The Structural Basis of Kidney Stone Fragility

描述（由申请人提供）：冲击波碎石术治疗肾结石并不总是成功的。很大一部分患者的结石不能完全破碎。这些患者可能会经历一次以上的SWL疗程，但没有阳性结果，然后必须通过侵入性手术（例如，经皮肾造口术或输尿管镜检查）进行治疗。即使SWL是成功的，医生也没有很好的指导方针来确定给药多少SW，而且患者可能接受的SW比打碎结石所需的要多。如果在诊断期间可以预测结石的易碎性，医生可以选择最佳的治疗方法，包括SWL的最佳SW数量，或者在SW抗性结石的情况下转移到替代疗法。螺旋计算机断层扫描（CT）有可能帮助预测结石的脆弱性。然而，我们对肾结石的结构缺乏足够的了解，无法了解区分易破结石和耐SWL、不宜SWL治疗的结石的CT特征。假设：对碎石机SW敏感的尿路结石可以从放射学上与对SW耐药的尿路结石区分开来。计划：拟议的研究将通过mu CT表征肾结石内可见的脆性相关结构。我们将确定与碎石机冲击波相关的特征（包括矿物成分和内部结构），从而可以用来预测石头的敏感性（或抵抗力），通过以下具体目标工作：

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.