Non-invasive Differentiation of Kidney Stone Types using X-ray Dark-Field Radiography

Treatment of renal calculi is highly dependent on the chemical composition of the stone in question, which is difficult to determine using standard imaging techniques. The objective of this study is to evaluate the potential of scatter-sensitive X-ray dark-field radiography to differentiate between the most common types of kidney stones in clinical practice. Here, we examine the absorption-to-scattering ratio of 118 extracted kidney stones with a laboratory Talbot-Lau Interferometer. Depending on their chemical composition, microscopic growth structure and morphology the various types of kidney stones show strongly varying, partially opposite contrasts in absorption and dark-field imaging. By assessing the microscopic calculi morphology with high resolution micro-computed tomography measurements, we illustrate the dependence of dark-field signal strength on the respective stone type. Finally, we utilize X-ray dark-field radiography as a non-invasive, highly sensitive (100%) and specific (97%) tool for the differentiation of calcium oxalate, uric acid and mixed types of stones, while additionally improving the detectability of radio-lucent calculi. We prove clinical feasibility of the here proposed method by accurately classifying renal stones, embedded within a fresh pig kidney, using dose-compatible measurements and a quick and simple visual inspection.

[1]  Dung Kai-cheung,et al.  The Catalog , 2001, Thresholds.

[2]  Pierre Conort,et al.  Helical CT evaluation of the chemical composition of urinary tract calculi with a discriminant analysis of CT-attenuation values and density , 2004, European Radiology.

[3]  Ernst J. Rummeny,et al.  Targeted dual-energy single-source CT for characterisation of urinary calculi: experimental and clinical experience , 2011, European Radiology.

[4]  Xavier Robin,et al.  pROC: an open-source package for R and S+ to analyze and compare ROC curves , 2011, BMC Bioinformatics.

[5]  Thomas Köhler,et al.  Noise properties of grating-based x-ray phase contrast computed tomography. , 2011, Medical physics.

[6]  F. Stacul,et al.  Present-day imaging of patients with renal colic , 2001, European Radiology.

[7]  Paola Coan,et al.  X-ray phase-contrast imaging: from pre-clinical applications towards clinics , 2013, Physics in medicine and biology.

[8]  Franz Pfeiffer,et al.  X-ray phase imaging with a grating interferometer. , 2005, Optics express.

[9]  Robert C. Smith,et al.  Diagnosis and Management of Acute Ureterolithiasis , 2000 .

[10]  M. Meng,et al.  Urinary Stone Disease , 2007 .

[11]  Ashley F. Stein,et al.  Interpretation of dark-field contrast and particle-size selectivity in grating interferometers. , 2011, Applied optics.

[12]  A. Momose,et al.  On the origin of visibility contrast in x-ray Talbot interferometry. , 2010, Optics express.

[13]  A. Evan,et al.  Kidney stone disease. , 2005, The Journal of clinical investigation.

[14]  W. Huda,et al.  Effective doses in radiology and diagnostic nuclear medicine: a catalog. , 2008, Radiology.

[15]  Nataly Wieberneit,et al.  A Study on Mastectomy Samples to Evaluate Breast Imaging Quality and Potential Clinical Relevance of Differential Phase Contrast Mammography , 2014, Investigative radiology.

[16]  Franz Pfeiffer,et al.  Experimental results from a preclinical X-ray phase-contrast CT scanner , 2012, Proceedings of the National Academy of Sciences.

[17]  R. Smith,et al.  Diagnosis and management of acute ureterolithiasis: CT is truth. , 2000, AJR. American journal of roentgenology.

[18]  A. Czarnecka,et al.  Novel clinical applications of dual energy computed tomography. , 2012, Advances in clinical and experimental medicine : official organ Wroclaw Medical University.

[19]  C. J. Kotre,et al.  Additional factors for the estimation of mean glandular breast dose using the UK mammography dosimetry protocol. , 2000, Physics in medicine and biology.

[20]  Franz Pfeiffer,et al.  Emphysema diagnosis using X-ray dark-field imaging at a laser-driven compact synchrotron light source , 2012, Proceedings of the National Academy of Sciences.

[21]  Franz Pfeiffer,et al.  Quantitative x-ray dark-field computed tomography , 2010, Physics in medicine and biology.

[22]  O. Bunk,et al.  Hard-X-ray dark-field imaging using a grating interferometer. , 2008, Nature materials.

[23]  S. Wilkins,et al.  Phase-contrast imaging of weakly absorbing materials using hard X-rays , 1995, Nature.

[24]  Liang Li,et al.  A novel metal artifact reducing method for cone-beam CT based on three approximately orthogonal projections , 2013, Physics in medicine and biology.

[25]  Jeremy Brown,et al.  Diagnostic and Treatment Patterns for Renal Colic in US Emergency Departments , 2005, International Urology and Nephrology.

[26]  Antonio Conte,et al.  Simple classification of renal calculi closely related to their micromorphology and etiology. , 2002, Clinica chimica acta; international journal of clinical chemistry.

[27]  D. R. White,et al.  The composition of body tissues. , 1986, The British journal of radiology.

[28]  J. Najarian,et al.  Experimental and Clinical Experience , 1970 .

[29]  O. Bunk,et al.  Phase retrieval and differential phase-contrast imaging with low-brilliance X-ray sources , 2006 .

[30]  D. Dance.  Monte Carlo calculation of conversion factors for the estimation of mean glandular breast dose. , 1990, Physics in medicine and biology.

[31]  F. Grases,et al.  Biopathological crystallization : a general view about the mechanisms of renal stone formation , 1998 .

[32]  Christoph Krafft,et al.  Disease recognition by infrared and Raman spectroscopy , 2009, Journal of biophotonics.

[33]  Marcus Radicke,et al.  On a dark-field signal generated by micrometer-sized calcifications in phase-contrast mammography , 2013, Physics in medicine and biology.

[34]  R Core Team,et al.  R: A language and environment for statistical computing. , 2014 .

[35]  Franz Pfeiffer,et al.  Bi-Directional X-Ray Phase-Contrast Mammography , 2014, PloS one.

[36]  M. Meng,et al.  Urinary stone disease : the practical guide to medical and surgical management , 2007 .

[37]  R. Smith,et al.  Helical CT of urinary tract stones. Epidemiology, origin, pathophysiology, diagnosis, and management. , 1999, Radiologic clinics of North America.

[38]  S. Wilkins,et al.  Phase-contrast imaging using polychromatic hard X-rays , 1996, Nature.