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Parada Villavicencio C, Mc Carthy RJ, Miller FH. Can diffusion-weighted magnetic resonance imaging of clear cell renal carcinoma predict low from high nuclear grade tumors. Abdom Radiol (NY) 2017; 42:1241-1249. [PMID: 27904923 DOI: 10.1007/s00261-016-0981-7] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To assess the diagnostic performance of the apparent diffusion coefficient (ADC) in predicting the Fuhrman nuclear grading of clear cell renal cell carcinomas (ccRCC). MATERIALS AND METHODS A total of 129 patients who underwent partial and radical nephrectomies with pathology-proven ccRCC were retrospectively evaluated. Histopathological characteristics and nuclear grades were analyzed. In addition, conventional magnetic resonance imaging (MRI) features were assessed in consensus by two radiologists to discriminate nuclear grading. ADC values were obtained from a region of interest (ROI) measurement in the ADC maps calculated from diffusion-weighted imaging (DWI) using b values of 50, 500, and 800 s/mm2. The threshold values for predicting and differentiating low-grade cancers (Fuhrman I-II) from high grade (Fuhrman III-IV) was obtained using binary logistic regression. The ADC cut-off value for differentiating low- and high-grade tumors was determined using classification analysis. RESULTS Significant associations (P < 0.001) were found between nuclear grading, conventional MR features, and DWI. Hemorrhage, necrosis, perirenal fat invasion, enhancement homogeneity, and cystic component were identified as independent predictors of tumor grade. High-grade ccRCC had significantly lower mean ADC values compared to low-grade tumors. An ADC cut-off value of 1.6 × 10-3 mm2/s had an optimal predictive percentage of 65.5% for low-grade tumors above this threshold and 81% for high-grade ccRCC below this threshold. Overall predictive accuracy was 70.5%. CONCLUSION The addition of ADC values to a model based on MRI conventional features demonstrates increased sensitivity and high specificity improving the distinguishing accuracy between both high-grade and low-grade ccRCC.
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Affiliation(s)
- Carolina Parada Villavicencio
- Department of Radiology, Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, 676 North Saint Clair St. Suite 800, Chicago, IL, USA
| | - Robert J Mc Carthy
- Department of Anesthesiology, Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, 676 North Saint Clair St. Suite 1050, Chicago, IL, USA
| | - Frank H Miller
- Department of Radiology, Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, 676 North Saint Clair St. Suite 800, Chicago, IL, USA.
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Tzortzakakis A, Gustafsson O, Karlsson M, Ekström-Ehn L, Ghaffarpour R, Axelsson R. Visual evaluation and differentiation of renal oncocytomas from renal cell carcinomas by means of 99mTc-sestamibi SPECT/CT. EJNMMI Res 2017; 7:29. [PMID: 28357787 PMCID: PMC5371538 DOI: 10.1186/s13550-017-0278-z] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Accepted: 03/15/2017] [Indexed: 12/28/2022] Open
Abstract
Background Despite the progress in the quality of multiphasic CT and MRI scans, it is still difficult to fully characterize a solid kidney lesion. Approximately 10% of all solid renal tumours turn out to be oncocytomas. In actual clinical practice, this is verified only following unnecessary surgery or a renal biopsy/ablation. The objective of our pilot study examines whether 99mTc-sestamibi SPECT/CT can play a crucial role in the characterization of solid renal neoplasms and the differentiation of oncocytomas from renal cell carcinomas. The study included 27 patients identified with 31 solid renal lesions. All patients were discussed in a multidisciplinary conference, and a decision for surgery or biopsy was taken. Prior to invasive procedures, patients underwent a SPECT/CT with 99mTc-sestamibi. Visual evaluation was performed, and any focal 99mTc-sestamibi uptake detected on SPECT in the localisation of tumour was considered as positive. Results Eleven out of 12 oncocytomas (91.6%) displayed positive uptake of 99mTc-sestamibi. Three hybrid tumours (mixed-type oncocytoma and chromophobe renal cancer) were positive on SPECT/CT. One papillary renal cell carcinoma had a slight uptake of 99mTc-sestamibi. The remaining 11 renal cell carcinomas were sestamibi negative. Conclusions Differentiation of benign renal oncocytomas from renal cell carcinomas seems very promising on 99mTc-sestamibi SPECT/CT examination. Additional supplement to visual evaluation, i.e. quantitative tools, should be sought for an accurate estimate of biological behaviour and hence a secure diagnosis.
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Affiliation(s)
- Antonios Tzortzakakis
- Radiology Department, Division of Medical Imaging and Technology, Karolinska University Hospital, C1-46, SE-141 86, Huddinge, Stockholm, Sweden.
| | - Ove Gustafsson
- Division of Urology, Karolinska University Hospital, Huddinge, Sweden.,Division of Radiology, Department for Clinical Science Intervention and Technology (CLINTEC), Karolinska Institute and Medical Physics and Nuclear Medicine, BOF Karolinska University Hospital, Huddinge, Sweden
| | - Mattias Karlsson
- Medical Radiation Physics and Nuclear Medicine, Functional Unit of Nuclear Medicine, Karolinska University Hospital, Huddinge, Sweden
| | | | | | - Rimma Axelsson
- Division of Radiology, Department for Clinical Science Intervention and Technology (CLINTEC), Karolinska Institute and Medical Physics and Nuclear Medicine, BOF Karolinska University Hospital, Huddinge, Sweden.,Medical Radiation Physics and Nuclear Medicine, Imaging and Physiology, Karolinska University Hospital, Huddinge, Sweden
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53
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Abstract
Detection of solid renal masses has increased, although it has not resulted in significant mortality reduction from renal cell carcinoma. Efforts for improved lesion characterization have been pursued and incorporated in management algorithms, in order to distinguish clinically significant tumors from favorable or benign conditions. Concurrently, imaging methods have produced evidence supporting their role as useful tools not only in lesion detection but also characterization. In addition, newer modalities, such as contrast-enhanced ultrasonography, and advanced applications of MR imaging, are being investigated. This article reviews the current role of different imaging methods in the characterization of solid renal masses.
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Affiliation(s)
- Fernando U Kay
- Department of Radiology, UT Southwestern Medical Center, Harry Hines 5323, 2201 Inwood Road, Dallas, TX 75390, USA
| | - Ivan Pedrosa
- Department of Radiology and Advanced Imaging Research Center, UT Southwestern Medical Center, Harry Hines 5323, 2201 Inwood Road, Dallas, TX 75390, USA.
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Corral de la Calle M, Encinas de la Iglesia J, Martín López M, Fernández Pérez G, Águeda del Bas D. The radiologist's role in the management of papillary renal cell carcinoma. RADIOLOGIA 2017. [DOI: 10.1016/j.rxeng.2017.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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55
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Corral de la Calle MÁ, Encinas de la Iglesia J, Martín López MR, Fernández Pérez GC, Águeda Del Bas DS. The radiologist's role in the management of papillary renal cell carcinoma. RADIOLOGIA 2017; 59:100-114. [PMID: 28160948 DOI: 10.1016/j.rx.2016.11.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Revised: 11/05/2016] [Accepted: 11/08/2016] [Indexed: 12/20/2022]
Abstract
Papillary carcinoma is the second most common renal cell carcinoma. It has a better prognosis than the more frequent clear cell carcinoma, although this does not hold true for advanced cases, because no specific treatment exists. It presents as a circumscribed peripheral tumor (small and homogeneously solid or larger and cystic/hemorrhagic) or as an infiltrating lesion that invades the veins, which has a worse prognosis. Due to their low vascular density, papillary renal cell carcinomas enhance less than other renal tumors, and this facilitates their characterization. On computed tomography, they might not enhance conclusively, and in these cases they are impossible to distinguish from hyperattenuating cysts. Contrast-enhanced ultrasonography and magnetic resonance imaging are more sensitive for detecting vascularization. Other characteristics include a specific vascular pattern, hypointensity on T2-weighted images, restricted water diffusion, and increased signal intensity in opposed phase images. We discuss the genetic, histologic, clinical, and radiological aspects of these tumors in which radiologists play a fundamental role in management.
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Affiliation(s)
| | | | - M R Martín López
- Servicio de Anatomía Patológica, Complejo Asistencial de Ávila, Ávila, España
| | - G C Fernández Pérez
- Servicio de Radiodiagnóstico, Hospital Universitario del Río Hortega, Valladolid, España
| | - D S Águeda Del Bas
- Servicio de Radiodiagnóstico, Complejo Asistencial de Ávila, Ávila, España
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Diagnostic value of 18F-FDG-PET/CT for the evaluation of solitary pulmonary nodules. Nucl Med Commun 2017; 38:67-75. [DOI: 10.1097/mnm.0000000000000605] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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57
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Kang SK, Mushlin AI. Designing Radiology Outcomes Studies-Essential Principles. Acad Radiol 2016; 23:898-904. [PMID: 27066756 DOI: 10.1016/j.acra.2016.03.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2015] [Revised: 03/01/2016] [Accepted: 03/06/2016] [Indexed: 11/25/2022]
Abstract
Health outcomes research is essential to align radiology with current standards of high-value patient care, through the assessment of end results of diagnostic tests, interventions, or policy on patient health. To bridge studies of diagnostic test accuracy and health outcomes research, key considerations include: (1) how to determine when a diagnostic test merits evaluation of impact on outcomes, (2) when study of intermediate/surrogate outcomes can be useful, (3) how to consider the possible harms as well as potential benefits of a test, and (4) how to integrate evidence of an imaging test's efficacy/effectiveness with clinical data to assess outcomes. Due to challenges in conducting studies of long-term outcomes consequent to imaging use, intermediate health outcomes may capture a test's impact on successful diagnosis and therapy, and can provide readily measurable, incremental insights into the role of imaging in health-care delivery and efficiency. In an era marked by recognition of quality and value of care, outcomes research will provide essential evidence to inform radiologists' guidance of imaging use toward improved patient care, creation of clinical guidelines, and policy decisions.
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Abstract
PURPOSE The purpose of the study is to provide an update on the imaging evaluation of cystic renal masses, to review benign and malignant etiologies of cystic renal masses, and to review current controversies and future directions in the management of these lesions. CONCLUSIONS Cystic renal masses are relatively common in daily practice. The Bosniak classification is a time-proven method for the imaging classification and management of these lesions. Knowledge of the pathognomonic features of certain benign Bosniak 2F/3 lesions is important to avoid surgery on these lesions (e.g., localized cystic disease, renal abscess). For traditionally surgical Bosniak lesions (Classes 3 and 4), there are evolving data that risk stratification based on patient demographics, imaging size, and appearance may allow for expanded management options including tailored surveillance or ablation, along with the traditional surgical approach.
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Affiliation(s)
- Nicole M Hindman
- Department of Radiology, NYU School of Medicine, 660 First Avenue, New York, NY, 10016, USA.
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Marconi L, Lam TB, Bex A, Ljungberg B, Volpe A. Reply to Jae Heon Kim's Letter to the Editor re: Lorenzo Marconi, Saeed Dabestani, Thomas B. Lam, et al. Systematic Review and Meta-analysis of Diagnostic Accuracy of Percutaneous Renal Tumour Biopsy. Eur Urol 2016;69:660-73. Eur Urol 2016; 70:e141-e142. [PMID: 27157996 DOI: 10.1016/j.eururo.2016.04.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Accepted: 04/20/2016] [Indexed: 11/24/2022]
Affiliation(s)
- Lorenzo Marconi
- Department of Urology, Coimbra University Hospital, Coimbra, Portugal.
| | - Thomas B Lam
- Academic Urology Unit, University of Aberdeen, Aberdeen
| | - Axel Bex
- Department of Urology, The Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Börje Ljungberg
- Department of Surgical and Perioperative Sciences, Urology and Andrology, Umeå University, Umeå, Sweden
| | - Alessandro Volpe
- Division of Urology, Maggiore della Carità Hospital, University of Eastern Piedmont, Novara, Italy
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60
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Kim JH. Re: Lorenzo Marconi, Saeed Dabestani, Thomas B. Lam, et al. Systematic Review and Meta-analysis of Diagnostic Accuracy of Percutaneous Renal Tumour Biopsy. Eur Urol 2016;69:660-73. Eur Urol 2016; 70:e139-e140. [PMID: 27157997 DOI: 10.1016/j.eururo.2016.04.027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2016] [Accepted: 04/20/2016] [Indexed: 10/21/2022]
Affiliation(s)
- Jae Heon Kim
- Department of Urology, Soonchunhyang University Hospital, Soonchunhyang University College of Medicine, Seoul, Korea.
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Siva S, Daniels CP, Ellis RJ, Ponsky L, Lo SS. Stereotactic ablative body radiotherapy for primary kidney cancer: what have we learned from prospective trials and what does the future hold? Future Oncol 2016; 12:601-6. [PMID: 26837548 DOI: 10.2217/fon.16.6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Affiliation(s)
- Shankar Siva
- Division of Radiation Oncology & Cancer Imaging, Peter MacCallum Cancer Centre, East Melbourne 3002, Australia.,Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville 8006, Australia
| | - Christopher P Daniels
- Division of Radiation Oncology & Cancer Imaging, Peter MacCallum Cancer Centre, East Melbourne 3002, Australia
| | - Rodney J Ellis
- Department of Radiation Oncology, University Hospitals Seidman Cancer Center, Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland, OH 44106, USA
| | - Lee Ponsky
- Department of Urology, University Hospitals Case Medical Center, Case Western Reserve University, Cleveland, OH 44106, USA
| | - Simon S Lo
- Department of Radiation Oncology, University Hospitals Seidman Cancer Center, Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland, OH 44106, USA
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Le J, Flusberg M, Rozenblit AM, Chernyak V. T1-hyperintense renal lesions: can high signal predict lack of enhancement? ACTA ACUST UNITED AC 2015; 40:3175-81. [DOI: 10.1007/s00261-015-0539-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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