Mayo Clinic Urology O'Brien Research Center

描述(由申请人提供)： 在美国，有症状的尿路结石每年影响大约90万人，每年的医疗费用估计为45亿美元。计算机断层扫描(CT)是公认的尿路结石成像方法，可以提供肾结石大小和位置的精确亚毫米细节。然而，在临床常规中，即使是最先进的CT系统也不能可靠地确定结石成分或量化结石材料的数量。 我们的长期目标是利用先进的CT方法对尿路结石的形态和成分进行量化，以指导临床治疗和促进临床研究。我们计划使用现有的和不断发展的技术来可靠地检测可能最小的结石和/或结石前体斑块。我们在这项应用中的目标是开发准确和可重复性的非侵入性CT成像工具，根据结石成分和负担将患者分成治疗组。基于我们广泛的初步结果，我们的中心假设是，双能量CT可以区分几种类型的肾结石(例如，尿酸、胱氨酸、鸟粪石和钙基结石)，并提供准确的结石负荷量化。此外，我们假设这种结石成分和负荷的定量评估可以使用碘增强双能CT数据进行，与传统的CT尿路造影相比，这提供了减少患者辐射剂量的机会。 我们的具体目标是：目标1：开发一种双能量CT成像技术来区分不同矿物成分的肾结石。目的2：应用双能CT对结石负荷进行准确、可靠的定量。目的3：建立一种在含碘造影剂存在的情况下对结石进行定性的方法。这项提议将开发成像技术，即使在存在碘对比剂的情况下，也可以同时识别尿路结石的类型和结石负荷的量化。其意义在于，这些先进的CT成像技术将使医生能够更有效地指导患者治疗和表型研究对象，潜在地避免与更高风险或成本相关的手术。

DESCRIPTION (provided by applicant): Symptomatic urinary stone disease affects approximately 900,000 persons in the United States each year, resulting in an estimated annual medical cost of $4.5 billion. Computed tomography (CT) is the established method for imaging urinary calculi and can provide accurate sub-millimeter details of the size and location of renal stones. However, in clinical routine, even the most modern CT system cannot reliably determine stone composition or quantify the amount of stone material. Our long term goal is to use advanced CT methodologies to quantitate the morphology and composition of urinary calculi for the purpose of directing clinical treatment and facilitating clinical investigation. We plan to use available and evolving technology to reliably detect the smallest possible stones and/or stone precursor plaques. Our objective in this application is to develop accurate and reproducible non-invasive CT imaging tools to stratify patients into treatment groups according to stone composition and burden. Based on our extensive preliminary results, our central hypothesis is that dual-energy CT can discriminate several types of renal stones (e.g., uric acid vs. cystine vs. struvite vs. calcium-based stones) and provide accurate quantification of stone burden. Furthermore, we hypothesize that this quantitative assessment of stone composition and burden can be performed using iodine-enhanced dual-energy CT data, which presents an opportunity to reduce patient radiation dose compared to a traditional CT urogram. Our Specific Aims are: Aim 1: Develop a dual-energy CT imaging technique to discriminate between renal stones of different mineral composition. Aim 2: Reliably and accurately quantitate stone burden using dual-energy CT. Aim 3: Develop a method for stone characterization in the presence of iodinated contrast material. This proposal will develop imaging techniques that allow simultaneous identification of urinary stone type and quantification of stone burden, even in the presence of iodinated contrast material. The significance of this is that these advanced CT imaging techniques will allow physicians to more efficiently direct patient therapy and phenotype research subjects, potentially avoiding procedures associated with higher risk or cost.