Department of Radiology, Changhai Hospital Affiliated to the Second Military Medical University, Changhai Road 168, Yangpu District, Shanghai, 200433 PR China.
Department of Nuclear Medicine, Changhai Hospital Affiliated to the Second Military Medical University, Changhai Road 168, Yangpu District, Shanghai, 200433 PR China.
Clin Radiol. 2019 May;74(5):408.e1-408.e7. doi: 10.1016/j.crad.2019.01.018. Epub 2019 Feb 23.
To find potential predictors at unenhanced computed tomography (CT) to evaluate the stone clearance rate (SCR) of pancreatic duct stones (PDS) by extracorporeal shock wave lithotripsy (ESWL).
A total of 106 consecutive patients with multiple stones of maximal transverse length (MTL) 0.3-3.6 cm in pancreatic head region were enrolled. Unenhanced CT was performed both before and after ESWL therapy. All patients underwent ESWL therapy using an electromagnetic lithotripter, and were divided into three groups with threshold values of >90%, 50-90% and <50% of SCR. Factors including sex, age, MTL, mean stone density (MSD), standard deviation of stone density (SDSD), variation coefficient of stone density (VCSD), attenuation density (AD), pancreatic duct diameter (PDD), skin-to-stone distance (SSD), and number of ESWL sessions were analysed, and their impact on SCR was evaluated by univariate and multivariate analyses. The diagnostic threshold of the independent predicting index was further calculated, and its relationship with SCR and ESWL was analysed by drawing a trend line.
The only significant predictor of SCR by ESWL was MSD (p<0.05). More courses of ESWL therapy are required in PDS patients with an MSD higher than the cut-off value of 375.4 HU (mean, 2.6 versus 1.8), but with a relatively lower SCR (mean, 43.96 versus 88.68%) .
MSD on pre-treatment unenhanced CT is an independent predictor for SCR of PDS patients treated with ESWL. Using a cut-off value of 375.4 HU, patients with low MSD are good candidates for ESWL therapy.
在未增强的计算机断层扫描（CT）中寻找潜在的预测因子，以评估体外冲击波碎石术（ESWL）治疗胰管结石（PDS）的结石清除率（SCR）。
共纳入 106 例胰头部多发性结石，最大横径（MTL）为 0.3-3.6cm。所有患者均在 ESWL 治疗前后进行了未增强 CT 检查。所有患者均采用电磁碎石机进行 ESWL 治疗，并根据 SCR 的阈值分为三组，>90%、50-90%和<50%。分析了性别、年龄、MTL、平均结石密度（MSD）、结石密度标准差（SDSD）、结石密度变异系数（VCSD）、衰减密度（AD）、胰管直径（PDD）、皮肤至结石距离（SSD）和 ESWL 治疗次数等因素，并通过单因素和多因素分析评估其对 SCR 的影响。进一步计算独立预测指标的诊断阈值，并通过绘制趋势线分析其与 SCR 和 ESWL 的关系。
唯一与 ESWL 相关的 SCR 显著预测因子是 MSD（p<0.05）。MSD 高于 375.4HU 截值（均值，2.6 比 1.8）的 PDS 患者需要更多的 ESWL 治疗次数，但 SCR 相对较低（均值，43.96 比 88.68%）。
治疗前未增强 CT 的 MSD 是 ESWL 治疗 PDS 患者 SCR 的独立预测因子。使用 375.4HU 的截值，MSD 较低的患者是 ESWL 治疗的良好候选者。
