101
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Abstract
Renal cell carcinoma (RCC) is the most common kidney cancer and includes several molecular and histological subtypes with different clinical characteristics. While survival rates are high if RCC is diagnosed when still confined to the kidney and treated definitively, there are no specific diagnostic screening tests available and symptoms are rare in early stages of the disease. Management of advanced RCC has changed significantly with the advent of targeted therapies, yet survival is usually increased by months due to acquired resistance to these therapies. DNA methylation, the covalent addition of a methyl group to a cytosine, is essential for normal development and transcriptional regulation, but becomes altered commonly in cancer. These alterations result in broad transcriptional changes, including in tumor suppressor genes. Because DNA methylation is one of the earliest molecular changes in cancer and is both widespread and stable, its role in cancer biology, including RCC, has been extensively studied. In this review, we examine the role of DNA methylation in RCC disease etiology and progression, the preclinical use of DNA methylation alterations as diagnostic, prognostic and predictive biomarkers, and the potential for DNA methylation-directed therapies.
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Affiliation(s)
- Brittany N Lasseigne
- HudsonAlpha Institute for Biotechnology, 601 Genome Way, Huntsville, AL, 35806-2908, USA.
| | - James D Brooks
- Department of Urology, Stanford University Medical Center, 300 Pasteur Drive, Stanford, CA, 94305-5118, USA
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102
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Stock KF, Kübler H, Holzapfel K. [Cystic renal masses as an incidental finding - ultrasound-based diagnostic algorithm and therapeutic consequences]. MMW Fortschr Med 2018; 159:60-65. [PMID: 28374361 DOI: 10.1007/s15006-017-9486-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Konrad Friedrich Stock
- Nephrologischer Ultraschall - Abteilung für Nephrologie, Klinikum rechts der Isar der TU München, Ismaninger Str. 22, D-81675, München, Deutschland.
| | - Hubert Kübler
- Klinik und Poliklinik für Urologie und Kinderurologie des Universitätsklinikums Würzburg, Würzburg, Deutschland
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103
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Prevalence of Solid Tumors in Incidentally Detected Homogeneous Renal Masses Measuring > 20 HU on Portal Venous Phase CT. AJR Am J Roentgenol 2018; 211:W173-W177. [PMID: 29995501 DOI: 10.2214/ajr.17.19351] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The purpose of this study was to determine the prevalence of solid tumors in incidental homogeneous renal masses with attenuation greater than 20 HU on portal venous phase CT images. MATERIALS AND METHODS In this retrospective study, the records of patients with incidental indeterminate (> 20 HU) homogeneous renal masses on portal venous phase CT scans from September 11, 2007, through March 18, 2017, were identified. Adult patients were included if they had undergone follow-up ultrasound, contrast-enhanced MRI, multiphase contrast-enhanced CT, or pathologic analysis alone to confirm the solid or cystic nature of the lesion. A single ROI was placed in the center of the mass, and lesions were characterized as ≥ 50% exophytic, < 50% exophytic, or entirely surrounded by renal parenchyma. RESULTS There were 322 masses in 267 patients. The mean lesion size was 16.6 (SD, 9.8) mm (range, 9-45 mm). Lesions were ≥ 50% exophytic in 92 cases, < 50% exophytic in 111 cases, and completely surrounded by renal parenchyma in 119 cases. All nonsolid lesions were characterized as benign cysts. The numbers of solid lesions per total number of lesions in each attenuation group were: 20-30 HU (0/140), 30-40 HU (0/67), 40-50 HU (1/38), 50-60 HU (3/24), 60-70 HU (5/17), 70-80 HU (5/17), and > 80 HU (8/19). All 207 lesions in the 20- to 40-HU range were benign cysts with no solid lesions (0%; 95% CI, 0.0-1.4%). CONCLUSION Small homogeneous renal masses measuring 20-40 HU on portal venous phase CT images are highly likely to be benign cysts.
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104
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O'Connor SD, Silverman SG, Cochon LR, Khorasani RK. Renal cancer at unenhanced CT: imaging features, detection rates, and outcomes. Abdom Radiol (NY) 2018; 43:1756-1763. [PMID: 29128991 DOI: 10.1007/s00261-017-1376-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
PURPOSE To describe and quantify the rate of detection of renal cancer on unenhanced CT. METHODS This retrospective, HIPAA-compliant study was approved by the Institutional Review Board. Electronic health records for all patients who underwent unenhanced abdominal CT at our institution between 2000 and 2005 were reviewed to identify patients subsequently diagnosed with renal cancer during a follow-up period of up to 12 years. Images were reviewed to determine if the cancer was visible at index (first) unenhanced CT and their findings recorded. Original radiology reports were reviewed to determine whether the renal cancer was reported; Fisher's Exact Test compared imaging features of detected and missed cancers. Clinical outcomes including time until diagnosis and stage at diagnosis were used to assess the potential impact of missed cancers. RESULTS Of 15,695 patients, 82 (0.52%) were diagnosed with renal cancer. Of these, 43/82 (52%) cancers were retrospectively detectable on index unenhanced CT. Among retrospectively detectable cancers, 63% (27/43) were originally detected and reported on index CT and 37% (16/43) were missed. Size was the only feature associated with detection; 83% (20/24) of cancers > 3.0 cm were detected versus 37% (7/19) of cancers ≤ 3.0 cm (p = 0.0036). Although none of the 16 missed renal cancers developed metastases between index CT and time of diagnosis (median 33.5 months), 4 (25%) progressed in stage. CONCLUSIONS Renal cancer was rare in patients undergoing unenhanced abdominal CT. Over one-third of potentially detectable cancers were missed prospectively. However, missed cancers did not metastasize and infrequently progressed in stage before being diagnosed.
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Affiliation(s)
- Stacy D O'Connor
- Center for Evidence-Based Imaging and Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA
- Medical College of Wisconsin, 9200 W. Wisconsin Avenue, Milwaukee, WI, 53226, USA
| | - Stuart G Silverman
- Center for Evidence-Based Imaging and Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA
| | - Laila R Cochon
- Center for Evidence-Based Imaging and Department of Radiology, Brigham and Women's Hospital, 20 Kent Street, 2nd Floor, Boston, MA, 02445, USA
| | - Ramin K Khorasani
- Center for Evidence-Based Imaging and Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA.
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105
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Abstract
The increase in serendipitous detection of solid renal masses on imaging has not resulted in a reduction in mortality from renal cell carcinoma. Consequently, efforts for improved lesion characterization have been pursued and incorporated into management algorithms for distinguishing clinically significant tumors from those with favorable histology or benign conditions. Although diagnostic imaging strategies have evolved for optimized lesion detection, distinction between benign tumors and both indolent and aggressive malignant neoplasms remain an important diagnostic challenge. Recent advances in cross-sectional imaging have expanded the role of these tests in the noninvasive characterization of solid renal tumors.
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Affiliation(s)
- Fernando U Kay
- Department of Radiology; UT Southwestern Medical Center, 2201 Inwood Road, Suite 210, Dallas, TX 75390, USA
| | - Ivan Pedrosa
- Department of Radiology; UT Southwestern Medical Center, 2201 Inwood Road, Suite 210, Dallas, TX 75390, USA.
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106
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Schabel C, Patel B, Harring S, Duvnjak P, Ramírez-Giraldo JC, Nikolaou K, Nelson RC, Farjat AE, Marin D. Renal Lesion Characterization with Spectral CT: Determining the Optimal Energy for Virtual Monoenergetic Reconstruction. Radiology 2018; 287:874-883. [DOI: 10.1148/radiol.2018171657] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Christoph Schabel
- From the Departments of Radiology (C.S., B.P., S.H., P.D., R.C.N., D.M.) and Biostatistics and Bioinformatics (A.E.F.), Duke University Medical Center, Box 3808 Erwin Rd, Durham, NC 27710; Department of Diagnostic and Interventional Radiology, University Hospital of Tuebingen, Tuebingen, Germany (C.S., K.N.); and Department of Computed Tomography, Siemens Medical Solutions USA, Malvern, Pa (J.C.R.)
| | - Bhavik Patel
- From the Departments of Radiology (C.S., B.P., S.H., P.D., R.C.N., D.M.) and Biostatistics and Bioinformatics (A.E.F.), Duke University Medical Center, Box 3808 Erwin Rd, Durham, NC 27710; Department of Diagnostic and Interventional Radiology, University Hospital of Tuebingen, Tuebingen, Germany (C.S., K.N.); and Department of Computed Tomography, Siemens Medical Solutions USA, Malvern, Pa (J.C.R.)
| | - Scott Harring
- From the Departments of Radiology (C.S., B.P., S.H., P.D., R.C.N., D.M.) and Biostatistics and Bioinformatics (A.E.F.), Duke University Medical Center, Box 3808 Erwin Rd, Durham, NC 27710; Department of Diagnostic and Interventional Radiology, University Hospital of Tuebingen, Tuebingen, Germany (C.S., K.N.); and Department of Computed Tomography, Siemens Medical Solutions USA, Malvern, Pa (J.C.R.)
| | - Petar Duvnjak
- From the Departments of Radiology (C.S., B.P., S.H., P.D., R.C.N., D.M.) and Biostatistics and Bioinformatics (A.E.F.), Duke University Medical Center, Box 3808 Erwin Rd, Durham, NC 27710; Department of Diagnostic and Interventional Radiology, University Hospital of Tuebingen, Tuebingen, Germany (C.S., K.N.); and Department of Computed Tomography, Siemens Medical Solutions USA, Malvern, Pa (J.C.R.)
| | - Juan Carlos Ramírez-Giraldo
- From the Departments of Radiology (C.S., B.P., S.H., P.D., R.C.N., D.M.) and Biostatistics and Bioinformatics (A.E.F.), Duke University Medical Center, Box 3808 Erwin Rd, Durham, NC 27710; Department of Diagnostic and Interventional Radiology, University Hospital of Tuebingen, Tuebingen, Germany (C.S., K.N.); and Department of Computed Tomography, Siemens Medical Solutions USA, Malvern, Pa (J.C.R.)
| | - Konstantin Nikolaou
- From the Departments of Radiology (C.S., B.P., S.H., P.D., R.C.N., D.M.) and Biostatistics and Bioinformatics (A.E.F.), Duke University Medical Center, Box 3808 Erwin Rd, Durham, NC 27710; Department of Diagnostic and Interventional Radiology, University Hospital of Tuebingen, Tuebingen, Germany (C.S., K.N.); and Department of Computed Tomography, Siemens Medical Solutions USA, Malvern, Pa (J.C.R.)
| | - Rendon C. Nelson
- From the Departments of Radiology (C.S., B.P., S.H., P.D., R.C.N., D.M.) and Biostatistics and Bioinformatics (A.E.F.), Duke University Medical Center, Box 3808 Erwin Rd, Durham, NC 27710; Department of Diagnostic and Interventional Radiology, University Hospital of Tuebingen, Tuebingen, Germany (C.S., K.N.); and Department of Computed Tomography, Siemens Medical Solutions USA, Malvern, Pa (J.C.R.)
| | - Alfredo E. Farjat
- From the Departments of Radiology (C.S., B.P., S.H., P.D., R.C.N., D.M.) and Biostatistics and Bioinformatics (A.E.F.), Duke University Medical Center, Box 3808 Erwin Rd, Durham, NC 27710; Department of Diagnostic and Interventional Radiology, University Hospital of Tuebingen, Tuebingen, Germany (C.S., K.N.); and Department of Computed Tomography, Siemens Medical Solutions USA, Malvern, Pa (J.C.R.)
| | - Daniele Marin
- From the Departments of Radiology (C.S., B.P., S.H., P.D., R.C.N., D.M.) and Biostatistics and Bioinformatics (A.E.F.), Duke University Medical Center, Box 3808 Erwin Rd, Durham, NC 27710; Department of Diagnostic and Interventional Radiology, University Hospital of Tuebingen, Tuebingen, Germany (C.S., K.N.); and Department of Computed Tomography, Siemens Medical Solutions USA, Malvern, Pa (J.C.R.)
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107
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Optimization of Scan and Reconstruction Parameters for Renal Artery CT Angiography with Iterative Reconstruction at Low kVp Compared with Filtered Back Projection at 120 kVp Acquisition. IRANIAN JOURNAL OF RADIOLOGY 2018. [DOI: 10.5812/iranjradiol.14860] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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108
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Scharitzer M, Tamandl D, Ba-Ssalamah A. [Incidental findings of the kidneys, adrenal glands, adnexa uteri, gastrointestinal tract, mesentery and lymph nodes : Assessment and management recommendations]. Radiologe 2018; 57:279-285. [PMID: 28283731 DOI: 10.1007/s00117-017-0236-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
CLINICAL ISSUE Besides the upper abdominal parenchymal organs, the increasing application of cross-sectional imaging has also led to a rising number of incidental findings in the kidneys, adrenal glands, adnexa uteri, the gastrointestinal tract, mesentery and abdominal lymph nodes. STANDARD RADIOLOGICAL METHODS Abdominal computed tomography investigations often show unexpected findings without any correlating symptoms. The growing clinical relevance is due to the large number of incidental findings as well as an increasing awareness of ethical and socioeconomic factors. ACHIEVEMENTS When interpreting radiological findings not only morphological criteria but also individual risk factors of the patient and the clinical context are of great importance. PRACTICAL RECOMMENDATIONS The aims of this article are the description and evaluation of frequent incidental findings detected by computed tomography and to provide information about management recommendations.
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Affiliation(s)
- M Scharitzer
- Universitätsklinik für Radiologie und Nuklearmedizin, Medizinische Universität Wien, Währinger Gürtel 18-20, 1090, Wien, Österreich.
| | - D Tamandl
- Universitätsklinik für Radiologie und Nuklearmedizin, Medizinische Universität Wien, Währinger Gürtel 18-20, 1090, Wien, Österreich
| | - A Ba-Ssalamah
- Universitätsklinik für Radiologie und Nuklearmedizin, Medizinische Universität Wien, Währinger Gürtel 18-20, 1090, Wien, Österreich
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109
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Schieda N, Lim RS, McInnes MDF, Thomassin I, Renard-Penna R, Tavolaro S, Cornelis FH. Characterization of small (<4cm) solid renal masses by computed tomography and magnetic resonance imaging: Current evidence and further development. Diagn Interv Imaging 2018; 99:443-455. [PMID: 29606371 DOI: 10.1016/j.diii.2018.03.004] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Accepted: 03/07/2018] [Indexed: 12/15/2022]
Abstract
Diagnosis of renal cell carcinomas (RCC) subtypes on computed tomography (CT) and magnetic resonance imaging (MRI) is clinically important. There is increased evidence that confident imaging diagnosis is now possible while standardization of the protocols is still required. Fat-poor angiomyolipoma show homogeneously increased unenhanced attenuation, homogeneously low signal on T2-weighted MRI and apparent diffusion coefficient (ADC) map, may contain microscopic fat and are classically avidly enhancing. Papillary RCC are also typically hyperattenuating and of low signal on T2-weighted MRI and ADC map; however, their gradual progressive enhancement after intravenous administration of contrast material is a differentiating feature. Clear cell RCC are avidly enhancing and may show intracellular lipid; however, these tumors are heterogeneous and are of characteristically increased signal on T2-weighted MRI. Oncocytomas and chromophobe tumors (collectively oncocytic neoplasms) show intermediate imaging findings on CT and MRI and are the most difficult subtype to characterize accurately; however, both show intermediately increased signal on T2-weighted with more gradual enhancement compared to clear cell RCC. Chromophobe tumors tend to be more homogeneous compared to oncocytomas, which can be heterogeneous, but other described features (e.g. scar, segmental enhancement inversion) overlap considerably between tumors. Tumor grade is another important consideration in small solid renal masses with emerging studies on both CT and MRI suggesting that high grade tumors may be separated from lower grade disease based upon imaging features.
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Affiliation(s)
- N Schieda
- Department of Medical Imaging, The Ottawa Hospital, The University of Ottawa, Ottawa, ON, Canada
| | - R S Lim
- Department of Medical Imaging, The Ottawa Hospital, The University of Ottawa, Ottawa, ON, Canada
| | - M D F McInnes
- Department of Medical Imaging, The Ottawa Hospital, The University of Ottawa, Ottawa, ON, Canada
| | - I Thomassin
- Sorbonne Université, Institut des Sciences du Calcul et des Données, Department of Radiology, Tenon Hospital - HUEP - APHP, 4 rue de la Chine, 75020 Paris, France
| | - R Renard-Penna
- Sorbonne Université, Institut des Sciences du Calcul et des Données, Department of Radiology, Tenon Hospital - HUEP - APHP, 4 rue de la Chine, 75020 Paris, France
| | - S Tavolaro
- Sorbonne Université, Institut des Sciences du Calcul et des Données, Department of Radiology, Tenon Hospital - HUEP - APHP, 4 rue de la Chine, 75020 Paris, France
| | - F H Cornelis
- Sorbonne Université, Institut des Sciences du Calcul et des Données, Department of Radiology, Tenon Hospital - HUEP - APHP, 4 rue de la Chine, 75020 Paris, France.
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110
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Energy-Specific Optimization of Attenuation Thresholds for Low-Energy Virtual Monoenergetic Images in Renal Lesion Evaluation. AJR Am J Roentgenol 2018; 210:W205-W217. [PMID: 29547057 DOI: 10.2214/ajr.17.18641] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
OBJECTIVE The purpose of this study was to determine in vitro and in vivo the optimal threshold for renal lesion vascularity at low-energy (40-60 keV) virtual monoenergetic imaging. MATERIALS AND METHODS A rod simulating unenhanced renal parenchymal attenuation (35 HU) was fitted with a syringe containing water. Three iodinated solutions (0.38, 0.57, and 0.76 mg I/mL) were inserted into another rod that simulated enhanced renal parenchyma (180 HU). Rods were inserted into cylindric phantoms of three different body sizes and scanned with single- and dual-energy MDCT. In addition, 102 patients (32 men, 70 women; mean age, 66.8 ± 12.9 [SD] years) with 112 renal lesions (67 nonvascular, 45 vascular) measuring 1.1-8.9 cm underwent single-energy unenhanced and contrast-enhanced dual-energy CT. Optimal threshold attenuation values that differentiated vascular from nonvascular lesions at 40-60 keV were determined. RESULTS Mean optimal threshold values were 30.2 ± 3.6 (standard error), 20.9 ± 1.3, and 16.1 ± 1.0 HU in the phantom, and 35.9 ± 3.6, 25.4 ± 1.8, and 17.8 ± 1.8 HU in the patients at 40, 50, and 60 keV. Sensitivity and specificity for the thresholds did not change significantly between low-energy and 70-keV virtual monoenergetic imaging (sensitivity, 87-98%; specificity, 90-91%). The AUC from 40 to 70 keV was 0.96 (95% CI, 0.93-0.99) to 0.98 (95% CI, 0.95-1.00). CONCLUSION Low-energy virtual monoenergetic imaging at energy-specific optimized attenuation thresholds can be used for reliable characterization of renal lesions.
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111
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Kim YH, Han K, Oh YT, Jung DC, Cho NH, Park SY. Morphologic analysis with computed tomography may help differentiate fat-poor angiomyolipoma from renal cell carcinoma: a retrospective study with 602 patients. Abdom Radiol (NY) 2018; 43:647-654. [PMID: 28677004 DOI: 10.1007/s00261-017-1244-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
PURPOSE To assess whether morphologic analysis using computed tomography (CT) could differentiate between fat-poor angiomyolipoma (fpAML) and renal cell carcinoma (RCC). METHODS A total of 602 patients with a histologically confirmed fpAML (n = 49) or RCC (n = 553) were evaluated. All renal lesions were less than 4 cm in size and had no gross fat on contrast-enhanced CT. For morphologic analysis, overflowing beer sign and angular interface were evaluated. Overflowing beer sign was defined as contact length between bulging-out portion of a mass and the adjacent renal capsule of 3 mm or greater. Angular interface was defined as the angle of parenchymal portion of a mass of 90° or less. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy were assessed. Multivariate analysis was conducted to determine which variable is predictive of fpAML. RESULTS Sensitivity, specificity, PPV, NPV, and accuracy were 61.2% (30/49), 97.1% (537/553), 65.2% (30/46), 96.6% (537/556), and 94.2% (567/602) with overflowing beer sign, while they were 55.1% (27/49), 81.9% (453/553), 21.3% (27/127), 95.4% (453/475), and 79.7% (480/602) with angular interface for fpAML, respectively. Both CT variables were predictive of fpAML (overflowing beer sign, odds ratio = 132.881, p < 0.001; angular interface, odds ratio = 5.766, p = 0.010). The multivariate model with CT variables showed good performance for predicting fpAML (AUC, 0.871 with angular interface, 0.943 with overflowing beer sign, and 0.949 with both). CONCLUSION Morphologic analysis with contrast-enhanced CT may be useful for differentiating fpAML from RCC. Overflowing beer sign has the potential as an imaging biomarker for fpAML.
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Affiliation(s)
- Yong Hee Kim
- Department of Radiology, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, 120-752, Republic of Korea
| | - Kyunghwa Han
- Department of Radiology, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, 120-752, Republic of Korea
| | - Young Taik Oh
- Department of Radiology, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, 120-752, Republic of Korea
| | - Dae Chul Jung
- Department of Radiology, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, 120-752, Republic of Korea
| | - Nam Hoon Cho
- Department of Pathology, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Sung Yoon Park
- Department of Radiology, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, 120-752, Republic of Korea.
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112
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Solid Small Renal Mass Without Gross Fat: CT Criteria for Achieving Excellent Positive Predictive Value for Renal Cell Carcinoma. AJR Am J Roentgenol 2018; 210:W148-W155. [PMID: 29470157 DOI: 10.2214/ajr.17.18421] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
OBJECTIVE The purpose of this study was to evaluate CT criteria for achieving high positive predictive value (PPV) for renal cell carcinoma (RCC) in patients with solid small renal masses (SRMs) less than 4 cm without macroscopic fat. MATERIALS AND METHODS One hundred fifty consecutive patients with a solid SRM without macroscopic fat (mean size ± SD, 2.5 ± 0.8 cm) who underwent CT including unenhanced, corticomedullary (CMP), and nephrographic phases (NP) were evaluated. Pathologically proven solid SRMs without macroscopic fat were classified into RCC (n = 131) and not RCC (n = 19). A "persistent low" sign was defined as a focal area or areas of low attenuation seen at the same location within the lesion on both CMP and NP imaging. Calcification, shape, and lesion attenuation on unenhanced CT were analyzed by two independent readers. RESULTS PPV of CT criteria (calcification [criterion 1] or spherical shape, lower or equal attenuation, and persistent low sign [criterion 2]) for RCC was 98.3% (58/59) for reader 1 and 100% (53/53) for reader 2. Weighted kappa of interreader agreement was 1.000 for calcification, 0.966 of lower or equal attenuation, 0.834 for spherical shape, 0.823 for persistent low sign, and 0.829 for CT criteria. CONCLUSION Interpretation of CT allowed reproducible and excellent PPV for RCC. Current CT criteria may effectively shorten the management process for solid SRMs without macroscopic fat by reducing unnecessary biopsy for a substantial number of RCCs showing typical CT findings.
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113
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Hu EM, Ellis JH, Silverman SG, Cohan RH, Caoili EM, Davenport MS. Expanding the Definition of a Benign Renal Cyst on Contrast-enhanced CT: Can Incidental Homogeneous Renal Masses Measuring 21-39 HU be Safely Ignored? Acad Radiol 2018; 25:209-212. [PMID: 29174191 DOI: 10.1016/j.acra.2017.09.021] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Revised: 09/27/2017] [Accepted: 09/27/2017] [Indexed: 11/30/2022]
Abstract
RATIONALE AND OBJECTIVE We aimed to determine the frequency and clinical significance of homogeneous renal masses measuring 21-39 Hounsfield units on contrast-enhanced computed tomography (CT). METHODS Subjects 40-69 years old undergoing portal-venous-phase contrast-enhanced abdominal CT from January 1, 2006 to December 31, 2010 with slice thickness ≤5 mm and no prior CT or magnetic resonance imaging were identified (n = 1387) for this institutional review board-approved retrospective cohort study. Images were manually reviewed by three radiologists in consensus to identify all circumscribed homogeneous renal masses (maximum of three per subject) ≥10 mm with a measured attenuation of 21-39 Hounsfield units. Exclusion criteria were known renal cancer or imaging performed for a renal indication. The primary outcome was retrospective characterization as a clinically significant mass, defined as a solid mass, a Bosniak IIF/III/IV mass, or extirpative therapy or metastatic renal cancer within 5 years' follow-up. RESULTS Eligible masses (n = 74) were found in 5% (63/1387) of subjects. Of those with a reference standard (n = 42), none (0% [95% CI: 0.0%-8.4%]) were determined to be clinically significant. CONCLUSION Incidental renal masses on contrast-enhanced CT that are homogeneous and display an attenuation of 21-39 Hounsfield units are uncommon in patients 40-69 years of age, unlikely to be clinically significant, and may not need further imaging evaluation. If these results can be replicated in an independent and larger population, the practical definition of a benign cyst on imaging may be able to be expanded.
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Affiliation(s)
- Eric M Hu
- Department of Radiology, University of Michigan Health System, 1500 E. Medical Center Dr B2-A209P, Ann Arbor, MI 48109; Michigan Radiology Quality Collaborative, Ann Arbor, Michigan
| | - James H Ellis
- Department of Radiology, University of Michigan Health System, 1500 E. Medical Center Dr B2-A209P, Ann Arbor, MI 48109; Department of Urology, University of Michigan Health System, Ann Arbor, Michigan
| | | | - Richard H Cohan
- Department of Radiology, University of Michigan Health System, 1500 E. Medical Center Dr B2-A209P, Ann Arbor, MI 48109
| | - Elaine M Caoili
- Department of Radiology, University of Michigan Health System, 1500 E. Medical Center Dr B2-A209P, Ann Arbor, MI 48109
| | - Matthew S Davenport
- Department of Radiology, University of Michigan Health System, 1500 E. Medical Center Dr B2-A209P, Ann Arbor, MI 48109; Michigan Radiology Quality Collaborative, Ann Arbor, Michigan; Department of Urology, University of Michigan Health System, Ann Arbor, Michigan.
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114
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Contrast-enhanced ultrasound of the kidney: a single-institution experience. Ir J Med Sci 2017; 187:795-802. [PMID: 29218489 DOI: 10.1007/s11845-017-1725-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2017] [Accepted: 11/29/2017] [Indexed: 12/17/2022]
Abstract
BACKGROUND Focal renal masses are typically evaluated by means of triphasic contrast-enhanced CT or MRI scan but use of iodinated contrast or gadolinium is unsuitable for some patients. Contrast-enhanced ultrasound (CEUS) is an imaging alternative in this scenario but has limited availability in Ireland. AIM The aim of the study was to retrospectively evaluate experience with selective use of CEUS for non-invasive characterization of focal renal masses in a tertiary referral institution in Ireland, with a particular focus on cystic renal lesions and the influence of CEUS on final Bosniak classification and treatment outcomes. METHODS All cases of renal CEUS between 2009 and 2017 were identified. Imaging history, patient records, histopathology reports, urology conference notes, clinical follow-up details, details of lesion progression or stability on surveillance, biopsy and/or resection details and pre- and post-CEUS Bosniak scores were recorded. RESULTS Thirty-one patients underwent renal CEUS (7 solid renal lesions, 21 cystic renal lesions and 3 'indeterminate' renal lesions). After CEUS, the CEUS-modified Bosniak score was upgraded in nine patients and downgraded in two patients. All three lesions upgraded from Bosniak III to IV were renal cell carcinomas. One of two lesions downgraded from Bosniak IV to III was resected (cystic nephroma) and the other showed no progression after 19 months of surveillance. CONCLUSION CEUS is a valuable alternative to CT in assessing complex cystic or solid renal lesions where iodinated CT contrast or gadolinium is inappropriate. CEUS can also refine the Bosniak category of atypical cystic renal lesions and help facilitate treatment decisions.
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Malignancy Rate, Histologic Grade, and Progression of Bosniak Category III and IV Complex Renal Cystic Lesions. AJR Am J Roentgenol 2017; 209:1285-1290. [DOI: 10.2214/ajr.17.18142] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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116
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Punjabi GV. Multi-energy spectral CT: adding value in emergency body imaging. Emerg Radiol 2017; 25:197-204. [PMID: 29185082 DOI: 10.1007/s10140-017-1569-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2017] [Accepted: 11/20/2017] [Indexed: 12/21/2022]
Abstract
Most vendors offer scanners capable of dual- or multi-energy computed tomography (CT) imaging. Advantages of multi-energy CT scanning include superior tissue characterization, detection of subtle iodine uptake differences, and opportunities to reduce contrast dose. However, utilization of this technology in the emergency department (ED) remains low. The purpose of this pictorial essay is to illustrate the value of multi-energy CT scanning in emergency body imaging.
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Affiliation(s)
- Gopal V Punjabi
- Hennepin County Medical Center, 701, Park Ave, Minneapolis, MN, 55455, USA.
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Park BK. Reply: Can Angiomyolipomas be classified fully into three types? Eur J Radiol 2017; 96:117-118. [PMID: 28969873 DOI: 10.1016/j.ejrad.2017.09.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2017] [Accepted: 09/22/2017] [Indexed: 12/26/2022]
Affiliation(s)
- Byung Kwan Park
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
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Recent Strategies for the Management of Renal Angiomyolipoma: A Review of Diagnostic and Therapeutic Approaches. Nephrourol Mon 2017. [DOI: 10.5812/numonthly.14251] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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119
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Characterization of Small (< 4 cm) Focal Renal Lesions: Diagnostic Accuracy of Spectral Analysis Using Single-Phase Contrast-Enhanced Dual-Energy CT. AJR Am J Roentgenol 2017; 209:815-825. [DOI: 10.2214/ajr.17.17824] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
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Destefani MH, Elias J, Serra Negra Trazzi AM, Kajiwara PP, Ferreira de Menezes A, Borges Dos Reis R, Muglia VF. Minimally Complex Renal Cysts: Outcomes and Ultrasound Evaluation Compared with Contrast-Enhanced Cross-Sectional Imaging Bosniak Classification. ULTRASOUND IN MEDICINE & BIOLOGY 2017; 43:2167-2173. [PMID: 28755789 DOI: 10.1016/j.ultrasmedbio.2017.06.028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/17/2017] [Revised: 06/12/2017] [Accepted: 06/23/2017] [Indexed: 06/07/2023]
Abstract
We correlated contrast-enhanced cross-sectional imaging and outcomes to assess the reproducibility of ultrasonographic criteria for renal minimally complex (MC) cysts. From 2003 to 2015, 143 cysts were described as complex or MC by ultrasound (US). After exclusions, 98 US studies were retrospectively evaluated and compared with computed tomography (CT)/magnetic resonance imaging (MRI). At sonography, 51 were MC cysts and 47 were complexes according to two independent observers. Inter-observer agreement for US was 0.704 and 0.745 for CT/MRI. Of 51 cysts classified as MC by US, 38 were Bosniak I/II and 6 were Bosniak IIF by CT/MRI. In 7, there were no cross-sectional images; however, they were stable for at least 2 y. Of 47 complex cysts, 9 were Bosniak II, 22 Bosniak IIF, 8 Bosniak III and 8 Bosniak IV. No Bosniak III/IV cysts by CT/MRI were classified as MC by US. Our results indicate that US offers reproducible criteria for MC cysts and may be used alone for these lesions.
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Affiliation(s)
- Marilia Henrique Destefani
- Internal Medicine Department, Imaging Center, Ribeirao Preto School Medicine, University of Sao Paulo, Sao Paulo, Brazil
| | - Jorge Elias
- Internal Medicine Department, Imaging Center, Ribeirao Preto School Medicine, University of Sao Paulo, Sao Paulo, Brazil
| | | | - Plinio Prizon Kajiwara
- Internal Medicine Department, Imaging Center, Ribeirao Preto School Medicine, University of Sao Paulo, Sao Paulo, Brazil
| | - Aila Ferreira de Menezes
- Internal Medicine Department, Imaging Center, Ribeirao Preto School Medicine, University of Sao Paulo, Sao Paulo, Brazil
| | - Rodolfo Borges Dos Reis
- Department of Surgery and Anatomy, Urology Division, Ribeirao Preto School Medicine, University of Sao Paulo, Ribeirao Preto, Brazil
| | - Valdair Francisco Muglia
- Internal Medicine Department, Imaging Center, Ribeirao Preto School Medicine, University of Sao Paulo, Sao Paulo, Brazil; Department of Surgery and Anatomy, Urology Division, Ribeirao Preto School Medicine, University of Sao Paulo, Ribeirao Preto, Brazil.
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Kurban LAS, Vosough A, Jacob P, Prasad D, Lam T, Scott N, Somani BK. Pathological nature of renal tumors - does size matter? Urol Ann 2017; 9:330-334. [PMID: 29118533 PMCID: PMC5656956 DOI: 10.4103/ua.ua_17_17] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Accepted: 06/08/2017] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION We examined the relationship between the size and nature of renal masses in term of malignant potential, histological grading, pathological staging and presence of necrosis and sarcomatoid changes. MATERIALS AND METHODS Retrospectively, we reviewed 323 consecutive nephrectomies between 2000 and 2010. Final pathology was correlated with tumour size. The renal tumours were stratified into three groups according to the largest diameter, defined as 4 cm or smaller, greater than 4 cm to 7 cm, and greater than 7 cm. We recorded the proportion of benign tumours, tumour grade and stage, presence of necrosis and sarcomatoid change. RESULTS Small renal masses ≤4 cm (SRMs) were more likely to be localised to the kidney (90%) and of lower histological grade (75%). The proportion of benign tumours in SRMs (15%) was higher than other two groups with the majority of benign tumours being oncocytomas. There was a statistically significant trend with greater necrosis and sarcomatoid change for the large size group. CONCLUSIONS SRMs are likely to be low grade and organ confined with little or no adverse pathological features. There is increased likelihood of benignity in SRTs with the majority of benign tumours being oncocytomas.
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Affiliation(s)
- Lutfi Ali S. Kurban
- Department of Radiology, Clinical Imaging Insitute, Al Ain Hospital, Al Ain, Abu Dhabi, UAE
| | | | - Preman Jacob
- Department of Interventional Radiology, St. Paul's Hospital, Saskatoon, SK, Canada
| | - Deepak Prasad
- Department of Radiology, PRP Diagnsotic Imaging Limited Bathurst, 2795 New South Wales, Australia
| | - Thomas Lam
- Department of Academic Urology, Division of Applied Health Sciences, University of Aberdeen, Aberdeen, AB25 2ZD, UK
| | - Neil Scott
- Department of Medical Statistics, Division of Applied Health Sciences, University of Aberdeen, Aberdeen, AB25 2ZD, UK
| | - Bhaskar K. Somani
- Department of Urology, University Hospital Southampton NHS Trust, Southampton SO16 6YD, UK
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Marino MA, Silipigni S, Barbaro U, Mazziotti S, Sofia C, Mazzei MA, Ascenti G. Dual Energy CT Scanning in Evaluation of the Urinary Tract. CURRENT RADIOLOGY REPORTS 2017. [DOI: 10.1007/s40134-017-0243-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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123
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Abstract
The increasing use of cross-sectional imaging has led to an increase in the diagnosis of incidental small renal masses (SRMs). About 20% of such masses are benign, while a significant proportion of malignant SRMs demonstrate slow growth kinetics and non-aggressive histologic features. Given these characteristics, lesions that were traditionally treated surgically are increasingly managed with less aggressive approaches. Further contributing to the evolving management paradigm is accumulating evidence supporting the safety of active surveillance and the efficacy of percutaneous renal mass biopsy in guiding management decisions. This review first discusses the epidemiology and diagnostic work-up of SRMs. The available management options are then examined, with emphasis placed on the clinical factors considered in selecting an appropriate approach. The existing evidence and long-term outcomes of each strategy are discussed. Finally, an overview of the current paradigm for the management of a patient with a SRM is provided. The goal is to provide physicians with the necessary understanding to appropriately manage this increasingly common condition.
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Affiliation(s)
- Nima Almassi
- Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, USA.,Lerner College of Medicine, Education Institute, Cleveland Clinic, Cleveland, USA
| | - Bradley C Gill
- Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, USA.,Lerner College of Medicine, Education Institute, Cleveland Clinic, Cleveland, USA
| | - Brian Rini
- Lerner College of Medicine, Education Institute, Cleveland Clinic, Cleveland, USA.,Department of Hematology and Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, USA
| | - Khaled Fareed
- Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, USA.,Lerner College of Medicine, Education Institute, Cleveland Clinic, Cleveland, USA
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Buj Pradilla MJ, Martí Ballesté T, Torra R, Villacampa Aubá F. Recommendations for imaging-based diagnosis and management of renal angiomyolipoma associated with tuberous sclerosis complex. Clin Kidney J 2017; 10:728-737. [PMID: 29225800 PMCID: PMC5716090 DOI: 10.1093/ckj/sfx094] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Accepted: 07/16/2017] [Indexed: 01/12/2023] Open
Abstract
Renal angiomyolipomas are found in up to 80% of tuberous sclerosis complex (TSC) patients. Although these tumours are usually asymptomatic, lesions >3 cm in diameter are prone to bleeding and up to 10% of TSC patients may experience a massive and potentially fatal retroperitoneal haemorrhage. Diagnosis can be complicated because of the initial lack of symptoms and the fat-poor content of atypical renal angiomyolipomas. After diagnosis, tumour growth and the emergence of new tumours must be monitored. Treatment with mammalian target of rapamycin (mTOR) inhibitors can reduce tumour size and is indicated in patients with TSC-associated renal angiomyolipomas >3 cm in diameter. Imaging-based assessment of kidney disease is essential to the diagnosis and management of patients with TSC. The aims of imaging studies in this context are to detect and characterize tumours, assess and detect the risk of complications and evaluate the response to treatment, especially in patients treated with mTOR inhibitors. A multidisciplinary expert panel developed a series of recommendations based on current evidence and professional experience for imaging studies in adults and children with TSC-associated renal angiomyolipoma. The recommendations cover radiological diagnosis and follow-up of the classic and atypical or fat-poor TSC-associated renal angiomyolipomas, biopsy indications, minimal requirements for radiological requests and reports and recommended technical features and protocols for computed tomography and magnetic resonance imaging.
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Affiliation(s)
| | | | - Roser Torra
- Inherited Renal Diseases, Department of Nephrology, Fundació Puigvert, REDINREN, IIB Sant Pau, Universitat Autónoma de Barcelona, Spain
| | - Felipe Villacampa Aubá
- Department of Urology, University Hospital 12 de Octubre, Madrid, Spain.,Centro de investigación Biomédica en Red de Cáncer CIBERONC
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125
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Renal cell carcinoma attenuation values on unenhanced CT: importance of multiple, small region-of-interest measurements. Abdom Radiol (NY) 2017; 42:2325-2333. [PMID: 28389785 DOI: 10.1007/s00261-017-1131-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVE Since it has been suggested that benign renal cysts can be diagnosed at unenhanced CT on the basis of homogeneity and attenuations of 20 HU or less, we determined the prevalence of renal cell carcinomas (RCCs) with these characteristics using two different methods of measuring attenuation. MATERIALS AND METHODS After IRB approval, two radiologists obtained unenhanced attenuation values of 104 RCCs (mean size 5.6 cm) using a single, large region of interest (ROI), two-thirds the size of the mass. They were then determined if the masses appeared heterogeneous. Of RCCs measuring 20 HU or less, those which appeared homogeneous were re-measured with multiple (6 or more), small (0.6 cm2 or smaller) ROIs dispersed throughout the lesion. Masses with attenuations 20 HU or less were compared to those with masses with HU greater than 20 for any differences in demographic data. RESULTS Of 104 RCCS, 24 RCC had HU less than 20 using a large ROI. Of these, 21 appeared heterogeneous and 3 appeared homogeneous. Using multiple small ROIs, these three RCCs revealed maximum attenuation values above 20 HU (Range: 26-32 HU). A greater portion of RCCs measuring 20 HU or less using a large ROI were clear cell sub-type. There were no other differences. CONCLUSIONS Renal cell carcinoma can measure 20 HU or less at unenhanced CT when a single large ROI is used. While most appear heterogeneous, some may appear homogeneous, but will likely reveal attenuations greater than 20 HU when multiple, small ROIs are used. This knowledge may prevent some RCCs from being misdiagnosed as cysts on unenhanced CT.
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126
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Bieniek JM, Juvet T, Margolis M, Grober ED, Lo KC, Jarvi KA. Prevalence and Management of Incidental Small Testicular Masses Discovered on Ultrasonographic Evaluation of Male Infertility. J Urol 2017; 199:481-486. [PMID: 28789946 DOI: 10.1016/j.juro.2017.08.004] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/01/2017] [Indexed: 11/28/2022]
Abstract
PURPOSE We report the safety of surveillance of small testicular masses incidentally discovered during evaluation of male infertility. MATERIALS AND METHODS We retrospectively reviewed a prospectively collected database to identify patients with male infertility found to have incidental small testicular masses (hypoechoic lesions less than 10 mm) on scrotal ultrasound. The men were offered close surveillance with interval imaging and office followup. Patient and imaging characteristics were collected to compare the surveillance and surgical groups with additional comparisons between benign and malignant pathologies to elucidate predictors of underlying malignancy. RESULTS Of 4,088 men in whom scrotal ultrasound was completed for male infertility evaluation 120 (2.9%) were found to have a subcentimeter testicular mass. Average followup was 1.30 years (range 0.1 to 16.9). A total of 18 men (15%) proceeded to extirpative surgery while 102 remained on surveillance at last followup. In those with at least 1 month of followup the mean lesion growth rate was -0.01 mm per year. Reasons for surgery included testicular exploration for infertility, mass growth, positive tumor markers, history of testis cancer, concerning imaging characteristics and patient choice. Six of the 18 men who underwent surgery were found to have malignancy, which was seminoma in all. All malignant lesions were greater than 5 mm on initial imaging and demonstrated vascularity, although size and vascularity were not significantly different from those of benign lesions on final pathology findings. No patients demonstrated advanced or recurrent disease. CONCLUSIONS Small testicular masses are not uncommon, especially in the infertile male population. Most of these masses do not show significant growth during long-term evaluation and can be safely surveilled with close followup.
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Affiliation(s)
- Jared M Bieniek
- Department of Urology, Hartford Hospital, Hartford, Connecticut.
| | - Tristan Juvet
- Division of Urology, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Myles Margolis
- Department of Radiology, University of Toronto, Toronto, Ontario, Canada
| | - Ethan D Grober
- Division of Urology, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Kirk C Lo
- Division of Urology, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Keith A Jarvi
- Division of Urology, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
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Lim RS, Flood TA, McInnes MDF, Lavallee LT, Schieda N. Renal angiomyolipoma without visible fat: Can we make the diagnosis using CT and MRI? Eur Radiol 2017; 28:542-553. [PMID: 28779401 DOI: 10.1007/s00330-017-4988-4] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Revised: 04/22/2017] [Accepted: 07/11/2017] [Indexed: 12/12/2022]
Abstract
Renal angiomyolipomas without visible fat (AML.wovf) are benign masses that are incidentally discovered mainly in women. AML.wovf are typically homogeneously hyperdense on unenhanced CT without calcification or haemorrhage. Unenhanced CT pixel analysis is not useful for diagnosis. AML.wovf are characteristically homogeneously hypointense on T2-weighted (T2W)-MRI and apparent diffusion coefficient (ADC) maps. Despite early reports, only a minority of AML.wovf show signal intensity drop on chemical-shift MRI due to microscopic fat. AML.wovf most commonly show avid early enhancement with washout kinetics at contrast-enhanced CT and MRI. The combination of homogeneously low T2W and/or ADC signal intensity with avid early enhancement and washout is highly accurate for diagnosis of AML.wovf. KEY POINTS • AML.wovf are small incidental benign renal masses occurring mainly in women. • AML.wovf are homogeneously hyperdense with low signal on T2W-MRI and ADC map. • AML.wovf typically show avid early enhancement with washout kinetics. • Combining features on CT/MRI is accurate for diagnosis of AML.wovf.
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Affiliation(s)
- Robert S Lim
- Department of Medical Imaging, The Ottawa Hospital, The University of Ottawa, Ottawa, Ontario, Canada
| | - Trevor A Flood
- Department of Anatomical Pathology, The Ottawa Hospital, The University of Ottawa, Ottawa, Ontario, Canada
| | - Matthew D F McInnes
- Department of Medical Imaging, The Ottawa Hospital, The University of Ottawa, Ottawa, Ontario, Canada
| | - Luke T Lavallee
- Department of Surgery, Division of Urology, The Ottawa Hospital, The University of Ottawa, Ottawa, Ontario, Canada
| | - Nicola Schieda
- Department of Medical Imaging, The Ottawa Hospital, The University of Ottawa, Ottawa, Ontario, Canada.
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Renal Angiomyolipoma: Radiologic Classification and Imaging Features According to the Amount of Fat. AJR Am J Roentgenol 2017; 209:826-835. [PMID: 28726505 DOI: 10.2214/ajr.17.17973] [Citation(s) in RCA: 65] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE The purposes of this article are to introduce the radiologic classifications of renal angiomyolipoma (AML) and the clinical implications, to show the imaging features of each type of AML, and to describe which types of AML should be biopsied. CONCLUSION Renal AML can be classified according to amount of fat as fat rich, fat poor, or fat invisible. To detect fat, one needs to thoroughly evaluate the entire AML by controlling the size and shape of the ROI. Fat-invisible AML should be biopsied, and fat-poor AML requires further investigation to determine whether biopsy is necessary to differentiate it from renal cell carcinoma. If differentiation between AML and renal cell carcinoma is not clear with CT and MRI, percutaneous biopsy may be performed.
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129
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Galia M, Albano D, Bruno A, Agrusa A, Romano G, Di Buono G, Agnello F, Salvaggio G, La Grutta L, Midiri M, Lagalla R. Imaging features of solid renal masses. Br J Radiol 2017; 90:20170077. [PMID: 28590813 DOI: 10.1259/bjr.20170077] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
The widespread use of abdominal imaging techniques has increased the detection of solid renal masses over the past years. Imaging plays a crucial role in the management and surveillance and in determining which lesions need treatment. The "classical angiomyolipoma" is the only benign solid renal mass that can be characterized with confidence by imaging through the detection of a fat-containing lesion without calcifications. There is a large overlap of imaging features between benign and malignant renal masses that often makes difficult a correct characterization of these lesions. In this review, we discuss the imaging features of the main solid renal masses that may suggest a likely benign diagnosis.
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Affiliation(s)
- Massimo Galia
- 1 Department of Radiology, DIBIMED, University of Palermo, Palermo, Italy
| | - Domenico Albano
- 1 Department of Radiology, DIBIMED, University of Palermo, Palermo, Italy
| | - Alberto Bruno
- 1 Department of Radiology, DIBIMED, University of Palermo, Palermo, Italy
| | - Antonino Agrusa
- 2 Department of General Surgery and Emergency, University of Palermo, Palermo, Italy
| | - Giorgio Romano
- 2 Department of General Surgery and Emergency, University of Palermo, Palermo, Italy
| | - Giuseppe Di Buono
- 2 Department of General Surgery and Emergency, University of Palermo, Palermo, Italy
| | - Francesco Agnello
- 1 Department of Radiology, DIBIMED, University of Palermo, Palermo, Italy
| | - Giuseppe Salvaggio
- 1 Department of Radiology, DIBIMED, University of Palermo, Palermo, Italy
| | - Ludovico La Grutta
- 1 Department of Radiology, DIBIMED, University of Palermo, Palermo, Italy
| | - Massimo Midiri
- 1 Department of Radiology, DIBIMED, University of Palermo, Palermo, Italy
| | - Roberto Lagalla
- 1 Department of Radiology, DIBIMED, University of Palermo, Palermo, Italy
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Active Surveillance of Nonfatty Renal Masses in Patients With Lymphangioleiomyomatosis: Use of CT Features and Patterns of Growth to Differentiate Angiomyolipoma From Renal Cancer. AJR Am J Roentgenol 2017; 209:611-619. [PMID: 28678574 DOI: 10.2214/ajr.16.17530] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
OBJECTIVE The objective of this study was to report our experience with active surveillance of nonfatty renal masses in a large cohort of patients with lymphangioleiomyomatosis (LAM), correlate their CT features and patterns of growth with histopathology results, and provide guidelines for management. SUBJECTS AND METHODS Yearly CT examinations were performed of 367 women (age range, 21-75 years; mean age, 47 years). For the 31 patients with 37 nonfatty renal masses that were biopsied, excised, or followed for ≥ 5 years, CT enhancement characteristics and patterns of growth were compared with the histopathology results. RESULTS Four of 37 nonfatty renal masses were biopsied without follow-up CT examinations: Two were heterogeneous renal cell carcinomas (RCCs), one was a heterogeneous nonfatty angiomyolipoma (AML), and one was homogeneous nonfatty AML. In the remaining 33 nonfatty renal masses with multiple follow-up CT examinations, two growth patterns were identified. Four showed a continuous increase in size of > 0.5 cm/y in some years, and all four in this first group were heterogeneous and were biopsy-proven RCC. The second group was composed of the remaining 29 masses. These 29 masses showed yearly no change, increase, or decrease in diameter. Eight were heterogeneous, and 21 were homogeneous. Of the masses showing a yearly increase, the increase was < 0.5 cm/y in all except one. In the one exception, the increase followed a decrease. Nine of the 29 masses were biopsied, and all nine were nonfatty renal masses (five homogeneous, four heterogeneous). CONCLUSION Our data provide further evidence in a large prospective study with longterm follow-up that active surveillance is an appropriate strategy in the management of nonfatty renal masses in patients with LAM. Our analysis of the growth patterns reveals duration of growth in addition to growth rate as criteria for biopsy or excision. Biopsy should be reserved for nonfatty renal masses that show sustained growth or growth > 0.5 cm/y during follow-up.
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Quantitative computer-aided diagnostic algorithm for automated detection of peak lesion attenuation in differentiating clear cell from papillary and chromophobe renal cell carcinoma, oncocytoma, and fat-poor angiomyolipoma on multiphasic multidetector computed tomography. Abdom Radiol (NY) 2017; 42:1919-1928. [PMID: 28280876 DOI: 10.1007/s00261-017-1095-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVE To evaluate the performance of a novel, quantitative computer-aided diagnostic (CAD) algorithm on four-phase multidetector computed tomography (MDCT) to detect peak lesion attenuation to enable differentiation of clear cell renal cell carcinoma (ccRCC) from chromophobe RCC (chRCC), papillary RCC (pRCC), oncocytoma, and fat-poor angiomyolipoma (fp-AML). MATERIALS AND METHODS We queried our clinical databases to obtain a cohort of histologically proven renal masses with preoperative MDCT with four phases [unenhanced (U), corticomedullary (CM), nephrographic (NP), and excretory (E)]. A whole lesion 3D contour was obtained in all four phases. The CAD algorithm determined a region of interest (ROI) of peak lesion attenuation within the 3D lesion contour. For comparison, a manual ROI was separately placed in the most enhancing portion of the lesion by visual inspection for a reference standard, and in uninvolved renal cortex. Relative lesion attenuation for both CAD and manual methods was obtained by normalizing the CAD peak lesion attenuation ROI (and the reference standard manually placed ROI) to uninvolved renal cortex with the formula [(peak lesion attenuation ROI - cortex ROI)/cortex ROI] × 100%. ROC analysis and area under the curve (AUC) were used to assess diagnostic performance. Bland-Altman analysis was used to compare peak ROI between CAD and manual method. RESULTS The study cohort comprised 200 patients with 200 unique renal masses: 106 (53%) ccRCC, 32 (16%) oncocytomas, 18 (9%) chRCCs, 34 (17%) pRCCs, and 10 (5%) fp-AMLs. In the CM phase, CAD-derived ROI enabled characterization of ccRCC from chRCC, pRCC, oncocytoma, and fp-AML with AUCs of 0.850 (95% CI 0.732-0.968), 0.959 (95% CI 0.930-0.989), 0.792 (95% CI 0.716-0.869), and 0.825 (95% CI 0.703-0.948), respectively. On Bland-Altman analysis, there was excellent agreement of CAD and manual methods with mean differences between 14 and 26 HU in each phase. CONCLUSION A novel, quantitative CAD algorithm enabled robust peak HU lesion detection and discrimination of ccRCC from other renal lesions with similar performance compared to the manual method.
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Extracolonic Findings at Screening CT Colonography: Prevalence, Benefits, Challenges, and Opportunities. AJR Am J Roentgenol 2017; 209:94-102. [DOI: 10.2214/ajr.17.17864] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Menezes MRD, Viana PCC, Yamanari TR, Arap MA, Reis LO, Nahas W. Safety and feasibility of radiofrequency ablation for treatment of Bosniak IV renal cysts. Int Braz J Urol 2017; 42:456-63. [PMID: 27286107 PMCID: PMC4920561 DOI: 10.1590/s1677-5538.ibju.2015.0444] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2015] [Accepted: 11/22/2015] [Indexed: 01/20/2023] Open
Abstract
Purpose To describe our initial experience with radiofrequency ablation (RFA) of Bosniak IV renal cysts. Materials and Methods From 2010 to 2014, 154 renal tumor cases were treated with percutaneous thermal ablation, of which 10 cases (6.4%) from nine patients were complex renal cysts and were treated with radiofrequency ablation. Results All complex cysts were classified as Bosniak IV (four women and five men; mean age: 63.6 yrs, range: 33–83 years). One patient had a single kidney. Lesion size ranged from 1.5 to 4.1cm (mean: 2.5cm) and biopsy was performed on four cysts immediately before the procedure, all of which were malignant (two clear cell and two papillary carcinoma). Mean volume reduction of complex cysts was 25% (range: 10–40%). No patients required retreatment with RFA and no immediate or late complications were observed. The follow-up of Bosniak IV cysts had a median of 27 months (interquartile range [IQR], 23 to 38) and no recurrence or significant loss of renal function were observed. Conclusions Mid-term follow-up of the cases in our database suggests that image-guided percutaneous RFA can treat Bosniak IV cysts with very low complication rates and satisfactorily maintain renal function.
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Affiliation(s)
- Marcos Roberto de Menezes
- Serviço de Intervenção Guiada de Radiologia e Imagem, Instituto do Câncer do Estado de São Paulo, Universidade de São Paulo, SP, Brasil.,Serviço de Intervenção Guiada de Radiologia e Imagem, Hospital Sírio Libanês, São Paulo, SP, Brasil
| | - Publio Cesar Cavalcante Viana
- Serviço de Intervenção Guiada de Radiologia e Imagem, Instituto do Câncer do Estado de São Paulo, Universidade de São Paulo, SP, Brasil.,Serviço de Intervenção Guiada de Radiologia e Imagem, Hospital Sírio Libanês, São Paulo, SP, Brasil
| | - Tassia Regina Yamanari
- Serviço de Intervenção Guiada de Radiologia e Imagem, Hospital Sírio Libanês, São Paulo, SP, Brasil
| | - Marco Antonio Arap
- Serviço de Intervenção Guiada de Radiologia e Imagem, Hospital Sírio Libanês, São Paulo, SP, Brasil.,Departamento de Urologia, Hospital das Clínicas da Faculdade de Medicina Universidade de São Paulo, SP, Brasil
| | - Leonardo Oliveira Reis
- Departamento de Urologia, Pontifícia Universidade Católica de Campinas, PUC - Campinas, Campinas, SP, Brasil
| | - William Nahas
- Departamento de Urologia, Hospital das Clínicas da Faculdade de Medicina Universidade de São Paulo, SP, Brasil
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134
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Tanaka H, Fujii Y, Tanaka H, Ishioka J, Matsuoka Y, Saito K, Uehara S, Numao N, Yuasa T, Yamamoto S, Masuda H, Yonese J, Kihara K. Stepwise algorithm using computed tomography and magnetic resonance imaging for diagnosis of fat-poor angiomyolipoma in small renal masses: Development and external validation. Int J Urol 2017; 24:511-517. [DOI: 10.1111/iju.13354] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Accepted: 03/16/2017] [Indexed: 11/26/2022]
Affiliation(s)
- Hajime Tanaka
- Department of Urology; Tokyo Medical and Dental University; Tokyo Japan
| | - Yasuhisa Fujii
- Department of Urology; Tokyo Medical and Dental University; Tokyo Japan
| | - Hiroshi Tanaka
- Department of Radiology; Ochanomizu Surugadai Clinic; Tokyo Japan
| | - Junichiro Ishioka
- Department of Urology; Tokyo Medical and Dental University; Tokyo Japan
| | - Yoh Matsuoka
- Department of Urology; Tokyo Medical and Dental University; Tokyo Japan
| | - Kazutaka Saito
- Department of Urology; Tokyo Medical and Dental University; Tokyo Japan
| | - Sho Uehara
- Department of Urology; Cancer Institute Hospital; Japanese Foundation for Cancer Research; Tokyo Japan
| | - Noboru Numao
- Department of Urology; Cancer Institute Hospital; Japanese Foundation for Cancer Research; Tokyo Japan
| | - Takeshi Yuasa
- Department of Urology; Cancer Institute Hospital; Japanese Foundation for Cancer Research; Tokyo Japan
| | - Shinya Yamamoto
- Department of Urology; Cancer Institute Hospital; Japanese Foundation for Cancer Research; Tokyo Japan
| | - Hitoshi Masuda
- Department of Urology; Cancer Institute Hospital; Japanese Foundation for Cancer Research; Tokyo Japan
| | - Junji Yonese
- Department of Urology; Cancer Institute Hospital; Japanese Foundation for Cancer Research; Tokyo Japan
| | - Kazunori Kihara
- Department of Urology; Tokyo Medical and Dental University; Tokyo Japan
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135
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Mazziotti S, Cicero G, D'Angelo T, Marino MA, Visalli C, Salamone I, Ascenti G, Blandino A. Imaging and Management of Incidental Renal Lesions. BIOMED RESEARCH INTERNATIONAL 2017; 2017:1854027. [PMID: 28642870 PMCID: PMC5470004 DOI: 10.1155/2017/1854027] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Accepted: 05/04/2017] [Indexed: 02/07/2023]
Abstract
The increased use of imaging modalities in the last years has led to a greater incidence in depicting abdominal incidental lesions. In particular, "incidentalomas" of the kidney are discovered in asymptomatic patients or patients who suffer from diseases not directly related to the kidneys. The aim of this paper is to provide the radiologist with a useful guide to recognize and classify the main incidental renal findings with the purpose of establishing the correct management. First we describe the so-called "pseudotumors" which are important to recognize in order to avoid a misdiagnosis. Afterwards we categorize true renal lesions into cystic and solid types, reporting radiological signs helpful in differentiating between benign and malignant nature.
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Affiliation(s)
- Silvio Mazziotti
- Department of Biomedical Sciences and Morphological and Functional Imaging, University of Messina, Policlinico “G. Martino”, Via Consolare Valeria 1, 98100 Messina, Italy
| | - Giuseppe Cicero
- Department of Biomedical Sciences and Morphological and Functional Imaging, University of Messina, Policlinico “G. Martino”, Via Consolare Valeria 1, 98100 Messina, Italy
| | - Tommaso D'Angelo
- Department of Biomedical Sciences and Morphological and Functional Imaging, University of Messina, Policlinico “G. Martino”, Via Consolare Valeria 1, 98100 Messina, Italy
| | - Maria Adele Marino
- Department of Biomedical Sciences and Morphological and Functional Imaging, University of Messina, Policlinico “G. Martino”, Via Consolare Valeria 1, 98100 Messina, Italy
| | - Carmela Visalli
- Department of Biomedical Sciences and Morphological and Functional Imaging, University of Messina, Policlinico “G. Martino”, Via Consolare Valeria 1, 98100 Messina, Italy
| | - Ignazio Salamone
- Department of Biomedical Sciences and Morphological and Functional Imaging, University of Messina, Policlinico “G. Martino”, Via Consolare Valeria 1, 98100 Messina, Italy
| | - Giorgio Ascenti
- Department of Biomedical Sciences and Morphological and Functional Imaging, University of Messina, Policlinico “G. Martino”, Via Consolare Valeria 1, 98100 Messina, Italy
| | - Alfredo Blandino
- Department of Biomedical Sciences and Morphological and Functional Imaging, University of Messina, Policlinico “G. Martino”, Via Consolare Valeria 1, 98100 Messina, Italy
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136
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Park BK. Ultrasound-guided genitourinary interventions: principles and techniques. Ultrasonography 2017; 36:336-348. [PMID: 28736429 PMCID: PMC5621800 DOI: 10.14366/usg.17026] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2017] [Revised: 05/28/2017] [Accepted: 05/29/2017] [Indexed: 12/30/2022] Open
Abstract
Ultrasound (US) is often used to guide various interventional procedures in the genitourinary (GU) tract because it can provide real-time imaging without any radiation hazard. Moreover, US can clearly visualize the pathway of an aspiration or biopsy needle to ensure the safety of the intervention. US guidance also helps clinicians to access lesions via the transabdominal, transhepatic, transvaginal, transrectal, and transperineal routes. Hence, US-guided procedures are useful for radiologists who wish to perform GU interventions. However, US-guided procedures and interventions are difficult for beginners because they involve a steep initial learning curve. The purpose of this review is to describe the basic principles and techniques of US-guided GU interventions.
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Affiliation(s)
- Byung Kwan Park
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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137
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Leng S, Takahashi N, Gomez Cardona D, Kitajima K, McCollough B, Li Z, Kawashima A, Leibovich BC, McCollough CH. Subjective and objective heterogeneity scores for differentiating small renal masses using contrast-enhanced CT. Abdom Radiol (NY) 2017; 42:1485-1492. [PMID: 28025654 DOI: 10.1007/s00261-016-1014-2] [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: 12/22/2022]
Abstract
PURPOSE The aim of this study was to assess the effect of denoising on objective heterogeneity scores and its diagnostic capability for the diagnosis of angiomyolipoma (AML) and renal cell carcinoma (RCC). MATERIALS AND METHODS A total of 158 resected renal masses ≤4 cm [98 clear cell (cc) RCCs, 36 papillary (pap)-RCCs, and 24 AMLs] from 139 patients were evaluated. A representative contrast-enhanced computed tomography (CT) image for each mass was selected by a genitourinary radiologist. A largest possible region of interest was drawn on each mass by the radiologist, from which three objective heterogeneity indices were calculated: standard deviation (SD), entropy (Ent), and uniformity (Uni). Objective heterogeneity indices were also calculated after images were processed with a denoising algorithm (non-local means) at three strengths: weak, medium, and strong. Two genitourinary radiologists also subjectively scored each mass independently using a three-point scale (1-3; with 1 the least and 3 the most heterogeneous), which were added to represent the final subjective heterogeneity score of each mass. Heterogeneity scores were compared among mass types, and area under the ROC curve (AUC) was calculated. RESULTS For all heterogeneity indices, cc-RCC was significantly more heterogeneous than pap-RCC and AML (p < 0.001), but no significant difference was found between pap-RCC and AML (p > 0.01). For cc-RCC and pap-RCC differentiation, AUCs were 0.91, 0.81, 0.78, and 0.78 for the subjective score, SD, Ent, and Uni, respectively, using original images. The corresponding AUC values were 0.84, 0.74, 0.79, and 0.80 for differentiation of AML and cc-RCC. Noise reduction at weak setting improves AUC values by 0.03, 0.05, and 0.05 for SD, entropy, and uniformity for differentiation of cc-RCC from pap-RCC. Further increase of filtering strength did not improve AUC values. For differentiation of AML vs. cc-RCC, the AUC values stayed relatively flat using the noise reduction technique at different strengths for all three indices. CONCLUSIONS Both subjective and objective heterogeneity indices can differentiate cc-RCC from pap-RCC and AML. Noise reduction improved differentiation of cc-RCC from pap-RCC, but not differentiation of AML from cc-RCC.
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Affiliation(s)
- Shuai Leng
- Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
| | - Naoki Takahashi
- Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Daniel Gomez Cardona
- Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
- Department of Medical Physics, University of Wisconsin-Madison, 1111 Highland Avenue, Madison, WI, 53705-2275, USA
| | - Kazuhiro Kitajima
- Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
- Department of Radiology, Faculty of Medicine, Kobe University, Kobe, Hyogo, Japan
| | - Brian McCollough
- Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Zhoubo Li
- Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
- GE Healthcare, 3000 N. Grandview Blvd, Waukesha, WI, 53188, USA
| | - Akira Kawashima
- Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Bradley C Leibovich
- Department of Urology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Cynthia H McCollough
- Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
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Behbahani S, Mittal S, Patlas MN, Moshiri M, Menias CO, Katz DS. "Incidentalomas" on abdominal and pelvic CT in emergency radiology: literature review and current management recommendations. Abdom Radiol (NY) 2017; 42:1046-1061. [PMID: 27695953 DOI: 10.1007/s00261-016-0914-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The purpose of this article is to familiarize radiologists and clinicians with a subset of common and uncommon incidental findings on abdominal and pelvic computed tomography examinations, including hepatic, splenic, renal, adrenal, pancreatic, aortic/iliac arterial, gynecological, and a few other miscellaneous findings, with an emphasis on "incidentalomas" discovered in the emergency setting. In addition, we will review the complex problem of diagnosing such entities, and provide current management recommendations. Representative case examples, which we have encountered in our clinical practices, will be demonstrated.
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Affiliation(s)
- Siavash Behbahani
- Department of Radiology, Winthrop-University Hospital, 259 First Street, Mineola, NY, 11501, USA.
| | - Sameer Mittal
- Department of Radiology, Winthrop-University Hospital, 259 First Street, Mineola, NY, 11501, USA
| | - Michael N Patlas
- Department of Radiology, Hamilton General Hospital, McMaster University, 237 Barton St., East Hamilton, ON, L8L 2X2, Canada
| | - Mariam Moshiri
- Department of Radiology, University of Washington Medical Center, 1959 NE Pacific Street, Seattle, WA, 98195, USA
| | - Christine O Menias
- Department of Radiology, Mayo Clinic, 13400 E. Shea Blvd., Scottsdale, AZ, 85259, USA
| | - Douglas S Katz
- Department of Radiology, Winthrop-University Hospital, 259 First Street, Mineola, NY, 11501, USA
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139
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Davenport MS, Hu EM, Smith AD, Chandarana H, Hafez K, Palapattu GS, Stuart Wolf J, Silverman SG. Reporting standards for the imaging-based diagnosis of renal masses on CT and MRI: a national survey of academic abdominal radiologists and urologists. Abdom Radiol (NY) 2017; 42:1229-1240. [PMID: 27878338 DOI: 10.1007/s00261-016-0962-x] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
PURPOSE To define important elements of a structured radiology report of a CT or MRI performed to evaluate an indeterminate renal mass. METHODS IRB approval was waived for this multi-site prospective quality improvement study. A 35-question survey investigating elements of a CT or MRI report describing a renal mass was created through an iterative process by the Society of Abdominal Radiology Disease-Focused Panel on renal cell carcinoma. Surveys were distributed to consenting abdominal radiologists and urologists at nine academic institutions. Consensus within and between specialties was defined as ≥70% agreement. Respondent rates were compared with Chi Square test. RESULTS The response rate was 68% (117/171; 55% [39/71] urologists, 78% [78/100] radiologists). Inter-specialty consensus was that the following were essential: mass size with comparison to prior imaging, mass type (cystic vs. solid), presence of fat, presence of enhancement, and radiologic stage. Urologists were more likely to prefer the Nephrometry score (75% [27/36] vs. 22% [17/76], p < 0.0001), quantitative reporting of enhancement on CT (85% [32/38] vs. 46% [36/77], p < 0.0001), and mass position with respect to the renal polar lines (67% [24/36] vs. 36% [27/76], p = 0.002). There was inter-specialty consensus that the Bosniak classification for cystic masses was preferred. Most urologists (60% [21/35]) preferred management recommendations be omitted for solid masses or Bosniak III-IV cystic masses. CONCLUSIONS Important elements to include in a CT or MRI report of an indeterminate renal mass are critical diagnostic features, the Bosniak classification if relevant, and the most likely specific diagnosis when feasible; including management recommendations is controversial.
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Affiliation(s)
- Matthew S Davenport
- Department of Radiology, University of Michigan Health System, 1500 E. Medical Center Dr. B2-A209P, Ann Arbor, MI, 48109, USA.
- Michigan Radiology Quality Collaborative, Ann Arbor, USA.
- Department of Urology, University of Michigan Health System, Ann Arbor, USA.
| | - Eric M Hu
- Department of Radiology, University of Michigan Health System, 1500 E. Medical Center Dr. B2-A209P, Ann Arbor, MI, 48109, USA
| | - Andrew D Smith
- Department of Radiology, University of Mississippi Medical Center, Jackson, USA
| | - Hersh Chandarana
- Department of Radiology, New York University Langone Medical Center, New York, USA
| | - Khaled Hafez
- Department of Urology, University of Michigan Health System, Ann Arbor, USA
| | - Ganesh S Palapattu
- Department of Urology, University of Michigan Health System, Ann Arbor, USA
| | - J Stuart Wolf
- Department of Urology, University of Michigan Health System, Ann Arbor, USA
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140
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Defining the Added Value of 99mTc-MIBI SPECT/CT to Conventional Cross-Sectional Imaging in the Characterization of Enhancing Solid Renal Masses. Clin Nucl Med 2017; 42:e188-e193. [DOI: 10.1097/rlu.0000000000001534] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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141
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Marin D, Davis D, Roy Choudhury K, Patel B, Gupta RT, Mileto A, Nelson RC. Characterization of Small Focal Renal Lesions: Diagnostic Accuracy with Single-Phase Contrast-enhanced Dual-Energy CT with Material Attenuation Analysis Compared with Conventional Attenuation Measurements. Radiology 2017; 284:737-747. [PMID: 28353408 DOI: 10.1148/radiol.2017161872] [Citation(s) in RCA: 60] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Purpose To determine whether single-phase contrast material-enhanced dual-energy material attenuation analysis improves the characterization of small (1-4 cm) renal lesions compared with conventional attenuation measurements by using histopathologic analysis and follow-up imaging as the clinical reference standards. Materials and Methods In this retrospective, HIPAA-compliant, institutional review board-approved study, 136 consecutive patients (95 men and 41 women; mean age, 54 years) with 144 renal lesions (111 benign, 33 malignant) measuring 1-4 cm underwent single-energy unenhanced and contrast-enhanced dual-energy computed tomography (CT) of the abdomen. For each renal lesion, attenuation measurements were obtained; attenuation change of greater than or equal to 15 HU was considered evidence of enhancement. Dual-energy attenuation measurements were also obtained by using iodine-water, water-iodine, calcium-water, and water-calcium material basis pairs. Mean lesion attenuation values and material densities were compared between benign and malignant renal lesions by using the two-sample t test. Diagnostic accuracy of attenuation measurements and dual-energy material densities was assessed and validated by using 10-fold cross-validation to limit the effect of optimistic bias. Results By using cross-validated optimal thresholds at 100% sensitivity, iodine-water material attenuation images significantly improved specificity for differentiating between benign and malignant renal lesions compared with conventional enhancement measurements (93% [103 of 111]; 95% confidence interval: 86%, 97%; vs 81% [90 of 111]; 95% confidence interval: 73%, 88%) (P = .02). Sensitivity with iodine-water and calcium-water material attenuation images was also higher than that with conventional enhancement measurements, although the difference was not statistically significant. Conclusion Contrast-enhanced dual-energy CT with material attenuation analysis improves specificity for characterization of small (1-4 cm) renal lesions compared with conventional attenuation measurements. © RSNA, 2017 Online supplemental material is available for this article.
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Affiliation(s)
- Daniele Marin
- From the Department of Radiology (D.M., D.D., B.P., R.T.G., A.M., R.C.N.) and Carl E. Ravin Advanced Imaging Laboratories (K.R.C.), Duke University Medical Center, Box 3808 Erwin Rd, Durham, NC 27710
| | - Drew Davis
- From the Department of Radiology (D.M., D.D., B.P., R.T.G., A.M., R.C.N.) and Carl E. Ravin Advanced Imaging Laboratories (K.R.C.), Duke University Medical Center, Box 3808 Erwin Rd, Durham, NC 27710
| | - Kingshuk Roy Choudhury
- From the Department of Radiology (D.M., D.D., B.P., R.T.G., A.M., R.C.N.) and Carl E. Ravin Advanced Imaging Laboratories (K.R.C.), Duke University Medical Center, Box 3808 Erwin Rd, Durham, NC 27710
| | - Bhavik Patel
- From the Department of Radiology (D.M., D.D., B.P., R.T.G., A.M., R.C.N.) and Carl E. Ravin Advanced Imaging Laboratories (K.R.C.), Duke University Medical Center, Box 3808 Erwin Rd, Durham, NC 27710
| | - Rajan T Gupta
- From the Department of Radiology (D.M., D.D., B.P., R.T.G., A.M., R.C.N.) and Carl E. Ravin Advanced Imaging Laboratories (K.R.C.), Duke University Medical Center, Box 3808 Erwin Rd, Durham, NC 27710
| | - Achille Mileto
- From the Department of Radiology (D.M., D.D., B.P., R.T.G., A.M., R.C.N.) and Carl E. Ravin Advanced Imaging Laboratories (K.R.C.), Duke University Medical Center, Box 3808 Erwin Rd, Durham, NC 27710
| | - Rendon C Nelson
- From the Department of Radiology (D.M., D.D., B.P., R.T.G., A.M., R.C.N.) and Carl E. Ravin Advanced Imaging Laboratories (K.R.C.), Duke University Medical Center, Box 3808 Erwin Rd, Durham, NC 27710
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Richard PO, Violette PD, Jewett MAS, Pouliot F, Leveridge M, So A, Whelan TF, Rendon R, Finelli A. CUA guideline on the management of cystic renal lesions. Can Urol Assoc J 2017; 11:E66-E73. [PMID: 28360949 DOI: 10.5489/cuaj.4484] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
- Patrick O Richard
- Division of Urology, Department of Surgery, Centre Hospitalier Universitaire de Sherbrooke and Centre de recherche du CHUS, Université de Sherbrooke, Sherbrooke, QC, Canada
| | | | - Michael A S Jewett
- Division of Urology, Departments of Surgery and Surgical Oncology, Princess Margaret Cancer Centre, University Health Network and the University of Toronto, Toronto, ON, Canada
| | - Frederic Pouliot
- Division of Urology, Department of Surgery, Université Laval, Centre de Recherche du Centre Hospitalier Universitaire de Québec, Quebec City, QC, Canada
| | - Michael Leveridge
- Department of Urology, Queen's University, Kingston General Hospital, Kingston, ON, Canada
| | - Alan So
- Division of Urology, Department of Surgery, University of British Columbia, Vancouver, BC, Canada
| | - Thomas F Whelan
- Division of Urology, Department of Surgery, Saint John Regional Hospital, Dalhousie University, Saint John, NB
| | - Ricardo Rendon
- Department of Urology, QEII Health Sciences Centre, Dalhousie University, Halifax, NS
| | - Antonio Finelli
- Division of Urology, Departments of Surgery and Surgical Oncology, Princess Margaret Cancer Centre, University Health Network and the University of Toronto, Toronto, ON, Canada
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143
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Shaaban AM, Rezvani M, Tubay M, Elsayes KM, Woodward PJ, Menias CO. Fat-containing Retroperitoneal Lesions: Imaging Characteristics, Localization, and Differential Diagnosis. Radiographics 2017; 36:710-34. [PMID: 27163589 DOI: 10.1148/rg.2016150149] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
The complex anatomy of the retroperitoneum is reflected in the spectrum of neoplastic and nonneoplastic conditions that can occur in the retroperitoneum and appear as soft-tissue masses. The presence of fat within a retroperitoneal lesion is helpful in refining the differential diagnosis. Fat is easily recognized because of its characteristic imaging appearance. It typically is hyperechoic at ultrasonography and demonstrates low attenuation at computed tomography (-10 to -100 HU). Magnetic resonance imaging is a more ideal imaging modality because it has better soft-tissue image contrast and higher sensitivity for depicting (a) microscopic fat by using chemical shift imaging and (b) macroscopic fat by using fat-suppression techniques. Whether a lesion arises from a retroperitoneal organ or from the soft tissues of the retroperitoneal space (primary lesion) is determined by examining the relationship between the lesion and its surrounding structures. Multiple imaging signs help to determine the organ of origin, including the "beak sign," the "embedded organ sign," the "phantom (invisible) organ sign," and the "prominent feeding artery sign." Adrenal adenoma is the most common adrenal mass that contains microscopic fat, while myelolipoma is the most common adrenal mass that contains macroscopic fat. Other adrenal masses, such as pheochromocytoma and adrenocortical carcinoma, rarely contain fat. Renal angiomyolipoma is the most common fat-containing renal mass. Other fat-containing renal lesions, such as lipoma and liposarcoma, are rare. Fatty replacement of the pancreas and pancreatic lipomas are relatively common, whereas pancreatic teratomas are rare. Of the primary retroperitoneal fat-containing lesions, lipoma and liposarcoma are common, while other lesions are relatively rare. (©)RSNA, 2016.
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Affiliation(s)
- Akram M Shaaban
- From the Department of Radiology, University of Utah, 30 North 1900 East, 1A71, Salt Lake City, UT 84132 (A.M.S., M.R., P.J.W.); Imaging Department, U.S. Air Force Academy Medical Clinic, USAF Academy, Colorado Springs, Colo (M.T.); Department of Radiology, University of Texas MD Anderson Cancer Center, Houston, Tex (K.M.E.); and Department of Radiology, Mayo Clinic, Scottsdale, Ariz (C.O.M.)
| | - Maryam Rezvani
- From the Department of Radiology, University of Utah, 30 North 1900 East, 1A71, Salt Lake City, UT 84132 (A.M.S., M.R., P.J.W.); Imaging Department, U.S. Air Force Academy Medical Clinic, USAF Academy, Colorado Springs, Colo (M.T.); Department of Radiology, University of Texas MD Anderson Cancer Center, Houston, Tex (K.M.E.); and Department of Radiology, Mayo Clinic, Scottsdale, Ariz (C.O.M.)
| | - Marc Tubay
- From the Department of Radiology, University of Utah, 30 North 1900 East, 1A71, Salt Lake City, UT 84132 (A.M.S., M.R., P.J.W.); Imaging Department, U.S. Air Force Academy Medical Clinic, USAF Academy, Colorado Springs, Colo (M.T.); Department of Radiology, University of Texas MD Anderson Cancer Center, Houston, Tex (K.M.E.); and Department of Radiology, Mayo Clinic, Scottsdale, Ariz (C.O.M.)
| | - Khaled M Elsayes
- From the Department of Radiology, University of Utah, 30 North 1900 East, 1A71, Salt Lake City, UT 84132 (A.M.S., M.R., P.J.W.); Imaging Department, U.S. Air Force Academy Medical Clinic, USAF Academy, Colorado Springs, Colo (M.T.); Department of Radiology, University of Texas MD Anderson Cancer Center, Houston, Tex (K.M.E.); and Department of Radiology, Mayo Clinic, Scottsdale, Ariz (C.O.M.)
| | - Paula J Woodward
- From the Department of Radiology, University of Utah, 30 North 1900 East, 1A71, Salt Lake City, UT 84132 (A.M.S., M.R., P.J.W.); Imaging Department, U.S. Air Force Academy Medical Clinic, USAF Academy, Colorado Springs, Colo (M.T.); Department of Radiology, University of Texas MD Anderson Cancer Center, Houston, Tex (K.M.E.); and Department of Radiology, Mayo Clinic, Scottsdale, Ariz (C.O.M.)
| | - Christine O Menias
- From the Department of Radiology, University of Utah, 30 North 1900 East, 1A71, Salt Lake City, UT 84132 (A.M.S., M.R., P.J.W.); Imaging Department, U.S. Air Force Academy Medical Clinic, USAF Academy, Colorado Springs, Colo (M.T.); Department of Radiology, University of Texas MD Anderson Cancer Center, Houston, Tex (K.M.E.); and Department of Radiology, Mayo Clinic, Scottsdale, Ariz (C.O.M.)
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Zarzour JG, Milner D, Valentin R, Jackson BE, Gordetsky J, West J, Rais-Bahrami S, Morgan DE. Quantitative iodine content threshold for discrimination of renal cell carcinomas using rapid kV-switching dual-energy CT. Abdom Radiol (NY) 2017; 42:727-734. [PMID: 27847998 DOI: 10.1007/s00261-016-0967-5] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE Determine iodine content threshold discriminating papillary renal cell carcinomas (pRCC) from complex cysts (CCs) using rapid kV-switching dual-energy CT (rsDECT). MATERIALS AND METHODS IRB-approved retrospective study of 72 consecutive patients with pathologic diagnosis of renal cell carcinoma, who underwent rsDECT from 2011 to 2015. Controls included consecutive patients with CC during same period. Iodine content of each pRCC (n = 27) was measured on rsDECT workstation for arterial (n = 15) or nephrographic phase (n = 12), and compared to iodine content for clear cell renal cell carcinomas (ccRCC, n = 46) and complex cysts (n = 54). An optimal iodine content threshold was estimated using logistic regressions and Youden's J based on maximum specificity and sensitivity. RESULTS Iodine threshold of 1.28 mg/cc was optimal to discriminate between pRCCs and CCs for nephrographic phase (sens 1.0, spec 0.96, PPV 0.92, and NPV 1.0, AUC 0.997, acc 0.97, p < 0.0001). Iodine threshold of 1.22 mg/cc was the optimal cutoff value to discriminate between pRCCs and CCs in the arterial phase (sens 0.67, spec 0.97, PPV 0.91, NPV 0.85, AUC 0.76, and acc 0.84, p = 0.006). The optimal threshold to discriminate between ccRCCs and pRCCs was 1.85 mg/cc in the arterial phase (sens 0.87, spec 0.92, PPV 0.87, NPV 0.92, p < 0001) and 2.71 mg/cc in the nephrographic phase (sens 1.0, spec 1.0, PPV 1.0, NPV 1.0, p < 0.0001). CONCLUSIONS Quantitative iodine values on rsDECT discriminate between papillary RCC and complex cysts, and between papillary RCC and clear cell RCC, the former addressing an important clinical challenge particularly when an unenhanced series has not been performed. These rsDECT thresholds differ from values derived from dual-source DECT technology.
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Affiliation(s)
- Jessica G Zarzour
- Department of Radiology, University of Alabama at Birmingham, 619 19th Street South, JTN 357, Birmingham, AL, 35294, USA.
| | - Desmin Milner
- Department of Radiology, University of Alabama at Birmingham, 619 19th Street South, JTN 357, Birmingham, AL, 35294, USA
| | - Roberto Valentin
- Department of Radiology, University of Alabama at Birmingham, 619 19th Street South, JTN 357, Birmingham, AL, 35294, USA
| | - Bradford E Jackson
- Department of Preventative Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Jennifer Gordetsky
- Department of Pathology, University of Alabama at Birmingham, Birmingham, AL, USA
- Department of Urology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Janelle West
- School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Soroush Rais-Bahrami
- Department of Radiology, University of Alabama at Birmingham, 619 19th Street South, JTN 357, Birmingham, AL, 35294, USA
- Department of Urology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Desiree E Morgan
- Department of Radiology, University of Alabama at Birmingham, 619 19th Street South, JTN 357, Birmingham, AL, 35294, USA
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Woo S, Kim SH. Differentiation of Small, Solid Renal Masses: A Pattern Recognition Approach. Semin Ultrasound CT MR 2017; 38:28-36. [DOI: 10.1053/j.sult.2016.08.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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Magnetic Resonance Imaging and the Use in Small Renal Masses. Indian J Surg Oncol 2017; 8:19-23. [PMID: 28127178 DOI: 10.1007/s13193-016-0575-4] [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: 07/07/2016] [Accepted: 07/21/2016] [Indexed: 01/06/2023] Open
Abstract
The incidence of small renal masses (SRM) has been increasing, and this is mainly attributed to the incidental finding of such masses on imaging performed in asymptomatic patients. Consequently, this calls for careful evaluation and management of these masses to determine their nature and need for treatment. This article reviews current literature regarding the evaluation and management of SRM. It focuses on the specific use of MRI in the diagnosis and management of SRM. A Medline review of the literature was performed from 1996 to the present time. Computed tomography (CT) imaging has been the investigation of choice for evaluating SRM. However, some remain difficult to determine their malignant or benign nature and remain indeterminate. In such cases, further imaging with magnetic resonance imaging (MRI) can be performed to evaluate the mass in more detail. It can also be used where CT is contraindicated and where active surveillance is the treatment of choice and radiation exposure is a concern. MRI is a useful tool in evaluating an indeterminate small renal mass. Accurate diagnosis and management of SRM require close collaboration between a urologist and radiologist to identify potentially malignant tumours to subsequently reduce mortality from renal cell cancer.
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Renal Masses Detected on FDG PET/CT in Patients With Lymphoma: Imaging Features Differentiating Primary Renal Cell Carcinomas From Renal Lymphomatous Involvement. AJR Am J Roentgenol 2017; 208:849-853. [PMID: 28095016 DOI: 10.2214/ajr.16.17133] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The purpose of this study is to analyze the 18F-FDG PET/CT features of solid renal masses detected in patients with lymphoma and to evaluate the ability of PET/CT to differentiate renal cell carcinoma (RCC) from renal lymphomatous involvement. MATERIALS AND METHODS Thirty-six patients with solid renal masses on PET/CT performed for staging or follow-up of lymphoma were evaluated retrospectively. The features recorded for each renal mass included the following standardized uptake values (SUVs) on PET/CT: the maximum SUV (SUVmax), the mean SUV (SUVmean), the ratio of the SUVmax of the tumor to that of the normal kidney cortex, the ratio of the SUVmean of the tumor to that of the normal kidney cortex, the ratio of the SUVmax of the tumor to that of the normal liver, and the ratio of the SUVmean of the tumor to that of the normal liver. Renal mass size and margins (well defined vs infiltrative) and the presence of calcifications were evaluated on CT. Renal biopsy results were used as the reference standard. Relationships between imaging parameters and histopathologic findings were assessed. RESULTS Of the 36 renal masses evaluated, 22 (61.1%) were RCCs and 14 (38.9%) were renal lymphomas. All SUV metrics were higher for renal lymphomas than for RCCs (p < 0.0001, for all). All renal lymphomas had an SUVmax higher than 5.98 g/mL (median, 10.99 g/mL), whereas all RCCs had an SUVmax lower than 5.26 g/mL (median, 2.91 g/mL). No statistically significant differences in mass size or margins were found between RCCs and renal lymphoma. CONCLUSION PET/CT features may be useful for differentiating RCCs from renal involvement in patients with lymphoma with solid renal masses.
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Lai BMH, Ka SYJ, Kan WK, Lam MW, Lee TF, Lui YH, Khoo JLS. Case 237: Renal Cell Carcinoma with Osseous Metaplasia. Radiology 2016; 282:293-298. [PMID: 28005510 DOI: 10.1148/radiol.2016140817] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
History A 47-year-old man presented with palpitations and decreased exercise tolerance. A peripheral blood smear revealed anemia, thrombocytopenia, and blast cells, and a diagnosis of acute myeloid leukemia was made. Immunohistochemistry revealed positivity for cluster of differentiation (or CD) markers, which have been reported to be associated with an increased risk of extramedullary leukemic involvement. Thus, contrast material-enhanced computed tomography (CT) of the thorax, abdomen, and pelvis was requested to enable exclusion of any extramedullary extension of leukemia. Unenhanced and contrast-enhanced nephrographic phase CT was performed. Follow-up CT 3 months later showed minimal interval change in the lesion (images not shown).
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Affiliation(s)
- Billy Ming Hei Lai
- From the Departments of Radiology (B.M.H.L., S.Y.J.K., W.K.K., T.F.L., J.L.S.K.) and Clinical Pathology (M.W.L., Y.H.L.), Pamela Youde Nethersole Eastern Hospital, 3 Lok Man Road, Chai Wan, Hong Kong
| | - Solomon Yig Joon Ka
- From the Departments of Radiology (B.M.H.L., S.Y.J.K., W.K.K., T.F.L., J.L.S.K.) and Clinical Pathology (M.W.L., Y.H.L.), Pamela Youde Nethersole Eastern Hospital, 3 Lok Man Road, Chai Wan, Hong Kong
| | - Wai Kuen Kan
- From the Departments of Radiology (B.M.H.L., S.Y.J.K., W.K.K., T.F.L., J.L.S.K.) and Clinical Pathology (M.W.L., Y.H.L.), Pamela Youde Nethersole Eastern Hospital, 3 Lok Man Road, Chai Wan, Hong Kong
| | - Man Wah Lam
- From the Departments of Radiology (B.M.H.L., S.Y.J.K., W.K.K., T.F.L., J.L.S.K.) and Clinical Pathology (M.W.L., Y.H.L.), Pamela Youde Nethersole Eastern Hospital, 3 Lok Man Road, Chai Wan, Hong Kong
| | - Tang Fei Lee
- From the Departments of Radiology (B.M.H.L., S.Y.J.K., W.K.K., T.F.L., J.L.S.K.) and Clinical Pathology (M.W.L., Y.H.L.), Pamela Youde Nethersole Eastern Hospital, 3 Lok Man Road, Chai Wan, Hong Kong
| | - Yun Hoi Lui
- From the Departments of Radiology (B.M.H.L., S.Y.J.K., W.K.K., T.F.L., J.L.S.K.) and Clinical Pathology (M.W.L., Y.H.L.), Pamela Youde Nethersole Eastern Hospital, 3 Lok Man Road, Chai Wan, Hong Kong
| | - Jennifer Lai San Khoo
- From the Departments of Radiology (B.M.H.L., S.Y.J.K., W.K.K., T.F.L., J.L.S.K.) and Clinical Pathology (M.W.L., Y.H.L.), Pamela Youde Nethersole Eastern Hospital, 3 Lok Man Road, Chai Wan, Hong Kong
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Clinical significance of incidentally detected bladder wall thickening on computed tomography. Int Urol Nephrol 2016; 49:191-196. [PMID: 27888433 DOI: 10.1007/s11255-016-1458-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Accepted: 11/04/2016] [Indexed: 10/20/2022]
Abstract
PURPOSE To evaluate the clinical significance of incidentally detected bladder wall thickening (BWT) on computed tomography (CT). METHODS A retrospective analysis was performed on 34,793 cystoscopy cases between January 2004 and December 2013. Among these, patients who underwent cystoscopy for the sole indication of incidentally detected BWT on CT were selected. Patients were categorized into the diffuse or focal group depending on the extent of BWT. Suspicious lesions on cystoscopy were biopsied to confirm histologic subtype. The incidence and predictive factors of bladder malignancy were examined. RESULTS A total of 167 (0.5%) patients received cystoscopy for incidentally detected BWT on CT, of which 11 (6.6%) patients were diagnosed with bladder malignancy. When a suspicious lesion was identified on cystoscopy, 11 of 25 (44%) patients were found to have a bladder malignancy. Of the 15 patients with diffuse BWT, 5 (33.3%) were diagnosed with bladder malignancy, consisting of carcinoma in situ in 2 patients, high-grade carcinoma in 2 patients and muscle invasive disease in 1 patient. Of the 10 patients with focal BWT, 6 (60.0%) were diagnosed with bladder malignancy, of which 3 patients had high-grade disease. On multivariate logistic regression analysis, focal BWT [95% confidence interval (CI) 1.400-25.357, P = 0.016] and atypical cells in urine cytology (95% CI 2.631-63.446, P = 0.002) were positively associated with bladder malignancy. CONCLUSIONS Incidentally detected BWT on CT can be suggestive of bladder malignancy. Therefore, further work-up including cystoscopy and urine cytology should be performed to assess bladder malignancy.
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