Qin Feng,He Tianqu,Zhao Yaowang,et al.Application of computed tomography Hounsfield unit in the determination of urinary stone composition in children[J].Journal of Clinical Pediatric Surgery,,():40-45.[doi:10.3760/cma.j.cn101785-202304043-008]
Application of computed tomography Hounsfield unit in the determination of urinary stone composition in children
- Keywords:
- Stone Composition; Judgment; Surgical Procedures; Operative; Child
- Abstract:
- Objective To explore the application value of CT Hounsfield unit (HU) of urinary calculi in the determination of stone composition in children.Methods For this retrospective study,between April 2009 and April 2022,422 children of urinary tract calculi were recruited as research subjects.Based upon the results of postoperative stone composition analysis,they were assigned into 4 groups of calcium oxalate calculus,uric acid calculus,struvite and cystine calculus.Urinary pH value,HU value in stone core,HU value in stone periphery,average HU value and Hounsfield unit density (HUD) of stone were statistically examined.Results The HU value in the periphery of uric acid calculus group (399±158),calcium oxalate calculus group (529±223),struvite group (556±312),cystine calculus group (566±154),uric acid calculus group was lower than calcium oxalate calculus group,struvite group and cystine calculus group,the differences were statistically significant (P<0.05).The average HU value of uric acid calculus group (425±166),calcium oxalate calculus group (585±251),struvite group (597±326),cystine calculus group (589±155),uric acid calculus group was lower than calcium oxalate calculus group,struvite group and cystine calculus group,the differences were statistically significant (P<0.05).The HU value in the core of the uric acid calculus group was (476±201),the calcium oxalate calculus group was (697±324),and the struvite group was (681±371).The HU value in the core of the uric acid calculus group was lower than that of the calcium oxalate calculus group and the struvite group,and the differences were statistically significant (P<0.05).The HUD of the calcium oxalate calculus group (65±27),uric acid calculus group (39±16),struvite group (54±25),cystine calculus group (41±17),calcium oxalate calculus group was higher than uric acid calculus group,struvite group and cystine calculus group,the differences were statistically significant (P<0.05).The HUD of uric acid calculus group was lower than that of struvite group,and the difference was statistically significant (P<0.05).The urine pH value of cystine calculus group was 6.5 (6.0,7.13),calcium oxalate calculus group was 6.0 (6.0,6.5),and uric acid calculus group was 6.0 (6.0,6.5).The urine pH value of cystine calculus group was higher than that of calcium oxalate calculus group and uric acid calculus group,and the differences were statistically significant (P<0.001).The area under curve (AUC) of HUD of calcium oxalate calculus and non-calcium oxalate calculus groups was 0.755 with a sensitivity of 0.722,a specificity of 0.705 and an optimal cut-off value of 48.Non-uric acid core calculus in uric acid calculus group had an AUC of 0.700 with a sensitivity of 0.607,a specificity of 0.764 and an optimal cutoff value of 566.AUC of median urinary pH value in cystine calculus and non-cystine calculus groups was 0.704 with a sensitivity of 0.682,a specificity of 0.657 and an optimal cutoff value of 6.25.Conclusions Measurement of CT HU value may provide references for determining the composition of calcium oxalate and uric acid calculi.When HU value of stone core is below 566,it hints at uric acid calculus.Calcium oxalate calculus is suggested when HUD is 48 or above.
References:
[1] Magni G,Unwin RJ,Moochhala SH.Renal tubular acidosis (RTA) and kidney stones:diagnosis and management[J].Arch Esp Urol,2021,74(1):123-128.
[2] Kovacevic L.Diagnosis and management of nephrolithiasis in children[J].Pediatr Clin North Am,2022,69(6):1149-1164.DOI:10.1016/j.pcl.2022.07.008.
[3] 刘李,彭柳成,李创业,等.单中心592例儿童泌尿系结石成分分析[J].中华泌尿外科杂志,2022,43(9):701-706.DOI:10.3760/cma.j.cn112330-20201125-00788. Liu L,Peng LC,Li CY,et al.Analysis of urinary calculi composition of 592 children at a single center[J].Chin J Urol,2022,43(9):701-706.DOI:10.3760/cma.j.cn112330-20201125-00788.
[4] Ye ZQ,Zeng GH,Yang H,et al.The status and characteristics of urinary stone composition in China[J].BJU Int,2020,125(6):801-809.DOI:10.1111/bju.14765.
[5] Rodríguez-Plata IT,Medina-Escobedo M,Basulto-Martínez M,et al.Implementation of a technique based on Hounsfield units and Hounsfield density to determine kidney stone composition[J].Tomography,2021,7(4):606-613.DOI:10.3390/tomography7040051.
[6] 舒露.CT值在感染性结石中的初步研究及预警[D].遵义:遵义医科大学,2020. Shu L.Preliminary researches and early warnings of CT value in infectious calculi[D].Zunyi:Zunyi Medical University,2020.
[7] 邢滇霞.能谱CT在体分析泌尿系结石成分与碎石难易程度的关系[D].石河子:石河子大学,2017. Xing DX.Energy spectrum CT in vivo analysis of urinary calculi composition and its relationship with grinding difficulties[D].Shihezi:Shihezi University,2017.
[8] Altan M,?itamak B,Bozaci AC,et al.Predicting the stone composition of children preoperatively by Hounsfield unit detection on non-contrast computed tomography[J].J Pediatr Urol,2017,13(5):505.e1-505.e6.DOI:10.1016/j.jpurol.2017.03.013.
[9] Senocak C,Ozcan C,Sahin T,et al.Risk factors of infectious complications after flexible uretero-renoscopy with laser lithotripsy[J].Urol J,2018,15(4):158-163.DOI:10.22037/uj.v0i0.3967.
[10] Schnabel MJ,Wagenlehner FME,Schneidewind L.Perioperative antibiotic prophylaxis for stone therapy[J].Curr Opin Urol,2019,29(2):89-95.DOI:10.1097/MOU.0000000000000576.
[11] Tekgül S,Stein R,Bogaert G,et al.European Association of Urology and European Society for Paediatric Urology guidelines on paediatric urinary stone disease[J].Eur Urol Focus,2022,8(3):833-839.DOI:10.1016/j.euf.2021.05.006.
[12] 赵夭望,李创业.儿童遗传性肾结石的治疗进展[J].临床小儿外科杂志,2020,19(8):666-671.DOI:10.3969/j.issn.1671-6353.2020.08.002. Zhao YW,Li CY.Recent advances in the treatment of hereditary nephrolithiasis in children[J].J Clin Ped Sur,2020,19(8):666-671.DOI:10.3969/j.issn.1671-6353.2020.08.002.
[13] 杨斌,汪道琦,周元,等.CT和AI技术预测泌尿系结石成分的研究进展[J].临床泌尿外科杂志,2023,38(2):139-145.DOI:10.13201/j.issn.1001-1420.2023.02.013. Yang B,Wang DQ,Zhou Y,et al.Research advances of CT and AI technology in predicting the composition of urinary calculi[J].J Clin Urol,2023,38(2):139-145.DOI:10.13201/j.issn.1001-1420.2023.02.013.
[14] Kachroo N,Jain R,Maskal S,et al.Can CT-based stone impaction markers augment the predictive ability of spontaneous stone passage?[J].J Endourol,2021,35(4):429-435.DOI:10.1089/end.2020.0645.
[15] Yu J,Zhou QC,Lin F,et al.Performance of dual-source CT in calculi component analysis:a systematic review and meta-analysis of 2151 calculi[J].Can Assoc Radiol J,2021,72(4):742-749.DOI:10.1177/0846537120951992.
[16] Zumstein V,Betschart P,Hechelhammer L,et al.CT-calculometry (CT-CM):advanced NCCT post-processing to investigate urinary calculi[J].World J Urol,2018,36(1):117-123.DOI:10.1007/s00345-017-2092-7.
[17] Lam JP,Alexander LF,William HE,et al.In vivo comparison of radiation exposure in third-generation vs second-generation dual-source dual-energy CT for imaging urinary calculi[J].J Endourol,2021,35(11):1581-1585.DOI:10.1089/end.2021.0103.
Memo
收稿日期:2023-4-17。
基金项目:湖南省儿童泌尿生殖疾病临床医学研究中心(2021SK4017); 湖南省卫健委重点资助课题(202204054938)
通讯作者:赵夭望,Email: yw508@ sina.com