The Structural Basis of Kidney Stone Fragility

肾结石脆性的结构基础

• 批准号: 7924716
• 负责人: JAMES C WILLIAMS
• 金额: $ 32.66万
• 依托单位: INDIANA UNIV-PURDUE UNIV AT INDIANAPOLIS
• 依托单位国家: 美国
• 财政年份: 2004
• 资助国家: 美国
• 起止时间: 2004-08-01 至 2012-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7924716
• 关键词: Address; Back; Calculi; Characteristics; Classification; Clinical; Clinical Research; Detection; Development; Diagnosis; Dose; Electroconvulsive Therapy; Environment; Equipment; Exposure to; Eye; Funding; Future; Goals; Grant; Health; Human; Image; Imaging Techniques; In Vitro; Injury; Kidney; Kidney Calculi; Knowledge; Lead; Left; Lithotripsy; Long-Term Effects; Measures; Modeling; Morphology; Patients; Positioning Attribute; Predisposition; Procedures; Psyche structure; Radiation; Relative (related person); Residual state; Resistance; Roentgen Rays; Scheme; Shapes; Shock; Solid; Somatotype; Spiral Computed Tomography; Structure; System; Technology; Testing; Urinary Calculi; Urinary system; Urologist; Work; X-Ray Computed Tomography; base; blind; clinically relevant; clinically significant; in vitro testing; in vivo; injured; research clinical testing; research study; sound; theories; tool; treatment planning; urinary

DESCRIPTION (provided by applicant): 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.

描述（由申请人提供）：冲击波碎石疗法（SWL）无法治疗所有尿石。在诊断时将石头识别为敏感或耐SWL的耐受性，将允许对患者免于不必要的SWL的治疗，从而减少SW诱导的损伤的机会。我们的假设：目前可用的成像技术“正确地使用了预测通过冲击波岩性疗法对尿石对处理的敏感性或抵抗力的能力，我们将评估临床螺旋CT（HCT）的实际界限SWL的破裂很重要，但在天然石头上很少研究。可以使用当前的螺旋CT技术（包括双能螺旋CT）来完成石材分析。 7 AIM 2。确定相对于SW轴的临界石形状是如何破裂的。 7 AIM 3。确定是否可以使用CT来检测尿石包裹物内的抗SW抗夹杂物，这会导致不完全粉碎，从而留下碎片。 7 AIM 4。开发一种方案，以预测石头对岩性4s的相对脆弱性，并测试该方案是否具有临床相关的石材成分和形状。该项目将为开发石材脆弱的临床指标提供合理的科学基础。我们设想，泌尿科医生将能够预测X辐射剂量最少的螺旋形CT图像的石材脆弱性，并且他们将能够使用此信息来计划患者治疗。这项工作的长期目标集中在为预测提供合理的实验基础，以便可以通过适当了解临床设备的潜在能力以及正确了解如何应用这些能力来完成未来的临床研究。冲击波碎石疗法并不总是能打破肾结石，冲击波会伤害肾脏，并可能对健康产生长期影响。实验证据表明，CT（CAT扫描）可以描述石头的形状，位置，组成和结构，从而可以鉴定出抗冲击波的石头。我们旨在详细研究这种可能性，并为使用CT识别应使用冲击波碎石疗法治疗哪些结石患者的逐步指南。