Popiolek Marcin, Jendeberg Johan, Olin Max, Wagenius Magnus, Sundqvist Pernilla, Lidén Mats
Department of Urology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
Department of Urology, Örebro University Hospital, Örebro, 701 85, Sweden.
Urolithiasis. 2025 Jul 17;53(1):139. doi: 10.1007/s00240-025-01797-y.
This work aims to evaluate whether radiological signs of stone impaction (RSSI) measured on non-contrast computed tomography (CT) can predict shock wave lithotripsy (SWL) outcomes for upper ureteral stones and to assess whether integrating these markers into an existing prediction model (the Niwa nomogram) improves predictive performance. We retrospectively analysed 256 patients treated with SWL for upper ureteral stones between 2012 and 2019. Standard stone parameters and RSSI, including ureteral wall thickness (UWT), ureteral diameters and CT attenuations above and below the stone, were assessed. Multivariable logistic regression, receiver operating characteristic (ROC) analysis, net reclassification improvement (NRI) and decision curve analysis (DCA) were used to evaluate predictive performance. The Niwa nomogram was enhanced by incorporating significant RSSI parameters and was internally validated using k-fold cross-validation. Maximum ureteral attenuation below the stone (UABSmax), ureter diameter above the stone (UDAS) and renal pelvis diameter (RPD) were found to be associated with SWL outcome. UABSmax had the highest individual predictive value (area under the curve (AUC) 0.66), while UWT showed no significant association or predictive value. Incorporating UABSmax and RPD into the Niwa nomogram (Niwa+) marginally increased AUC (0.72 vs. 0.71) but did not lead to significant improvements in NRI or DCA. In conclusion, certain RSSI- particularly UABSmax and RPD- were associated with SWL outcome but provided limited value when added to an already validated nomogram.
本研究旨在评估在非增强计算机断层扫描（CT）上测量的结石嵌顿的放射学征象（RSSI）能否预测输尿管上段结石的冲击波碎石术（SWL）效果，并评估将这些标志物纳入现有的预测模型（丹羽列线图）是否能提高预测性能。我们回顾性分析了2012年至2019年间接受SWL治疗的256例输尿管上段结石患者。评估了标准结石参数和RSSI，包括输尿管壁厚度（UWT）、输尿管直径以及结石上下方的CT衰减值。采用多变量逻辑回归、受试者工作特征（ROC）分析、净重新分类改善（NRI）和决策曲线分析（DCA）来评估预测性能。通过纳入显著的RSSI参数对丹羽列线图进行了改进，并使用k折交叉验证进行内部验证。发现结石下方的最大输尿管衰减值（UABSmax）、结石上方的输尿管直径（UDAS）和肾盂直径（RPD）与SWL效果相关。UABSmax具有最高的个体预测价值（曲线下面积（AUC）为0.66），而UWT未显示出显著关联或预测价值。将UABSmax和RPD纳入丹羽列线图（丹羽+）使AUC略有增加（0.72对0.71），但未导致NRI或DCA有显著改善。总之，某些RSSI——特别是UABSmax和RPD——与SWL效果相关，但添加到已验证的列线图中时提供的价值有限。
