CT-Based Determination of Maximum Ureteral Stone Area: A Predictor of Spontaneous Passage
CT-Based Determination of Maximum Ureteral Stone Area: A Predictor of Spontaneous Passage
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DOI：
10.2214/ajr.11.7276
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发表时间：
2012-03-01
影响因子：
5
通讯作者：
Silverman, Stuart G.
中科院分区：
文献类型：
--
作者：
Demehri, Shadpour;Steigner, Michael L.;Silverman, Stuart G.
OBJECTIVE.本研究的目的是检验输尿管结石的最大轴向面积比最大轴向直径更能准确预测结石的自发通过。本研究回顾性分析了211例急诊科患者（平均年龄48.8岁;年龄范围18-88岁），这些患者因输尿管结石而急性腰痛，使用非增强CT诊断。使用固定（FTM）和可变（VTM）阈值方法测量最大心房面积。对于FTM，使用130 HU的衰减阈值分割结石。对于VTM，使用由单个结石衰减的一半确定的衰减阈值分割结石。使用软组织和骨窗设置获得最大心房直径的测量值。采用受试者工作特征（ROC）分析比较最大心房面积和最大心房直径测量预测自发性房颤的准确性。57例患者（27%）需要泌尿外科干预。使用FTM（0.83，p = 0.013）和VTM（0.84，p = 0.004）的最大心房面积的ROC曲线下面积（AUC）大于使用骨窗设置的最大心房直径的AUC（0.8，p = 0.4）或使用软组织窗设置的最大心房内径的AUC（0.79）。对于最大心房直径（软组织窗设置）> 5 mm的结石，
OBJECTIVE. The purpose of this study was to test the hypothesis that the maximum axial area of ureteral stones is a more accurate predictor of spontaneous passage than the maximum axial diameter.MATERIALS AND METHODS. This study retrospectively reviewed 211 consecutive emergency department patients (mean age, 48.8 years; age range, 18-88 years) with acute flank pain due to ureteral stones diagnosed using unenhanced CT. Measurements of maximum atrial area were obtained using fixed (FTM) and variable (VTM) threshold methods. For the FTM, stones were segmented using an attenuation threshold of 130 HU. For the VTM, stones were segmented using an attenuation threshold determined by one half of individual stone attenuation. Measurements of maximum atrial diameter were obtained using soft-tissue and bone window settings. Receiver operating characteristic (ROC) analysis was used to compare the accuracy of maximum atrial area with maximum atrial diameter measurements for predicting spontaneous passage.RESULTS. Fifty-seven patients (27%) required urologic intervention. The areas under the ROC curve (AUC) of maximum atrial area using FTM (0.83, p = 0.013) and VTM (0.84, p = 0.004) were larger than the AUC (0.8, p = 0.4) for maximum atrial diameter using bone window settings or AUC (0.79) for maximum atrial iameter using soft-tissue window settings. For stones with maximum atrial diameter (in soft-tissue window settings) > 5 mm and