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Re: Dual-Energy Dual-Source CT With Additional Spectral Filtration Can Improve the Differentiation of Non-Uric Acid Renal Stones: An Ex Vivo Phantom Study
Urological Survey
Urolithiasis/Endourology Re: Dual-Energy Dual-Source CT With Additional Spectral Filtration Can Improve the Differentiation of Non-Uric Acid Renal Stones: An Ex Vivo Phantom Study M. Qu, J. C. Ramirez-Giraldo, S. Leng, J. C. Williams, T. J. Vrtiska, J. C. Lieske and C. H. McCollough Department of Radiology, Mayo Clinic, Rochester, Minnesota AJR Am J Roentgenol 2011; 196: 1279 –1287.
Objective: The purpose of this study was to determine the ex vivo ability of dual-energy dual-source CT (DSCT) with additional tin filtration to differentiate among five groups of human renal stone types. Materials and Methods: Forty-three renal stones of 10 types were categorized into five primary groups on the basis of effective atomic numbers, which were calculated as the weighted average of the atomic numbers of constituent atoms. Stones were embedded in porcine kidneys and placed in a 35-cm water phantom. Dual-energy DSCT scans were performed at 80 and 140 kV with and without tin filtration of the 140-kV beam. The CT number ratio, defined as the ratio of the CT number of a given material in the low-energy image to the CT number of the same material in the high-energy image, was calculated on a volumetric voxel-by-voxel basis for each stone. Statistical analysis was performed, and receiver operating characteristic (ROC) curves were plotted to compare the difference in CT number ratio with and without tin filtration, and to measure the discrimination among stone groups. Results: The CT number ratio of non-uric acid stones increased on average by 0.17 (range, 0.03– 0.36) with tin filtration. The CT number ratios for non-uric acid stone groups were not significantly different (p ⬎ 0.05) between any of the two adjacent groups without tin filtration. Use of the additional tin filtration on the high-energy x-ray tube significantly improved the separation of non-uric acid stone types by CT number ratio (p ⬍ 0.05). The area under the ROC curve increased from 0.78 to 0.84 without fin filtration and to 0.89 – 0.95 with tin filtration. Conclusion: Our results showed better separation among different stone types when additional tin filtration was used on dual-energy DSCT. The increased spectral separation allowed a five-group stone classification scheme. Some overlapping between particular stone types still exists, including brushite and calcium oxalate. Editorial Comment: The increased spectral separation with tin filtration allowed good discrimination between uric acid, struvite and cystine stones. However, there was still overlap with calcium stones. Cost and radiation exposure may limit the use of this technology. Dean Assimos, M.D.
Re: Oxalate and Sucralose Absorption in Idiopathic Calcium Oxalate Stone Formers J. Knight, J. Jiang, K. D. Wood, R. P. Holmes and D. G. Assimos Department of Urology, Wake Forest University Medical Center, Winston-Salem, North Carolina Urology 2011; Epub ahead of print.
Objectives: To better understand intestinal oxalatetransport by correlating oxalate and sucralose absorption in idiopathic calcium oxalate stoneformers. Oxalate has been hypothesized to undergo 0022-5347/11/1865-1916/0 THE JOURNAL OF UROLOGY® © 2011 by AMERICAN UROLOGICAL ASSOCIATION EDUCATION
1916
www.jurology.com
AND
RESEARCH, INC.
Vol. 186, 1916-1922, November 2011 Printed in U.S.A. DOI:10.1016/j.juro.2011.07.052
Urolithiasis/Endourology Re: Dual-Energy Dual-Source CT With Additional Spectral Filtration Can Improve the Differentiation of Non-Uric Acid Renal Stones: An Ex Vivo Phantom Study M. Qu, J. C. Ramirez-Giraldo, S. Leng, J. C. Williams, T. J. Vrtiska, J. C. Lieske and C. H. McCollough Department of Radiology, Mayo Clinic, Rochester, Minnesota AJR Am J Roentgenol 2011; 196: 1279 –1287.
Objective: The purpose of this study was to determine the ex vivo ability of dual-energy dual-source CT (DSCT) with additional tin filtration to differentiate among five groups of human renal stone types. Materials and Methods: Forty-three renal stones of 10 types were categorized into five primary groups on the basis of effective atomic numbers, which were calculated as the weighted average of the atomic numbers of constituent atoms. Stones were embedded in porcine kidneys and placed in a 35-cm water phantom. Dual-energy DSCT scans were performed at 80 and 140 kV with and without tin filtration of the 140-kV beam. The CT number ratio, defined as the ratio of the CT number of a given material in the low-energy image to the CT number of the same material in the high-energy image, was calculated on a volumetric voxel-by-voxel basis for each stone. Statistical analysis was performed, and receiver operating characteristic (ROC) curves were plotted to compare the difference in CT number ratio with and without tin filtration, and to measure the discrimination among stone groups. Results: The CT number ratio of non-uric acid stones increased on average by 0.17 (range, 0.03– 0.36) with tin filtration. The CT number ratios for non-uric acid stone groups were not significantly different (p ⬎ 0.05) between any of the two adjacent groups without tin filtration. Use of the additional tin filtration on the high-energy x-ray tube significantly improved the separation of non-uric acid stone types by CT number ratio (p ⬍ 0.05). The area under the ROC curve increased from 0.78 to 0.84 without fin filtration and to 0.89 – 0.95 with tin filtration. Conclusion: Our results showed better separation among different stone types when additional tin filtration was used on dual-energy DSCT. The increased spectral separation allowed a five-group stone classification scheme. Some overlapping between particular stone types still exists, including brushite and calcium oxalate. Editorial Comment: The increased spectral separation with tin filtration allowed good discrimination between uric acid, struvite and cystine stones. However, there was still overlap with calcium stones. Cost and radiation exposure may limit the use of this technology. Dean Assimos, M.D.
Re: Oxalate and Sucralose Absorption in Idiopathic Calcium Oxalate Stone Formers J. Knight, J. Jiang, K. D. Wood, R. P. Holmes and D. G. Assimos Department of Urology, Wake Forest University Medical Center, Winston-Salem, North Carolina Urology 2011; Epub ahead of print.
Objectives: To better understand intestinal oxalatetransport by correlating oxalate and sucralose absorption in idiopathic calcium oxalate stoneformers. Oxalate has been hypothesized to undergo 0022-5347/11/1865-1916/0 THE JOURNAL OF UROLOGY® © 2011 by AMERICAN UROLOGICAL ASSOCIATION EDUCATION
1916
www.jurology.com
AND
RESEARCH, INC.
Vol. 186, 1916-1922, November 2011 Printed in U.S.A. DOI:10.1016/j.juro.2011.07.052