Dual enerji bilgisayarlı tomografi ile üriner sistem taşlarının in vivo analizi
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Dosyalar
Tarih
2015
Yazarlar
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Cilt Başlığı
Yayıncı
Selçuk Üniversitesi Tıp Fakültesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Giriş ve Amaç: Üriner sistem taşlarının kimyasal yapısına göre oluşum mekanizmaları ve tedavileri farklılık göstermektedir. Bu nedenle taşın tipini saptayabilmek, koruyucu önlemlerin alınmasında ve tedavi planlanmasında kilit rol oynamaktadır. İn-vitro analiz yöntemleri ile taşın tipi saptanabilmektedir fakat her hastada taşı elde etmek mümkün olmamaktadır. Bilgisayarlı tomografi (BT)'de son yıllarda kullanıma giren dual enerji teknolojisi, üriner sistem taşlarının analizini in-vivo olarak yapmayı mümkün kılmıştır. Bu çalışmamızda üriner sistem taşlarının analizinde dual enerji BT (DEBT) sonuçlarını, altın standart kabul edilen in-vitro analiz sonuçları ile karşılaştırarak DEBT'nin tanısal etkinliğini değerlendirmeyi amaçladık. Gereç ve Yöntem: DEBT tetkikleri Eylül 2014 - Temmuz 2015 tarihleri arasında, üriner sistem taşı olan 373 hastada, 128-kesitli dual enerji BT cihazı (Somatom Definition Flash, Siemens Healthcare, Forchheim, Almanya) kullanılarak yapıldı. Hastalara işlemden önce bilgi verilerek, aydınlatılmış onam alındı. DEBT inceleme yalnızca taşın olduğu kesitlere yönelik yapıldı. İş istasyonu (Syngo.via, Siemens Healthcare, Forchheim, Almanya) üzerinde taşların düşük ve yüksek kVp değerlerindeki atenüasyon oranlarının analizi yapılarak taşlar hidroksiapatit, kalsiyum oksalat, sistin ve ürik asit taşı şeklinde sınıflandırıldı. Takiplerde ameliyat veya düşürme sonucu taşı elde edilen 35 hastada taşların in-vitro analizi yapıldı. DEBT ve in-vitro analiz sonuçları karşılaştırıldı ve istatistiksel olarak değerlendirildi. Bulgular: Çalışmaya dahil edilen 373 hastanın 256'sı erkek (%68.6.), 117'si kadın (%31.4) olup, olguların yaşları 18 ile 90 arasında değişmekteydi (Ortalama yaş: 48.5±15.2). DEBT ile hastaların 136'sında (%36.5) hidroksiapatit, 160'ında (%42.9) kalsiyum oksalat, 20'sinde (%5.4) sistin, 57'sinde (%15.3) ise ürik asit taşı saptandı. Takipte taşı elde edilen 35 hastada taşların in-vitro analizi yapıldı ve taşların 8'inin (%22.8) hidroksiapatit, 18'inin (%51.4) kalsiyum oksalat, 6'sının (%17.2) ürik asit, 3'ünün de (%8.6) sistin taşı olduğu saptandı. DEBT analiz sonuçları, in-vitro sonuçlar ile karşılaştırıldığında 32 hastada (%91.4) taşın tipi doğru olarak saptanırken, 3 hastada (%8.6) ise doğru olarak saptanamadı. Taş tiplerine göre ayrı ayrı değerlendirildiğinde; ürik asit ve sistin taşlarının tamamı DEBT ile doğru olarak saptanabildi. DEBT ile hidroksiapatit taşı olarak belirtilen 11 taşın, 8 tanesi in-vitro analiz ile hidroksiapatit ile uyumlu olarak bulundu. Diğer 3 taşın ise in-vitro analizde kalsiyum oksalat taşı olduğu görüldü. DEBT ile kalsiyum oksalat taşı olduğu belirtilen 15 taşın ise in-vitro analizde de kalsiyum oksalat taşı olduğu doğrulandı. Sonuç: Gelişmiş post-proçes analiz yöntemleri ile birlikte DEBT, üriner taşların analizini yapabilmektedir. Özellikle ürik asit ve sistin taşlarını saptamada DEBT'nin çok üstün olduğu görülmektedir. Hidroksiapatit ve kalsiyum okzalat taşlarını saptamadaki başarısı da yüksektir. Limitasyon olarak, DEBT ile miks taşların bileşimi ve kalsiyum oksalat monohidrat-dihidrat gibi taş subgrupları ayırt edilememektedir. Sonuç olarak, DEBT ile in-vivo ortamda taş analizi yapıldığında, DEBT'nin tedavinin kişiselleştirilmesine ve optimize edilmesine büyük katkı sağlayacağı şüphesizdir.
Introduction and Purpose: Formation mechanisms and treatment of the urinary tract stones are different, depending on their chemical structure. Therefore, determining the stone type plays a key role in planning treatment and preventive measures. Type of a stone can be determined by in-vitro analysis methods. But obtaining the stone is not possible in all patients. Computed tomography (CT) with the use of dual energy technology in recent years, has made it possible to do in-vivo analysis of urinary stones. In this study, we aimed to evaluate the diagnostic efficacy of dual energy CT (DECT) analysis results and compare them with in-vitro analysis which is accepted as gold standard for analysis of urinary tract stones. Materials and Methods: DECT examinations were performed between September 2014 - July 2015, on 373 patients with urinary stone disease, using with 128-slice dual source CT scanner (Somatom Definition Flash, Siemens Healthcare, Forchheim, Germany). The patients were informed before the procedure and informed consent was obtained. DECT examination was performed on only the section of the stone. Analysis of attenuation ratios in the high and low kVp values of the stone was performed on workstation (Syngo.via, Siemens Healthcare, Forchheim, Germany) and stones were classified as hydroxyapatite, calcium oxalate, cystine and uric acid. In follow-up, stone was obtained in 35 patients as a result of surgery or dropping it. In-vitro analysis of the stones were performed. DECT and in-vitro analysis results were compared and statistically evaluated. Results: 373 patients, 256 (68.6%) men and 117 (31.4%) women were included in the study. The ages of the patients ranged from 18 to 90 (average age: 48.5±15.2). In all patients, 136 (36.5%) hydroxyapatite, 160 (42.9%) calcium oxalate, 20 (5.4%) cystine, and 57 (15.3%) uric acid stones were detected with DECT. In vitro analysis of the stones were performed in 35 patients whose stones were obtained at follow-up and 8 (22.8%) hydroxyapatite, 18 (51.4%) calcium oxalate, 6 (17.2%) uric acid and 3 (8.6%) cystine stones were detected. When DECT analysis results were compared with in-vitro analysis results; stone types were detected correctly in 32 (91.4%) patients and were detected incorrectly in 3 (8.6%) patients. If evaluated separately by types of stone; all uric acid and cystine stones could be detected correctly with DECT. In 11 stones detected as hydroxyapatite in DECT, 8 of them were found to be compatible with hydroxyapatite in in-vitro analysis. The other 3 were found to be calcium oxalate stone in in-vitro analysis. 15 stones were detected as calcium oxalate with DECT and all of them were verified as calcium oxalate stone in in-vitro analysis. Conclusion: With advanced post-process analysis methods, DECT is able to analyze urinary stones. DECT found superior especially in detecting uric acid and cystine stones. Its success in detecting hydroxyapatite and calcium oxalate stones is also high. As a limitation, composition of mixed stones and stone subgroups such as calcium oxalate monohydrate and dihydrate can not be differentiated with DECT now. As a result, when in-vivo analysis of the stones are performed with DECT, it is undoubtedly going to make a great contribution to the personalization and optimization of the treatment.
Introduction and Purpose: Formation mechanisms and treatment of the urinary tract stones are different, depending on their chemical structure. Therefore, determining the stone type plays a key role in planning treatment and preventive measures. Type of a stone can be determined by in-vitro analysis methods. But obtaining the stone is not possible in all patients. Computed tomography (CT) with the use of dual energy technology in recent years, has made it possible to do in-vivo analysis of urinary stones. In this study, we aimed to evaluate the diagnostic efficacy of dual energy CT (DECT) analysis results and compare them with in-vitro analysis which is accepted as gold standard for analysis of urinary tract stones. Materials and Methods: DECT examinations were performed between September 2014 - July 2015, on 373 patients with urinary stone disease, using with 128-slice dual source CT scanner (Somatom Definition Flash, Siemens Healthcare, Forchheim, Germany). The patients were informed before the procedure and informed consent was obtained. DECT examination was performed on only the section of the stone. Analysis of attenuation ratios in the high and low kVp values of the stone was performed on workstation (Syngo.via, Siemens Healthcare, Forchheim, Germany) and stones were classified as hydroxyapatite, calcium oxalate, cystine and uric acid. In follow-up, stone was obtained in 35 patients as a result of surgery or dropping it. In-vitro analysis of the stones were performed. DECT and in-vitro analysis results were compared and statistically evaluated. Results: 373 patients, 256 (68.6%) men and 117 (31.4%) women were included in the study. The ages of the patients ranged from 18 to 90 (average age: 48.5±15.2). In all patients, 136 (36.5%) hydroxyapatite, 160 (42.9%) calcium oxalate, 20 (5.4%) cystine, and 57 (15.3%) uric acid stones were detected with DECT. In vitro analysis of the stones were performed in 35 patients whose stones were obtained at follow-up and 8 (22.8%) hydroxyapatite, 18 (51.4%) calcium oxalate, 6 (17.2%) uric acid and 3 (8.6%) cystine stones were detected. When DECT analysis results were compared with in-vitro analysis results; stone types were detected correctly in 32 (91.4%) patients and were detected incorrectly in 3 (8.6%) patients. If evaluated separately by types of stone; all uric acid and cystine stones could be detected correctly with DECT. In 11 stones detected as hydroxyapatite in DECT, 8 of them were found to be compatible with hydroxyapatite in in-vitro analysis. The other 3 were found to be calcium oxalate stone in in-vitro analysis. 15 stones were detected as calcium oxalate with DECT and all of them were verified as calcium oxalate stone in in-vitro analysis. Conclusion: With advanced post-process analysis methods, DECT is able to analyze urinary stones. DECT found superior especially in detecting uric acid and cystine stones. Its success in detecting hydroxyapatite and calcium oxalate stones is also high. As a limitation, composition of mixed stones and stone subgroups such as calcium oxalate monohydrate and dihydrate can not be differentiated with DECT now. As a result, when in-vivo analysis of the stones are performed with DECT, it is undoubtedly going to make a great contribution to the personalization and optimization of the treatment.
Açıklama
Anahtar Kelimeler
Üriner sistem taş hastalığı, Dual enerji, Taş analizi, Urinary stone disease, Dual energy, Stone analysis
Kaynak
WoS Q Değeri
Scopus Q Değeri
Cilt
Sayı
Künye
Erdoğan, H. (2015). Dual enerji bilgisayarlı tomografi ile üriner sistem taşlarının in vivo analizi. Selçuk Üniversitesi, Yayımlanmış uzmanlık tezi, Konya.
