The Structural Basis of Kidney Stone Fragility

肾结石脆性的结构基础

• 批准号: 8134332
• 负责人: JAMES C WILLIAMS
• 金额: $ 32.33万
• 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 2013-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8134332
• 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; Ureter; 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

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）不能治疗所有尿路结石。在诊断时识别结石对 SWL 敏感或耐药，可以进行治疗，使患者免受不必要的 SWL 影响，从而减少 SW 引起的损伤的机会。我们的假设：“正确使用”目前可用的成像技术能够预测泌尿系结石对冲击波碎石治疗的敏感性或抵抗力。首先，我们将评估临床螺旋 CT (HCT) 在检测结石的结构、形状和成分方面的实际局限性。其次，我们将探讨结石形状/方向与其内部成分/结构对其易感性的相对影响。 SWL 造成的破损。这种现象很重要，但在天然石材中却很少被研究。第三，我们将探讨宝石内耐 SW 内含物是否是 SWL 中残留碎片的主要原因。最后，我们将使用 HCT 提供的信息开发和测试一种方案，用于预测碎石机 SW 中结石的脆性，并使用一系列结石类型测试和完善该方案。 7 目标 1. 确定相关程度 结石分析可以使用现有的螺旋CT技术来完成，包括双能螺旋CT。 7 目标 2. 确定相对于 SW 轴的结石形状对结石破碎的影响程度。 7 目标 3. 确定 CT 是否可用于检测尿路结石内含物的耐 SW 内含物，这些内含物会导致不完全粉碎，留下碎片。 7 目标 4. 制定一个方案来预测碎石术中结石的相对脆性，以及 测试临床相关的各种结石成分和形状的方案。该项目将为结石脆性临床指标的制定提供良好的科学依据。我们设想，泌尿科医生将能够利用最小剂量的 X 射线从螺旋 CT 图像中预测结石的脆性，并且他们将能够利用这些信息来规划患者的治疗。这项工作的长期目标是为预测提供良好的实验基础，以便未来的临床研究能够 通过正确了解临床设备的潜在能力以及如何应用这些能力来完成。冲击波碎石术并不总能有效分解肾结石，而且冲击波会损伤肾脏，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。我们的目标是详细研究这种可能性，并且 提供使用 CT 来确定哪些结石患者应接受冲击波碎石术治疗的分步指南。

项目成果

Dual-energy dual-source CT with additional spectral filtration can improve the differentiation of non-uric acid renal stones: an ex vivo phantom study.

• DOI: 10.2214/ajr.10.5041
• 发表时间: 2011-06
• 期刊: AJR. American journal of roentgenology
• 作者: Qu M;Ramirez-Giraldo JC;Leng S;Williams JC;Vrtiska TJ;Lieske JC;McCollough CH
• 通讯作者: McCollough CH

Urinary stone differentiation in patients with large body size using dual-energy dual-source computed tomography.

• DOI: 10.1007/s00330-012-2727-4
• 发表时间: 2013-05
• 期刊: European radiology
• 影响因子: 5.9
• 作者: Qu M;Jaramillo-Alvarez G;Ramirez-Giraldo JC;Liu Y;Duan X;Wang J;Vrtiska TJ;Krambeck AE;Lieske J;McCollough CH
• 通讯作者: McCollough CH

Stability of the infection marker struvite in urinary stone samples.

泌尿系结石样品中感染标志物鸟粪石的稳定性。

• DOI: 10.1089/end.2011.0274
• 发表时间: 2012
• 期刊: Journal of endourology
• 影响因子: 2.7
• 作者: WilliamsJr,JamesC;Sacks,AndrewJ;Englert,Kate;Deal,Rachel;Farmer,TakeishaL;Jackson,MollyE;Lingeman,JamesE;McAteer,JamesA
• 通讯作者: McAteer,JamesA

Protein content of human apatite and brushite kidney stones: significant correlation with morphologic measures.

• DOI: 10.1007/s00240-008-0151-7
• 发表时间: 2008-10
• 期刊: UROLOGICAL RESEARCH
• 作者: Pramanik, Rocky;Asplin, John R.;Jackson, Molly E.;Williams, James C., Jr.
• 通讯作者: Williams, James C., Jr.

Using Helical CT to Predict Stone Fragility in Shock Wave Lithotripsy (SWL).

使用螺旋 CT 预测冲击波碎石术 (SWL) 中的结石脆性。

• DOI: 10.1063/1.2723592
• 发表时间: 2007
• 期刊: AIP conference proceedings
• 作者: WilliamsJr,JamesC;Zarse,ChadA;Jackson,MollyE;Lingeman,JamesE;McAteer,JamesA
• 通讯作者: McAteer,JamesA