Three-dimensional mean stone density measurement is superior for predicting extracorporeal shock wave lithotripsy success
Three-dimensional mean stone density measurement is superior for predicting extracorporeal shock wave lithotripsy success
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DOI：
10.1111/iju.13827
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发表时间：
2019-02-01
影响因子：
2.6
通讯作者：
Hara, Isao
中科院分区：
文献类型：
--
作者：
Yamashita, Shimpei;Kohjimoto, Yasuo;Hara, Isao
目的探讨三维图像测量结石平均密度对预测冲击波碎石疗效的作用。方法回顾分析239例患者行冲击波碎石术前的CT平扫。我们使用高功能的观察器自动测量了石头的三维图像的平均石头密度。为了进行比较，还使用了两种先前报道的技术，在结石最大直径的水平上使用腹窗和骨窗在轴位切片上测量平均结石密度。我们将第一次治疗后的结果预测力与其他四种方法测量的结果进行了比较。并进行Logistic回归分析，包括三维图像测量的平均结石密度。结果单次治疗成功率为48.5%。三维图像测得的结石平均密度的影响大小(14.148)高于其他4种人工测量方法。此外，三维图像测得的结石平均密度曲线下面积(0.6330)明显高于其他方法。多因素分析显示，结石体积增大(P=0.002)和平均结石密度增大(P=0.023)是影响治疗效果的显著独立因素。结论本研究首次比较了不同平均结石密度测量方法对冲击波碎石疗效的预测能力。有迹象表明，通过结石的三维图像自动测量平均结石密度比其他测量方法更有利于预测冲击波碎石术的疗效。
Objectives The objective of the present study was to investigate the usefulness of three-dimensional images of stones to measure mean stone density for predicting the outcome of shock wave lithotripsy. Methods We retrospectively identified 239 patients who underwent shock wave lithotripsy with pretreatment non-contrast computed tomography. We automatically measured the mean stone density of three-dimensional images of stones using a high-functional viewer. For comparison, mean stone density was also measured by two previously reported techniques using both the abdominal windows and the bone windows on the axial slice at the level of the largest diameter of the stone. We compared the outcome predictive power after the first treatment with outcomes according to measurement by four other methods. We also carried out logistic regression analysis, including mean stone density measured by three-dimensional images. Results The single treatment success rate was 48.5%. The effect size (14.148) of the mean stone density measured by three-dimensional images was higher than those of the other four manual methods. In addition, the area under the curve (0.6330) of the mean stone density measured by three-dimensional images was significantly higher than those of the other methods. Increasing stone volume (P = 0.002) and increasing mean stone density measured by three-dimensional images (P = 0.023) were significant independent predictors of the treatment outcome on multivariate analysis. Conclusions This is the first study to compare the predictive powers for shock wave lithotripsy outcome of various mean stone density measuring methods. There is an indication that mean stone density automatically measured by three-dimensional images of stones is more useful than other measuring methods for predicting outcomes of shock wave lithotripsy.