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Alharbi AS. et al., 2024: Assessment of Hounsfield Units and Factors Associated with Fragmentation of Renal Stones by Extracorporeal Shock Wave Lithotripsy: A Computerized Tomography Study.

Alharbi AS, Gameraddin M, Gareeballah A, Shrwani ZJ, Sindi MA, Alsaedi HI, Qurashi AA, Aloufi KM, Alshamrani AFA, Alzain AF.
Medical Imaging Department, King Fahad Hospital, Al-Madinah 42210, Saudi Arabia.
Department of Diagnostic Radiology Technology, College of Applied Medical Sciences, Taibah University, Al-Madinah 41477, Saudi Arabia.
Department of Diagnostic Radiology, Faculty of Radiological Sciences and Medical Imaging, Alzaiem Alazhari University, Khartoum 13311, Sudan.
Medical Imaging Department, King Abdulaziz Medical City, Jeddah 21423, Saudi Arabia.

Abstract

The success rate of extracorporeal shock wave lithotripsy (ESWL) is influenced by various factors, including stone density, and is determined through computed tomography scans in terms of Hounsfield units (HU).

Materials and methods: This retrospective single-center study was conducted in the King Fahad Hospital. Sixty-seven adult patients with renal and ureteric stones were selected randomly and enrolled in the study. Their ages ranged from 20 to 69 years. The patients were examined with non-contrast enhancement (NCCT) to assess the HU of their stones and were consequently treated with ESWL.

Results: Of the 67 patients, 37.3% had stones that were completely fragmented, while 62.7% had stones that were partially fragmented. The HU, location of the stone, multiplicity of the stone, and patient age were found to be significant factors contributing to stone fragility (p-values < 0.05). The HU data were found to have a positive significant linear correlation with serum calcium (r = 0.28, p-value = 0.036), while serum acid had a negative correlation (r = -0.55, p-value < 0.001). Thus, the probability of calcium-containing stone formation increases with increased HU. In contrast, uric acid stone formation likely develops with decreasing HU with serum uric acid. Renal stones in patients with diabetes mellitus and hypertension were not completely fragmented compared to those without clinical history.

Conclusions: Mean HU, location of the stone, laterality, stone status, and the number of ESWL sessions are the most significant factors affecting stone fragility. CT attenuation values can predict the composition of stones from serum calcium and uric acid examinations. Hypertension and diabetes mellitus are risk factors for renal stone fragmentation.

Tomography. 2024 Jan 11;10(1):90-100. doi: 10.3390/tomography10010008. PMID: 38250954
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Comments 1

Hans-Göran Tiselius on Tuesday, 18 June 2024 11:00

Extensive literature data have shown that stone composition is of outstanding importance for predicting the outcome of SWL. Unfortunately, the present article is not particularly helpful to illustrate this factor.
A small study was carried out comprising 67 patients treated with SWL. There is, however, no information on which lithotripter that was used or how the treatment was carried out. The overall result of stone disintegration was less successful than expected with only 37% of the stones successfully disintegrated and that seems to be the outcome despite repeated treatment sessions.
One of the most remarkable reported findings was the relationship between HU and serum calcium. A positive correlation was shown. A quick look at the diagram, however, shows that the slope of the regression line entirely depends on an “outlier” with very low HU and low calcium. The regression line obtained for HU and uric acid, on the other hand, is as expected according to the literature.
No explanation is given why diabetes and hypertension resulted in good stone disintegration.
The article is in some ways confusing because of poor proof-reading which resulted in contradictory results reported in text and tables.
Although the research question formulated by the authors is interesting, the result of the study is not better than any other similar report in the literature and it does not add anything important to what we already know
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Hans-Göran Tiselius

Extensive literature data have shown that stone composition is of outstanding importance for predicting the outcome of SWL. Unfortunately, the present article is not particularly helpful to illustrate this factor. A small study was carried out comprising 67 patients treated with SWL. There is, however, no information on which lithotripter that was used or how the treatment was carried out. The overall result of stone disintegration was less successful than expected with only 37% of the stones successfully disintegrated and that seems to be the outcome despite repeated treatment sessions. One of the most remarkable reported findings was the relationship between HU and serum calcium. A positive correlation was shown. A quick look at the diagram, however, shows that the slope of the regression line entirely depends on an “outlier” with very low HU and low calcium. The regression line obtained for HU and uric acid, on the other hand, is as expected according to the literature. No explanation is given why diabetes and hypertension resulted in good stone disintegration. The article is in some ways confusing because of poor proof-reading which resulted in contradictory results reported in text and tables. Although the research question formulated by the authors is interesting, the result of the study is not better than any other similar report in the literature and it does not add anything important to what we already know . Hans-Göran Tiselius
Friday, 12 July 2024