Current computed tomography techniques can detect duct of Bellini plugging but not Randall's plaques

Amy E. Krambeck*, John C. Lieske, Xujian Li, Eric J. Bergstralh, Andrew D. Rule, David Holmes, Cynthia M. McCollough, Terri J. Vrtiska

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

15 Scopus citations

Abstract

Objective: To assess the ability of noninvasive computed tomography (CT) scans to detect interstitial calcium phosphate deposits (Randall's plaques) and duct of Bellini plugs, which are possible stone precursor lesions. Methods: At time of percutaneous nephrolithotomy (PCNL) for stone removal, all accessible individual papillae of 105 patients were endoscopically visualized and video recorded. Image-processing software was used to estimate the percentage of papillary surface occupied by plaque or plug in each pole (upper, middle, lower). The location of stones was also recorded. A radiologist blinded to the mapping results scored presurgical (n = 98) and postsurgical (n = 105) abdominal CT scans for the presence or absence of calcification by pole. Results: The cohort was a mean age of 56 years (range, 23-84 years). Maximum papillary surface area of each area of the kidney occupied by plug correlated with CT calcifications on pre- and postprocedure images by rank sum test. However, maximum plaque surface area did not correlate with radiographic findings (P =.10-.90 for each pole by rank sum test). Sensitivity was 81% and specificity was 69% of CT to detect plugs of at least 1% of the papillary surface area. Conclusion: Calcifications seen on current generation clinical CT scans correspond to ductal plugging involving at least 1% of the papillary surface area. Current clinical CT scan technology appears inadequate for detecting Randall's plaques.

Original languageEnglish (US)
Pages (from-to)301-306
Number of pages6
JournalUrology
Volume82
Issue number2
DOIs
StatePublished - Aug 2013
Externally publishedYes

ASJC Scopus subject areas

  • Urology

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