Advertisement

World Journal of Urology

, Volume 36, Issue 5, pp 727–732 | Cite as

Retrospective comparison of measured stone size and posterior acoustic shadow width in clinical ultrasound images

  • Jessica C. Dai
  • Barbrina Dunmire
  • Kevan M. Sternberg
  • Ziyue Liu
  • Troy Larson
  • Jeff Thiel
  • Helena C. Chang
  • Jonathan D. Harper
  • Michael R. Bailey
  • Mathew D. Sorensen
Original Article

Abstract

Purpose

Posterior acoustic shadow width has been proposed as a more accurate measure of kidney stone size compared to direct measurement of stone width on ultrasound (US). Published data in humans to date have been based on a research using US system. Herein, we compared these two measurements in clinical US images.

Methods

Thirty patient image sets where computed tomography (CT) and US images were captured less than 1 day apart were retrospectively reviewed. Five blinded reviewers independently assessed the largest stone in each image set for shadow presence and size. Shadow size was compared to US and CT stone sizes.

Results

Eighty percent of included stones demonstrated an acoustic shadow; 83% of stones without a shadow were ≤ 5 mm on CT. Average stone size was 6.5 ± 4.0 mm on CT, 10.3 ± 4.1 mm on US, and 7.5 ± 4.2 mm by shadow width. On average, US overestimated stone size by 3.8 ± 2.4 mm based on stone width (p < 0.001) and 1.0 ± 1.4 mm based on shadow width (p < 0.0098). Shadow measurements decreased misclassification of stones by 25% among three clinically relevant size categories (≤ 5, 5.1–10, > 10 mm), and by 50% for stones ≤ 5 mm.

Conclusions

US overestimates stone size compared to CT. Retrospective measurement of the acoustic shadow from the same clinical US images is a more accurate reflection of true stone size than direct stone measurement. Most stones without a posterior shadow are ≤ 5 mm.

Keywords

Ultrasonography Calculi Nephrolithiasis Urolithiasis Computed tomography Size 

Abbreviations

CT

Computed tomography

US

Ultrasound

BMI

Body mass index

ICC

Intra-class correlation

Notes

Acknowledgements

This work is part of a large collaborative effort, and we appreciate the help of our many collaborators at the University of Vermont, University of Washington (UW) Center for Industrial and Medical Ultrasound, the UW Department of Urology, and within National Institute of Diabetes and Digestive Kidney Diseases (NIDDK) Program Project DK043881.

Author contributions

JCD: Project development, data collection and management, data analysis, manuscript writing/editing. BD: Project development, data collection and management, data analysis, manuscript writing/editing. KMS: Project development, data collection, manuscript editing. ZL: Data analysis, manuscript editing. TL: Data collection and management, manuscript editing. JT: Data collection, manuscript editing. HCC: Data collection, manuscript editing. JDH: Project development, manuscript editing. MRB: Project development, manuscript writing/editing. MDS: Project development, data collection, manuscript editing.

Funding

Funding was provided by the National Space Biomedical Research Institute through National Aeronautics and Space Association (NASA) Grant NCC 9-58 and National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) Grant DK043881.

Compliance with ethical standards

Conflict of interest

Michael R. Bailey, Barbrina Dunmire, and Mathew D. Sorensen have equity in and consulting agreements with SonoMotion Inc. which has licensed intellectual property from the University of Washington related to this technology. For the remaining authors, no competing conflicts of interest exist.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. For this type of study formal consent is not required.

References

  1. 1.
    Hubner WA, Irby P, Stoller ML (1993) Natural history and current concepts for the treatment of small ureteral calculi. Eur Urol 24:172–176CrossRefPubMedGoogle Scholar
  2. 2.
    Assimos D et al (2016) Surgical management of stones: American Urological Association/Endourological Society Guideline. PART II. J Urol 196:1161–1169CrossRefPubMedGoogle Scholar
  3. 3.
    Fowler KAB, Locken JA, Duchesne JH, Williamson MR (2002) US for detecting renal calculi with nonenhanced CT as a reference standard. Radiology 222:109–113CrossRefPubMedGoogle Scholar
  4. 4.
    Ray AA, Ghiculete D, Pace KT, Honey RJD (2010) Limitations to ultrasound in the detection and measurement of urinary tract calculi. Urology 76:295–300CrossRefPubMedGoogle Scholar
  5. 5.
    Sternberg KM et al (2016) Ultrasonography significantly overestimates stone size when compared to low-dose. Noncontrast computed tomography. Urology 95:67–71CrossRefPubMedGoogle Scholar
  6. 6.
    Smith-Bindman R et al (2014) Ultrasonography vs computed tomography for suspected nephrolithiasis. N Engl J Med 371:1100–1110CrossRefPubMedGoogle Scholar
  7. 7.
    Ferrandino MN et al (2009) Radiation exposure in the acute and short-term management of urolithiasis at 2 academic centers. J Urol 181:668–673CrossRefPubMedGoogle Scholar
  8. 8.
    Coursey CA et al (2012) ACR Appropriateness Criteria® acute onset flank pain-suspicion of stone disease. Ultrasound Q 28:227–233CrossRefPubMedGoogle Scholar
  9. 9.
    Dunmire B et al (2016) Use of the acoustic shadow width to determine kidney stone size with ultrasound. J Urol 195:171–176CrossRefPubMedGoogle Scholar
  10. 10.
    May PC, Haider Y, Dunmire B, Cunitz BW, Thiel J, Liu Z, Bruce M, Bailey MR, Sorensen MD, Harper JD (2016) Stone-mode ultrasound for determining renal stone size. J Endourol 30(9):958–962CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    Dunmire B et al (2015) Tools to improve the accuracy of kidney stone sizing with ultrasound. J Endourol 29:147–152CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Kanno T et al (2014) The efficacy of ultrasonography for the detection of renal stone. Urology 84:285–288CrossRefPubMedGoogle Scholar
  13. 13.
    Kishore TAA, Pedro RN, Hinck B, Monga M (2008) Estimation of size of distal ureteral stones: noncontrast CT scan versus actual size. Urology 72:761–764CrossRefPubMedGoogle Scholar
  14. 14.
    Ganesan V, De S, Greene D, Torricelli FCM, Monga M (2017) Accuracy of ultrasonography for renal stone detection and size determination: is it good enough for management decisions? BJU Int 119:464–469CrossRefPubMedGoogle Scholar
  15. 15.
    Sternberg KM, Littenberg B (2017) Trends in imaging use for the evaluation and follow-up of kidney stone disease: a single center experience. J Urol 198:383–388CrossRefPubMedGoogle Scholar
  16. 16.
    Patel SR et al (2011) Automated renal stone volume measurement by noncontrast computerized tomography is more reproducible than manual linear size measurement. J Urol 186:2275–2279CrossRefPubMedGoogle Scholar
  17. 17.
    Lidén M, Andersson T, Geijer H (2011) Making renal stones change size-impact of CT image post processing and reader variability. Eur Radiol 21:2218–2225CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2017

Authors and Affiliations

  • Jessica C. Dai
    • 1
  • Barbrina Dunmire
    • 2
  • Kevan M. Sternberg
    • 3
  • Ziyue Liu
    • 4
  • Troy Larson
    • 5
  • Jeff Thiel
    • 6
  • Helena C. Chang
    • 1
  • Jonathan D. Harper
    • 1
  • Michael R. Bailey
    • 1
    • 2
  • Mathew D. Sorensen
    • 1
    • 7
  1. 1.Department of UrologyUniversity of Washington School of MedicineSeattleUSA
  2. 2.Center for Industrial and Medical Ultrasound, Applied Physics LaboratoryUniversity of WashingtonSeattleUSA
  3. 3.Division of UrologyUniversity of VermontBurlingtonUSA
  4. 4.Department of BiostatisticsIndiana UniversityIndianapolisUSA
  5. 5.Department of UrologyUniversity of FloridaGainesvilleUSA
  6. 6.Department of RadiologyUniversity of Washington School of MedicineSeattleUSA
  7. 7.Division of UrologyDepartment of Veteran Affairs Medical CenterSeattleUSA

Personalised recommendations