The Structural Basis of Kidney Stone Fragility

肾结石脆性的结构基础

• 批准号: 7677997
• 负责人: JAMES C WILLIAMS
• 金额: $ 32.99万
• 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 2012-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7677997
• 关键词: Address; Back; Calculi; Characteristics; Classification; Clinical; Clinical Research; Detection; Development; Diagnosis; Dose; Electroconvulsive Therapy; Environment; Equipment; Exposure to; Eye; Funding; Future; Goals; Grant; Health; Human; Image; Imaging Techniques; In Vitro; Injury; Kidney; Kidney Calculi; Knowledge; Lead; Left; Lithotripsy; Long-Term Effects; Measures; Modeling; Morphology; Patients; Positioning Attribute; Predisposition; Procedures; Psyche structure; Radiation; Relative (related person); Residual state; Resistance; Roentgen Rays; Scheme; Shapes; Shock; Solid; Somatotype; Spiral Computed Tomography; Structure; System; Technology; Testing; Urinary Calculi; Urinary system; Urologist; Work; X-Ray Computed Tomography; base; blind; clinically relevant; clinically significant; in vitro testing; in vivo; injured; research clinical testing; research study; sound; theories; tool; treatment planning; urinary

DESCRIPTION (provided by applicant): Shock wave lithotripsy (SWL) is not able to treat all urinary stones. Identifying stones as susceptible or resistant to SWL at diagnosis would allow treatment that spares patients from unnecessary SWL, thereby reducing the chance of SW-induced injury. Our hypothesis: Presently available imaging techniques"utilized correctly'have the capability of predicting the susceptibility or resistance of urinary stones to treatment by shock wave lithotripsy First, we will assess the practical limits of clinical helical CT (HCT) for the detection of structure, shape, and composition in stones. Second, we will explore the relative influence of stone shape/orientation versus their internal composition/structure in their susceptibility to breakage by SWL. This phenomenon is important but has been little studied in natural stones. Third, we will explore the possibility that SW-resistant inclusions within stones are the primary cause of residual fragments in SWL. Finally, we will develop and test a scheme for predicting the fragility of stones to lithotripter SWs using the information available from HCT, and test and refine this scheme using a range of stone types. 7 Aim 1. Determine the degree to which relevant stone analysis can be accomplished using present helical CT technology, including dual-energy helical CT. 7 Aim 2. Determine how critical stone shape relative to SW axis is to stone breakage. 7 Aim 3. Determine if CT can be used to detect SW-resistant inclusions within urinary stones inclusions that will result in incomplete comminution, leaving behind fragments. 7 Aim 4. Develop a scheme for predicting the relative fragility of stones to lithotripsy, and test the scheme for a clinically relevant variety of stone compositions and shapes. This project will provide a sound scientific basis for the development of clinical indicators of stone fragility. We envision that urologists will be able to predict stone fragility from helical CT images with minimal doses of X-radiation and that they will be able to use this information to plan patient treatment. The long-term goals of this work are focused on providing a sound experimental basis for prediction, so that future clinical studies can be done with proper knowledge of the potential abilities of clinical equipment and proper knowledge of how to apply these abilities. Shock wave lithotripsy doesn't always work to break up a kidney stone, and shock waves can injure the kidneys and may have long-term effects on health. Experimental evidence suggests that CT (CAT scan) can describe the shape, position, composition, and structure of stones so that shock wave-resistant stones can be identified. We aim to study this possibility in detail, and provide a step-by- step guide to the use of CT for identifying which stone patients should be treated with shock wave lithotripsy.

描述（由申请人提供）：冲击波碎石术（SWL）无法治疗所有泌尿系结石。在诊断时将结石识别为对SWL敏感或耐药，可以进行治疗，使患者免受不必要的SWL，从而减少SW诱导损伤的机会。我们的假设是：目前可用的成像技术“正确利用”有能力预测尿路结石的敏感性或抗冲击波碎石术治疗首先，我们将评估临床螺旋CT（HCT）的实际限制，用于检测结石的结构，形状和成分。其次，我们将探讨结石形状/方向与其内部成分/结构对SWL破碎敏感性的相对影响。这种现象很重要，但在天然石材中研究得很少。第三，我们将探讨结石内抗SW夹杂物是SWL中残留碎片的主要原因的可能性。最后，我们将使用HCT提供的信息开发和测试一种预测结石对碎石机SW的脆弱性的方案，并使用一系列结石类型测试和完善该方案。7目标1.确定使用当前螺旋CT技术（包括双能量螺旋CT）可完成相关结石分析的程度。7目标2.确定相对于SW轴的结石形状对结石破碎的关键程度。3.确定CT是否可用于检测尿结石内含物中的抗SW内含物，这些内含物将导致不完全粉碎，留下碎片。7目标4.制定一个预测结石对碎石术的相对脆弱性的方案，并针对临床相关的各种结石成分和形状测试该方案。该项目将为结石脆性临床指标的开发提供可靠的科学依据。我们设想泌尿科医生将能够预测结石的脆弱性，从螺旋CT图像与最小剂量的X射线辐射，他们将能够使用这些信息来计划病人的治疗。这项工作的长期目标是为预测提供一个良好的实验基础，以便在适当了解临床设备的潜在能力和如何应用这些能力的情况下进行未来的临床研究。冲击波碎石术并不总是能打碎肾结石，冲击波会伤害肾脏，并可能对健康产生长期影响。实验证据表明，CT（CAT扫描）可以描述结石的形状、位置、成分和结构，从而可以识别抗冲击波结石。我们的目的是详细研究这种可能性，并提供一个循序渐进的指南，使用CT来确定哪些结石患者应该接受冲击波碎石术治疗。