with all compositions except with OCMix. CT showed in both bone and soft tissue window, a higher UH attenuation for OCM (907/717), followed by OCMix (839/682), CA (742/690) and UR (292/278). The differences were not significant when comparing OCM-OCMix (p = 0.16) or CA-OXMix (p = 0.33) in bone window or soft tissue window (p = 0.21 and 0.62 respectively). There was not statistically significance between OCM-CA (p = 0.46). All comparisons showed significant differences with UR. Conclusions: In our model, both simple radiography and CT achieved statistically significant results to distinguish urolithiasis composition. However, both radiological tests showed overlap values, especially in simple radiography. Only uric acid lithiasis showed different values in both radiological techniques. Attenuation measurement (UH) in bone window is better than soft tissue window to distinguish lithiasic components. E88 CT scan evaluation of renal papillary density in kidney Shavit L.1, Girfoglio D.2, Kirkham A.3, Allen D.4, Ferraro P.M.5, Moochhala S.6, Unwin R.6 1Shaare Zedek Medical Center, Dept. of Adult Nephrology, Jerusalem, Israel, 2UCL Centre For Nephrology, Royal Free Campus and Hospital, University College London Medical School, Dept. of Nephrology, London, United Kingdom, 3 University College London Medical School, Dept. of UCL centre for medical imaging, London, United Kingdom, 4University College London Medical School, Dept. of Urology, London, United Kingdom, 5 Catholic University of The Sacred Heart, Dept. of Nephrology, Rome, Italy, 6UCL Centre For Nephrology, Royal Free Campus and Hospital, University College London Medical School, Dept. of Nephrology, London, Israel Introduction and objectives: A number of previous studies have reported an increase in Hounsfield unit density (HU) of the renal papillae in patients with nephrolithiasis compared with controls. Kidney stone formers (KSF) were found to have higher papillary and cortical density in both kidneys, irrespective of which side had calculi and it was proposed that this may be related to the presence of hypercalciuria. The current study was designed 1) to determine whether recurrent KSF have higher papillary density compared with healthy controls; 2) to test the association between higher renal papillary density and the presence of hypercalciuria in KSF. Materials and methods: We investigated 111 patients, of whom 57 were KSF and 54 were healthy controls.The CT attenuation values were measured within a 0.2 sq cm area of the renal
papilla in the upper, middle, and lower segments of each kidney and were compared between KSF and non-stone formers and between KSF with and without hypercalciuria. Results: There were no significant differences in age and sex between groups. Papillary density was significantly higher in KSF by both crude and adjusted analyses (p value < 0.001). However, there was no association between higher papillary density and hypercalciuria in KSF. Conclusions: The papillary density measured by CT is a useful, non-invasive tool to differentiate between KSF and healthy controls. However, the absence of any correlation between papillary density and hypercalciuria suggests that the presence of clinically significant underlying renal stone disease, rather than urinary metabolic abnormalities, correlates with radiologically detectable interstitial calcification. E89 Attenuation of renal tissue on CT as a predictive factor in urinary stone formation Hawizy A.1, Bourdoumis A.2, Kirkham A.3 1The Ipswich Hospital NHS Trust, Dept. of Urology, Ipswich, United Kingdom, 2Torbay Hospital, South Devon Healthcare NHS Foundation Trust, Dept. of Urology, Torquay, United Kingdom, 3University College Hospital London, Dept. of Radiology, London, United Kingdom Introduction and objectives: According to existing evidence, renal tissue attenuation on CT KUB could predict the probability for recurrent and/or future urinary stone formation. Materials and methods: Data were collected retrospectively from 260 consecutive CT KUB scans of patients who attended the emergency department with acute flank pain. Attenuation was measured in Hounsfield units by placing region of interests (ROI) in random areas of the renal papillae and cortex in 105 patients with stones and in 55 patients without lithiasis, who served as controls. A total of six measurements on each site were recorded. The mean values were compared using two tailed independent sample t-test to identify the significance of differences between the two groups (p<0.05). Results: There was no difference in attenuation of renal papillae between the two sides in unilateral stone formers. On the contrary, there was a statisticaly significant difference in attenuation between stone formers and the control group (p=0.004). In the absence of hydronephrosis, there was no difference in attenuation between the control and study groups. However, in stone formers with hydronephrosis the cortical attenuation was significantly lower than that of the control group (p=0.004). Conclusions: Renal papillae attenuation seems to be higher in stone-forming patients in comparison to non stone formers. There was a reduction in the cortical density in the presence of hydronephrosis which can serve as an indirect diagnostic imaging sign of obstructive uropathy. E91 Meaning 3 D CT Reconstruction of Access in percutaneous surgery in pediatric patients Hoshimov N., Nadjimitdinov Y. Republic centre of urology, Dept. of Urology, Tashkent, Uzbekistan Introduction and objectives: Three-Dimensional CT scan stone reconstrution for planning of Percutaneous surgery in pediatric patients. To assess the utility of spiral computed tomography (CT) with three-dimensional reconstruction for preoperative planning of percutaneous nephrostolithotomy in pediatric patients with complex branched renal calculi.
FRIDAY 11 SEPTEMBER 2015 / EUROPEAN UROLOGY SUPPLEMENTS 14 (2015) 29–78
lithotripsy (ESWL) and to assess the suitability of this, or if we due to employ other techniques. To assess the ability of simple radiology, using the advances in digitalization and image processing, and CT in bone and soft window to classify four types stones of different composition. Materials and methods: We present an experimental, prospective and blind study with 308 urinary calculi from four hospitals. We rejected 115 lithiasis because they did not meet the inclusion criteria: Intact stones, larger than 0.5 cm. They must also be pure calcium oxalate monohydrate (COM), uric (UR), carbonate apatite (CA) or mixed calcium oxalate mono or dihydrate composition (OCMix). The remaining 193 were subjected to radiography and tomography (CT), valuing digitally gray attenuation presented by Adobe Photoshop® CS5 program, and attenuation in Hounsfield units (HU) with different techniques. Results: Medium gray values (GMDA) found in simple radiography were higher for CA (246), followed by OCMix (230.5), COM (228) and finally UR (160.5). The differences were significant for the comparison GMDA of OCMix and CA (p <0.005) and UR (p <0.002). OCM also showed differences with all compositions except with OCMix. CT showed in both bone and soft tissue window, a higher UH attenuation for OCM (907/717), followed by OCMix (839/682), CA (742/690) and UR (292/278). The differences were not significant when comparing OCM-OCMix (p = 0.16) or CA-OXMix (p = 0.33) in bone window or soft tissue window (p = 0.21 and 0.62 respectively). There was not statistically significance between OCM-CA (p = 0.46). All comparisons showed significant differences with UR. Conclusions: In our model, both simple radiography and CT achieved statistically significant results to distinguish urolithiasis composition. However, both radiological tests showed overlap values, especially in simple radiography. Only uric acid lithiasis showed different values in both radiological techniques. Attenuation measurement (UH) in bone window is better than soft tissue window to distinguish lithiasic components. E88 CT scan evaluation of renal papillary density in kidney Shavit L.1, Girfoglio D.2, Kirkham A.3, Allen D.4, Ferraro P.M.5, Moochhala S.6, Unwin R.6 1Shaare Zedek Medical Center, Dept. of Adult Nephrology, Jerusalem, Israel, 2UCL Centre For Nephrology, Royal Free Campus and Hospital, University College London Medical School, Dept. of Nephrology, London, United Kingdom, 3 University College London Medical School, Dept. of UCL centre for medical imaging, London, United Kingdom, 4University College London Medical School, Dept. of Urology, London, United Kingdom, 5 Catholic University of The Sacred Heart, Dept. of Nephrology, Rome, Italy, 6UCL Centre For Nephrology, Royal Free Campus and Hospital, University College London Medical School, Dept. of Nephrology, London, Israel Introduction and objectives: A number of previous studies have reported an increase in Hounsfield unit density (HU) of the renal papillae in patients with nephrolithiasis compared with controls. Kidney stone formers (KSF) were found to have higher papillary and cortical density in both kidneys, irrespective of which side had calculi and it was proposed that this may be related to the presence of hypercalciuria. The current study was designed 1) to determine whether recurrent KSF have higher papillary density compared with healthy controls; 2) to test the association between higher renal papillary density and the presence of hypercalciuria in KSF. Materials and methods: We investigated 111 patients, of whom 57 were KSF and 54 were healthy controls.The CT attenuation values were measured within a 0.2 sq cm area of the renal
papilla in the upper, middle, and lower segments of each kidney and were compared between KSF and non-stone formers and between KSF with and without hypercalciuria. Results: There were no significant differences in age and sex between groups. Papillary density was significantly higher in KSF by both crude and adjusted analyses (p value < 0.001). However, there was no association between higher papillary density and hypercalciuria in KSF. Conclusions: The papillary density measured by CT is a useful, non-invasive tool to differentiate between KSF and healthy controls. However, the absence of any correlation between papillary density and hypercalciuria suggests that the presence of clinically significant underlying renal stone disease, rather than urinary metabolic abnormalities, correlates with radiologically detectable interstitial calcification. E89 Attenuation of renal tissue on CT as a predictive factor in urinary stone formation Hawizy A.1, Bourdoumis A.2, Kirkham A.3 1The Ipswich Hospital NHS Trust, Dept. of Urology, Ipswich, United Kingdom, 2Torbay Hospital, South Devon Healthcare NHS Foundation Trust, Dept. of Urology, Torquay, United Kingdom, 3University College Hospital London, Dept. of Radiology, London, United Kingdom Introduction and objectives: According to existing evidence, renal tissue attenuation on CT KUB could predict the probability for recurrent and/or future urinary stone formation. Materials and methods: Data were collected retrospectively from 260 consecutive CT KUB scans of patients who attended the emergency department with acute flank pain. Attenuation was measured in Hounsfield units by placing region of interests (ROI) in random areas of the renal papillae and cortex in 105 patients with stones and in 55 patients without lithiasis, who served as controls. A total of six measurements on each site were recorded. The mean values were compared using two tailed independent sample t-test to identify the significance of differences between the two groups (p<0.05). Results: There was no difference in attenuation of renal papillae between the two sides in unilateral stone formers. On the contrary, there was a statisticaly significant difference in attenuation between stone formers and the control group (p=0.004). In the absence of hydronephrosis, there was no difference in attenuation between the control and study groups. However, in stone formers with hydronephrosis the cortical attenuation was significantly lower than that of the control group (p=0.004). Conclusions: Renal papillae attenuation seems to be higher in stone-forming patients in comparison to non stone formers. There was a reduction in the cortical density in the presence of hydronephrosis which can serve as an indirect diagnostic imaging sign of obstructive uropathy. E91 Meaning 3 D CT Reconstruction of Access in percutaneous surgery in pediatric patients Hoshimov N., Nadjimitdinov Y. Republic centre of urology, Dept. of Urology, Tashkent, Uzbekistan Introduction and objectives: Three-Dimensional CT scan stone reconstrution for planning of Percutaneous surgery in pediatric patients. To assess the utility of spiral computed tomography (CT) with three-dimensional reconstruction for preoperative planning of percutaneous nephrostolithotomy in pediatric patients with complex branched renal calculi.