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Laser lithotripsy for proximal ureteral calculi in adults: can 3D CT texture analysis help predict treatment success?

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A Correction to this article was published on 22 June 2021

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Abstract

Objective

To explore whether multiple 3D computed tomography texture analysis (3D-CTTA) parameters can predict the therapeutic effects of holmium: YAG laser lithotripsy (LL) on ureteral calculi.

Methods

The files from 94 patients (102 stones) with proximal ureteral calculi treated only by LL at a single institution were retrospectively retrieved from January 2016 to March 2019. According to intra-operative observations and postoperative reexamination, samples were divided into a completely crushed and a non-crushed group. Preoperative non-contrast-enhanced computed tomography (NCCT) images obtained by multiple CT scanners were imported to MaZda software for 3D texture analysis (TA). The CT-derived value of each target stone was measured, and 15 TA parameters were extracted by delineating volumes of interest (VOIs). Receiver operating characteristic (ROC) curves were drawn to determine the optimal critical value of each parameter based on the Youden index, and univariable and multivariable logistic regression analyses determined the significant factors for LL success.

Results

In univariable analysis, significant differences (p < 0.05) were observed among 7 parameters. In multivariable analysis, Perc.01 3D > 2062 (p = 0.03) and Z-fraction of image in runs (Z-Fraction) > 0.45570 (p = 0.009) were significant independent predictors, with odds ratios (ORs) of 24.204 and 60.329, respectively. In subgroup analysis based on the cutoff value of the CT-derived value (HU = 960), Perc.01 3D (OR = 44.154, 95% CI (2.379, 819.618), p = 0.011) and Z-Fraction (OR = 14.519, 95% CI (2.088, 100.953), p = 0.007) remained statistically significant.

Conclusions

The combination of 3D-CTTA parameters and the CT-derived value can be used as a quantitative reference to predict whether a target stone could be completely crushed by LL.

Key Points

• Computed tomography texture analysis (CTTA) may be helpful in selecting suitable laser lithotripsy (LL) patients.

• 3D-CTTA better predicts stone fragility than commonly used methods (such as the CT-derived value).

• The combination of CTTA and the CT-derived value can be used as a preoperative quantitative reference.

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Change history

Abbreviations

3D-CTTA:

Three-dimensional computed tomography texture analysis

LL:

Laser lithotripsy

NCCT:

Non-contrast-enhanced computed tomography

RLM:

Run length matrix

ROI:

Region of interest

VOI:

Volumes of interest

Z-Fraction:

Z-fraction of image in runs

Z-GLevNonU:

Z-gray-level non-uniformity

Z-LngREmph:

Z-long run emphasis

Z-RLNonUni:

Z-run length non-uniformity

Z-ShrtREmp:

Z-short run emphasis

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Acknowledgments

Thanks to all the authors. In particular, we would like to thank Haiyi Wang. MD (Department of Radiology, First Medical Center, Chinese PLA General Hospital) for his advice during the project.

Funding

The authors state that this work has not received any funding.

Author information

Authors and Affiliations

  1. The Clinical School of Medicine, Dali University, 2 Shenghong Road, Gucheng, Dali, 671000, Yunnan Province, China

    Rui Wang

  2. Department of Radiology, Second People’s Hospital of Yunnan Province, 176 Qingnian Road, Wuhua District, Kunming, 650021, Yunnan Province, China

    Yunshan Su, Chongwen Mao, Mengjing You & Shutian Xiang

  3. Department of Urology, Second People’s Hospital of Yunnan Province, 176 Qingnian Road, Wuhua District, Kunming, 650021, Yunnan Province, China

    Song Li

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Correspondence to Yunshan Su.

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The scientific guarantor of this publication is Yunshan Su.MD.

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The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.

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No complex statistical methods were necessary for this paper.

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Written informed consent was waived by the Institutional Review Board.

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Wang, R., Su, Y., Mao, C. et al. Laser lithotripsy for proximal ureteral calculi in adults: can 3D CT texture analysis help predict treatment success?. Eur Radiol 31, 3734–3744 (2021). https://doi.org/10.1007/s00330-020-07498-x

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