Fragility of brushite stones in shock wave lithotripsy: Absence of correlation with computerized tomography visible structure

James Williams, Tariq Hameed, Molly E. Jackson, Syed Aftab, Alessia Gambaro, Yuri A. Pishchalnikov, James E. Lingeman, James A. McAteer

Research output: Contribution to journalArticle

11 Citations (Scopus)

Abstract

Purpose: Brushite stones were imaged in vitro and then broken with shock wave lithotripsy to assess whether stone fragility correlates with internal stone structure visible on helical computerized tomography. Materials and Methods: A total of 52 brushite calculi were scanned by micro computerized tomography, weighed, hydrated and placed in a radiological phantom. Stones were scanned using a Philips® Brilliance iCT 256 system and images were evaluated for the visibility of internal structural features. The calculi were then treated with shock wave lithotripsy in vitro. The number of shock waves needed to break each stone to completion was recorded. Results: The number of shock waves needed to break each stone normalized to stone weight did not differ by HU value (p = 0.84) or by computerized tomography visible structures that could be identified consistently by all observers (p = 0.053). Stone fragility correlated highly with stone density and brushite content (each p <0.001). Calculi of almost pure brushite required the most shock waves to break. When all observations of computerized tomography visible structures were used for analysis by logistic fit, computerized tomography visible structure predicted increased stone fragility with an overall area under the ROC curve of 0.64. Conclusions: The shock wave lithotripsy fragility of brushite stones did not correlate with internal structure discernible on helical computerized tomography. However, fragility did correlate with stone density and increasing brushite mineral content, consistent with clinical experience with patients with brushite calculi. Thus, current diagnostic computerized tomography technology does not provide a means to predict when brushite stones will break well using shock wave lithotripsy.

Original languageEnglish
Pages (from-to)996-1001
Number of pages6
JournalJournal of Urology
Volume188
Issue number3
DOIs
StatePublished - Sep 2012

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Lithotripsy
Tomography
Calculi
dibasic calcium phosphate dihydrate
ROC Curve
Area Under Curve
Minerals
Technology
Weights and Measures

Keywords

  • brushite
  • calculi
  • high-energy shock waves
  • kidney
  • spiral computed
  • tomography

ASJC Scopus subject areas

  • Urology

Cite this

Fragility of brushite stones in shock wave lithotripsy : Absence of correlation with computerized tomography visible structure. / Williams, James; Hameed, Tariq; Jackson, Molly E.; Aftab, Syed; Gambaro, Alessia; Pishchalnikov, Yuri A.; Lingeman, James E.; McAteer, James A.

In: Journal of Urology, Vol. 188, No. 3, 09.2012, p. 996-1001.

Research output: Contribution to journalArticle

Williams, James ; Hameed, Tariq ; Jackson, Molly E. ; Aftab, Syed ; Gambaro, Alessia ; Pishchalnikov, Yuri A. ; Lingeman, James E. ; McAteer, James A. / Fragility of brushite stones in shock wave lithotripsy : Absence of correlation with computerized tomography visible structure. In: Journal of Urology. 2012 ; Vol. 188, No. 3. pp. 996-1001.
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abstract = "Purpose: Brushite stones were imaged in vitro and then broken with shock wave lithotripsy to assess whether stone fragility correlates with internal stone structure visible on helical computerized tomography. Materials and Methods: A total of 52 brushite calculi were scanned by micro computerized tomography, weighed, hydrated and placed in a radiological phantom. Stones were scanned using a Philips{\circledR} Brilliance iCT 256 system and images were evaluated for the visibility of internal structural features. The calculi were then treated with shock wave lithotripsy in vitro. The number of shock waves needed to break each stone to completion was recorded. Results: The number of shock waves needed to break each stone normalized to stone weight did not differ by HU value (p = 0.84) or by computerized tomography visible structures that could be identified consistently by all observers (p = 0.053). Stone fragility correlated highly with stone density and brushite content (each p <0.001). Calculi of almost pure brushite required the most shock waves to break. When all observations of computerized tomography visible structures were used for analysis by logistic fit, computerized tomography visible structure predicted increased stone fragility with an overall area under the ROC curve of 0.64. Conclusions: The shock wave lithotripsy fragility of brushite stones did not correlate with internal structure discernible on helical computerized tomography. However, fragility did correlate with stone density and increasing brushite mineral content, consistent with clinical experience with patients with brushite calculi. Thus, current diagnostic computerized tomography technology does not provide a means to predict when brushite stones will break well using shock wave lithotripsy.",
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