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KMID : 0358320130540070454
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Korean Journal of Urology
2013 Volume.54 No. 7 p.454 ~ p.459
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Stone Attenuation Value and Cross-Sectional Area on Computed Tomography Predict the Success of Shock Wave Lithotripsy
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Tanaka Michio
Fujime Makoto
Horie Shigeo
Yokota Eisuke
Toyonaga Yoichiro
Shimizu Fumitaka
Ishii Yoshiyuki
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Abstract
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Purpose: To identify the parameters on noncontrast computed tomography (NCCT) that best predict the success of shock wave lithotripsy (SWL).
Materials and Methods: We reviewed the records of 75 patients who underwent SWL for urinary calculi measuring 5 to 20 mm. Using NCCT images, we estimated the largest stone cross-sectional area and contoured the inner edge of the stone. Clinical outcome was classified as successful (stone-free or <4 mm in diameter) or failed (stone fragments, ≥4 mm). The impact of preoperative parameters was evaluated by univariate and multivariate analysis.
Results: The overall success rate was 73.3%. Average stone attenuation value, stone length, and stone cross-sectional area in the success and failure groups were 627.4±166.5 HU (Hounsfield unit) vs. 788.1±233.9 HU (p=0.002), 11.7±3.8 mm vs. 14.2±3.6 mm (p=0.015), and 0.31±0.17 cm2 vs. 0.57±0.41 cm2 (p<0.001), respectively. In the multivariate analysis, stone attenuation value was the only independent predictor of SWL success (p=0.023), although stone cross-sectional area had a tendency to be associated with SWL success (p=0.053). Patients were then classified into four groups by using cutoff values of 780 HU for stone attenuation value and 0.4 cm2 for cross-sectional area. By use of these cutoff values, the group with a low stone attenuation value and a low cross-sectional area was more than 11.6 times as likely to have a successful result on SWL as were all other groups (odds ratio, 11.6; 95% confidence interval, 3.9 to 54.7; p<0.001).
Conclusions: Stone attenuation value and stone cross-sectional area are good predictors of extracorporeal SWL outcome
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KEYWORD
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Noncontrast computed tomography, Treatment outcome
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