Optimizing colon identification by window setting modulation on non-contrast computerized tomography prior to percutaneous nephrolithotomy.

BACKGROUND

Preoperative identification of the bowel on imaging is essential in planning renal access during percutaneous nephrolithotomy (PCNL) and avoiding colonic injury. We aimed this study to assess which non-contrast computed tomography (NCCT) window setting provides the optimal colonic identification for PCNL preoperative planning.

METHODS

Ten urologic surgeons (4 seniors, 6 residents) reviewed 22 images of NCCT scans in both abdomen and lung window settings in a randomized blinded order. Colonic area delineation in each image was performed using a dedicated commercially available area calculator software. Comparison of the marked colonic area between the abdomen and lung window settings was performed.

RESULTS

Overall, the mean marked colonic area was greater in the lung window compared to abdomen window (8.82 cm2 vs 7.4 cm2, respectively, p < 0.001). Switching the CT-window from abdomen to lung increased the identified colonic area in 50 cases (50%). Intraclass correlation showed good agreement between the senior readers and among all readers (0.92 and 0.87, respectively). Similar measurements of the colonic area in both abdomen and lung windows were observed in 26/44 (60%) of the seniors cases and in 7/66 (10%) of the residents cases (p=0.002).

CONCLUSION

Lung window solely or in combination with abdomen window appears to provide the most accurate colonic identification for pre-operative planning of PCNL access, and potentially reduce the risk of colonic injury. This pattern is more evident among young urologists, and we propose to introduce it as a standard sequence in PCNL pre-planning.