The Structural Basis of Kidney Stone Fragility

说明(申请人提供)：冲击波碎石术(SWL)不能治疗所有的尿路结石。在诊断时将结石识别为对SWL敏感或耐受，将使患者免于进行不必要的SWL，从而减少SWL导致损伤的机会。我们的假设：目前可用的成像技术“正确使用”具有预测尿路结石对冲击波碎石治疗的敏感性或抵抗力的能力。首先，我们将评估临床螺旋CT(HCT)在检测结石结构、形状和成分方面的实用限度。其次，我们将探索石头形状/取向与其内部成分/结构对其SWL易碎性的相对影响。这一现象很重要，但在天然石头中很少被研究。第三，我们将探索结石中抗SWL包裹体是SWL中残留碎片的主要原因的可能性。最后，我们将开发和测试一个方案，用于使用从HCT获得的信息来预测结石对碎石机SWS的易碎性，并使用一系列结石类型来测试和改进该方案。7目的1.确定目前螺旋CT技术(包括双能螺旋CT)在多大程度上能够完成相关结石的分析。7目标2.确定相对于西南轴的临界石形对石块破碎有多大影响。7目的3.确定CT是否可以用于检测尿路结石包裹物中的抗SW包裹物，这些包裹物将导致不完全粉碎，留下碎片。7目的4.开发一种预测结石对碎石术的相对脆弱性的方案，并对临床上相关的各种结石成分和形状进行测试。该项目将为制定结石脆性临床指标提供良好的科学依据。我们设想，泌尿科医生将能够在最小剂量的X射线照射下从螺旋CT图像中预测结石的脆弱性，并能够利用这些信息来计划患者的治疗。这项工作的长期目标是为预测提供可靠的实验基础，以便未来的临床研究可以在适当了解临床设备的潜在能力以及如何应用这些能力的情况下进行。冲击波碎石术并不总是有效地粉碎肾结石，冲击波会损害肾脏，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的结石。我们的目标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治疗。

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.