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Objective <p>This study aimed to prospectively assess whether dual-source CT‑guided identification of uric acid stones can effectively direct patients to successful medical dissolution therapy.</p> Methods <p>A retrospective diagnostic study of 760 patients with urinary stones was conducted. Preoperative dual-source CT parameters were compared with postoperative infrared spectroscopy to establish diagnostic cut-off values. In the prospective intervention study, 60 patients with uric acid stones—identified by a dual-energy ratio ≤ 1.15 on dual-source CT—were randomized to an experimental group (stone dissolution therapy with sodium potassium hydrogen citrate plus lifestyle guidance) or a control group (lifestyle guidance only). Treatment outcomes were evaluated at 3&#xa0;months.</p> Results <p>In the retrospective cohort, dual-source CT demonstrated excellent diagnostic accuracy for uric acid stones, with an area under the curve of 0.998 for the dual-energy ratio. Optimal cut-offs were as follows: dual-energy ratio ≤ 1.165, attenuation at 100&#xa0;kV &lt; 641.5&#xa0;HU, and attenuation at 150&#xa0;kV &lt; 570.5&#xa0;HU. In the prospective trial, the experimental group achieved significantly higher complete dissolution rates (80% vs. 20%), lower non-response rates (3.3% vs. 33.3%), and lower surgical rates (3.3% vs. 30%). Urine pH improved in the experimental group without significant change in serum uric acid.</p> Conclusion <p>Dual-source CT accurately identifies uric acid stones using a dual-energy ratio threshold of ≤1.15, enabling targeted medical therapy. This imaging-guided strategy significantly improves stone dissolution outcomes and reduces the need for surgical intervention.</p>

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Dual-source CT for medical dissolution of uric acid stones: a retrospective derivation and prospective validation study

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年2月2日

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  • Wang Li,
  • Hong Xie,
  • Yanduo Lin,
  • Rong Chen,
  • Kun Zheng,
  • Luyi Yang,
  • Ranxing Yang

摘要

Objective

This study aimed to prospectively assess whether dual-source CT‑guided identification of uric acid stones can effectively direct patients to successful medical dissolution therapy.

Methods

A retrospective diagnostic study of 760 patients with urinary stones was conducted. Preoperative dual-source CT parameters were compared with postoperative infrared spectroscopy to establish diagnostic cut-off values. In the prospective intervention study, 60 patients with uric acid stones—identified by a dual-energy ratio ≤ 1.15 on dual-source CT—were randomized to an experimental group (stone dissolution therapy with sodium potassium hydrogen citrate plus lifestyle guidance) or a control group (lifestyle guidance only). Treatment outcomes were evaluated at 3 months.

Results

In the retrospective cohort, dual-source CT demonstrated excellent diagnostic accuracy for uric acid stones, with an area under the curve of 0.998 for the dual-energy ratio. Optimal cut-offs were as follows: dual-energy ratio ≤ 1.165, attenuation at 100 kV < 641.5 HU, and attenuation at 150 kV < 570.5 HU. In the prospective trial, the experimental group achieved significantly higher complete dissolution rates (80% vs. 20%), lower non-response rates (3.3% vs. 33.3%), and lower surgical rates (3.3% vs. 30%). Urine pH improved in the experimental group without significant change in serum uric acid.

Conclusion

Dual-source CT accurately identifies uric acid stones using a dual-energy ratio threshold of ≤1.15, enabling targeted medical therapy. This imaging-guided strategy significantly improves stone dissolution outcomes and reduces the need for surgical intervention.