The Structural Basis of Kidney Stone Fragility

肾结石脆性的结构基础

• 批准号: 6824997
• 负责人: JAMES C WILLIAMS
• 金额: $ 26.51万
• 依托单位: INDIANA UNIV-PURDUE UNIV AT INDIANAPOLIS
• 依托单位国家: 美国
• 财政年份: 2004
• 资助国家: 美国
• 起止时间: 2004-08-01 至 2008-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/6824997
• 关键词: bioimaging /biomedical imaging; biomedical resource; calcium; cats; clinical research; computed axial tomography; cystine; dogs; electron probe spectrometry; infrared spectrometry; interferometry; light microscopy; lithotripsy; method development; oxalates; physical property; protein quantitation /detection; proteomics; species difference; three dimensional imaging /topography; urinary calculi

DESCRIPTION (provided by applicant): Shock wave lithotripsy (SWL) of kidney stones is not always successful. Stones in a significant percentage of patients fail to fragment completely. These patients may undergo more than one SWL session with no positive outcome, and then must be treated by an invasive procedure (e.g., percutaneous nephrostomy or ureteroscopy). Even when SWL is successful, the physician has no good guidelines to follow in determining how many SW's to administer, and patients may receive many more SW's than is required to break up the stone. If stone fragility could be predicted during diagnosis, the physician could select the best treatment, including the optimal number of SW's for SWL, or in the case of SW-resistant stones move to an alternative therapy. Helical computed tomography (CT) has the potential to help predict stone fragility. However, we lack sufficient knowledge about the structure of kidney stones to know the CT features that distinguish easy-to-break stones from those that are SW-resistant and should not be treated by SWL. Hypothesis: Urinary stones that are susceptible to lithotripter SW's can be distinguished radiologically from those stones that are SW-resistant. Plan: The proposed research will characterize fragility-relevant structures that are visible within kidney stones by mu CT. We will identify features (including mineral compositions and internal structures) that correlate with--and thus, can be used to predict-the susceptibility (or resistance) of stones to lithotripter shock waves, working through the following Specific Aims: 1. Calibrate micro computerized tomography (mu CT) imaging of urinary stones so that stones can be analyzed for composition and for three-dimensional structure using this non-destructive analytical tool. 2. Determine the degree to which similar stone analysis can be accomplished using present helical CT technology. 3. Determine if stone fragility in SWL correlates with CT-visible structure. 4. Determine if fragility in SWL for some stones might be determined by features below the resolution of CT. The long-term goal of this work is to enable the physician to predict the fragility of kidney stones at diagnosis so that the best treatment option can be chosen.

描述(申请人提供)：肾结石的冲击波碎石术(SWL)并不总是成功的。相当大比例的患者结石未能完全碎裂。这些患者可能会接受一次以上的SWL治疗，但没有积极的结果，然后必须通过侵入性程序(如经皮肾造瘘术或输尿管镜)进行治疗。即使SWL成功了，医生也没有很好的指导方针来决定要实施多少次SWL，患者可能会收到比粉碎结石所需的更多的SWL。如果在诊断过程中可以预测结石的脆性，医生可以选择最好的治疗方法，包括SWL的最佳SWL数量，或者在SWL抵抗结石的情况下转向替代治疗。螺旋计算机断层扫描(CT)可以帮助预测结石的脆性。然而，我们对肾结石的结构缺乏足够的了解，无法知道区分易碎性结石和不能接受SWL治疗的结石的CT特征。假设：对碎石机碎石敏感的尿路结石可以从放射学上与抵抗碎石术的结石区分开来。计划：拟议的研究将表征肾结石内可见的与脆性相关的结构。我们将确定与结石对碎石机冲击波的敏感性(或抵抗力)相关的特征(包括矿物成分和内部结构)，从而可以用来预测结石的敏感性(或抵抗力)，具体目标如下： 1.校准尿路结石的微型计算机断层扫描(MU CT)成像，以便使用这种非破坏性分析工具分析结石的成分和三维结构。 2.确定目前螺旋CT技术在多大程度上可以完成类似结石的分析。 3.确定SWL的结石脆性是否与CT可见结构相关。 4.确定某些结石的SWL脆性是否可以由低于CT分辨率的特征来确定。这项工作的长期目标是使医生能够在诊断时预测肾结石的脆弱性，以便选择最佳的治疗方案。