CT, US and MRI of xanthine urinary stones: in-vitro and in-vivo analyses
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RESEARCH ARTICLE
Open Access
CT, US and MRI of xanthine urinary stones: in‑vitro and in‑vivo analyses Stephanie B. Shamir1* , Qi Peng1, Alan H. Schoenfeld1, Beth A. Drzewiecki2 and Mark C. Liszewski3
Abstract Background: Xanthine urinary stones are a rare entity that may occur in patients with Lesch–Nyhan syndrome receiving allopurinol. There is little literature describing imaging characteristics of these stones, and the most appropriate approach to imaging these stones is therefore unclear. We performed in-vitro and in-vivo analyses of xanthine stones using computed tomography (CT) at different energy levels, ultrasound (US), and magnetic resonance imaging (MRI). Methods: Five pure xanthine stones from a child with Lesch-Nyhan were imaged in-vitro and in-vivo. CT of the stones was performed at 80 kVp, 100 kVp, 120 kVp and 140 kVp and CT numbers of the stones were recorded in Hounsfield units (HU). US of the stones was performed and echogenicity, acoustic shadowing and twinkle artifact were assessed. MRI of the stones was performed and included T2-weighted, ultrashort echo-time-weighted and T2/ T1-weighted 3D bFFE sequences and signal was assessed. Results: In-vitro analysis on CT demonstrated that xanthine stones were radiodense and the average attenuation coefficient did not differ with varying kVp, measuring 331.0 ± 51.7 HU at 80 kVp, 321.4 ± 63.4 HU at 100 kVp, 329.7 ± 54.2 HU at 120 kVp and 328.4 ± 61.1 HU at 140 kVp. In-vivo analysis on CT resulted in an average attenuation of 354 ± 35 HU. On US, xanthine stones where echogenic with acoustic shadowing and twinkle artifact. On MRI, stones lacked signal on all tested sequences. Conclusion: Xanthine stone analyses, both in-vitro and in-vivo, demonstrate imaging characteristics typical of most urinary stones: dense on CT, echogenic on US, and lacking signal on MRI. Therefore, the approach to imaging xanthine stones should be comparable to that of other urinary stones. Background Xanthine urolithiasis is a rare entity, occurring in patients with Lesch–Nyhan syndrome, who are receiving allopurinol treatment, and in patients with hereditary xanthinuria [1–4]. While a rare condition, xanthine urolithiasis may cause recurrent symptoms in this group of patients and require frequent medical attention. Children with Lesch–Nyhan syndrome are developmentally delayed, and often cannot appropriately
*Correspondence: [email protected] 1 Department of Radiology, Montefiore Medical Center, Albert Einstein College of Medicine, 111 East, 210th Street, Bronx, NY 10467, USA Full list of author information is available at the end of the article
verbalize their symptoms or localize their pain, making clinical assessment difficult. This often leads to multiple imaging studies over time. Understanding the imaging characteristics of these stones on different imaging modalities is imperative for effective clinical management. Little is written in the medical literature about the imaging of xanthine stones, and no previous in-vitro studies have described the imaging charact
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