Department of Radiology, Adıyaman University Education and Research Hospital, Adıyaman, Turkey.
Department of Urology, Adıyaman University Education and Research Hospital, Adıyaman, Turkey.
Diagn Interv Radiol. 2022 May;28(3):187-192. doi: 10.5152/dir.2022.20945.
PURPOSE This study aimed to evaluate the use of stone density variation coefficient (SDVC) as an indicator of stone heterogeneity and previously reported parameters for predicting extracorporeal shock wave lithotripsy (ESWL) outcome in urinary calculi. Moreover, a new formula that could be used to predict ESWL success was suggested. METHODS A total of 850 patients, who underwent the first session of ESWL for urinary stones between 2015 and 2020, were examined, and 220 eligible patients were included in the study. Stone density variation coefficient and other parameters associated with stone attenuation values and stone size parameters were studied as potential predictors based on noncontrast com- puted tomography (NCCT). Extracorporeal shock wave lithotripsy success was considered after 3 months by radiography or NCCT. Logistic regression analysis was performed to determine the factors contributing to treatment success. RESULTS For the 220 patients, ESWL success rate was 39.5%. The receiver operating characteristic analysis showed that SDVC (AUC=0.82; 95% confidence interval [CI]: 0.76-0.87; P < .001), mean stone density (AUC=0.81; 95% CI:0.75-0.87; P < .001), maximum stone density (AUC=0.70; 95% CI: 0.63-0.78; P < .001), stone volume (AUC=0.70; 95% CI: 0.62-0.77; P < .001), and major diam- eter (AUC=0.67; 95% CI: 0.59-0.74; P < .001) had significant prediction accuracy from high to low. Additionally, SDVC was found to be successful in predicting ESWL success, especially for patients with high mean stone density (OR = 10; 95% CI: 3.55-28.57; P < .001). The logistic regres- sion model, in which the "stone disintegration probability" (SDP) formula was found, correctly predicted ESWL success with a single session by 79.1%. CONCLUSION In conclusion, size and attenuation values were predictors of treatment success, and the best predictor was SDVC. Evaluation of SDP formula prior to ESWL could predict treatment outcomes and facilitate the decisions regarding treatment strategies.
目的 本研究旨在评估结石密度变异系数（SDVC）作为结石异质性指标的应用，并评估先前报道的参数在预测体外冲击波碎石术（ESWL）治疗尿结石中的作用。此外，提出了一种新的公式，可以用于预测 ESWL 的成功率。
方法 回顾性分析 2015 年至 2020 年间行首次 ESWL 治疗的 850 例尿结石患者资料，根据平扫 CT 值选择 220 例符合条件的患者作为研究对象。研究基于平扫 CT 值，探讨了与结石衰减值和结石大小参数相关的结石密度变异系数和其他参数作为潜在预测因素。术后 3 个月通过影像学检查评价 ESWL 效果。采用 Logistic 回归分析确定影响治疗效果的因素。
结果 220 例患者中，ESWL 成功率为 39.5%。ROC 分析显示，SDVC（AUC=0.82；95%CI：0.76-0.87；P<0.001）、平均结石密度（AUC=0.81；95%CI：0.75-0.87；P<0.001）、最大结石密度（AUC=0.70；95%CI：0.63-0.78；P<0.001）、结石体积（AUC=0.70；95%CI：0.62-0.77；P<0.001）和最大径（AUC=0.67；95%CI：0.59-0.74；P<0.001）的预测准确性由高到低。此外，SDVC 成功预测 ESWL 成功率，特别是对于平均结石密度较高的患者（OR=10；95%CI：3.55-28.57；P<0.001）。该逻辑回归模型发现的“结石粉碎概率”（SDP）公式可以正确预测单次 ESWL 治疗的成功率，达到 79.1%。
结论 综上所述，结石大小和衰减值是治疗效果的预测因素，最佳预测因素是 SDVC。在 ESWL 治疗前评估 SDP 公式可以预测治疗结果，并有助于制定治疗策略。
