دور التصو ر المقطعي عديم التباين منخفض الجرعة في توقع نجاح علاج تفتيت حصاة الكلية بالموجات الصادمة من خراج الجسم == Role of Low Dose Noncontrast Computed Tomography in Predicting the Success of Extracorporeal Shock Wave Lithotripsy Treatment of Renal Stone
Author name:
احمد عباس محمد
Supervisor name:
ليث احمد خلف | عادل حفظي حمودي
General topic:
Medicine
Specific topic:
Diagnostic Radiology
Degree:
Higher Diploma
University:
University of Baghdad - Faculty Of Medicine
Language:
English
University location:
Baghdad
First pages:
19T1286 - p.pdf
Abstract:
Currently, extracorporeal shock wave lithotripsy (ESWL) is the most common mode of therapy for small renal stones. Many studies have attempted to correlate the radiographic findings of non - contrast computed tomography (NCCT) with ESWL success and prospective assessment of patients with renal calculi.Objective : To assess the role of low dose non - contrast computed tomography in predicting the success of extracorporeal shock wave lithotripsy for renal stone treatment.Patients and Methods : A prospective study was conducted at Al - Shaheed Ghazi Al - Hariri teaching hospital in Baghdad medical city during the period from the 15th of December 2013 to the 30th of July 2014. Fifty patients who met the inclusion criteria and agreed to participate in this study were recruited . Data collected using a pre constructed data collection form in which the demographics and clinical data were reported. Stone characteristics were based on the pre - treatment non - contrast CT scanning reviewed and reported by one urologist and one radiologist. Diagnosis of renal stone was made by a specialist urologist depending on the clinical features and proved by urinalysis , KUB, Ultrasound and the non - contrast CT images. The SSD was calculated by measuring the 90° distance from the center of the stone to the skin .Patients received one session of ESWL and followed up for two weeks. Successful treatment considered if there was complete clearance of the stone with no residual fragments (stone - free) or presence of gravels less than 4 mm . Those who failed received another session 2 week after the first one. Data wereXIIanalysed using the statistical package for social sciences (SPSS) version 21, and appropriate statistical tests were used to assess the significance which set at ≤ 0.05 to be significant.Results : The age of the studied group ranged (23 - 74) years with a mean of (41.5± 12.5) years. Only 20% of the patients aged 30 years or less. Male to female ratio was (2.3 : 1). After the 1st session , 40% of patients had successful treatment and they became stone free. After the second session, the overall response rate (successful ESWL) was (66%). Success of treatment was significantly affected by the initial stone size . patients with successful treatment had the lower stone area (96.4 ± 34.4 mm2) compared to (150.8 ± 81.2 mm2) in those with unsuccessful treatment , (P=0.016). Stone density showed an inverse correlation with the success rate, the mean stone density was the lower among those with successful treatment (640.3 ± 301.2) HU , (P<0.001). Multiple logistic regression showed that stone size and density were the most significant predictors for successful treatment. Patients characteristics (age and sex), site of the stone and SSD didn’t reach the statistical significance for prediction (P>0.05) .Conclusion : Non - contrast Computed Tomography (NCCT) is a noninvasive and useful for obtaining a lot of information about the patient and renal calculi and can predict the success of ESWL. Stone density and size were significant predictors of the outcome of ESWL . Lower stone density and size predicted by NCCT associated with higher success rate of ESWL.
