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Fourniol C, Dariane C, Correas J, Audenet F, Pinar U, Anract J, Hostettler A, Panthier F, Timsit MO, Mejean A. Volumetric and functional outcomes at 1-year between percutaneous-ablation and partial-nephrectomy for T1b renal tumors. Prog Urol 2023; 33:509-518. [PMID: 37633733 DOI: 10.1016/j.purol.2023.08.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 07/16/2023] [Accepted: 08/01/2023] [Indexed: 08/28/2023]
Abstract
INTRODUCTION Indication for percutaneous-ablation (PA) is gradually expanding to renal tumors T1b (4-7cm). Few data exist on the alteration of renal functional volume (RFV) post-PA. Yet, it is a surrogate marker of post partial-nephrectomy (PN) glomerular filtration rate (GFR) impairment. The objective was to compare RFV and GFR at 1-year post-PN or PA, in this T1b population. METHODS Patients with unifocal renal tumor≥4cm treated between 2014 and 2019 were included. Tumor, homolateral (RFVh), contralateral RFV, and total volumes were assessed by manual segmentation (3D Slicer) before and at 1 year of treatment, as was GFR. The loss of RFV, contralateral hypertrophy, and preservation of GFR were compared between both groups (PN vs. PA). RESULTS 144 patients were included (87PN, 57PA). Preoperatively, PA group was older (74 vs. 59 years; P<0.0001), had more impaired GFR (73 vs. 85mL/min; P=0.0026) and smaller tumor volume(31.1 vs. 55.9cm3; P=0.0007) compared to PN group. At 1 year, the PN group had significantly more homolateral RFV loss (-19 vs. -14%; P=0.002), and contralateral compensatory hypertrophy (+4% vs. +1,8%; P=0.02, respectively). Total-RFV loss was similar between both (-21.7 vs. -19cm3; P=0.07). GFR preservation was better in the PN group (95.9 vs. 90.7%; P=0.03). In multivariate analysis, age and tumor size were associated with loss of RFVh. CONCLUSION For renal tumors T1b, PN is associated with superior compensatory hypertrophy compared with PA, compensating for the higher RFVh loss, resulting in similar ΔRFV-total between both groups. The superior post-PN GFR preservation suggests that the preserved quantitative RFV factor is insufficient. Therefore, the underlying quality of the parenchyma would play a major role in postoperative GFR.
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Affiliation(s)
- C Fourniol
- Service d'urologie, hôpital européen Georges-Pompidou, AP-HP, centre, université de Paris, 20, rue Leblanc, 75015 Paris, France.
| | - C Dariane
- Service d'urologie, hôpital européen Georges-Pompidou, AP-HP, centre, université de Paris, 20, rue Leblanc, 75015 Paris, France
| | - J Correas
- Service de radiologie adulte, hôpital Necker-Enfants-Malades, AP-HP, centre, université de Paris, 245, rue de Sèvres, 75015 Paris, France
| | - F Audenet
- Service d'urologie, hôpital européen Georges-Pompidou, AP-HP, centre, université de Paris, 20, rue Leblanc, 75015 Paris, France
| | - U Pinar
- Service d'urologie, hôpital Pitié-Salpêtrière, AP-HP-centre, Sorbonne université, 47-83, boulevard de l'Hôpital, 75013 Paris, France
| | - J Anract
- Service d'urologie, hôpital Cochin, AP-HP-centre, université de Paris, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France
| | - A Hostettler
- Département de recherche et développement, IRCAD France, 1, place de l'Hôpital, 67000 Strasbourg, France
| | - F Panthier
- Service d'urologie, hôpital européen Georges-Pompidou, AP-HP, centre, université de Paris, 20, rue Leblanc, 75015 Paris, France
| | - M O Timsit
- Service d'urologie, hôpital européen Georges-Pompidou, AP-HP, centre, université de Paris, 20, rue Leblanc, 75015 Paris, France
| | - A Mejean
- Service d'urologie, hôpital européen Georges-Pompidou, AP-HP, centre, université de Paris, 20, rue Leblanc, 75015 Paris, France
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Houshyar R, Glavis-Bloom J, Bui TL, Chahine C, Bardis MD, Ushinsky A, Liu H, Bhatter P, Lebby E, Fujimoto D, Grant W, Tran-Harding K, Landman J, Chow DS, Chang PD. Outcomes of Artificial Intelligence Volumetric Assessment of Kidneys and Renal Tumors for Preoperative Assessment of Nephron Sparing Interventions. J Endourol 2021; 35:1411-1418. [PMID: 33847156 DOI: 10.1089/end.2020.1125] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background Renal cell carcinoma is the most common kidney cancer and the 13th most common cause of cancer death worldwide. Partial nephrectomy and percutaneous ablation, increasingly utilized to treat small renal masses and preserve renal parenchyma, require precise preoperative imaging interpretation. We sought to develop and evaluate a convolutional neural network (CNN), a type of deep learning artificial intelligence, to act as a surgical planning aid by determining renal tumor and kidney volumes via segmentation on single-phase computed tomography (CT). Materials and Methods After institutional review board approval, the CT images of 319 patients were retrospectively analyzed. Two distinct CNNs were developed for (1) bounding cube localization of the right and left hemi-abdomen and (2) segmentation of the renal parenchyma and tumor within each bounding cube. Training was performed on a randomly selected cohort of 269 patients. CNN performance was evaluated on a separate cohort of 50 patients using Sorensen-Dice coefficients (which measures the spatial overlap between the manually segmented and neural network derived segmentations) and Pearson correlation coefficients. Experiments were run on a GPU-optimized workstation with a single NVIDIA GeForce GTX Titan X (12GB, Maxwell architecture). Results Median Dice coefficients for kidney and tumor segmentation were 0.970 and 0.816, respectively; Pearson correlation coefficients between CNN-generated and human-annotated estimates for kidney and tumor volume were 0.998 and 0.993 (p < 0.001), respectively. End-to-end trained CNNs were able to perform renal parenchyma and tumor segmentation on a new test case in an average of 5.6 seconds. Conclusions Initial experience with automated deep learning artificial intelligence demonstrates that it is capable of rapidly and accurately segmenting kidneys and renal tumors on single-phase contrast-enhanced CT scans and calculating tumor and renal volumes.
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Affiliation(s)
- Roozbeh Houshyar
- University of California Irvine School of Medicine, 12219, Radiological Sciences, Orange, California, United States;
| | - Justin Glavis-Bloom
- University of California Irvine School of Medicine, 12219, Radiological Sciences, Orange, California, United States;
| | - Thanh-Lan Bui
- University of California Irvine School of Medicine, 12219, Radiological Sciences, Orange, California, United States;
| | - Chantal Chahine
- University of California Irvine School of Medicine, 12219, Radiological Sciences, Orange, California, United States;
| | - Michelle D Bardis
- University of California Irvine School of Medicine, 12219, Radiological Sciences, Orange, California, United States.,University of California Irvine Center for Artificial Intelligence in Diagnostic Medicine, Irvine, California, United States;
| | - Alexander Ushinsky
- Washington University in St Louis School of Medicine, 12275, Mallinckrodt Institute of Radiology, St Louis, Missouri, United States;
| | - Hanna Liu
- University of California Irvine School of Medicine, 12219, Radiological Sciences, Orange, California, United States;
| | - Param Bhatter
- University of California Irvine School of Medicine, 12219, Radiological Sciences, Orange, California, United States;
| | - Elliott Lebby
- University of California Irvine School of Medicine, 12219, Radiological Sciences, Orange, California, United States;
| | - Dylann Fujimoto
- University of California Irvine School of Medicine, 12219, Radiological Sciences, Orange, California, United States;
| | - William Grant
- University of California Irvine School of Medicine, 12219, Radiological Sciences, Orange, California, United States;
| | - Karen Tran-Harding
- University of California Irvine School of Medicine, 12219, Radiological Sciences, Orange, California, United States;
| | - Jaime Landman
- University of California Irvine, Urology, 333 City Blvd West, Orange, California, United States, 92868;
| | - Daniel S Chow
- University of California Irvine School of Medicine, 12219, Radiological Sciences, 101 The City Dr S, Orange, California, United States, 92697-3950.,University of California Irvine Center for Artificial Intelligence in Diagnostic Medicine, 4100 E. Peltason Dr., Irvine, California, United States, 92617;
| | - Peter D Chang
- University of California Irvine School of Medicine, 12219, Radiological Sciences, Orange, California, United States.,University of California Irvine Center for Artificial Intelligence in Diagnostic Medicine, Irvine, California, United States;
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Singla N, Hutchinson R, Menegaz C, Haddad AQ, Jiang L, Sagalowsky AI, Cadeddu JA, Lotan Y, Margulis V. Comparing Changes in Renal Function After Radical Surgery for Upper Tract Urothelial Carcinoma and Renal Cell Carcinoma. Urology 2016; 96:44-53. [DOI: 10.1016/j.urology.2016.07.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2016] [Revised: 07/03/2016] [Accepted: 07/09/2016] [Indexed: 01/20/2023]
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Liu W, Zhu Y, Zhu X, Yang G, Xu Y, Tang L. CT-based renal volume measurements: correlation with renal function in patients with renal tumours. Clin Radiol 2015; 70:1445-50. [PMID: 26454346 DOI: 10.1016/j.crad.2015.09.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2015] [Revised: 07/28/2015] [Accepted: 09/03/2015] [Indexed: 11/19/2022]
Abstract
AIM To evaluate the correlations between renal cortical volume (RCV), renal parenchymal volume (RPV), and renal function in patients with renal tumours before and after laparoscopic partial nephrectomy (LPN). MATERIALS AND METHODS Thirty-five patients with a single unilateral renal tumour who had undergone contrast-enhanced computed tomography (CT) and renal nuclear scintigraphy before and after LPN were retrospectively studied. RCV and RPV were calculated as renal volume, excluding tumours or cysts, using a semi-automatic segmentation program. The correlations between RCV, RPV, and glomerular filtration rate (GFR) were undertaken preoperatively and postoperatively using the Pearson correlation coefficient. RESULTS Preoperatively, the correlations between RCV and GFR, and RPV and GFR for the operated kidneys was r=0.502 (p=0.002) and 0.527 (p=0.001), respectively, whereas the correlations for the contralateral side were r=0.384 (p=0.023) and r=0.412 (p=0.014). The mean RCV and RPV of the operated kidneys decreased by 27.4% and 24.8%. The mean split GFR of the operated kidneys decreased by 36.4%. Postoperatively, residual RCV (r=0.619, p<0.001) and RPV (r=0.593, p<0.001) correlated moderately with the GFR of the operated kidneys. CONCLUSIONS Renal volume, both RCV and RPV, had a moderate relationship with renal function before and after operation. CT-based renal volume measurements could serve as a simple and effective method for estimation of postoperative renal function.
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Affiliation(s)
- W Liu
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, Jiangsu, China
| | - Y Zhu
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, Jiangsu, China
| | - X Zhu
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, Jiangsu, China
| | - G Yang
- Lab of Image Science and Technology, School of Computer Science and Engineering, Southeast University, 2 Sipailou, Nanjing, 210096, Jiangsu, China
| | - Y Xu
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, Jiangsu, China.
| | - L Tang
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, Jiangsu, China.
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Breau RH, Clark E, Bruner B, Cervini P, Atwell T, Knoll G, Leibovich BC. A simple method to estimate renal volume from computed tomography. Can Urol Assoc J 2013; 7:189-92. [PMID: 23826046 DOI: 10.5489/cuaj.1338] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Renal parenchymal volume can be used clinically to estimate differential renal function. Unfortunately, conventional methods to determine renal volume from computed tomography (CT) are time-consuming or difficult due to software limitations. We evaluated the accuracy of simple renal measurements to estimate renal volume as compared with estimates made using specialized CT volumetric software. METHODS We reviewed 28 patients with contrast-enhanced abdominal CT. Using a standardized technique, one urologist and one urology resident independently measured renal length, lateral diameter and anterior-posterior diameter. Using the ellipsoid method, the products of the linear measurements were compared to 3D volume measurements made by a radiologist using specialized volumetric software. RESULTS LINEAR KIDNEY MEASUREMENTS WERE HIGHLY CONSISTENT BETWEEN THE UROLOGIST AND THE UROLOGY RESIDENT (INTRACLASS CORRELATION COEFFICIENTS: 0.97 for length, 0.96 for lateral diameter, and 0.90 for anterior-posterior diameter). Average renal volume was 170 (SD: 36) cm(3) using the ellipsoid method compared with 186 (SD 37) cm(3) using volumetric software, for a mean absolute bias of -15.2 (SD 15.0) cm(3) and a relative volume bias of -8.2% (p < 0.001). Thirty-one of 56 (55.3%) estimated volumes were within 10% of the 3D measured volume and 54 of 56 (96.4%) were within 30%. CONCLUSION Renal volume can be easily approximated from contrast-enhanced CT scans using the ellipsoid method. These findings may obviate the need for 3D volumetric software analysis in certain cases. Prospective validation is warranted.
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Affiliation(s)
- Rodney H Breau
- Ottawa Hospital Research Institute, Ottawa, ON; ; Division of Urology, University of Ottawa, Ottawa ON
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