Skip to main content
SpringerLink
Log in

Helical CT evaluation of the chemical composition of urinary tract calculi with a discriminant analysis of CT-attenuation values and density

  • Experimental
  • Published:
European Radiology Aims and scope Submit manuscript

Abstract

The aim of this study was to evaluate the efficacy of helical CT using a combination of CT-attenuation values and visual assessment of stone density as well as discriminant linear analysis to predict the chemical composition of urinary calculi. One hundred human urinary calculi were obtained from a stone-analysis laboratory and placed in 20 excised pig kidneys. They were scanned at 80, 120 and 140 kV with 3-mm collimation. Average, highest and lowest CT-attenuation values and CT variability were recorded. The internal calculus structure was assessed using a wide window setting, and visual assessment of stone density was recorded. A stepwise discriminant linear analysis was performed. The following three variables were discriminant: highest CT-attenuation value, visual density, and highest CT-attenuation value/area ratio, all at 80 kV. The probability of correctly classifying stone composition with these three variables was 0.64, ranging from 0.54 for mixed calculi to 0.69 for pure calculi. The probabilities of correctly classifying calculus composition were: 0.91 for calcium oxalate monohydrate and brushite, 0.89 for cystine, 0.85 for uric acid, 0.11 for calcium oxalate dihydrate, 0.10 for hydroxyapatite, and 0.07 for struvite calculi. When the first two ranks of highest probability for the accurate classification of each calculus type were taken into account, 81% of the calculi were correctly classified. Assessment at 80 kV of the highest CT-attenuation value, visual density and the highest CT-attenuation value/area ratio accurately predicts the chemical composition of 64–81% of urinary calculi. When the first two ranks of highest probability for the accurate classification of each calculus type were taken into account, all cystine, calcium oxalate monohydrate and brushite calculi were correctly classified.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Renner C, Rassweiler J (1999) Treatment of renal stones by extracorporeal shock wave lithotripsy. Nephron 81[Suppl 1]:71–81

    Article  PubMed  Google Scholar 

  2. Dretler SP (1994) Special article: calculus breakability—fragility and durility. J Endourol 8:1–3

    CAS  PubMed  Google Scholar 

  3. Logarakis NF, Jewett MA, Luymes J et al (2000) Variation in clinical outcome following shock wave lithotripsy. J Urol 163:721–725

    Article  CAS  PubMed  Google Scholar 

  4. Miller OF, Rineer SK, Reicherd SR et al (1998) Prospective comparison of unenhanced helical computed tomography and intravenous urography in the evaluation of acute flank pain. Urology 52:982–987

    Article  CAS  PubMed  Google Scholar 

  5. Boulay I, Holtz P, Foley WD, White B, Begun FP (1999) Ureteral calculi: diagnostic efficacy of helical CT and implications for treatment of patients. Am J Roentgenol 172:1485–1490

    CAS  Google Scholar 

  6. Sourtzis S, Thibeau JF, Damry N, Raslan A, Vandendris M, Bellemans M (1999) Radiologic investigation of renal colic: unenhanced helical CT compared with excretory urography. Am J Roentgenol 172:1491–1494

    CAS  Google Scholar 

  7. Yilmaz S, Sindel T, Arslan G et al (1998) Renal colic: comparison of spiral CT, US and IVU in the detection of ureteral calculi. Eur Radiol 8:212–217

    Article  CAS  PubMed  Google Scholar 

  8. Ripolles T, Agramunt M, Errando J, Martinez MJ, Coronel B, Morales M (2004) Suspected ureteral colic: plain film and sonography vs unenhanced helical CT. A prospective study in 66 patients. Eur Radiol 14:129–136

    Article  PubMed  Google Scholar 

  9. Preminger GM, Vieweg J, Leder RA, Nelson RC (1998) Urolithiasis: detection and management with unenhanced spiral CT—a urologic perspective. Radiology 207:308–309

    CAS  PubMed  Google Scholar 

  10. Nakada SY, Hoff DG, Attai S, Heisey D, Blankenbaker D, Pozniak M (2000) Determination of stone composition by noncontrast spiral computed tomography in the clinical setting. Urology 55:816–819

    Article  CAS  PubMed  Google Scholar 

  11. Motley G, Dalrymple N, Keesling C, Fischer J, Harmon W (2001) Hounsfield unit density in the determination of urinary stone composition. Urology 58:170–173

    Article  CAS  PubMed  Google Scholar 

  12. Herremans D, Vandeursen H, Pittomvils G et al (1993) In vitro analysis of urinary calculi: type differentiation using computed tomography and bone densitometry. Br J Urol 72:544–548

    CAS  PubMed  Google Scholar 

  13. Newhouse JH, Prien EL, Amis ES, Dretler SP, Pfister RC (1984) Computed tomographic analysis of urinary calculi. Am J Roentgenol 142:545–548

    CAS  Google Scholar 

  14. Saw KC, McAteer JA, Monga AG, Chua GT, Lingeman JE, Williams JC Jr (2000) Helical CT of urinary calculi: effect of stone composition, stone size, and scan collimation. Am J Roentgenol 175:329–332

    CAS  Google Scholar 

  15. Tellez Marinez-Fornes M, Burgos Revilla FJ, Saez Garrido JC et al (1997) In vitro study with techniques of imaging of the composition of urinary calculi. Actas Urol Esp 21:89–99

    PubMed  Google Scholar 

  16. Hillman P, Gaines BJ, Drach GW, Tracey JA (1984) Computed tomographic analysis of renal calculi. Am J Roentgenol 142:549–552

    CAS  Google Scholar 

  17. Burgos FJ, Sanchez J, Avila S, Saez JC, Escudero Barrilero A (1993) The usefulness of computerized axial tomography (CT) in establishing the composition of calculi. Arch Esp Urol 46:383–391

    CAS  PubMed  Google Scholar 

  18. Mostafavi MR, Ernst RD, Saltzman B (1998) Accurate determination of chemical composition of urinary calculi by spiral computerized tomography. J Urol 159:673–675

    Article  CAS  PubMed  Google Scholar 

  19. Williams JC, Paterson RF, Kopecky KK, Lingeman JE, McAteer JA (2001) High resolution detection of internal structure of renal calculi by helical computerized tomography. J Urol 167:322–326

    Google Scholar 

  20. Liu W, Esler SJ, Kenny BJ, Goh RH, Rainbow AJ, Stevenson GW (2000) Low-dose nonenhanced helical CT of renal colic: assessment of ureteric stone detection and measurement of effective dose equivalent. Radiology 215:51–54

    CAS  PubMed  Google Scholar 

  21. Dalrymple NC, Verga M, Anderson KR et al (1998) The value of unenhanced helical computerized tomography in the management of acute flank pain. J Urol 159:735–740

    Article  CAS  PubMed  Google Scholar 

  22. Rassweiler JJ, Renner C, Chaussy C, Thuroff S (2001) Treatment of renal stones by extracorporeal shockwave lithotripsy: an update. Eur Urol 39:187–199

    Article  CAS  PubMed  Google Scholar 

  23. Rassweiler JJ, Körhrmann KU, Seemann O et al (1996) Clinical comparison of EWSL. In: Coe FL, Favus MJ, Pak CYC et al (eds) Kidney stones: medical and surgical management. Lippincott-Raven, Philadelphia, p 571

  24. Parienty RA, Ducellier R, Pradel J, Lubrano J-M, Coquille F, Richard F (1982) Diagnostic value of CT numbers in pelvocalyceal filling defects. Radiology 145:743–747

    CAS  PubMed  Google Scholar 

  25. Tublin ME, Murphy ME, Delong DM, Tessler FN, Kliewer MA (2002) Conspicuity of renal calculi at unenhanced CT: effects of calculus size and CT technique. Radiology 225:91–96

    PubMed  Google Scholar 

  26. Levi C, Gray JE, McCullough EC, Hattery RR (1982) The unreliability of CT numbers as absolute values. Am J Roentgenol 139:443–447

    CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Radiology, Hôpital Paul-Brousse, AP-HP, Université Paris 11, 12-14 av P.V. Couturier, 94804, Villejuif Cedex, France

    Marie-France Bellin & Jean-Baptiste Meric

  2. Department of Radiology, Hôpital Pitié-Salpêtriere, AP-HP, 43, bd de l’Hôpital, 75651, Paris Cedex 13, France

    Raphaëlle Renard-Penna & Philippe Grenier

  3. Department of Urology, Hôpital Pitié-Salpêtriere, AP-HP, 43, bd de l’Hôpital, 75651, Paris Cedex 13, France

    Pierre Conort & François Richard

  4. Department of Biostatistics, Hôpital Pitié-Salpêtriere, AP-HP, 43, bd de l’Hôpital, 75651, Paris Cedex 13, France

    Anne Bissery & Alain Mallet

  5. Department of Biochemistry, Hôpital Necker, AP-HP, 149-161, rue de Sèvres, 75743, Paris Cedex 15, France

    Michel Daudon

Authors
  1. Marie-France Bellin
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Raphaëlle Renard-Penna
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Pierre Conort
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Anne Bissery
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Jean-Baptiste Meric
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Michel Daudon
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Alain Mallet
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. François Richard
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Philippe Grenier
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Marie-France Bellin.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Bellin, MF., Renard-Penna, R., Conort, P. et al. Helical CT evaluation of the chemical composition of urinary tract calculi with a discriminant analysis of CT-attenuation values and density. Eur Radiol 14, 2134–2140 (2004). https://doi.org/10.1007/s00330-004-2365-6

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00330-004-2365-6

Keywords

Search

Navigation