Prediction of calcium level in melamine-related urinary calculi with helical CT: diagnostic performance evaluation and clinical significance

Yuan, Li; XiaoRui, Ru; Gang, Huang; XinSheng, Xi; XiaoGang, Huang; Li, Dong; YiRong, Chen
June 2012
Urological Research;Jun2012, Vol. 40 Issue 3, p231
Academic Journal
The aim of the study was to investigate the relationship between CT-attenuation and stone calcium level in melamine-related urinary calculi (MRUC). A total of 25 MRUC with known composition and calcium level were included (11 uric acid stones, 2 calcium oxalate stones and 12 mixture stones of uric acid and calcium oxalate). Of all, 18 renal stones accepted alkalization therapy except for 5 lower urinary tract stones and 2 stones of unknown position. With well-matched composition, 61 adult urinary stones were included as controls. Every stone was scanned by helical CT (80 kV/120 kV, 300 mA, pitch 0.625 mm) and the highest CT-attenuation value measured. CT-attenuation values of MRUC increased gradually from uric acid stones, mixture stones to calcium oxalate stones, but were always lower than the values of controls. Furthermore, a strong positive correlation was found between stone CT-attenuation value and stone calcium level ( n = 25, r = 0.883, p = 0.000; r = 0.855, p = 0.000). Compared with alkalization-therapy-alone group, stone CT-attenuation values and stone calcium level in the comprehensive-therapy group were significantly greater (CT 1,057 � 639 vs. 172 � 61 HU, p = 0.001; CT 783 � 476 vs. 162 � 60 HU, p = 0.001; Ca 19.83 � 7.48% vs. 1.30 � 1.51%, p = 0.000). Fisher's exact test suggested that the stones with higher CT-attenuation values tended to resist alkalization when 400 HU served as the cutoff value ( P = 0.002, P = 0.000). In conclusion, the study was the first to illustrate that the CT-attenuation value could reflect calcium level in MRUC and found that stones with higher CT-attenuation value were not amenable to alkalization because they probably contained greater calcium. For those patients, we believe that comprehensive therapy will be the best choice.


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