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Matteo M, Elena B, Cristina BM, Ginevra D, Costanza V, Simone A, Vittorio M. Rare case of an upper urinary tract carcinoma (UTUC) in renal pelvis and ureter associated to renal vein thrombosis: diagnostic imaging with CECT, MRI and CEUS. J Ultrasound 2019; 22:373-379. [PMID: 31243704 DOI: 10.1007/s40477-019-00396-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Accepted: 06/18/2019] [Indexed: 01/14/2023] Open
Abstract
A 58-year-old woman complaining of dyspnea and mild flank pain was admitted to our radiology department after undergoing ultrasonography in another institution. She showed hydronephrosis and left kidney swelling. We performed a contrast-enhanced computed tomography (CECT) that confirmed the hydronephrosis and revealed a widely hypoperfused left kidney, a concentric thickening of the proximal ureter, and a slight and diffuse thickening of the renal pelvic wall, with a hyperdense content in the unenhanced CT phase and poor contrast enhancement in the post-contrast phases. A proximal ipsilateral renal vein thrombosis was associated. Non-contrast magnetic resonance imaging confirmed the CECT findings. At the same time, we performed a contrast-enhanced ultrasonography examination, which proved to be helpful for the characterization of the lesion and for patient management.
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Affiliation(s)
- Mastrorosato Matteo
- Department of Radiology, Azienda Ospedaliero-Universitaria Careggi, Largo G.A. Brambilla 3, 50134, Florence, Italy
| | - Bertelli Elena
- Department of Radiology, Azienda Ospedaliero-Universitaria Careggi, Largo G.A. Brambilla 3, 50134, Florence, Italy
| | - Bonini Maria Cristina
- Department of Radiology, Azienda Ospedaliero-Universitaria Careggi, Largo G.A. Brambilla 3, 50134, Florence, Italy
| | - Danti Ginevra
- Department of Radiology, Azienda Ospedaliero-Universitaria Careggi, Largo G.A. Brambilla 3, 50134, Florence, Italy.
| | - Vannini Costanza
- Department of Radiology, Azienda Ospedaliero-Universitaria Careggi, Largo G.A. Brambilla 3, 50134, Florence, Italy
| | - Agostini Simone
- Department of Radiology, Azienda Ospedaliero-Universitaria Careggi, Largo G.A. Brambilla 3, 50134, Florence, Italy
| | - Miele Vittorio
- Department of Radiology, Azienda Ospedaliero-Universitaria Careggi, Largo G.A. Brambilla 3, 50134, Florence, Italy
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Bhatt JR, Finelli A. Landmarks in the diagnosis and treatment of renal cell carcinoma. Nat Rev Urol 2014; 11:517-25. [PMID: 25112856 DOI: 10.1038/nrurol.2014.194] [Citation(s) in RCA: 159] [Impact Index Per Article: 15.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
The most common renal cancer is renal cell carcinoma (RCC), which arises from the renal parenchyma. The global incidence of RCC has increased over the past two decades by 2% per year. RCC is the most lethal of the common urological cancers: despite diagnostic advances, 20-30% of patients present with metastatic disease. A clearer understanding of the genetic basis of RCC has led to immune-based and targeted treatments for this chemoresistant cancer. Despite promising results in advanced disease, overall response rates and durable complete responses are rare. Surgery remains the main treatment modality, especially for organ-confined disease, with a selective role in advanced and metastatic disease. Smaller tumours are increasingly managed with biopsy, minimally invasive interventions and surveillance. The future promises multimodal, integrated and personalized care, with further understanding of the disease leading to new treatment options.
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Affiliation(s)
- Jaimin R Bhatt
- Princess Margaret Cancer Centre, University of Toronto, Division of Urology, 610 University Avenue 3-130, Toronto, ON M5G 2M9, Canada
| | - Antonio Finelli
- Princess Margaret Cancer Centre, University of Toronto, Division of Urology, 610 University Avenue 3-130, Toronto, ON M5G 2M9, Canada
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Moloney F, Murphy KP, Twomey M, O'Connor OJ, Maher MM. Haematuria: an imaging guide. Adv Urol 2014; 2014:414125. [PMID: 25136357 PMCID: PMC4124848 DOI: 10.1155/2014/414125] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2014] [Revised: 06/24/2014] [Accepted: 06/25/2014] [Indexed: 11/23/2022] Open
Abstract
This paper discusses the current status of imaging in the investigation of patients with haematuria. The physician must rationalize imaging so that serious causes such as malignancy are promptly diagnosed while at the same time not exposing patients to unnecessary investigations. There is currently no universal agreement about the optimal imaging work up of haematuria. The choice of modality to image the urinary tract will depend on individual patient factors such as age, the presence of risk factors for malignancy, renal function, a history of calculus disease and pregnancy, and other factors, such as local policy and practice, cost effectiveness and availability of resources. The role of all modalities, including conventional radiography, intravenous urography/excretory urography, ultrasonography, retrograde pyelography, multidetector computed tomography urography (MDCTU), and magnetic resonance urography, is discussed. This paper highlights the pivotal role of MDCTU in the imaging of the patient with haematuria and discusses issues specific to this modality including protocol design, imaging of the urothelium, and radiation dose. Examination protocols should be tailored to the patient while all the while optimizing radiation dose.
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Affiliation(s)
- Fiachra Moloney
- Department of Radiology, Cork University Hospital, Wilton, Cork, Ireland
| | - Kevin P. Murphy
- Department of Radiology, Cork University Hospital, Wilton, Cork, Ireland
| | - Maria Twomey
- Department of Radiology, Cork University Hospital, Wilton, Cork, Ireland
| | - Owen J. O'Connor
- Department of Radiology, Cork University Hospital, Wilton, Cork, Ireland
| | - Michael M. Maher
- Department of Radiology, Cork University Hospital, Wilton, Cork, Ireland
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Lee CU, Glockner JF. Vascular staging of renal and adrenal malignancies with a noncontrast enhanced steady state free precession technique. J Magn Reson Imaging 2011; 33:1406-13. [PMID: 21591010 DOI: 10.1002/jmri.22568] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
PURPOSE To compare a noncontrast enhanced balanced steady state free precession (bSSFP) MRI technique with a conventional dynamic contrast-enhanced (DCE) three-dimensional (3D) spoiled gradient recalled echo (SPGR) imaging in the vascular staging of renal and adrenal malignancies. MATERIALS AND METHODS Sixty-three MRIs with both bSSFP and DCE acquisitions performed for initial staging of renal and adrenal malignancies were retrospectively evaluated for presence and extent of thrombus in the renal veins and inferior vena cava (IVC). Thrombus characterization was also evaluated. DCE imaging was used as the standard-of-reference. Histopathology was available in 46 of 63 cases as an additional external standard. RESULTS There is very good agreement between bSSFP and DCE imaging for determining the presence or absence of thrombus in the renal veins (r = 0.95; P < 0.0001) and IVC (r = 0.91; P < 0.0001). BSSFP is less successful at distinguishing bland from tumor thrombus. CONCLUSION Noncontrast enhanced bSSFP is an acceptable alternative to DCE imaging for vascular staging of locally advanced renal/adrenal malignancies, with somewhat limited ability to distinguish bland from tumor thrombus.
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Affiliation(s)
- Christine U Lee
- Department of Radiology, Mayo Clinic, Rochester, Minnesota 55905, USA.
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Abstract
Excellent contrast resolution and lack of ionizing radiation make magnetic resonance urography (MRU) a promising technique for noninvasively evaluating the entire urinary tract. While MRU currently lags behind CT urography (CTU) in spatial resolution and efficiency, new hardware and sequence developments have contributed to a resurgence of interest in MRU techniques. By combining unenhanced sequences with multiphase contrast-enhanced and excretory phase imaging, a comprehensive assessment of the kidneys, ureters, bladder, and surrounding structures is possible with image quality rivaling that obtained with other techniques. At the same time, formidable challenges remain to be overcome and further clinical validation is necessary before MRU can replace other forms of urography. In this article, we demonstrate the current potential of MRU to demonstrate a spectrum of urologic pathology involving the kidneys, ureters, and bladder while discussing the limitations and current status of this evolving technique.
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Affiliation(s)
- John R Leyendecker
- Department of Radiology, Wake Forest University School of Medicine, Winston-Salem, NC 27157, USA.
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Bach AM, Zhang J. Contemporary Radiologic Imaging of Renal Cortical Tumors. Urol Clin North Am 2008; 35:593-604; vi. [DOI: 10.1016/j.ucl.2008.07.012] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Abstract
OBJECTIVE This educational review focuses on the staging and radiologic evaluation of renal cell carcinoma. It includes discussion of the epidemiology, pathology, and therapeutic options of renal cell carcinoma and the implications for radiologic follow-up. CONCLUSION The incidence of renal cell carcinoma has been increasing. Imaging plays a central role in its detection, staging, and treatment evaluation and follow-up.
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Abstract
Advances in molecular genetics have expanded the understanding of renal cell tumors. Now it is understood that renal cortical tumors are a family of neoplasms with distinct cytogenetics and molecular defects, unique histopathologic features, and different malignant potentials. Imaging contributes to clinical management of patients with renal tumors in providing diagnostic information for tumor detection, characterization, staging, treatment planning, and follow-up.
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Affiliation(s)
- Jingbo Zhang
- Department of Radiology, Memorial Sloan-Kettering Cancer Center, Cornell University Weill Medical College, New York, NY 10021, USA.
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Abstract
Tumor stage, which describes the anatomic extent of disease, is a powerful determinant of prognosis and survival for patients with renal cell carcinoma (RCC). Stratification of patients based on prognostic outcomes derived from staging systems facilitates therapeutic decision-making, disease surveillance, and clinical research. Staging for RCC has evolved from the Robson classification into the TNM system, developed by the International Union Against Cancer and the American Joint Committee on Cancer. The most recent revisions of the TNM system for RCC introduced in 1997 and 2002 further subdivided organ-confined tumors, reclassified tumors with venous involvement, and clarified the staging of tumors that invade the perisinus fat. Most studies suggest that these revisions have substantially improved prognostication for RCC. Nevertheless, additional modifications have been proposed that would alter the subclassification of organ-confined disease, integrate various levels of venous involvement with other aspects of local tumor aggressiveness, and upgrade the classification of adrenal involvement. The data in support of each of these proposals will be discussed, and the current limitations of clinical and radiographic staging for RCC will be reviewed. Finally, a glimpse into the future of staging of RCC will be offered with a discussion of integrated staging and prognostic systems.
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Affiliation(s)
- Carvell T Nguyen
- Glickman Urological Institute, Cleveland Clinic Foundation, OH 44195, USA
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Abstract
This article familiarizes the urologist with the most common pulse sequences used in MRI to evaluate the kidneys and adrenal glands. It serves as a basis on which interpretation of genitourinary MRI can be facilitated, and includes specifics on how to perform these studies. MRI analysis of renal masses, cysts, and cystic masses is reviewed thoroughly and the critical factor in determining enhancement in renal lesions is detailed. Adrenal imaging for metastatic disease is reviewed. MR urography is also discussed briefly.
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Affiliation(s)
- Matthew J Bassignani
- Department of Radiology, University of Virginia Health Sciences Center, P.O. Box 800170, Lee Street, Charlottesville, VA 22908, USA.
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Beer AJ, Dobritz M, Zantl N, Weirich G, Stollfuss J, Rummeny EJ. Comparison of 16-MDCT and MRI for Characterization of Kidney Lesions. AJR Am J Roentgenol 2006; 186:1639-50. [PMID: 16714654 DOI: 10.2214/ajr.04.1545] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
OBJECTIVE The objective of our study was to compare the diagnostic performance of 16-MDCT with that of MRI in the characterization of kidney lesions. SUBJECTS AND METHODS Twenty-eight patients with kidney lesions detected with sonography and requiring further evaluation were examined. MDCT was performed in the unenhanced, arterial, and portal venous phases. MRI was performed at 1.5 T with T2- and T1-weighted and dynamic gadolinium-enhanced sequences. Consensus reading was done by two radiologists. Image quality was rated on a four-point scale. Classification of lesions as surgical or nonsurgical was done with five levels of confidence, and it was required that a definite diagnosis be assigned to each lesion. The 1997 TNM classification was used for staging. Statistical analysis was done by receiver operating characteristic analysis or paired Student's t test. Histologic or follow-up findings at least 12 months after the primary diagnosis served as the standard of reference. RESULTS The image quality of MDCT (mean grade, 2.79 on a 0-3 scale) was superior to that of MRI (1.93; p < 0.01). The area under the curve for differentiating surgical from nonsurgical lesions was 0.979 for MDCT and 0.957 for MRI with resulting sensitivity and specificity values of 92.3% and 96.3% for MDCT and 92.3% and 91.3% for MRI. Sensitivity and specificity for definite classification of the lesions were 93.8% and 68.4% for MDCT and 93.8% and 71.4% for MRI. CONCLUSION Both MDCT and MRI are excellent for differentiating surgical from nonsurgical kidney lesions. Both methods have low specificity for the differentiation of benign from malignant lesions.
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Affiliation(s)
- Ambros J Beer
- Department of Radiology, Technische Universitaet Munichen, Ismaninger Strasse 21, Munich, Germany, 81675.
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Pavlica P, Derchi L, Martorana G, Brunocilla E, Bertaccini A, Manferrari F, Franceschelli A, Barozzi L. Renal Cell Carcinoma Imaging. ACTA ACUST UNITED AC 2006. [DOI: 10.1016/j.eursup.2006.03.010] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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Affiliation(s)
- Chaan S Ng
- Department of Radiology, The University of Texas M. D. Anderson Cancer Center, Houston, TX 77030-4009, USA.
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Browne RFJ, Meehan CP, Colville J, Power R, Torreggiani WC. Transitional Cell Carcinoma of the Upper Urinary Tract: Spectrum of Imaging Findings. Radiographics 2005; 25:1609-27. [PMID: 16284138 DOI: 10.1148/rg.256045517] [Citation(s) in RCA: 128] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Transitional cell carcinoma (TCC) accounts for up to 10% of neoplasms of the upper urinary tract and usually manifests as hematuria. Imaging plays an important role in assessment of upper tract disease, unlike in bladder TCC, diagnosis of which is usually made at cystoscopy. Traditional imaging modalities, such as excretory urography, retrograde pyelography, and ultrasonography, still play pivotal roles in diagnosis of upper tract TCC, in combination with endourologic techniques. The multicentric nature of TCC makes assessment of the entire urothelium essential before treatment. The advent of minimally invasive surgery, which allows renal preservation in selected patients, makes accurate tumor staging mandatory to determine the appropriate therapy; staging is usually performed with computed tomography (CT) or magnetic resonance (MR) imaging. Vigilant urologic and radiologic follow-up is warranted to assess for metachronous lesions and recurrence. The emerging technique of CT urography allows detection of urinary tract tumors and calculi, assessment of perirenal tissues, and staging of lesions; it may offer the opportunity for one-stop evaluation in the initial assessment of hematuria and in follow-up of TCC. Similar MR imaging protocols can be used in patients who are not candidates for CT urography, although detection of urinary tract calcifications may be suboptimal.
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Affiliation(s)
- Ronan F J Browne
- Department of Radiology, Adelaide and Meath Hospital, Tallaght, Dublin 24, Ireland
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Abstract
High tissue contrast, multiplanar image capabilities, and tissue characterization render MR into an ideal imaging modality for effective evaluation of a wide range of renal disorders. It provides high details of anatomy and can suggest the composition of lesions. Improvements of MRI technology during the last years have made MRI increasingly attractive for body imaging. Fast imaging sequences and parallel imaging techniques have proved to be useful in minimizing artifacts from respiratory motion and magnetic susceptibility differences providing superior imaging quality. Additionally, the use of renally eliminated paramagnetic contrast agents permits assessment of parenchymal perfusion and visualization of the excretion of the contrast medium providing information on renal function.
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Affiliation(s)
- Nomdo S Renken
- Department of Radiology, Erasmus MC, Rotterdam, The Netherlands
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Huang GJ, Israel G, Berman A, Taneja SS. Preoperative renal tumor evaluation by three-dimensional magnetic resonance imaging: Staging and detection of multifocality. Urology 2005; 64:453-7. [PMID: 15351569 DOI: 10.1016/j.urology.2004.04.037] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2004] [Accepted: 04/21/2004] [Indexed: 10/26/2022]
Abstract
OBJECTIVES To evaluate, retrospectively, the staging accuracy of three-dimensional magnetic resonance imaging (3D-MRI) in our institution as a prelude to a prospective comparison of 3D-MRI and 3D computed tomography (CT) for preoperative planning of partial nephrectomy. In recent years, the use of 3D-CT for preoperative evaluation and surgical planning in patients undergoing nephron-sparing surgery has gained considerable popularity. METHODS The images of 26 consecutive patients evaluated by 3D-MRI as part of the preoperative imaging studies for renal tumor were evaluated retrospectively and compared with the surgical pathologic findings to evaluate the ability of 3D-MRI to predict tumor multifocality, tumor stage, collecting system invasion, and venous invasion. RESULTS 3D-MRI accurately predicted tumor multifocality in 1 of 2 cases. Imaging identified five of seven multifocal lesions. Two subcentimeter lesions were missed. Preoperative staging was correct in 29 of 30 lesions (97% accuracy). One T3b tumor was incorrectly staged as T2. Venous invasion was identified in 2 of 3 cases (67% sensitivity), but no false-positive results were seen. 3D-MRI had 100% sensitivity and 88% specificity in the prediction of collecting system invasion. CONCLUSIONS The staging accuracy of 3D-MRI appears to be quite good. Given the accuracy of this technique, along with the popularity of 3D imaging before renal surgery, these results provide the impetus for a future study directly comparing 3D-CT with 3D-MRI in the capacity of surgical preoperative planning.
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Affiliation(s)
- George J Huang
- Department of Urology, New York University School of Medicine, New York, New York 10016, USA
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Abstract
Matrix stone is a rare form of renal calculi, and it is often difficult to make an exact preoperative diagnosis. To our knowledge, we reported the first case of matrix stones which received magnetic resonance imaging (MRI) for image study. They showed hypointense signal in T1-weighted images and slight hyperintense signal in T2-weighted images. No obvious contrast enhancement was found after gadolinium administration in T1-weighted images. Besides, postoperative study of computerized tomography (CT) for matrix stones also showed the characteristic of soft tissue densities by measuring the Hounsfield units. We think our experiences may provide some help for the diagnosis of matrix stones when someone encounters the same situation and may prevent overtreatment due to misdiagnosis as malignancy.
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Affiliation(s)
- Chia-Chu Liu
- Department of Urology, Kaohsiung Medical University, Taiwan
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