Magnetic resonance imaging of urinary calculi

Accurate prediction of the response of an individual patient to lithotripsy remains impossible. Certain factors such as the chemical composition, size, and position of the calculus are known to be important in determining the success rate. This paper reports the use of magnetic resonance imaging (MRI) to evaluate 141 urinary calculi in vitro. A wide range of signals for each chemical type of calculus was found on each of the three imaging sequences used (T1-weighted, T2-weighted, and proton density). None of the chemical groups examined showed a typical MRI profile allowing it to be distinguished from the other groups. Analysis of variance showed a statistical difference between signals for apatite and struvite on the T1-weighted sequence, and between struvite and uric acid on the proton density sequence (both, P < 0.05). These results show for the first time that MRI is capable of distinguishing between different chemical types of stones. This is particularly important for the comparison of struvite and apatite which appear to be similar in conventional investigations but have quite different hardness values. Further work is in progress correlating the results of this study with stone microhardness and extracorporeal shockwave lithotripsy fragility tests to determine whether MRI accurately predicts the success of lithotripsy.