The classification of renal stones by gratings-based dark-field radiography

INTRODUCTION: Occurrence of urinary calculi is a common medical condition. Since treatment and prevention measures depend on the type of stone found, reliable diagnostic tools are required. Dual energy computed tomography (CT) allows for rough classification of the stones found. After extraction, stone composition can be confirmed by laboratory analysis. We investigated to which degree gratings-based X-ray interferometry, which can measure attenuation, refraction and scattering (dark-field) properties of samples, allows for the discrimination of urinary stone type by calculating the ratio (R) of attenuation and scattering signals. MATERIAL AND METHODS: In an experimental setup we investigated 322 renal stone fragments from 96 patients which were extracted during routine clinical practice. Laboratory analysis showed the chemical composition of the urinary stones. These were correlated with dark field analysis of the stone samples. Measurements were performed on a X-rays gratings interferometer prototype. The attenuation, refraction and scattering signals were measured and the R-value calculated. RESULTS: The spread of R-values of a given type of calculi is large, reducing the specificity of the method. Only uric acid stones can reliably be distinguished (sensitivity of 0.86 at a specificity of 0.9) from the other stones. CONCLUSIONS: Gratings-based dark-field imaging is a non-destructive and potentially non-invasive technique that allows to discriminate between uric acid and non-uric acid stones, which from a clinical point of view represents by far the most important question for stone treatment.