Estimate Therapeutic Effect Of Laser Lithotripsy With CT Three-dimensional Texture Analysis In Patients With Ureteral Calculi

ObjectiveTo explore the predictive value of estimating therapeutic effect of laser lithotripsy(LL)with three-dimensional CT texture analysis(3D-CTTA)in patients with ureteral calculi.Materials and Methods72 patients(a total of 80 stones)with ureteral calculus diagnosed by CT,who had undergone LL treatment were retrospectively evaluated and selected.They included 59 males and 13 females,with an average age of 45.99±13.23 years.According to intra-operative observations and postoperative reexamination,samples were divided into a completely crushed and a non-crushed group.Completely crushed group: defined as patients whose the target calculi were smashed successfully during the operation,and no clear calculi were found in the postoperative imaging review,including 48 patients(a total of 53 stones).Non-crushed group: defined as patients whose the target stones clearly pushed up into the renal pelvis or only partially fractured during LL or had residual ureteral stones on imaging reexamination,including 24 patients(a total of 27 stones)The CT value of each target stone was measured,and 15 texture analysis(TA)parameters was extracted by delineating the 3D region of interest(ROI)on Mazda software,including shape features,histogram features and run length matrix features.The independent sample t test was used to compare the CT value,skewness,kurtosis,perc.90%,perc.99%,z-short run emphasis(z-shrtremp)and z-fraction of image in runs(z-fraction)between the two groups,and the Mann-Whitney U test was used to compare the remaining TA features.Then,the receiver operating characteristic(ROC)curve was drawn to evaluate the diagnostic efficiency of the success of LL.Results1.Comparison of CT value of calculi and TA parametersThe CT value(916.60±255.35 versus.644.12±255.32),volume(284.00(179.75,694.25)versus.81.00(40.75,174.25)),variance(567.04(371.53,693.21)versus.214.32(101.89,420.83)),z-run length nonuniformity(z-rlnonuni)(47.61(31.02,74.13)versus.16.28(11.61,26.01))and z-grey level nonuniformity(z-glevnonu)(111.75(67.29,178.30)versus.39.00(22.81,63.07))of the non-crushed completely group were higher than that of the crushed completely group,while the skewness(0.40±0.46 versus.0.79±0.35),kurtosis(-1.08±-0.82 versus.-0.39±-0.99)was lower than that of crushed completely group(all P < 0.05).There was no statistically significant difference in the remaining parameters between the 2 groups(all P > 0.05).2.Compared with previous commonly used predictor(such as CT value)The area under the curve(AUC)of volume(0.850),z-rlnonuni(0.832),and z-glevnonu(0.851)is greater than CT value(0.782).3.Comparison of receiver operating characteristic(ROC)curveThe AUC value(0.851)of z-glevnonu was the largest,the AUC value(0.771)of skewness was the smallest,and the diagnostic efficiency of CT value and 6 TA parameters was good(AUC: 0.734～0.851).The sensitivity of CT value and variance(81.48%)was the highest,and the sensitivity of skewness and kurtosis(62.96%)was the lowest.The specificity of kurtosis(86.79%)was the highest,and that of CT value(64.15%)was the lowest.Conclusion3D texture analysis can be a quantitative indicator for predicting whether stones can be completely crushed by LL in patients with ureteral calculus.Among them,the predicted values of volume,z-rlnonuni,and z-glevnonu are better than CT values.