Tanaka N et al, 2013: Stone attenuation value and cross-sectional area on computed tomography predict the success of shock wave lithotripsy
Tanaka M, Yokota E, Toyonaga Y, Shimizu F, Ishii Y, Fujime M, Horie S
Department of Urology, Juntendo University, Tokyo, Japan
PURPOSE: To identify the parameters on noncontrast computed tomography (NCCT) that best predict the success of shock wave lithotripsy (SWL).
MATERIALS AND METHODS: We reviewed the records of 75 patients who underwent SWL for urinary calculi measuring 5 to 20 mm. Using NCCT images, we estimated the largest stone cross-sectional area and contoured the inner edge of the stone. Clinical outcome was classified as successful (stone-free or <4 mm in diameter) or failed (stone fragments, ≥4 mm). The impact of preoperative parameters was evaluated by univariate and multivariate analysis.
RESULTS: The overall success rate was 73.3%. Average stone attenuation value, stone length, and stone cross-sectional area in the success and failure groups were 627.4±166.5 HU (Hounsfield unit) vs. 788.1±233.9 HU (p=0.002), 11.7±3.8 mm vs. 14.2±3.6 mm (p=0.015), and 0.31±0.17 cm(2) vs. 0.57±0.41 cm(2) (p<0.001), respectively. In the multivariate analysis, stone attenuation value was the only independent predictor of SWL success (p=0.023), although stone cross-sectional area had a tendency to be associated with SWL success (p=0.053). Patients were then classified into four groups by using cutoff values of 780 HU for stone attenuation value and 0.4 cm(2) for cross-sectional area. By use of these cutoff values, the group with a low stone attenuation value and a low cross-sectional area was more than 11.6 times as likely to have a successful result on SWL as were all other groups (odds ratio, 11.6; 95% confidence interval, 3.9 to 54.7; p<0.001).
CONCLUSIONS: Stone attenuation value and stone cross-sectional area are good predictors of extracorporeal SWL outcome.
Korean J Urol. 2013 Jul;54(7):454-9. doi: 10.4111/kju.2013.54.7.454. Epub 2013 Jul 15
PMID:23878688 [PubMed ]PMCID:PMC3715709. FREE ARTICLE
In this comparison between successful and failed disintegration with a Dornier Compact S lithotripter, the authors found that the CT-predictors for treatment outcome were stone attenuation and cross-sectional area. This finding confirms well established knowledge.