Differential diagnosis for urinary stones of different chemical composition, by using dual energy computed tomography

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Abstract

The use of dual energy computed tomography (DECT) has become widespread in urology, including in the diagnosis of urolithiasis. DECT makes it possible to visualize and differentiate urinary stones of different chemical density and composition from each other. Studies have shown the advantages of DECT not only in the detection, but also in the differentiation of the main groups of urinary stones. At the same time, a number of in vivo studies evaluate DECT as a technique for the high-accuracy differential diagnosis of urate stones. The accuracy of diagnosing urate stones with DECT reaches 92-100%, as confirmed by sensitivity (84.6-98.4%) and specificity (100%).

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About the authors

V. Ryazanov

Saint Petersburg State Pediatric Medical University, Ministry of Health of Russia

Author for correspondence.
Email: val9126@mail.ru

MD

Russian Federation, Saint Petersburg

V. Kutsenko

Saint Petersburg State Pediatric Medical University, Ministry of Health of Russia

Email: val9126@mail.ru

Candidate of Medical Sciences

Russian Federation, Saint Petersburg

G. Sadykova

Saint Petersburg State Pediatric Medical University, Ministry of Health of Russia

Email: val9126@mail.ru

Candidate of Medical Sciences

Russian Federation, Saint Petersburg

S. Menshikova

Saint Petersburg State Pediatric Medical University, Ministry of Health of Russia

Email: val9126@mail.ru
Russian Federation, Saint Petersburg

P. Seliverstov

S.M. Kirov Military Medical Academy

Email: val9126@mail.ru

Candidate of Medical Sciences

Russian Federation, Saint Petersburg

S. Bagnenko

Saint Petersburg State Pediatric Medical University, Ministry of Health of Russia; S.M. Kirov Military Medical Academy

Email: val9126@mail.ru

MD

Russian Federation, Saint Petersburg; Saint Petersburg

A. Nikolaev

Saint Petersburg State Pediatric Medical University, Ministry of Health of Russia

Email: val9126@mail.ru
Russian Federation, Saint Petersburg

R. Postanogov

Saint Petersburg State Pediatric Medical University, Ministry of Health of Russia

Email: val9126@mail.ru
Russian Federation, Saint Petersburg

A. Libert

Saint Petersburg State Pediatric Medical University, Ministry of Health of Russia

Email: val9126@mail.ru
Russian Federation, Saint Petersburg

References

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  4. Nazarov T.K., Rychkov I.V., Lebedev D.G., Trubnikova K.E. Comparative analysis of data from a dual-energy computer tomograph and the results of a mineralogical research of urinary stones. Diagnostic radiology and radiotherapy. 2018; 2: 54–8 (in Russ.). doi: 10.22328/2079-5343-2018-9-2-54-58
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2. Fig. 1. Three patients with nephrolithiasis: a – right uric acid stone on conventional CT scan is seen as (b) red on the corresponding DECT image; c – left non-uric acid stone is visualized as blue on the DECT image; d – mixed composition left lower pole stone seen as both red and blue on the DECT image (source [9])

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3. Fig. 2. In a 60-year-old patient, a 22×12-cm stone (arrow) is seen in the bladder lumen in the unenhanced axial CT image (a). The stone is coded with pink, consistent with uric acid stone in axial (b) and 3D reformatted (c) images, which were obtained at high and low kVp values and analyzed at the workstation; d – when this stone, the attenuation rate of which are calculated as 0.96 at different kVp values, is positioned on the graphics on which cutoff values are shown, the stone is seen to be coherent with uric acid stone; b – the yellow circle in the second image shows the scanned area (FOV) belonging to the second tube, on which an evaluation can be made with dual energy (source [7])

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4. Fig. 3. With the help of DECT, in the lower group of calyxes of the left kidney, a 10,9×11,2 cm and 535 cm3 irregular rounded calculus is visible. Estimated chemical composition: mixed stone (purple color) with a predominance of the uric acid component (source [2])

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