Diagnostic performance and feasibility of dual-layer detector dual-energy CT for characterization of urinary stones in patients of different sizes.

Autor: Pisuchpen, Nisanard, Parakh, Anushri, Cao, Jinjin, Yuenyongsinchai, Kampon, Joseph, Evita, Lennartz, Simon, Kongboonvijit, Sasiprang, Sahani, Dushyant, Kambadakone, Avinash
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Zdroj: Abdominal Radiology; Jan2024, Vol. 49 Issue 1, p209-219, 11p
Abstrakt: Background: Urinary stones are frequently encountered in urology and are typically identified using non-contrast CT scans. Dual-energy CT (DECT) is a valuable imaging technique that produces material-specific images and allows for precise assessment of stone composition by estimating the effective atomic number (Zeff), a capability not achievable with the conventional single-energy CT's attenuation measurement method. Purpose: To investigate the diagnostic performance and image quality of dual-layer detector DECT (dlDECT) in characterizing urinary stones in patients of different sizes. Methods: All consecutive dlDECT examinations with stone protocol and presence of urinary stones between July 2018 and November 2019 were retrospectively evaluated. Two radiologists independently reviewed 120 kVp and color-overlay Zeff images to determine stone composition (reference standard = crystallography) and image quality. The objective analysis included image noise and Zeff values measurement. Results: A total of 739 urinary stones (median size 3.7 mm, range 1–35 mm) were identified on 177 CT examinations from 155 adults (mean age, 57 ± 15 years, 80 men, median weight 82.6 kg, range 42.6–186.9 kg). Using color-overlay Zeff images, the radiologists could subjectively interpret the composition in all stones ≥ 3 mm (n = 491). For stones with available reference standards (n = 74), dlDECT yielded a sensitivity of 80% (95%CI 44–98%) and a specificity of 98% (95%CI 92–100%) in visually discriminating uric acid from non-uric acid stones. Patients weighing > 90 kg and ≤ 90 kg had similar stone characterizability (p = 0.20), with 86% of stones characterized in the > 90 kg group and 87% in the ≤ 90 kg group. All examinations throughout various patients' weights revealed acceptable image quality. A Zeff cutoff of 7.66 accurately distinguished uric acid from non-uric acid stones (AUC = 1.00). Zeff analysis revealed AUCs of 0.78 and 0.91 for differentiating calcium-based stones from other non-uric stones and all stone types, respectively. Conclusion: dlDECT allowed accurate differentiation of uric acid and non-uric acid stones among patients with different body sizes with acceptable image quality. Clinical impact: The ability to accurately differentiate uric acid stones from non-uric acid stones using color-overlay Zeff images allows for better tailored treatment strategies, helping to choose appropriate interventions and prevent potential complications related to urinary stones in patient care. [ABSTRACT FROM AUTHOR]
Databáze: Complementary Index
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