Репозиторий Университета

© 2018 Russian Electronic Journal of Radiology. All rights reserved. Purpose. To improve the diagnosis of urolithiasis using the latest technique-dualenergy computed tomography (DECT). Materials and methods. A prospective study of a group of 91 (100%) patients was conducted at the department of radiology and urology at the Russian-Japanese Center in Sechenov University. All patients underwent a dual-energy CT scan to predict the chemical composition of urinary stones "in vivo". All patients underwent surgical treatment after diagnostics: distance lithotripsy (DLT), percutaneous nephrolithotripsy (PHNLT), contact ureterolithotripsy (CULT). All the stones after operations were subjected to physico-chemical analysis (X-ray phase analysis, infrared spectroscopy) in order to verify the composition. Further, the diagnostic value of the dual-energy computed tomography was assessed by comparing the DECT results with the physico-chemical analysis data. Results. Using DECT in the preoperative period, the following results were obtained: 40 patients had vevellit stones, 34 patients had Ca-containing stones without vevellit, 10 patients had stones with uric acid, in 7 patients stones were classified in the group of cystine/struvite. After verification studies in the postoperative period, the following urinary stone composition was determined: 42 stones-vevellit, 34 stones-Ca-containing stones without vevellit, 10 stones with uric acid, 5 stones-struvite stones. At the same time the following results were obtained incorrectly using DECT: 7 stones with vevellit from which 4 stones were postoperatively confermed to the group of Ca-containing stones without vevellit, 3 stones-struvite/cystine stones; 4 Ca-containing stones without vevellite were classified in the group of the vevellite; 2 struvite stones: 1 stone was incorrectly assigned to the group of uric acid, 1 stone-to the group of the vevellite; 1 stone uric acid was incorrectly assigned to the group of struvite stones. It should also be noted that 1 stone had a mixed composition (uric acid 70% + vevellit 23% + veddellite 7%), according to the results of DECT it was incorrectly assigned to the group of stones from uric acid, at the same time the prevailing component was determined correctly. Conclusions. In order to predict the chemical composition of the stone "in vivo" with a high degree of reliability DECT in the preoperative period can differentiate not only the urate and Ca-containing stones, but also separately identify the stones in which vevellit is the predominant component. The detailed differentiation of Ca-containing stones, as well as of more rare stones, such as struvite and cystine, requires further studies with more significant groups of stones.

© 2018 Russian Electronic Journal of Radiology. All rights reserved. Purpose. The aim of the study is an increasing frequency of predicting the results of remote shock wave lithotripsy in patients with nephrolithiasis. Matherials and methods. The study involved 127 patients with diagnosed urolithiasis with the presence of a single renal calculus from 10 to 17 mm in size. All patients underwent a complex of laboratory analyses, multispiral computed tomography. The concrement elimination was carried out by extracorporeal shock-wave lithotripsy. Results. In this study, there were no sufficient relationships between the maximum size and average density of stone and the number of extracorporeal lithotripsy sessions in patients with nephrolithiasis. On the contrary, the parameter of the "homogeneity" of the stone, reflecting its structure, showed a strong reliable relationship with the effectiveness of extracorporeal shock-wave lithotripsy, as well as high sensitivity and specificity. Using this indicator, it was possible to increase the percentage of successful procedures from 56,9% to 75,8%. Conclusion. The maximum size and average density of stone have insufficient diagnostic value in predicting the results of shock-wave lithotripsy in patients with single kidney stones 10-17 mm in size. In this case, an indicator of the "homogeneity" can be used to select the optimal method of treatment.