Seeing Beyond the Scan: Predicting ESWL Success Through Quantitative CT Parameters

Purpose Extracorporeal shock wave lithotripsy (ESWL) is a non-invasive treatment for urolithiasis; however, predicting its success remains challenging. This study aimed to provide guidance on the key predictors and clinical criteria for anticipating the success of ESWL. Materials and Methods We retrospectively analyzed 488 patients who underwent ESWL between 2011 and 2020. Predictive features included patient demographics, stone characteristics on non-contrast computed tomography (NCCT), composite scores (triple D, quadruple D), and ESWL energy parameters. Logistic regression, random forest, and decision tree models were used to identify key predictors of treatment success based on accuracy, sensitivity, and specificity. Results Logistic regression showed 94.3% accuracy (area under the curve [AUC] 0.883), with 92.6% (AUC 0.936) for random forest and 91.4% (AUC 0.559) for decision tree. Small stones, lower Hounsfield unit, higher stone heterogeneity index, and favorable locations (pelvis/upper) were consistent predictors of success. Although the sample size was robust, the single-center design may have limited the external validity of the findings. Conclusions NCCT-derived stone characteristics are sufficient to predict ESWL outcomes. This study provides a threshold-based guidance for each predictor, enabling clinicians to make timely and informed decisions regarding ESWL in patients with urolithiasis.