Shock wave lithotripsy (SWL) is not able to treat all urinary stones. Identifying stones as susceptible or resistant to SWL at diagnosis would allow treatment that spares patients from unnecessary SWL, thereby reducing the chance of SW-induced injury. Our hypothesis: Presently available imaging techniques""""""""utilized correctly'have the capability of predicting the susceptibility or resistance of urinary stones to treatment by shock wave lithotripsy First, we will assess the practical limits of clinical helical CT (HCT) for the detection of structure, shape, and composition in stones. Second, we will explore the relative influence of stone shape/orientation versus their internal composition/structure in their susceptibility to breakage by SWL. This phenomenon is important but has been little studied in natural stones. Third, we will explore the possibility that SW-resistant inclusions within stones are the primary cause of residual fragments in SWL. Finally, we will develop and test a scheme for predicting the fragility of stones to lithotripter SWs using the information available from HCT, and test and refine this scheme using a range of stone types.
7 Aim 1. Determine the degree to which relevant stone analysis can be accomplished using present helical CT technology, including dual-energy helical CT.
7 Aim 2. Determine how critical stone shape relative to SW axis is to stone breakage.
7 Aim 3. Determine if CT can be used to detect SW-resistant inclusions within urinary stones inclusions that will result in incomplete comminution, leaving behind fragments.
7 Aim 4. Develop a scheme for predicting the relative fragility of stones to lithotripsy, and test the scheme for a clinically relevant variety of stone compositions and shapes. This project will provide a sound scientific basis for the development of clinical indicators of stone fragility. We envision that urologists will be able to predict stone fragility from helical CT images with minimal doses of X-radiation and that they will be able to use this information to plan patient treatment. The long-term goals of this work are focused on providing a sound experimental basis for prediction, so that future clinical studies can be done with proper knowledge of the potential abilities of clinical equipment and proper knowledge of how to apply these abilities. Shock wave lithotripsy doesn't always work to break up a kidney stone, and shock waves can injure the kidneys and may have long-term effects on health. Experimental evidence suggests that CT (CAT scan) can describe the shape, position, composition, and structure of stones so that shock wave-resistant stones can be identified.
We aim to study this possibility in detail, and provide a step-by- step guide to the use of CT for identifying which stone patients should be treated with shock wave lithotripsy.

Agency
National Institute of Health (NIH)
Institute
National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)
Type
Research Project (R01)
Project #
5R01DK059933-08
Application #
8134332
Study Section
Special Emphasis Panel (ZRG1-RUS-F (50))
Program Officer
Kirkali, Ziya
Project Start
2001-07-01
Project End
2013-08-31
Budget Start
2011-09-01
Budget End
2013-08-31
Support Year
8
Fiscal Year
2011
Total Cost
$323,302
Indirect Cost
Name
Indiana University-Purdue University at Indianapolis
Department
Anatomy/Cell Biology
Type
Schools of Medicine
DUNS #
603007902
City
Indianapolis
State
IN
Country
United States
Zip Code
46202
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Williams Jr, James C (2015) Re: Stewart et al.: stone size limits the use of hounsfield units for prediction of calcium oxalate stone composition (Urology 2015;85:292-295). Urology 85:965
Williams Jr, James C; Lingeman, James E; Coe, Fredric L et al. (2015) Micro-CT imaging of Randall's plaques. Urolithiasis 43 Suppl 1:13-7
Ribeiro, T R; Costa, F W G; Soares, E C S et al. (2015) Enamel and dentin mineralization in familial hypophosphatemic rickets: a micro-CT study. Dentomaxillofac Radiol 44:20140347
Englert, Kate M; McAteer, James A; Lingeman, James E et al. (2013) High carbonate level of apatite in kidney stones implies infection, but is it predictive? Urolithiasis 41:389-94
Qu, Mingliang; Jaramillo-Alvarez, Giselle; Ramirez-Giraldo, Juan C et al. (2013) Urinary stone differentiation in patients with large body size using dual-energy dual-source computed tomography. Eur Radiol 23:1408-14
Duan, Xinhui; Qu, Mingliang; Wang, Jia et al. (2013) Differentiation of calcium oxalate monohydrate and calcium oxalate dihydrate stones using quantitative morphological information from micro-computerized and clinical computerized tomography. J Urol 189:2350-6
Williams Jr, James C; McAteer, James A (2013) Retention and growth of urinary stones: insights from imaging. J Nephrol 26:25-31
Williams Jr, James C; Hameed, Tariq; Jackson, Molly E et al. (2012) Fragility of brushite stones in shock wave lithotripsy: absence of correlation with computerized tomography visible structure. J Urol 188:996-1001
Wang, Jia; Qu, Mingliang; Duan, Xinhui et al. (2012) Characterisation of urinary stones in the presence of iodinated contrast medium using dual-energy CT: a phantom study. Eur Radiol 22:2589-96

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