Habashy David, Xia Ryan, Ridley William, Chan Lewis, Ridley Lloyd
Department of Urology, Concord Repatriation General Hospital, Sydney, New South Wales, Australia.
Department of Radiology, Concord Repatriation General Hospital, Sydney, New South Wales, Australia.
J Med Imaging Radiat Oncol. 2016 Oct;60(5):624-631. doi: 10.1111/1754-9485.12497. Epub 2016 Jul 28.
Dual energy CT (DECT) is a recent technique that is increasingly being used to differentiate between calcium and uric acid urinary tract calculi. The aim of this study is to determine if urinary calculi composition analysis determined by DECT scanning results in a change of patient management.
All patients presenting with symptoms of renal colic, who had not previously undergone DECT scanning underwent DECT KUB. DECT data of all patients between September 2013 and July 2015 were reviewed. Urinary calculi composition based on dual energy characterization was cross-matched with patient management and outcome.
A total of 585 DECT KUB were performed. 393/585 (67%) DECT scans revealed urinary tract calculi. After excluding those with isolated bladder or small asymptomatic renal stones, 303 patients were found to have symptomatic stone(s) as an explanation for their presentation. Of these 303 patients, there were 273 (90.1%) calcium calculi, 19 (6.3%) uric acid calculi and 11 (3.4%) mixed calculi. Of those with uric acid calculi, 15 were commenced on dissolution therapy. Twelve of those commenced on dissolution therapy had a successful outcome, avoiding need for surgical intervention (lithotripsy or stone retrieval). Three patients failed dissolution therapy and required operative intervention for definitive management of the stone.
Predicting urinary tract calculi composition by DECT plays an important role in identifying patients who may be managed with dissolution therapy. Identification of uric acid stone composition altered management in 15 of 303 (5.0%) patients, and was successful in 12, thereby avoiding surgery and its attendant risks.
双能量CT（DECT）是一种近来越来越多地用于区分含钙和尿酸尿路结石的技术。本研究的目的是确定通过DECT扫描进行的尿路结石成分分析是否会导致患者治疗方案的改变。
所有出现肾绞痛症状且此前未接受过DECT扫描的患者均接受了DECT腹部平片检查。回顾了2013年9月至2015年7月期间所有患者的DECT数据。基于双能量特征的尿路结石成分与患者的治疗方案和结局进行了交叉比对。
共进行了585次DECT腹部平片检查。393/585（67%）的DECT扫描显示存在尿路结石。在排除那些仅有膀胱结石或无症状小肾结石的患者后，发现有303例患者有症状性结石可解释其临床表现。在这303例患者中，有273例（90.1%）为含钙结石，19例（6.3%）为尿酸结石，11例（3.4%）为混合性结石。在那些患有尿酸结石的患者中，有15例开始接受溶石治疗。开始接受溶石治疗的患者中有12例取得了成功，避免了手术干预（碎石或取石）的需要。3例患者溶石治疗失败，需要进行手术干预以最终处理结石。
通过DECT预测尿路结石成分在识别可能接受溶石治疗的患者方面起着重要作用。在303例患者中有15例（5.0%）因识别出尿酸结石成分而改变了治疗方案，其中12例成功，从而避免了手术及其相关风险。
