1
|
Trovato P, Simonetti I, Morrone A, Fusco R, Setola SV, Giacobbe G, Brunese MC, Pecchi A, Triggiani S, Pellegrino G, Petralia G, Sica G, Petrillo A, Granata V. Scientific Status Quo of Small Renal Lesions: Diagnostic Assessment and Radiomics. J Clin Med 2024; 13:547. [PMID: 38256682 PMCID: PMC10816509 DOI: 10.3390/jcm13020547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Revised: 01/05/2024] [Accepted: 01/16/2024] [Indexed: 01/24/2024] Open
Abstract
Background: Small renal masses (SRMs) are defined as contrast-enhanced renal lesions less than or equal to 4 cm in maximal diameter, which can be compatible with stage T1a renal cell carcinomas (RCCs). Currently, 50-61% of all renal tumors are found incidentally. Methods: The characteristics of the lesion influence the choice of the type of management, which include several methods SRM of management, including nephrectomy, partial nephrectomy, ablation, observation, and also stereotactic body radiotherapy. Typical imaging methods available for differentiating benign from malignant renal lesions include ultrasound (US), contrast-enhanced ultrasound (CEUS), computed tomography (CT), and magnetic resonance imaging (MRI). Results: Although ultrasound is the first imaging technique used to detect small renal lesions, it has several limitations. CT is the main and most widely used imaging technique for SRM characterization. The main advantages of MRI compared to CT are the better contrast resolution and tissue characterization, the use of functional imaging sequences, the possibility of performing the examination in patients allergic to iodine-containing contrast medium, and the absence of exposure to ionizing radiation. For a correct evaluation during imaging follow-up, it is necessary to use a reliable method for the assessment of renal lesions, represented by the Bosniak classification system. This classification was initially developed based on contrast-enhanced CT imaging findings, and the 2019 revision proposed the inclusion of MRI features; however, the latest classification has not yet received widespread validation. Conclusions: The use of radiomics in the evaluation of renal masses is an emerging and increasingly central field with several applications such as characterizing renal masses, distinguishing RCC subtypes, monitoring response to targeted therapeutic agents, and prognosis in a metastatic context.
Collapse
Affiliation(s)
- Piero Trovato
- Radiology Division, Istituto Nazionale Tumori-IRCCS-Fondazione G. Pascale, 80131 Naples, Italy; (P.T.); (I.S.); (S.V.S.); (A.P.); (V.G.)
| | - Igino Simonetti
- Radiology Division, Istituto Nazionale Tumori-IRCCS-Fondazione G. Pascale, 80131 Naples, Italy; (P.T.); (I.S.); (S.V.S.); (A.P.); (V.G.)
| | - Alessio Morrone
- Division of Radiology, Università degli Studi della Campania Luigi Vanvitelli, 80138 Naples, Italy;
| | - Roberta Fusco
- Medical Oncology Division, Igea SpA, 80013 Naples, Italy
- Italian Society of Medical and Interventional Radiology (SIRM), SIRM Foundation, Via della Signora 2, 20122 Milan, Italy
| | - Sergio Venanzio Setola
- Radiology Division, Istituto Nazionale Tumori-IRCCS-Fondazione G. Pascale, 80131 Naples, Italy; (P.T.); (I.S.); (S.V.S.); (A.P.); (V.G.)
| | - Giuliana Giacobbe
- General and Emergency Radiology Department, “Antonio Cardarelli” Hospital, 80131 Naples, Italy;
| | - Maria Chiara Brunese
- Diagnostic Imaging Section, Department of Medical and Surgical Sciences & Neurosciences, University of Molise, 86100 Campobasso, Italy;
| | - Annarita Pecchi
- Department of Radiology, University of Modena and Reggio Emilia, 41121 Modena, Italy;
| | - Sonia Triggiani
- Postgraduate School of Radiodiagnostics, University of Milan, 20122 Milan, Italy; (S.T.); (G.P.)
| | - Giuseppe Pellegrino
- Postgraduate School of Radiodiagnostics, University of Milan, 20122 Milan, Italy; (S.T.); (G.P.)
| | - Giuseppe Petralia
- Department of Medical Imaging and Radiation Sciences, IEO European Institute of Oncology IRCCS, Via Ripamonti 435, 20141 Milan, Italy;
| | - Giacomo Sica
- Radiology Unit, Monaldi Hospital, Azienda Ospedaliera dei Colli, 80131 Naples, Italy;
| | - Antonella Petrillo
- Radiology Division, Istituto Nazionale Tumori-IRCCS-Fondazione G. Pascale, 80131 Naples, Italy; (P.T.); (I.S.); (S.V.S.); (A.P.); (V.G.)
| | - Vincenza Granata
- Radiology Division, Istituto Nazionale Tumori-IRCCS-Fondazione G. Pascale, 80131 Naples, Italy; (P.T.); (I.S.); (S.V.S.); (A.P.); (V.G.)
| |
Collapse
|
2
|
Nguyen K, Siegelman ES, Tu W, Schieda N. Update on MR Imaging of cystic retroperitoneal masses. Abdom Radiol (NY) 2020; 45:3172-3183. [PMID: 31501965 DOI: 10.1007/s00261-019-02196-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE This article reviews the MRI appearance of cystic retroperitoneal (RP) masses. CONCLUSION Lymphangiomas are the most common RP cystic masses and typically appear simple; microscopic fat is a specific but insensitive finding. Location, internal complexity, and enhancement pattern suggest alternative diagnoses which range from normal anatomic variants to congenital abnormalities and importantly include benign, neurogenic, and malignant neoplasms. An approach to the MR imaging of cystic RP masses is presented.
Collapse
Affiliation(s)
- Kathleen Nguyen
- Department of Medical Imaging, The Ottawa Hospital, The University of Ottawa, Ottawa, Canada
| | - Evan S Siegelman
- Department of Radiology, The Hospital of the University of Pennsylvania, Philadelphia, USA
| | - Wendy Tu
- Department of Medical Imaging, The Ottawa Hospital, The University of Ottawa, Ottawa, Canada
| | - Nicola Schieda
- The Ottawa Hospital, The University of Ottawa, 1053 Carling Avenue, Ottawa, ON, K1Y 4E9, Canada.
| |
Collapse
|
3
|
Abstract
Due to the widespread use of imaging, incidental adrenal masses are commonly encountered. A number of pitfalls can result in misdiagnosis of these lesions, including inappropriate choice of imaging technique, presence of pseudolesions, and overlap of imaging features of different adrenal lesions. This article explores the potential pitfalls in imaging of the adrenal glands, on computed tomography and magnetic resonance imaging, that can lead to misinterpretation. Clues to correct diagnoses are provided to evade potential misinterpretation.
Collapse
|
4
|
Utility of MRI to Differentiate Clear Cell Renal Cell Carcinoma Adrenal Metastases From Adrenal Adenomas. AJR Am J Roentgenol 2017; 209:W152-W159. [DOI: 10.2214/ajr.16.17649] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
|
5
|
CARSOTE MARA, GHEMIGIAN ADINA, TERZEA DANA, GHEORGHISAN-GALATEANU ANCUTAAUGUSTINA, VALEA ANA. Cystic adrenal lesions: focus on pediatric population (a review). CLUJUL MEDICAL (1957) 2017; 90:5-12. [PMID: 28246490 PMCID: PMC5305088 DOI: 10.15386/cjmed-677] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/13/2016] [Revised: 05/18/2016] [Accepted: 05/26/2016] [Indexed: 12/25/2022]
Abstract
BACKGROUND AND AIM The cysts may potentially affect any organ; adrenals cysts are rare. This is a review of the literature regarding adrenal cysts, focusing on children and young adults. GENERAL DATA Three major types have been described: pure cysts (endothelial, epithelial, and hemorrhagic or pseudocyst), parasitic (as hydatid) cysts and cystic part of a tumour (most frequent are neuroblastoma, ganglioneuroma, pheocromocytoma, and teratoma). The complications are: bleeding, local pressure effects; infection; rupture (including post-traumatic); arterial hypertension due to renal vessels compression. Adrenal hemorrhage represents a particular condition associating precipitating factors such as: coagulation defects as Factor IX or X deficiency, von Willebrand disease, thrombocytopenia; antiphospholipid syndrome; previous therapy with clopidogrel or corticosteroids; the rupture of a prior tumour. At birth, the most suggestive features are abdominal palpable mass, anemia, and persistent jaundice. Adrenal insufficiency may be found especially in premature delivery. The hemorrhage is mostly self-limiting. Antenatal ultrasound diagnosis of a cyst does not always predict the exact pathology result. The most important differential diagnosis of adrenal hemorrhage/hemorrhagic cyst is cystic neuroblastoma which is highly suggestive in the presence of distant metastases and abnormal catecholamine profile. The major clue to differentiate the two conditions is the fact that the tumor is stable or increases over time while the adrenal hemorrhage is expected to remit within one to two weeks. CONCLUSION Pediatric adrenal cysts vary from simple cysts with a benign behavior to neoplasia- related lesions displaying severe prognosis as seen in cystic neuroblastoma. A multidisciplinary team is required for their management which is conservative as close follow-up or it makes necessary different surgical procedures in cases with large masses or if a malignancy suspicion is presented. Recently, laparoscopic approach is regarded as a safe procedure by some authors but generally, open surgery is more frequent used compare to adults; in most cases the preservation of normal gland is advisable.
Collapse
Affiliation(s)
- MARA CARSOTE
- Endocrinology Department, Carol Davila University of Medicine and Pharmacy & C.I. Parhon National Institute of Endocrinology, Bucharest, Romania
| | - ADINA GHEMIGIAN
- Endocrinology Department, Carol Davila University of Medicine and Pharmacy & C.I. Parhon National Institute of Endocrinology, Bucharest, Romania
| | - DANA TERZEA
- Endocrinology Department, Monza Oncoteam Hospital & C.I. Parhon National Institute of Endocrinology, Bucharest, Romania
| | | | - ANA VALEA
- Endocrinology Department, Iuliu Hatieganu University of Medicine and Pharmacy & Clinical County Hospital, Cluj-Napoca, Romania
| |
Collapse
|
6
|
Sankineni S, Brown A, Cieciera M, Choyke PL, Turkbey B. Imaging of renal cell carcinoma. Urol Oncol 2015; 34:147-55. [PMID: 26094171 DOI: 10.1016/j.urolonc.2015.05.020] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2015] [Revised: 05/13/2015] [Accepted: 05/19/2015] [Indexed: 02/02/2023]
Abstract
Renal cell carcinoma (RCC) is the most common kidney cancer in adults. Early and accurate imaging plays an important role in the detection, staging, and follow-up of RCC. Patient care and case management revolves heavily around diagnostic imaging so it is imperative that appropriate and adequate imaging is acquired. There are well-established standard imaging protocols available to patients and their providers, although at the same time, there is also extensive ongoing research on improving the various modalities. Ultrasound has been the most commonly used imaging technique for renal imaging in general. However, computed tomography (CT) is the first choice for imaging of renal masses, and has been the mainstay for several decades. High resolution, reproducibility, reasonable preparation and acquisition time, and acceptable cost allow CT to remain as the primary choice for radiologic imaging. Magnetic resonance imaging (MRI) is considered as an important alternative in patients requiring further imaging or in cases of allergies, pregnancy, or surveillance. With increasing concern over radiation exposure, there has been a trend toward the higher use of MRI. It is important to understand the various imaging options available, as well as the current status of and results from recent RCC imaging studies. In this review we discuss these modalities, including the current state of ultrasound, CT, and MRI in RCC.
Collapse
Affiliation(s)
- Sandeep Sankineni
- Molecular Imaging Program, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Anna Brown
- Molecular Imaging Program, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Matthaeus Cieciera
- Molecular Imaging Program, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Peter L Choyke
- Molecular Imaging Program, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Baris Turkbey
- Molecular Imaging Program, National Cancer Institute, National Institutes of Health, Bethesda, MD.
| |
Collapse
|
7
|
Ramamurthy NK, Moosavi B, McInnes MDF, Flood TA, Schieda N. Multiparametric MRI of solid renal masses: pearls and pitfalls. Clin Radiol 2014; 70:304-16. [PMID: 25472466 DOI: 10.1016/j.crad.2014.10.006] [Citation(s) in RCA: 101] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2014] [Revised: 10/04/2014] [Accepted: 10/08/2014] [Indexed: 12/17/2022]
Abstract
Functional imaging [diffusion-weighted imaging (DWI) and dynamic contrast enhancement (DCE)] techniques combined with T2-weighted (T2W) and chemical-shift imaging (CSI), with or without urography, constitutes a comprehensive multiparametric (MP) MRI protocol of the kidneys. MP-MRI of the kidneys can be performed in a time-efficient manner. Breath-hold sequences and parallel imaging should be used to reduce examination time and improve image quality. Increased T2 signal intensity (SI) in a solid renal nodule is specific for renal cell carcinoma (RCC); whereas, low T2 SI can be seen in RCC, angiomyolipoma (AML), and haemorrhagic cysts. Low b-value DWI can replace conventional fat-suppressed T2W. DWI can be performed free-breathing (FB) with two b-values to reduce acquisition time without compromising imaging quality. RCC demonstrates restricted diffusion; however, restricted diffusion is commonly seen in AML and in chronic haemorrhage. CSI must be performed using the correct echo combination at 3 T or T2* effects can mimic intra-lesional fat. Two-dimensional (2D)-CSI has better image quality compared to three-dimensional (3D)-CSI, but volume averaging in small lesions can simulate intra-lesional fat using 2D techniques. SI decrease on CSI is present in both AML and clear cell RCC. Verification of internal enhancement with MRI can be challenging and is improved with image subtraction. Subtraction imaging is prone to errors related to spatial misregistration, which is ameliorated with expiratory phase imaging. SI ratios can be used to confirm subtle internal enhancement and enhancement curves are predictive of RCC subtype. MR urography using conventional extracellular gadolinium must account for T2* effects; however, gadoxetic acid enhanced urography is an alternative. The purpose of this review it to highlight important technical and interpretive pearls and pitfalls encountered with MP-MRI of solid renal masses.
Collapse
Affiliation(s)
- N K Ramamurthy
- Department of Radiology, The Ottawa Hospital, The University of Ottawa, Civic Campus C1 1053 Carling Avenue, Ottawa, Ontario, Canada, K1Y 4E9
| | - B Moosavi
- Department of Radiology, The Ottawa Hospital, The University of Ottawa, Civic Campus C1 1053 Carling Avenue, Ottawa, Ontario, Canada, K1Y 4E9
| | - M D F McInnes
- Department of Radiology, The Ottawa Hospital, The University of Ottawa, Civic Campus C1 1053 Carling Avenue, Ottawa, Ontario, Canada, K1Y 4E9
| | - T A Flood
- Division of Anatomical Pathology, The Ottawa Hospital, The University of Ottawa, 501 Smyth Road, 4th Floor CCW, Room 4278, Ottawa, Ontario, Canada, K1Y 4E9
| | - N Schieda
- Department of Radiology, The Ottawa Hospital, The University of Ottawa, Civic Campus C1 1053 Carling Avenue, Ottawa, Ontario, Canada, K1Y 4E9.
| |
Collapse
|