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Barkovich KJ, Gibson AC, Brahmbhatt S, Tadisetty S, Wilds EC, Nelson LW, Gupta M, Gedaly R, Khurana A. Contrast-enhanced ultrasound of renal masses in the pre-transplant setting: literature review with case highlights. Abdom Radiol (NY) 2024:10.1007/s00261-024-04366-w. [PMID: 38900316 DOI: 10.1007/s00261-024-04366-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2024] [Revised: 04/29/2024] [Accepted: 04/29/2024] [Indexed: 06/21/2024]
Abstract
With the rising incidence of chronic kidney disease worldwide, an increasing number of patients are expected to require renal transplantation, which remains the definitive treatment of end stage renal disease. Medical imaging, primarily ultrasonography and contrast-enhanced CT and/or MRI, plays a large role in pre-transplantation assessment, especially in the characterization of lesions within the native kidneys. However, patients with CKD/ESRD often have relative contraindications to CT- and MR-contrast agents, limiting their utilization within this patient population. Contrast-enhanced ultrasound (CEUS), which combines the high temporal and spatial resolution of ultrasonography with intravascular microbubble contrast agents, provides a promising alternative. This review aims to familiarize the reader with the literature regarding the use of CEUS in the evaluation of cystic and solid renal lesions and provide case examples of its use at our institution in the pre-transplant setting.
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Affiliation(s)
- Krister J Barkovich
- Department of Radiology, University of California, San Diego, La Jolla, CA, 92093, USA
| | - Amanda C Gibson
- Department of Radiology, University of Kentucky, Lexington, KY, 40508, USA
| | - Sneh Brahmbhatt
- Department of Radiology, Mayo Clinic Florida, Jacksonville, FL, 32224, USA
| | - Sindhura Tadisetty
- Department of Radiology, University of Kentucky, Lexington, KY, 40508, USA
| | - Emory C Wilds
- College of Medicine, University of Kentucky, Lexington, KY, 40506, USA
| | - Leslie W Nelson
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, WI, 53792, USA
| | - Meera Gupta
- Department of Surgery, University of Kentucky, Lexington, KY, 40508, USA
| | - Roberto Gedaly
- Department of Surgery, University of Kentucky, Lexington, KY, 40508, USA
| | - Aman Khurana
- Department of Radiology, University of California, San Diego, La Jolla, CA, 92093, USA.
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Rau S, Rau A, Stein T, Hagar MT, Faby S, Bamberg F, Weiss J. Value of virtual non-contrast images to identify uncomplicated cystic renal lesions: photon-counting detector CT vs. dual-energy integrating detector CT. LA RADIOLOGIA MEDICA 2024; 129:669-676. [PMID: 38512614 PMCID: PMC11088563 DOI: 10.1007/s11547-024-01801-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 02/14/2024] [Indexed: 03/23/2024]
Abstract
PURPOSE To investigate the value of photon-counting detector CT (PCD-CT) derived virtual non-contrast (VNC) reconstructions to identify renal cysts in comparison with conventional dual-energy integrating detector (DE EID) CT-derived VNC reconstructions. MATERIAL AND METHODS We prospectively enrolled consecutive patients with simple renal cysts (Bosniak classification-Version 2019, density ≤ 20 HU and/or enhancement ≤ 20 HU) who underwent multiphase (non-contrast, arterial, portal venous phase) PCD-CT and for whom non-contrast and portal venous phase DE EID-CT was available. Subsequently, VNC reconstructions were calculated for all contrast phases and density as well as contrast enhancement within the cysts were measured and compared. MRI and/or ultrasound served as reference standards for lesion classification. RESULTS 19 patients (1 cyst per patient; age 69.5 ± 10.7 years; 17 [89.5%] male) were included. Density measurements on PCD-CT non-contrast and VNC reconstructions (arterial and portal venous phase) revealed no significant effect on HU values (p = 0.301). In contrast, a significant difference between non-contrast vs. VNC images was found for DE EID-CT (p = 0.02). For PCD-CT, enhancement for VNC reconstructions was < 20 HU for all evaluated cysts. DE EID-CT measurements revealed an enhancement of > 20 HU in five lesions (26.3%) using the VNC reconstructions, which was not seen with the non-contrast images. CONCLUSION PCD-CT-derived VNC images allow for reliable and accurate characterization of simple cystic renal lesions similar to non-contrast scans whereas VNC images calculated from DE EID-CT resulted in substantial false characterization. Thus, PCD-CT-derived VNC images may substitute for non-contrast images and reduce radiation dose and follow-up imaging.
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Affiliation(s)
- Stephan Rau
- Department of Diagnostic and Interventional Radiology, Medical Center, Faculty of Medicine, University of Freiburg, Hugstetter Str. 55, 79106, Freiburg, Germany.
| | - Alexander Rau
- Department of Diagnostic and Interventional Radiology, Medical Center, Faculty of Medicine, University of Freiburg, Hugstetter Str. 55, 79106, Freiburg, Germany
| | - Thomas Stein
- Department of Diagnostic and Interventional Radiology, Medical Center, Faculty of Medicine, University of Freiburg, Hugstetter Str. 55, 79106, Freiburg, Germany
| | - Muhammad Taha Hagar
- Department of Diagnostic and Interventional Radiology, Medical Center, Faculty of Medicine, University of Freiburg, Hugstetter Str. 55, 79106, Freiburg, Germany
| | - Sebastian Faby
- Siemens Healthcare GmbH, Siemensstr. 3, 91301, Forchheim, Germany
| | - Fabian Bamberg
- Department of Diagnostic and Interventional Radiology, Medical Center, Faculty of Medicine, University of Freiburg, Hugstetter Str. 55, 79106, Freiburg, Germany
| | - Jakob Weiss
- Department of Diagnostic and Interventional Radiology, Medical Center, Faculty of Medicine, University of Freiburg, Hugstetter Str. 55, 79106, Freiburg, Germany
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Dev R, Chauhan U, Nandolia KK. Multifaceted Imaging of Renal Lesions With an Emphasis on Cross-Sectional Imaging. Cureus 2024; 16:e59956. [PMID: 38854236 PMCID: PMC11161908 DOI: 10.7759/cureus.59956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/09/2024] [Indexed: 06/11/2024] Open
Abstract
Introduction Renal lesions are common findings encountered in cross-sectional imaging. Ultrasonography (USG), computed tomography (CT), and magnetic resonance imaging (MRI) are available modalities for evaluating renal lesions. The Bosniak classification system aids in classifying a renal lesion into a particular category based on various imaging characteristics on contrast-enhanced CT (CECT). Materials and methods The CT report archives were searched for the keyword 'Bosniak' lesions, and six illustrative cases were selected to be included in the review. Results Six cases under Bosniak categories I to IV were included in the review. Operative follow-ups were added in cases where patients underwent surgery. Discussion We have reviewed the imaging features of various renal lesions with cross-sectional modalities, namely CT and MRI, with special emphasis on the Bosniak classification system, including its amendments. Conclusion The Bosniak system is widely used to classify and characterize renal lesions. The authors have presented a scoping review of the features of renal lesions and the Bosniak system.
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Affiliation(s)
- Rahul Dev
- Diagnostic and Intervention Radiology, All India Institute of Medical Sciences, Rishikesh, IND
| | - Udit Chauhan
- Diagnostic and Intervention Radiology, All India Institute of Medical Sciences, Rishikesh, IND
| | - Khanak K Nandolia
- Diagnostic and Intervention Radiology, All India Institute of Medical Sciences, Rishikesh, IND
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Acosta Ruiz V, Dahlman P, Brekkan E, Lönnemark M, Magnusson A. Microwave ablation of 105 T1 renal tumors: technique efficacy with a mean follow-up of two years. Acta Radiol 2024; 65:294-301. [PMID: 32910687 DOI: 10.1177/0284185120956283] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
BACKGROUND Thermal ablation (TA) with radiofrequency (RFA) or cryoablation (CA) are established treatments for small renal masses (≤4 cm). Microwave ablation (MWA) has several potential benefits (decreased ablation time, less susceptibility to heat-sink, higher lesion temperatures than RFA) but is still considered experimental considering the available small-sample studies with short follow-up. PURPOSE To evaluate technique efficacy and complications of our initial experience of renal tumors treated using percutaneous MWA with a curative intent. MATERIAL AND METHODS A total of 105 renal tumors (in 93 patients) were treated between April 2014 and August 2017. MWA was performed percutaneously with computed tomography (CT) guidance under conscious sedation (n=82) or full anesthesia. Patients were followed with contrast-enhanced CT scans at six months and yearly thereafter for a minimum of five years. The mean follow-up time was 2.1 years. The percentage of tumors completely ablated in a single session (primary efficacy rate) and those successfully treated after repeat ablation (secondary efficacy rate) were recorded. Patient and tumor characteristics as well as complications were collected retrospectively. RESULTS The median patient age was 70 years and median tumor size was 25 mm. Primary efficacy rate was 96.2% (101/105 tumors). After including two residual tumors for a second ablation session, secondary efficacy was 97.1% (102/105). Periprocedural complications were found in 5.2% (5/95) sessions: four Clavien-Dindo I and one Clavien-Dindo IIIa. One postprocedural Clavien-Dindo II complication was found. CONCLUSION MWA has high efficacy rates and few complications compared to other TA methods at a mean follow-up of two years.
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Affiliation(s)
- Vanessa Acosta Ruiz
- Department of Surgical Sciences - Radiology, Uppsala University, Uppsala Sweden
| | - Pär Dahlman
- Department of Surgical Sciences - Radiology, Uppsala University, Uppsala Sweden
| | - Einar Brekkan
- Department of Surgical Sciences - Urology, Uppsala University, Uppsala Sweden
| | - Maria Lönnemark
- Department of Surgical Sciences - Radiology, Uppsala University, Uppsala Sweden
| | - Anders Magnusson
- Department of Surgical Sciences - Radiology, Uppsala University, Uppsala Sweden
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Elbanna KY, Krishna S, Finelli A, Atri M. Contrast-Enhanced Ultrasound of the Indeterminate Renal Mass, From the AJR "How We Do It" Special Series. AJR Am J Roentgenol 2024. [PMID: 38415576 DOI: 10.2214/ajr.24.30817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/29/2024]
Abstract
Contrast-enhanced ultrasound (CEUS) is distinguished from CT and MRI by the use of microbubble ultrasound contrast agents (UCAs) with intravascular blood pool distribution. When performing CEUS, low-intensity ultrasound allows real-time tissue subtraction imaging, whereas high-intensity ultrasound leads to microbubble destruction, enabling visualization of the contrast inflow pattern. CEUS has exceptional contrast resolution that enables the detection of even minimal blood flow, achieving very high NPV for ruling out vascular perfusion and providing high frame rates in the evaluation of tissue perfusion dynamics. UCAs undergo hepatic metabolism and pulmonary clearance, ensuring safety in patients with renal impairment. CEUS excels in distinguishing solid from cystic renal masses, with higher sensitivity than CT or MRI for detection of lesion enhancement. CEUS can aid the further characterization of both solid and cystic lesions and may have particular applications in the surveillance of cystic masses and surveillance after renal cell carcinoma ablation. This review describes the use of CEUS to help characterize indeterminate renal masses, based on the authors' institutional experience. The article highlights key differences between CEUS and CT or MRI, and provides practical insights for performing and interpreting CEUS of renal masses.
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Affiliation(s)
- Khaled Y Elbanna
- Department of Medical Imaging, University Medical Imaging Toronto, University of Toronto, Canada
| | - Satheesh Krishna
- Department of Medical Imaging, University Medical Imaging Toronto, University of Toronto, Canada
| | - Antonio Finelli
- Division of Urology, Departments of Surgery and of Surgical Oncology, Princess Margaret Hospital and the University Health Network, University of Toronto, Canada
| | - Mostafa Atri
- Department of Medical Imaging, University Medical Imaging Toronto, University of Toronto, Canada
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Walmer RW, Ritter VS, Sridharan A, Kasoji SK, Altun E, Lee E, Olinger K, Wagner S, Radhakrishna R, Johnson KA, Rathmell WK, Qaqish B, Dayton PA, Chang EH. The Performance of Flash Replenishment Contrast-Enhanced Ultrasound for the Qualitative Assessment of Kidney Lesions in Patients with Chronic Kidney Disease. J Clin Med 2023; 12:6494. [PMID: 37892632 PMCID: PMC10607866 DOI: 10.3390/jcm12206494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 09/26/2023] [Accepted: 10/05/2023] [Indexed: 10/29/2023] Open
Abstract
We investigated the accuracy of CEUS for characterizing cystic and solid kidney lesions in patients with chronic kidney disease (CKD). Cystic lesions are assessed using Bosniak criteria for computed tomography (CT) and magnetic resonance imaging (MRI); however, in patients with moderate to severe kidney disease, CT and MRI contrast agents may be contraindicated. Contrast-enhanced ultrasound (CEUS) is a safe alternative for characterizing these lesions, but data on its performance among CKD patients are limited. We performed flash replenishment CEUS in 60 CKD patients (73 lesions). Final analysis included 53 patients (63 lesions). Four readers, blinded to true diagnosis, interpreted each lesion. Reader evaluations were compared to true lesion classifications. Performance metrics were calculated to assess malignant and benign diagnoses. Reader agreement was evaluated using Bowker's symmetry test. Combined reader sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) for diagnosing malignant lesions were 71%, 75%, 45%, and 90%, respectively. Sensitivity (81%) and specificity (83%) were highest in CKD IV/V patients when grouped by CKD stage. Combined reader sensitivity, specificity, PPV, and NPV for diagnosing benign lesions were 70%, 86%, 91%, and 61%, respectively. Again, in CKD IV/V patients, sensitivity (81%), specificity (95%), and PPV (98%) were highest. Inter-reader diagnostic agreement varied from 72% to 90%. In CKD patients, CEUS is a potential low-risk option for screening kidney lesions. CEUS may be particularly beneficial for CKD IV/V patients, where kidney preservation techniques are highly relevant.
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Affiliation(s)
- Rachel W. Walmer
- Joint Department of Biomedical Engineering, University of North Carolina at Chapel Hill and North Carolina State University, Chapel Hill, NC 27599, USA; (A.S.)
| | - Victor S. Ritter
- Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Anush Sridharan
- Joint Department of Biomedical Engineering, University of North Carolina at Chapel Hill and North Carolina State University, Chapel Hill, NC 27599, USA; (A.S.)
- Fox Chase Cancer Center, Philadelphia, PA 19111, USA
| | - Sandeep K. Kasoji
- Joint Department of Biomedical Engineering, University of North Carolina at Chapel Hill and North Carolina State University, Chapel Hill, NC 27599, USA; (A.S.)
- Triangle Biotechnology, Durham, NC 27709, USA
| | - Ersan Altun
- Department of Radiology, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA; (E.A.); (K.O.)
| | - Ellie Lee
- Department of Radiology, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA; (E.A.); (K.O.)
| | - Kristen Olinger
- Department of Radiology, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA; (E.A.); (K.O.)
| | - Sean Wagner
- Department of Radiology, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA; (E.A.); (K.O.)
| | - Roshni Radhakrishna
- Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA (E.H.C.)
| | - Kennita A. Johnson
- Joint Department of Biomedical Engineering, University of North Carolina at Chapel Hill and North Carolina State University, Chapel Hill, NC 27599, USA; (A.S.)
| | | | - Bahjat Qaqish
- Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Paul A. Dayton
- Joint Department of Biomedical Engineering, University of North Carolina at Chapel Hill and North Carolina State University, Chapel Hill, NC 27599, USA; (A.S.)
| | - Emily H. Chang
- Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA (E.H.C.)
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Huang L, Feng W, Lin W, Chen J, Peng S, Du X, Li X, Liu T, Ye Y. Enhanced and unenhanced: Radiomics models for discriminating between benign and malignant cystic renal masses on CT images: A multi-center study. PLoS One 2023; 18:e0292110. [PMID: 37768941 PMCID: PMC10538730 DOI: 10.1371/journal.pone.0292110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Accepted: 09/13/2023] [Indexed: 09/30/2023] Open
Abstract
BACKGROUND Machine learning algorithms used to classify cystic renal masses (CRMs) nave not been applied to unenhanced CT images, and their diagnostic accuracy had not been compared against radiologists. METHOD This retrospective study aimed to develop radiomics models that discriminate between benign and malignant CRMs in a triple phase computed tomography (CT) protocol and compare the diagnostic accuracy of the radiomics approach with experienced radiologists. Predictive models were established using a training set and validation set of unenhanced and enhanced (arterial phase [AP] and venous phase [VP]) CT images of benign and malignant CRMs. The diagnostic capabilities of the models and experienced radiologists were compared using Receiver Operating Characteristic (ROC) curves. RESULTS On unenhanced, AP and VP CT images in the validation set, the AUC, specificity, sensitivity and accuracy for discriminating between benign and malignant CRMs were 90.0 (95%CI: 81-98%), 90.0%, 90.5% and 90.2%; 93.0% (95%CI: 86-99%), 86.7%, 95.2% and 88.3%; and 95.0% (95%CI: 90%-100%), 93.3%, 90.5% and 92.1%, respectively, for the radiomics models. Diagnostic accuracy of the radiomics models differed significantly on unenhanced images in the training set vs. each radiologist (p = 0.001 and 0.003) but not in the validation set (p = 0.230 and 0.590); differed significantly on AP images in the validation set vs. each radiologist (p = 0.007 and 0.007) but not in the training set (p = 0.663 and 0.663); and there were no differences on VP images in the training or validation sets vs. each radiologist (training set: p = 0.453 and 0.051, validation set: p = 0.236 and 0.786). CONCLUSIONS Radiomics models may have clinical utility for discriminating between benign and malignant CRMs on unenhanced and enhanced CT images. The performance of the radiomics model on unenhanced CT images was similar to experienced radiologists, implying it has potential as a screening and diagnostic tool for CRMs.
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Affiliation(s)
- Lesheng Huang
- Department of Radiology, Guangdong Provincial Hospital of Traditional Chinese Medicine, Zhuhai, China
| | - Wenhui Feng
- Department of Radiology, Zhuhai People’s Hospital, Zhuhai, China
| | - Wenxiang Lin
- Department of Radiology, Zhuhai People’s Hospital, Zhuhai, China
| | - Jun Chen
- Department of Radiology, Guangdong Provincial Hospital of Traditional Chinese Medicine, Zhuhai, China
| | - Se Peng
- Department of Laboratory, Guangdong Provincial Hospital of Traditional Chinese Medicine, Zhuhai, China
| | - Xiaohua Du
- Department of Radiology, Guangdong Provincial Hospital of Traditional Chinese Medicine, Zhuhai, China
| | - Xiaodan Li
- Department of Gynaecology, Guangdong Provincial Hospital of Traditional Chinese Medicine, Zhuhai, China
| | - Tianzhu Liu
- Department of Radiology, Guangdong Provincial Hospital of Traditional Chinese Medicine, Zhuhai, China
| | - Yongsong Ye
- Department of Radiology, Guangdong Provincial Hospital of Traditional Chinese Medicine, Zhuhai, China
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Zhou Z, Qian X, Hu J, Geng C, Zhang Y, Dou X, Che T, Zhu J, Dai Y. Multi-phase-combined CECT radiomics models for Fuhrman grade prediction of clear cell renal cell carcinoma. Front Oncol 2023; 13:1167328. [PMID: 37692840 PMCID: PMC10485140 DOI: 10.3389/fonc.2023.1167328] [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: 02/16/2023] [Accepted: 07/24/2023] [Indexed: 09/12/2023] Open
Abstract
Objective This study aimed to evaluate the effectiveness of multi-phase-combined contrast-enhanced CT (CECT) radiomics methods for noninvasive Fuhrman grade prediction of clear cell renal cell carcinoma (ccRCC). Methods A total of 187 patients with four-phase CECT images were retrospectively enrolled and then were categorized into training cohort (n=126) and testing cohort (n=61). All patients were confirmed as ccRCC by histopathological reports. A total of 110 3D classical radiomics features were extracted from each phase of CECT for individual ccRCC lesion, and contrast-enhanced variation features were also calculated as derived radiomics features. These features were concatenated together, and redundant features were removed by Pearson correlation analysis. The discriminative features were selected by minimum redundancy maximum relevance method (mRMR) and then input into a C-support vector classifier to build multi-phase-combined CECT radiomics models. The prediction performance was evaluated by the area under the curve (AUC) of receiver operating characteristic (ROC). Results The multi-phase-combined CECT radiomics model showed the best prediction performance (AUC=0.777) than the single-phase CECT radiomics model (AUC=0.711) in the testing cohort (p value=0.039). Conclusion The multi-phase-combined CECT radiomics model is a potential effective way to noninvasively predict Fuhrman grade of ccRCC. The concatenation of first-order features and texture features extracted from corticomedullary phase and nephrographic phase are discriminative feature representations.
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Affiliation(s)
- Zhiyong Zhou
- Suzhou Institute of Biomedical Engineering and Technology, Chinese Academy of Sciences, Suzhou, Jiangsu, China
| | - Xusheng Qian
- Suzhou Institute of Biomedical Engineering and Technology, Chinese Academy of Sciences, Suzhou, Jiangsu, China
- School of Biomedical Engineering (Suzhou), Division of Life Sciences and Medicine, University of Science and Technology of China, Suzhou, Jiangsu, China
| | - Jisu Hu
- Suzhou Institute of Biomedical Engineering and Technology, Chinese Academy of Sciences, Suzhou, Jiangsu, China
- School of Biomedical Engineering (Suzhou), Division of Life Sciences and Medicine, University of Science and Technology of China, Suzhou, Jiangsu, China
| | - Chen Geng
- Suzhou Institute of Biomedical Engineering and Technology, Chinese Academy of Sciences, Suzhou, Jiangsu, China
| | - Yongsheng Zhang
- Department of Pathology, Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Xin Dou
- Department of Radiology, Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Tuanjie Che
- Key Laboratory of Functional Genomic and Molecular Diagnosis of Gansu Province, Lanzhou, Gansu, China
- Suzhou Science & Technology Town Hospital, Gusu School, Nanjing Medical University, Suzhou, Jiangsu, China
| | - Jianbing Zhu
- Suzhou Science & Technology Town Hospital, Gusu School, Nanjing Medical University, Suzhou, Jiangsu, China
| | - Yakang Dai
- Suzhou Institute of Biomedical Engineering and Technology, Chinese Academy of Sciences, Suzhou, Jiangsu, China
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Baio R, Molisso G, Caruana C, Di Mauro U, Intilla O, Pane U, D’Angelo C, Campitelli A, Pentimalli F, Sanseverino R. "To Be or Not to Be Benign" at Partial Nephrectomy for Presumed RCC Renal Masses: Single-Center Experience with 195 Consecutive Patients. Diseases 2023; 11:diseases11010027. [PMID: 36810541 PMCID: PMC9945135 DOI: 10.3390/diseases11010027] [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: 11/15/2022] [Revised: 01/21/2023] [Accepted: 01/31/2023] [Indexed: 02/11/2023] Open
Abstract
In daily medical practice, an increasing number of kidney masses are being incidentally detected using common imaging techniques, owing to the improved diagnostic accuracy and increasingly frequent use of these techniques. As a consequence, the rate of detection of smaller lesions is increasing considerably. According to certain studies, following surgical treatment, up to 27% of small enhancing renal masses are identified as benign tumors at the final pathological examination. This high rate of benign tumors challenges the appropriateness of surgery for all suspicious lesions, given the morbidity associated with such an intervention. The objective of the present study was, therefore, to determine the incidence of benign tumors at partial nephrectomy (PN) for a solitary renal mass. To meet this end, a total of 195 patients who each underwent one PN for a solitary renal lesion with the intent to cure RCC were included in the final retrospective analysis. A benign neoplasm was identified in 30 of these patients. The age of the patients ranged from 29.9-79 years (average: 60.9 years). The tumor size range was 1.5-7 cm (average: 3 cm). All the operations were successful using the laparoscopic approach. The pathological results were renal oncocytoma in 26 cases, angiomyolipomas in two cases, and cysts in the remaining two cases. In conclusion, we have shown in our present series the incidence rate of benign tumors in patients who have been subjected to laparoscopic PN due to a suspected solitary renal mass. Based on these results, we advise that the patient should be counseled not only about the intra- and post-operative risks of nephron-sparing surgery but also about its dual therapeutic and diagnostic role. Therefore, the patients should be informed of the considerably high probability of a benign histological result.
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Affiliation(s)
- Raffaele Baio
- Department of Medicine and Surgery “Scuola Medica Salernitana”, University of Salerno, 84081 Baronissi, Italy
- Correspondence:
| | - Giovanni Molisso
- Department of Urology, Umberto I, Nocera Inferiore, 84014 Salerno, Italy
| | | | - Umberto Di Mauro
- Department of Urology, Umberto I, Nocera Inferiore, 84014 Salerno, Italy
| | - Olivier Intilla
- Department of Urology, Umberto I, Nocera Inferiore, 84014 Salerno, Italy
| | - Umberto Pane
- Department of Urology, Umberto I, Nocera Inferiore, 84014 Salerno, Italy
| | - Costantino D’Angelo
- Department of Medical Biotechnologies, University of Siena, 53100 Siena, Italy
| | - Antonio Campitelli
- Department of Urology, Umberto I, Nocera Inferiore, 84014 Salerno, Italy
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Dunn M, Linehan V, Clarke SE, Keough V, Nelson R, Costa AF. Diagnostic Performance and Interreader Agreement of the MRI Clear Cell Likelihood Score for Characterization of cT1a and cT1b Solid Renal Masses: An External Validation Study. AJR Am J Roentgenol 2022; 219:793-803. [PMID: 35642765 DOI: 10.2214/ajr.22.27378] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND. The clear cell likelihood score (ccLS) has been proposed for the noninvasive differentiation of clear cell renal cell carcinoma (ccRCC) from other renal neoplasms on multiparametric MRI (mpMRI), though further external validation remains needed. OBJECTIVE. The purpose of our study was to evaluate the diagnostic performance and interreader agreement of the ccLS version 2.0 (v2.0) for characterizing solid renal masses as ccRCC. METHODS. This retrospective study included 102 patients (67 men, 35 women; mean age, 56.9 ± 12.8 [SD] years) who underwent mpMRI between January 2013 and February 2018, showing a total of 108 (≥ 25% enhancing tissue) solid renal masses measuring 7 cm or smaller (83 cT1a [≤ 4 cm] and 25 cT1b [> 4 cm and ≤ 7 cm]), all with a histologic diagnosis. Three abdominal radiologists independently reviewed the MRI examinations using ccLS v2.0. Median reader sensitivity, specificity, and accuracy were computed for predicting ccRCC by ccLS of 4 or greater, and individual reader AUCs were derived. The percentage of masses that were ccRCC was calculated, stratified by ccLS. Interobserver agreement was assessed by the Fleiss kappa statistic. RESULTS. The sample included 45 ccRCCs (34 cT1a, 11 cT1b), 30 papillary renal cell carcinomas (RCCs), 13 chromophobe RCCs, 14 oncocytomas, and six fat-poor angiomyolipomas. Median reader sensitivity, specificity, and accuracy for predicting ccRCC by ccLS of 4 or greater were 85%, 82%, and 83% among cT1a masses and 82%, 100%, and 92% among cT1b masses. The three readers' AUCs for predicting ccRCC by ccLS for cT1a masses were 0.90, 0.84, and 0.89 and for cT1b masses were 0.99, 0.97, and 0.92. Across readers, the percentage of masses that were ccRCC among cT1a masses was 0%, 0%, 20%, 68%, and 93% for ccLS of 1, 2, 3, 4, and 5, respectively; among cT1b masses, the percentage of masses that were ccRCC was 0%, 0%, 32%, 90%, and 100% for ccLS of 1, 2, 3, 4, and 5, respectively. Interobserver agreement among cT1a and cT1b masses for ccLS of 4 or greater was 0.82 and 0.83 and for ccLS of 1-5 overall was 0.65 and 0.62, respectively. CONCLUSION. This study provides external validation of the ccLS, finding overall high measures of diagnostic performance and interreader agreement. CLINICAL IMPACT. The ccLS provides a standardized approach to the noninvasive diagnosis of ccRCC by MRI.
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Affiliation(s)
- Marshall Dunn
- Department of Diagnostic Radiology, Queen Elizabeth II Health Sciences Centre and Dalhousie University, 1276 S Park St, Victoria Bldg, Rm 307, Halifax, NS B3H 2Y9, Canada
| | - Victoria Linehan
- Department of Diagnostic Radiology, Queen Elizabeth II Health Sciences Centre and Dalhousie University, 1276 S Park St, Victoria Bldg, Rm 307, Halifax, NS B3H 2Y9, Canada
| | - Sharon E Clarke
- Department of Diagnostic Radiology, Queen Elizabeth II Health Sciences Centre and Dalhousie University, 1276 S Park St, Victoria Bldg, Rm 307, Halifax, NS B3H 2Y9, Canada
| | - Valerie Keough
- Department of Diagnostic Radiology, Queen Elizabeth II Health Sciences Centre and Dalhousie University, 1276 S Park St, Victoria Bldg, Rm 307, Halifax, NS B3H 2Y9, Canada
| | - Ralph Nelson
- Department of Diagnostic Radiology, McGill University Health Centre, Montreal General Hospital Site, Montreal, QC, Canada
| | - Andreu F Costa
- Department of Diagnostic Radiology, Queen Elizabeth II Health Sciences Centre and Dalhousie University, 1276 S Park St, Victoria Bldg, Rm 307, Halifax, NS B3H 2Y9, Canada
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11
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Li A, Li S, Hu Y, Shen Y, Hu X, Hu D, Kamel IR, Li Z. Bosniak classification of cystic renal masses, version 2019: Is it helpful to incorporate the diffusion weighted imaging characteristic of lesions into the guideline? Front Oncol 2022; 12:1004690. [PMID: 36330478 PMCID: PMC9623058 DOI: 10.3389/fonc.2022.1004690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 09/16/2022] [Indexed: 11/23/2022] Open
Abstract
Objective To improve understanding of diffusion weighted imaging (DWI) characteristic of MRI and clinical variables, further optimize the Bosniak classification for diagnosis of cystic renal masses (CRMs). Methods This study retrospectively analyzed 130 CRMs in 125 patients with CT or MRI, including 87 patients with DWI (b = 600, 1000 s/mm2). Clinical variables and histopathological results were recorded. Two radiologists in consensus analyzed images of each lesion for the size, thickness of wall, number of septum, enhancement of wall/septum, wall nodule, signal intensity on DWI, calcification, and cyst content. Clinical variables, CT and MRI image characteristics were compared with pathology or follow-up results to evaluate the diagnostic performance for CRMs. Results Of the 130 lesions in 125 patients, histological analysis reported that 36 were malignant, 38 were benign, and no change was found in 56 followed-up lesions (mean follow-up of 24 months). The incidences of cystic wall thickened, more septa, measurable enhancement of wall/septum, nodule(s) on CT/MRI, and high signal intensity on DWI were significantly higher in malignant than in benign CRMs (CT: p = 0.005, p < 0.001, p < 0.001, p < 0.001, p < 0.001; MRI: p < 0.001, p < 0.001, p < 0.001, p < 0.001, p < 0.001, p < 0.001). Combination of MRI including DWI features with CT findings showed the highest area under ROC curve (0.973) in distinguishing benign and malignant CRMs. Conclusions Incorporating DWI characteristic of CRMs into Bosniak classification helps to improve diagnostic efficiency.
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Affiliation(s)
- Anqin Li
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Shichao Li
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yao Hu
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yaqi Shen
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xuemei Hu
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Daoyu Hu
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Ihab R. Kamel
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Medical Institutions, Baltimore, MD, United States
| | - Zhen Li
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- *Correspondence: Zhen Li,
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12
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Effect of Ultra-High Resolution CT on Pseudoenhancement in Renal Cysts: A Phantom Experiment and Clinical Study. AJR Am J Roentgenol 2022; 219:624-633. [PMID: 35583427 DOI: 10.2214/ajr.22.27354] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Background: Ultra-high resolution CT (U-HRCT) allows acquisition using a small detector element size, in turn allowing very high spatial resolutions. The high resolution may reduce partial-volume averaging and thereby renal cyst pseudoenhancement. Objective: To assess the impact of U-HRCT on renal cyst pseudoenhancement. Methods: A phantom was constructed that contained 7-, 15-, and 25-mm simulated cysts within compartments simulating unenhanced and nephrographic-phase renal parenchyma. The phantom underwent two U-HRCT acquisitions using 0.25- and 0.5-mm detector elements, with reconstruction at varying matrices and slice thicknesses. A retrospective study was performed of 36 patients (24 men, 12 women; mean age, 75.7±9.4 years) with 118 renal cysts who underwent renal-mass protocol CT using U-HRCT and the 0.25-mm detector element, with reconstruction at varying matrices and slice thicknesses; detector element size could not be retrospectively adjusted. ROIs were placed to measure cysts' attenuation increase from unenhanced to nephrographic phases (to reflect pseudoenhancement), and SD of unenhanced-phase attenuation (to reflect image noise). Results: In the phantom, attenuation increase was lower for the 0.25 mm than 0.5 mm detector element for the 15-mm cyst (4.6±2.7 HU vs 6.8±2.9 HU, p=.03) and 25-mm cyst (2.3±1.4 HU vs 3.8±1.2 HU, p=.02), but not the 7-mm cyst (p=.72). Attenuation increase was not different between 512×512 and 1024×1024 matrices for any cyst size in the phantom or patients (p>.05). Attenuation increase was not associated with slice thickness for any cyst size in the phantom or for ≥5-to-<10 mm and ≥10 mm cysts in patients (p>.05). For cysts <5 mm in patients, attenuation increase showed decreases with thinner slices (3 mm: 23.7±22.5, 2 mm: 20.2±22.7 HU, 0.5 mm: 11.6±17.5 HU, 0.25 mm: 12.6±19.7 HU; p<.001). Smaller detector element size, increased matrix size, and thinner slices all increased image noise for cysts of all sizes in the phantom and patients (p<.05). Conclusion: U-HRCT may reduce renal cyst pseudoenhancement through a smaller detector element size and, for <5 mm cysts, very thin slices; however, these adjustments result in increased noise. Clinical Impact: Although requiring further clinical evaluation, U-HRCT may facilitate characterization of small cystic renal lesions, thereby reducing equivocal interpretations and follow-up recommendations.
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Renal Lesion Characterization by Dual-Layer Dual-Energy CT: Comparison of Virtual and True Unenhanced Images. AJR Am J Roentgenol 2022; 219:614-623. [PMID: 35441533 DOI: 10.2214/ajr.21.27272] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Background: Prior studies have provided mixed results for the ability to replace true unenhanced (TUE) images with virtual unenhanced (VUE) images when characterizing renal lesions by dual-energy CT. Detector-based dual-layer dual-energy (dlDECT) systems may optimize performance of VUE images for this purpose. Objective: To compare dual-phase dlDECT examinations evaluated using VUE and TUE images in differentiating cystic and solid renal masses. Methods: This retrospective study included 110 patients (mean age, 64.3±11.8 years; 46 women, 64 men) who underwent renal-mass protocol dlDECT between July 2018 and February 2022. TUE, VUE, and nephrographic-phase image sets were reconstructed. Lesions were diagnosed as solid masses by histopathology or MRI. Lesions were diagnosed as cysts by composite criteria reflecting findings from MRI, ultrasound, and the TUE and nephrographic-phase images of the dlDECT examinations. One radiologist measured lesions' attenuation on all dlDECT image sets. Lesion characterization was compared between use of VUE and TUE images, including when considering enhancement ≥20 HU to indicate presence of a solid mass. Results: The analysis included 219 lesions [33 solid masses; 186 cysts (132 simple, 20 septated, 34 hyperattenuating]. TUE and VUE attenuation were significantly different for solid masses (33.4 ± 7.1 HU vs 35.4 ± 8.6 HU, p=.002), simple cysts (10.8±5.6 vs 7.1±8.1 HU, p<.001), and hyperattenuating cysts (56.3±21.0 HU vs 47.6±16.3 HU, p<.001), but not septated cysts (13.6±8.1 HU vs 14.0±6.8 HU, p=.79). Frequency of enhancement ≥20 HU when using TUE and VUE images was 90.9% and 90.9% in solid masses, 0.0% and 9.1% in simple cysts, 15.0% and 10.0% in septated cysts, and 11.8% and 38.2% in hyperattenuating cysts. All solid lesions were concordant in terms of enhancement ≥20 HU when using TUE and VUE images. Twelve simple cysts and nine hyperattenuating cysts showed enhancement ≥20 HU when using VUE but not TUE images. Conclusion: Use of VUE images reliably detected enhancement in solid masses. However, VUE images underestimated attenuation of simple and hyperattenuating cysts, leading to false-positive findings of enhancement by such lesions. Clinical impact: The findings do not support replacement of TUE acquisitions with VUE images when characterizing renal lesions by dlDECT.
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Small Renal Masses without Gross Fat: What Is the Role of Contrast-Enhanced MDCT? Diagnostics (Basel) 2022; 12:diagnostics12020553. [PMID: 35204643 PMCID: PMC8871355 DOI: 10.3390/diagnostics12020553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 02/17/2022] [Accepted: 02/18/2022] [Indexed: 11/17/2022] Open
Abstract
Increased detection of small renal masses (SRMs) has encouraged research for non-invasive diagnostic tools capable of adequately differentiating malignant vs. benign SRMs and the type of the tumour. Multi-detector computed tomography (MDCT) has been suggested as an alternative to intervention, therefore, it is important to determine both the capabilities and limitations of MDCT for SRM evaluation. In our study, two abdominal radiologists retrospectively blindly assessed MDCT scan images of 98 patients with incidentally detected lipid-poor SRMs that did not present as definitely aggressive lesions on CT. Radiological conclusions were compared to histopathological findings of materials obtained during surgery that were assumed as the gold standard. The probability (odds ratio (OR)) in regression analyses, sensitivity (SE), and specificity (SP) of predetermined SRM characteristics were calculated. Correct differentiation between malignant vs. benign SRMs was detected in 70.4% of cases, with more accurate identification of malignant (73%) in comparison to benign (65.7%) lesions. The radiological conclusions of SRM type matched histopathological findings in 56.1%. Central scarring (OR 10.6, p = 0.001), diameter of lesion (OR 2.4, p = 0.003), and homogeneous accumulation of contrast medium (OR 3.4, p = 0.03) significantly influenced the accuracy of malignant diagnosis. SE and SP of these parameters varied from 20.6% to 91.3% and 22.9% to 74.3%, respectively. In conclusion, MDCT is able to correctly differentiate malignant versus uncharacteristic benign SRMs in more than 2/3 of cases. However, frequency of the correct histopathological SRM type MDCT identification remains low.
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Gorsi U, Jain R, Bansal A, Kalra N, Kang M, Chaluvashetty SB, Mavuduru RS, Kumar S, Singh SK, Sandhu MS. Percutaneous Cryoablation of Renal Tumors: Initial Indian Experience. JOURNAL OF CLINICAL INTERVENTIONAL RADIOLOGY ISVIR 2022. [DOI: 10.1055/s-0041-1740570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
Abstract
Objective The purpose of this study was to report short-term outcomes of cryoablation of early-stage renal tumors (T1a and T1b) at a tertiary hospital in India.
Methods This was a retrospective study of consecutive patients who underwent cryoablation for renal cell carcinoma (RCC) from November 2018 to June 2020. Cryoablation was performed under combined ultrasound and computed tomography guidance using a helium-argon cryoablation system. Tumor number, size, location, nephrometry score, relationship of the tumor with pelvicalyceal system, and adjacent organs were tabulated, and technical and clinical success evaluated. Early and late recurrence and complications were also assessed.
Results Eleven patients (median age: 62 years) with 11 tumors underwent cryoablation. The mean tumor size was 2.58 cm (range: 1.62–5.62 cm) with 10 lesions being T1a and one lesion T1b. Tissue sampling was done in 9/11 patients, 3 were papillary RCC and the rest, clear cell RCC. In two patients, the tumor was completely endophytic, three patients had partially endophytic tumors while 6 patients had exophytic lesions. The median nephrometry score was 6 (range: 4–11, Mode 4). Technical success was achieved in all patients. Complete response was achieved in 81% (9/11) of the patients at 1-month follow-up. Median follow-up period was 6 months. Two patients showed residual disease on follow-up imaging at 1 and 3 months, respectively.
Conclusion Cryoablation is a promising, relatively new minimally invasive therapy for treating small renal tumors in India. It is safe, technically feasible, and shows excellent short-term efficacy.
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Affiliation(s)
- Ujjwal Gorsi
- Department of Radiodiagnosis, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Rishabh Jain
- Department of Radiodiagnosis, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Akash Bansal
- Department of Radiodiagnosis, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Naveen Kalra
- Department of Radiodiagnosis, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Mandeep Kang
- Department of Radiodiagnosis, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Sreedhara B. Chaluvashetty
- Department of Radiodiagnosis, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | | | - Santosh Kumar
- Department of Urology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Shrawan K. Singh
- Department of Urology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Manavjit Singh Sandhu
- Department of Radiodiagnosis, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
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Schieda N, Krishna S, Pedrosa I, Kaffenberger SD, Davenport MS, Silverman SG. Active Surveillance of Renal Masses: The Role of Radiology. Radiology 2021; 302:11-24. [PMID: 34812670 DOI: 10.1148/radiol.2021204227] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Active surveillance of renal masses, which includes serial imaging with the possibility of delayed treatment, has emerged as a viable alternative to immediate therapeutic intervention in selected patients. Active surveillance is supported by evidence that many benign masses are resected unnecessarily, and treatment of small cancers has not substantially reduced cancer-specific mortality. These data are a call to radiologists to improve the diagnosis of benign renal masses and differentiate cancers that are biologically aggressive (prompting treatment) from those that are indolent (allowing treatment deferral). Current evidence suggests that active surveillance results in comparable cancer-specific survival with a low risk of developing metastasis. Radiology is central in this. Imaging is used at the outset to estimate the probability of malignancy and degree of aggressiveness in malignant masses and to follow up masses for growth and morphologic change. Percutaneous biopsy is used to provide a more definitive histologic diagnosis and to guide treatment decisions, including whether active surveillance is appropriate. Emerging applications that may improve imaging assessment of renal masses include standardized assessment of cystic and solid masses and radiomic analysis. This article reviews the current and future role of radiology in the care of patients with renal masses undergoing active surveillance.
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Affiliation(s)
- Nicola Schieda
- From the Department of Medical Imaging, The Ottawa Hospital, University of Ottawa, 1053 Carling Ave, Ottawa, ON, Canada K1H 1H6 (N.S.); Joint Department of Medical Imaging, University Health Network, Mount Sinai Hospital and Women's College Hospital, University of Toronto, Toronto, Canada (S.K.); Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (I.P.); Departments of Urology (S.D.K., M.S.D.) and Radiology (M.S.D.), Michigan Medicine, University of Michigan, Ann Arbor, Mich; and Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass (S.G.S.)
| | - Satheesh Krishna
- From the Department of Medical Imaging, The Ottawa Hospital, University of Ottawa, 1053 Carling Ave, Ottawa, ON, Canada K1H 1H6 (N.S.); Joint Department of Medical Imaging, University Health Network, Mount Sinai Hospital and Women's College Hospital, University of Toronto, Toronto, Canada (S.K.); Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (I.P.); Departments of Urology (S.D.K., M.S.D.) and Radiology (M.S.D.), Michigan Medicine, University of Michigan, Ann Arbor, Mich; and Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass (S.G.S.)
| | - Ivan Pedrosa
- From the Department of Medical Imaging, The Ottawa Hospital, University of Ottawa, 1053 Carling Ave, Ottawa, ON, Canada K1H 1H6 (N.S.); Joint Department of Medical Imaging, University Health Network, Mount Sinai Hospital and Women's College Hospital, University of Toronto, Toronto, Canada (S.K.); Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (I.P.); Departments of Urology (S.D.K., M.S.D.) and Radiology (M.S.D.), Michigan Medicine, University of Michigan, Ann Arbor, Mich; and Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass (S.G.S.)
| | - Samuel D Kaffenberger
- From the Department of Medical Imaging, The Ottawa Hospital, University of Ottawa, 1053 Carling Ave, Ottawa, ON, Canada K1H 1H6 (N.S.); Joint Department of Medical Imaging, University Health Network, Mount Sinai Hospital and Women's College Hospital, University of Toronto, Toronto, Canada (S.K.); Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (I.P.); Departments of Urology (S.D.K., M.S.D.) and Radiology (M.S.D.), Michigan Medicine, University of Michigan, Ann Arbor, Mich; and Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass (S.G.S.)
| | - Matthew S Davenport
- From the Department of Medical Imaging, The Ottawa Hospital, University of Ottawa, 1053 Carling Ave, Ottawa, ON, Canada K1H 1H6 (N.S.); Joint Department of Medical Imaging, University Health Network, Mount Sinai Hospital and Women's College Hospital, University of Toronto, Toronto, Canada (S.K.); Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (I.P.); Departments of Urology (S.D.K., M.S.D.) and Radiology (M.S.D.), Michigan Medicine, University of Michigan, Ann Arbor, Mich; and Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass (S.G.S.)
| | - Stuart G Silverman
- From the Department of Medical Imaging, The Ottawa Hospital, University of Ottawa, 1053 Carling Ave, Ottawa, ON, Canada K1H 1H6 (N.S.); Joint Department of Medical Imaging, University Health Network, Mount Sinai Hospital and Women's College Hospital, University of Toronto, Toronto, Canada (S.K.); Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (I.P.); Departments of Urology (S.D.K., M.S.D.) and Radiology (M.S.D.), Michigan Medicine, University of Michigan, Ann Arbor, Mich; and Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass (S.G.S.)
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Haroon M, Sathiadoss P, Hibbert RM, Jeyaraj SK, Lim C, Schieda N. Imaging considerations for thermal and radiotherapy ablation of primary and metastatic renal cell carcinoma. Abdom Radiol (NY) 2021; 46:5386-5407. [PMID: 34245341 DOI: 10.1007/s00261-021-03178-6] [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: 04/02/2021] [Revised: 06/09/2021] [Accepted: 06/10/2021] [Indexed: 10/20/2022]
Abstract
Ablative (percutaneous and stereotactic) thermal and radiotherapy procedures for management of both primary and metastatic renal cell carcinoma are increasing in popularity in clinical practice. Data suggest comparable efficacy with lower cost and morbidity compared to nephrectomy. Ablative therapies may be used alone or in conjunction with surgery or chemotherapy for treatment of primary tumor and metastatic disease. Imaging plays a crucial role in pre-treatment selection and planning of ablation, intra-procedural guidance, evaluation for complications, short- and long-term post-procedural surveillance of disease, and treatment response. Treatment response and disease recurrence may differ considerably after ablation, particularly for stereotactic radiotherapy, when compared to conventional surgical and chemotherapies. This article reviews the current and emerging role of imaging for ablative therapy of renal cell carcinoma.
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Evaluation of class II cystic renal masses proposed in Bosniak classification version 2019: a systematic review of supporting evidence. Abdom Radiol (NY) 2021; 46:4888-4897. [PMID: 34152438 DOI: 10.1007/s00261-021-03180-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 06/11/2021] [Accepted: 06/13/2021] [Indexed: 12/22/2022]
Abstract
PURPOSE The Bosniak classification of cystic renal masses version 2019 (v.2019) includes an expanded number of types of masses in class II; such masses are considered benign in clinical practice. Data supporting these additions have not been well-documented. We aim to determine the proportion of malignant or probably malignant renal masses among the types added to Bosniak v.2019 class II. METHODS Multiple databases were searched for studies evaluating the proportion of malignant or probably malignant renal masses among new Bosniak v.2019 class II types, four for CT and two for MRI. Risk of bias and applicability was assessed using the QUADAS-2 tool. RESULTS Ten studies (2068 renal masses) met inclusion criteria. Among the four added class II types at CT, the proportion of malignancy among (1) 'homogeneous hyperattenuating (≥ 70 HU) masses at unenhanced CT' was 0% (0/32) in three studies; (2) 'homogeneous masses - 9 to 20 HU at unenhanced CT' was 0% (0/1454) in two studies, and (3) 'homogeneous masses 21 to 30 HU at portal-venous phase CT' was 0% (0/454) in four studies. Masses that are homogeneous, have low attenuation, and are too small to characterize on CT had no supportive evidence. Among the two added class II types at MRI, the proportion of malignancy among (1) 'homogeneous masses markedly hyperintense at unenhanced T2-weighted MR imaging (similar to CSF) was 0% (0/72) in one study, and (2) 'homogeneous masses markedly hyperintense at T1-weighted MR imaging (~ 2.5 × renal parenchyma signal intensity)' was 0% (0/32) and 5% (2/37) in two studies. Nine studies were at risk of bias within at least one QUADAS-2 domain. CONCLUSION The addition of six types of cystic renal masses to Class II in the Bosniak v.2019 proposal may be justified but based on limited evidence, with no evidence for 'homogeneous low attenuation masses that are too small to characterize' on CT, and thus considering them benign is in part based on expert opinion. Protocol Registration: PROSERO CRD42020196408.
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Jaggi A, Mastrodicasa D, Charville GW, Jeffrey RB, Napel S, Patel B. Quantitative image features from radiomic biopsy differentiate oncocytoma from chromophobe renal cell carcinoma. J Med Imaging (Bellingham) 2021; 8:054501. [PMID: 34514033 DOI: 10.1117/1.jmi.8.5.054501] [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: 01/08/2021] [Accepted: 08/05/2021] [Indexed: 11/14/2022] Open
Abstract
Purpose: To differentiate oncocytoma and chromophobe renal cell carcinoma (RCC) using radiomics features computed from spherical samples of image regions of interest, "radiomic biopsies" (RBs). Approach: In a retrospective cohort study of 102 CT cases [68 males (67%), 34 females (33%); mean age ± SD, 63 ± 12 years ], we pathology-confirmed 42 oncocytomas (41%) and 60 chromophobes (59%). A board-certified radiologist performed two RB rounds. From each RB round, we computed radiomics features and compared the performance of a random forest and AdaBoost binary classifier trained from the features. To control for overfitting, we performed 10 rounds of 70% to 30% train-test splits with feature-selection, cross-validation, and hyperparameter-optimization on each split. We evaluated the performance with test ROC AUC. We tested models on data from the other RB round and compared with the same round testing with the DeLong test. We clustered important features for each round and measured a bootstrapped adjusted Rand index agreement. Results: Our best classifiers achieved an average AUC of 0.71 ± 0.024 . We found no evidence of an effect for RB round ( p = 1 ). We also found no evidence for a decrease in model performance when tested on the other RB round ( p = 0.85 ). Feature clustering produced seven clusters in each RB round with high agreement ( Rand index = 0.981 ± 0.002 , p < 0.00001 ). Conclusions: A consistent radiomic signature can be derived from RBs and could help distinguish oncocytoma and chromophobe RCC.
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Affiliation(s)
- Akshay Jaggi
- Stanford University School of Medicine, Department of Radiology, Stanford, California, United States
| | - Domenico Mastrodicasa
- Stanford University School of Medicine, Department of Radiology, Stanford, California, United States
| | - Gregory W Charville
- Stanford University School of Medicine, Department of Pathology, Stanford, California, United States
| | - R Brooke Jeffrey
- Stanford University School of Medicine, Department of Radiology, Stanford, California, United States
| | - Sandy Napel
- Stanford University School of Medicine, Department of Radiology, Stanford, California, United States
| | - Bhavik Patel
- Mayo Clinic Arizona, Department of Radiology, Phoenix, Arizona, United States.,Arizona State University, Ira A. Fulton School of Engineering, Phoenix, Arizona, United States
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Xia Q, Yuan X, Huang M, Zhou X, Zhou Z. Contrast-enhanced Ultrasound for Diagnosis of Renal Cystic Mass. Curr Med Imaging 2021; 18:292-298. [PMID: 34825641 DOI: 10.2174/1573405617666210719141831] [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: 02/17/2021] [Revised: 05/30/2021] [Accepted: 06/02/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND Cystic Renal Cell Carcinoma (CRCC) is often challenging to differentiate from complex cysts with sonographic manifestations of renal carcinoma. Contrast-Enhanced Ultrasound (CEUS) is a new technology, and its clinical utility in the diagnosis of renal cystic mass has not been established. OBJECTIVE To analyze the characteristics of CEUS of renal cystic masses and to explore the clinical significance and value of CEUS in the diagnosis of CRCC. METHODS This study was a retrospective study. A total of 32 cystic masses from January 2018 to December 2019 were selected. The images of conventional ultrasound (US) and CEUS were confirmed via surgical pathology. The routine US was used to observe the location, shape, size, boundary, cyst wall, internal echo, and blood supply of each cystic mass. CEUS observed contrast enhancement of the cyst wall, cystic septa, and solid nodules of cystic masses. RESULTS There were 26 cases of CRCC, 5 cases of renal cysts, and 1 case of renal tuberculosis. The enhancement pattern, degree of enhancement, and pseudocapsular sign by CEUS in benign and malignant masses had statistically significant differences (P<.05). In the diagnosis of CRCC, the sensitivity, specificity, accuracy, positive predictive value, and negative predictive value were 92.3%, 83.3%, 90.6%, 96.0%, and 71.4% for CEUS; 57.6%, 66.7%, 59.3%, 88.2%, and 26.7% for conventional US, respectively. CEUS had a higher sensitivity and accuracy than the conventional US (P<.05). However, the diagnostic specificity, positive predictive value, and negative predictive value of the two methods were not significantly different (P>.05). CONCLUSION CEUS is more accurate in the diagnosis of renal cystic masses, and it can be used as an effective imaging method.
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Affiliation(s)
- Qingqing Xia
- Department of Ultrasound, The First Affiliated Hospital of Nanchang University. China
| | - Xinchun Yuan
- Department of Ultrasound, The First Affiliated Hospital of Nanchang University, No. 17 YongWai Zheng Street, Nanchang 330006. China
| | - Meifeng Huang
- Department of Ultrasound, The First Affiliated Hospital of Nanchang University. China
| | - Xiling Zhou
- Department of Ultrasound, The First Affiliated Hospital of Nanchang University. China
| | - Zhiyu Zhou
- College of Traditional Chinese Medicine, Jiangxi University of Traditional Chinese Medicine, Nanchang 330004. China
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Gao R, Qin H, Lin P, Ma C, Li C, Wen R, Huang J, Wan D, Wen D, Liang Y, Huang J, Li X, Wang X, Chen G, He Y, Yang H. Development and Validation of a Radiomic Nomogram for Predicting the Prognosis of Kidney Renal Clear Cell Carcinoma. Front Oncol 2021; 11:613668. [PMID: 34295804 PMCID: PMC8290524 DOI: 10.3389/fonc.2021.613668] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2020] [Accepted: 06/01/2021] [Indexed: 12/12/2022] Open
Abstract
Purpose The present study aims to comprehensively investigate the prognostic value of a radiomic nomogram that integrates contrast-enhanced computed tomography (CECT) radiomic signature and clinicopathological parameters in kidney renal clear cell carcinoma (KIRC). Methods A total of 136 and 78 KIRC patients from the training and validation cohorts were included in the retrospective study. The intraclass correlation coefficient (ICC) was used to assess reproducibility of radiomic feature extraction. Univariate Cox analysis and least absolute shrinkage and selection operator (LASSO) as well as multivariate Cox analysis were utilized to construct radiomic signature and clinical signature in the training cohort. A prognostic nomogram was established containing a radiomic signature and clinicopathological parameters by using a multivariate Cox analysis. The predictive ability of the nomogram [relative operating characteristic curve (ROC), concordance index (C-index), Hosmer–Lemeshow test, and calibration curve] was evaluated in the training cohort and validated in the validation cohort. Patients were split into high- and low-risk groups, and the Kaplan–Meier (KM) method was conducted to identify the forecasting ability of the established models. In addition, genes related with the radiomic risk score were determined by weighted correlation network analysis (WGCNA) and were used to conduct functional analysis. Results A total of 2,944 radiomic features were acquired from the tumor volumes of interest (VOIs) of CECT images. The radiomic signature, including ten selected features, and the clinical signature, including three selected clinical variables, showed good performance in the training and validation cohorts [area under the curve (AUC), 0.897 and 0.712 for the radiomic signature; 0.827 and 0.822 for the clinical signature, respectively]. The radiomic prognostic nomogram showed favorable performance and calibration in the training cohort (AUC, 0.896, C-index, 0.846), which was verified in the validation cohort (AUC, 0.768). KM curves indicated that the progression-free interval (PFI) time was dramatically shorter in the high-risk group than in the low-risk group. The functional analysis indicated that radiomic signature was significantly associated with T cell activation. Conclusions The nomogram combined with CECT radiomic and clinicopathological signatures exhibits excellent power in predicting the PFI of KIRC patients, which may aid in clinical management and prognostic evaluation of cancer patients.
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Affiliation(s)
- Ruizhi Gao
- Department of Medical Ultrasound, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Hui Qin
- Department of Medical Ultrasound, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Peng Lin
- Department of Medical Ultrasound, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Chenjun Ma
- Department of Urology, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Chengyang Li
- Department of Urology, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Rong Wen
- Department of Medical Ultrasound, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Jing Huang
- Department of Medical Ultrasound, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Da Wan
- Department of Medical Ultrasound, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Dongyue Wen
- Department of Medical Ultrasound, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Yiqiong Liang
- Department of Radiology, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Jiang Huang
- Department of Radiology, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Xin Li
- GE Healthcare Global Research, GE, Shanghai, China
| | - Xinrong Wang
- GE Healthcare Global Research, GE, Shanghai, China
| | - Gang Chen
- Department of Pathology, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Yun He
- Department of Medical Ultrasound, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Hong Yang
- Department of Medical Ultrasound, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
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22
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Salvador R, Sebastià M, Cárdenas G, Páez-Carpio A, Paño B, Solé M, Nicolau C. CT differentiation of fat-poor angiomyolipomas from papillary renal cell carcinomas: development of a predictive model. Abdom Radiol (NY) 2021; 46:3280-3287. [PMID: 33674961 DOI: 10.1007/s00261-021-02988-y] [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: 11/06/2020] [Revised: 01/19/2021] [Accepted: 02/09/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE To identify specific contrast-enhanced CT (CECT) findings and develop a predictive model with logistic regression to differentiate fat-poor angiomyolipomas (fpAML) from papillary renal cell carcinomas (pRCC). METHODS This is a single-institution retrospective study that assess CT features of histologically proven 67 pRCC and 13 fpAML. CECT variables were studied by means of univariate logistic regression. Variables included patients' demographics, tumor attenuation (unenhanced and at arterial, venous and excretory post-contrast phases), type of enhancement, morphological features (axial long and short diameters, long-short axis ratio (LSR) and tumor to kidney angle interface) and presence of visible calcifications or vessels. Those variables with a p ≤ 0.05 underwent standard stepwise logistic regression to find predictive combinations of clinical variables. Best models were evaluated by AUROC curves and were subjected to Leave-one-out cross validation to assess their robustness. RESULTS Odds ratio (OR) between pRCC and fpAML was statistically significant for patient's gender, tumor attenuation in arterial, venous and excretory phases, tumor's long diameter, short diameter, LSR, type of enhancement, presence of intratumoral vessels and tumor-kidney angle interface. The best predictive model resulted in an area under the curve (AUC) of 0.971 and included gender, tumor-kidney angle interface and venous attenuation with the following equation: Log(p/1 - p) = - 2.834 + 4.052 * gender + - 0.066 * AngleInterface + 0.074 * VenousphaseHU. CONCLUSIONS The combination of patients' gender, tumor to kidney angle interface and venous enhancement helps to distinguish fpAML from pRCC.
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Affiliation(s)
- R Salvador
- Department of Radiology, Hospital Clínic, Villarroel 170, 08036, Barcelona, Spain.
- Faculty of Medicine and Health Sciences, Universitat de Barcelona, Casanova 143, 08036, Barcelona, Spain.
| | - M Sebastià
- Department of Radiology, Hospital Clínic, Villarroel 170, 08036, Barcelona, Spain
| | - G Cárdenas
- Department of Radiology, Hospital Clínico de la Universidad de Chile, Dr. Carlos Lorca Tobar 999, Independencia, Región Metropolitana, Chile
| | - A Páez-Carpio
- Department of Radiology, Hospital Clínic, Villarroel 170, 08036, Barcelona, Spain
| | - B Paño
- Department of Radiology, Hospital Clínic, Villarroel 170, 08036, Barcelona, Spain
| | - M Solé
- Department of Pathology, Hospital Clínic, Villarroel 170, 08036, Barcelona, Spain
| | - C Nicolau
- Department of Radiology, Hospital Clínic, Villarroel 170, 08036, Barcelona, Spain
- Faculty of Medicine and Health Sciences, Universitat de Barcelona, Casanova 143, 08036, Barcelona, Spain
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23
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Mastrodicasa D, Willemink MJ, Madhuripan N, Chima RS, Ho AA, Ding Y, Marin D, Patel BN. Diagnostic performance of single-phase dual-energy CT to differentiate vascular and nonvascular incidental renal lesions on portal venous phase: comparison with CT. Eur Radiol 2021; 31:9600-9611. [PMID: 34114058 DOI: 10.1007/s00330-021-08097-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2021] [Revised: 05/13/2021] [Accepted: 05/25/2021] [Indexed: 01/14/2023]
Abstract
OBJECTIVES To determine whether single-phase dual-energy CT (DECT) differentiates vascular and nonvascular renal lesions in the portal venous phase (PVP). Optimal iodine threshold was determined and compared to Hounsfield unit (HU) measurements. METHODS We retrospectively included 250 patients (266 renal lesions) who underwent a clinically indicated PVP abdominopelvic CT on a rapid-kilovoltage-switching single-source DECT (rsDECT) or a dual-source DECT (dsDECT) scanner. Iodine concentration and HU measurements were calculated by four experienced readers. Diagnostic accuracy was determined using biopsy results and follow-up imaging as reference standard. Area under the curve (AUC) was calculated for each DECT scanner to differentiate vascular from nonvascular lesions and vascular lesions from hemorrhagic/proteinaceous cysts. Univariable and multivariable logistic regression analyses evaluated the association between variables and the presence of vascular lesions. RESULTS A normalized iodine concentration threshold of 0.25 mg/mL yielded high accuracy in differentiating vascular and nonvascular lesions (AUC 0.93, p < 0.001), with comparable performance to HU measurements (AUC 0.93). Both iodine concentration and HU measurements were independently associated with vascular lesions when adjusted for age, gender, body mass index, and lesion size (AUC 0.95 and 0.95, respectively). When combined, diagnostic performance was higher (AUC 0.96). Both absolute and normalized iodine concentrations performed better than HU measurements (AUC 0.92 vs. AUC 0.87) in differentiating vascular lesions from hemorrhagic/proteinaceous cysts. CONCLUSION A single-phase (PVP) DECT scan yields high accuracy to differentiate vascular from nonvascular renal lesions. Iodine concentration showed a slightly higher performance than HU measurements in differentiating vascular lesions from hemorrhagic/proteinaceous cysts. KEY POINTS • A single-phase dual-energy CT scan in the portal venous phase differentiates vascular from nonvascular renal lesions with high accuracy (AUC 0.93). • When combined, iodine concentration and HU measurements showed the highest diagnostic performance (AUC 0.96) to differentiate vascular from nonvascular renal lesions. • Compared to HU measurements, iodine concentration showed a slightly higher performance in differentiating vascular lesions from hemorrhagic/proteinaceous cysts.
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Affiliation(s)
- Domenico Mastrodicasa
- Department of Radiology, Stanford University School of Medicine, 300 Pasteur Dr, Stanford, CA, 94305, USA
| | - Martin J Willemink
- Department of Radiology, Stanford University School of Medicine, 300 Pasteur Dr, Stanford, CA, 94305, USA
| | - Nikhil Madhuripan
- Department of Radiology, Stanford University School of Medicine, 300 Pasteur Dr, Stanford, CA, 94305, USA.,Department of Radiology, University of Colorado, 12401 East 17th Avenue, Aurora, CO, 80045, USA
| | - Ranjit Singh Chima
- Department of Radiology, Stanford University School of Medicine, 300 Pasteur Dr, Stanford, CA, 94305, USA
| | - Amanzo A Ho
- Department of Radiology, Stanford University School of Medicine, 300 Pasteur Dr, Stanford, CA, 94305, USA
| | - Yuqin Ding
- Department of Radiology, Duke University Medical Center, 2301 Erwin Rd, Durham, NC, 27710, USA.,Department of Radiology, Zhongshan Hospital, Fudan University; Shanghai Institute of Medical Imaging, Shanghai, 200032, People's Republic of China
| | - Daniele Marin
- Department of Radiology, Duke University Medical Center, 2301 Erwin Rd, Durham, NC, 27710, USA
| | - Bhavik N Patel
- Department of Radiology, Mayo Clinic, 13400 E Shea Blvd, Scottsdale, AZ, 85259, USA.
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24
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Tsili AC, Andriotis E, Gkeli MG, Krokidis M, Stasinopoulou M, Varkarakis IM, Moulopoulos LA. The role of imaging in the management of renal masses. Eur J Radiol 2021; 141:109777. [PMID: 34020173 DOI: 10.1016/j.ejrad.2021.109777] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 05/09/2021] [Accepted: 05/14/2021] [Indexed: 12/26/2022]
Abstract
The wide availability of cross-sectional imaging is responsible for the increased detection of small, usually asymptomatic renal masses. More than 50 % of renal cell carcinomas (RCCs) represent incidental findings on noninvasive imaging. Multimodality imaging, including conventional US, contrast-enhanced US (CEUS), CT and multiparametric MRI (mpMRI) is pivotal in diagnosing and characterizing a renal mass, but also provides information regarding its prognosis, therapeutic management, and follow-up. In this review, imaging data for renal masses that urologists need for accurate treatment planning will be discussed. The role of US, CEUS, CT and mpMRI in the detection and characterization of renal masses, RCC staging and follow-up of surgically treated or untreated localized RCC will be presented. The role of percutaneous image-guided ablation in the management of RCC will be also reviewed.
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Affiliation(s)
- Athina C Tsili
- Department of Clinical Radiology, School of Health Sciences, Faculty of Medicine, University of Ioannina, 45110, Ioannina, Greece.
| | - Efthimios Andriotis
- Department of Newer Imaging Methods of Tomography, General Anti-Cancer Hospital Agios Savvas, 11522, Athens, Greece.
| | - Myrsini G Gkeli
- 1st Department of Radiology, General Anti-Cancer Hospital Agios Savvas, 11522, Athens, Greece.
| | - Miltiadis Krokidis
- 1st Department of Radiology, School of Medicine, National and Kapodistrian University of Athens, Areteion Hospital, 11528, Athens, Greece; Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital Bern University Hospital, University of Bern, 3010, Bern, Switzerland.
| | - Myrsini Stasinopoulou
- Department of Newer Imaging Methods of Tomography, General Anti-Cancer Hospital Agios Savvas, 11522, Athens, Greece.
| | - Ioannis M Varkarakis
- 2nd Department of Urology, National and Kapodistrian University of Athens, Sismanoglio Hospital, 15126, Athens, Greece.
| | - Lia-Angela Moulopoulos
- 1st Department of Radiology, School of Medicine, National and Kapodistrian University of Athens, Areteion Hospital, 11528, Athens, Greece.
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25
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Elbanna KY, Jang HJ, Kim TK, Khalili K, Guimarães LS, Atri M. The added value of contrast-enhanced ultrasound in evaluation of indeterminate small solid renal masses and risk stratification of cystic renal lesions. Eur Radiol 2021; 31:8468-8477. [PMID: 33912992 DOI: 10.1007/s00330-021-07964-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Revised: 02/09/2021] [Accepted: 03/29/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To investigate accuracy of contrast-enhanced ultrasound (CEUS) to characterize indeterminate small solid renal masses (sSRMs), excluding lipid-rich AMLs, and cystic renal masses (CRMs) according to the proposed Bosniak Classification 2019 MATERIALS AND METHODS: CEUS of pathology-proven CRMs and sSRMs (without definite enhancement or macroscopic fat on CT/MRI), and CRMs with ≥18 months follow-up were retrospectively reviewed. Two radiologists blindly categorized CRMs according to new Bosniak Classification on CT/MRI. On CEUS, two other radiologists evaluated arterial-phase enhancement of sSRMs relative to renal cortex and categorized CRMs following new Bosniak Classification. Fisher's exact/chi-squared test was used to compare categorical variables, and Cohen κ statistics for inter-observer agreement RESULTS: A total of 237 patients had 241 lesions: 161 pathology-proven sSRMs (122 malignant and 39 benign), 29 pathology-proven CRMs, 51 CRMs with adequate follow-up. Arterial-phase enhancement < renal cortex predicted malignancy with specificity of 97.4% (38/39) (CI 85.6-99.9%), and positive predictive value (PPV) of 98.2% (54/55) (CI 90.4-99.9%). Inter-observer kappa was 0.95. In pathology-proven CRMS, sensitivity of CEUS vs CT/MRI was 100% (15/15) (CI 79.6-100%) vs 60% (9/15) (CI 35.8-80.1%) (p value = .002) and negative predictive value (NPV) 100% (2/2) (CI 17.8-100%) vs 25% (2/8 ) (CI 4.4-59.1%) (p value < 0.0001), with similar specificity (50%) and PPV- 88.2% (15/17) (CI 65.7-97.9%) vs 81.8% (9/11) (CI 52.3-96.8%) ( p value = 0.586). Bosniak Classification inter-observer kappa was 0.92 for CEUS vs 0.68 for CT/MRI (p value = 0.009). CONCLUSION In our cohort, CEUS had high specificity and PPV to diagnose RCC in sSRMs excluding lipid-rich AML. CEUS had significantly higher sensitivity/NPV to diagnose malignancy in CRMs as compared to CT/MRI. KEY POINTS • Once lipid-rich AML is excluded by the other modalities, sSRM arterial phase hypo-enhancement relative to renal cortex on CEUS yielded high specificity (97.4%) and PPV (98.2%) to diagnose RCC. • When applying the proposed Bosniak Classification 2019, CEUS showed higher sensitivity compared to CT/MRI (100% vs 60%), p value=.0024, in the stratification of cystic renal masses to diagnose malignancy. • CEUS may reduce the number of CT/MRI Bosniak IIF lesions by assigning them to either II or III/IV categories.
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Affiliation(s)
- Khaled Y Elbanna
- Toronto Joint Department of Medical Imaging, University Health Network, Sinai Health System and Women's College Hospital, University of Toronto, Toronto, ON, Canada
| | - Hyun-Jung Jang
- Toronto Joint Department of Medical Imaging, University Health Network, Sinai Health System and Women's College Hospital, University of Toronto, Toronto, ON, Canada
| | - Tae Kyoung Kim
- Toronto Joint Department of Medical Imaging, University Health Network, Sinai Health System and Women's College Hospital, University of Toronto, Toronto, ON, Canada
| | - Korosh Khalili
- Toronto Joint Department of Medical Imaging, University Health Network, Sinai Health System and Women's College Hospital, University of Toronto, Toronto, ON, Canada
| | - Luís S Guimarães
- Toronto Joint Department of Medical Imaging, University Health Network, Sinai Health System and Women's College Hospital, University of Toronto, Toronto, ON, Canada
| | - Mostafa Atri
- Toronto Joint Department of Medical Imaging, University Health Network, Sinai Health System and Women's College Hospital, University of Toronto, Toronto, ON, Canada.
- Department of Medical Imaging, Toronto General Hospital, University of Toronto, 585 University Avenue, Toronto, ON M5G 2N2, Canada.
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26
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Schieda N, Davenport MS, Krishna S, Edney EA, Pedrosa I, Hindman N, Baroni RH, Curci NE, Shinagare A, Silverman SG. Bosniak Classification of Cystic Renal Masses, Version 2019: A Pictorial Guide to Clinical Use. Radiographics 2021; 41:814-828. [PMID: 33861647 DOI: 10.1148/rg.2021200160] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Cystic renal masses are commonly encountered in clinical practice. In 2019, the Bosniak classification of cystic renal masses, originally developed for CT, underwent a major revision to incorporate MRI and is referred to as the Bosniak Classification, version 2019. The proposed changes attempt to (a) define renal masses (ie, cystic tumors with less than 25% enhancing tissue) to which the classification should be applied; (b) emphasize specificity for diagnosis of cystic renal cancers, thereby decreasing the number of benign and indolent cystic masses that are unnecessarily treated or imaged further; (c) improve interobserver agreement by defining imaging features, terms, and classes of cystic renal masses; (d) reduce variation in reported malignancy rates for each of the Bosniak classes; (e) incorporate MRI and to some extent US; and (f) be applicable to all cystic renal masses encountered in clinical practice, including those that had been considered indeterminate with the original classification. The authors instruct how, using CT, MRI, and to some extent US, the revised classification can be applied, with representative clinical examples and images. Practical tips, pitfalls to avoid, and decision tree rules are included to help radiologists and other physicians apply the Bosniak Classification, version 2019 and better manage cystic renal masses. An online resource and mobile application are also available for clinical assistance. An invited commentary by Siegel and Cohan is available online. ©RSNA, 2021.
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Affiliation(s)
- Nicola Schieda
- From the Department of Medical Imaging, The Ottawa Hospital, University of Ottawa, 1053 Carling Ave, Ottawa, ON, Canada K1H 1H6 (N.S.); Departments of Radiology (M.S.D., N.E.C.) and Urology (M.S.D.), Michigan Medicine, University of Michigan, Ann Arbor, Mich; Joint Department of Medical Imaging, University Health Network, Mount Sinai Hospital and Women's College Hospital, University of Toronto, Toronto, ON, Canada (S.K.); Department of Radiology, University of Nebraska Medical Center, Omaha, Neb (E.A.E.); Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (I.P.); Department of Radiology, New York University Langone Medical Center, New York, NY (N.H.); Department of Radiology and Diagnostic Imaging, Hospital Israelita Albert Einstein, São Paulo, Brazil (R.H.B.); Department of Radiology, Brigham and Women's Hospital/Dana-Farber Cancer Institute, Harvard Medical School, Boston, Mass (A.S.); and Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass (S.G.S.)
| | - Matthew S Davenport
- From the Department of Medical Imaging, The Ottawa Hospital, University of Ottawa, 1053 Carling Ave, Ottawa, ON, Canada K1H 1H6 (N.S.); Departments of Radiology (M.S.D., N.E.C.) and Urology (M.S.D.), Michigan Medicine, University of Michigan, Ann Arbor, Mich; Joint Department of Medical Imaging, University Health Network, Mount Sinai Hospital and Women's College Hospital, University of Toronto, Toronto, ON, Canada (S.K.); Department of Radiology, University of Nebraska Medical Center, Omaha, Neb (E.A.E.); Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (I.P.); Department of Radiology, New York University Langone Medical Center, New York, NY (N.H.); Department of Radiology and Diagnostic Imaging, Hospital Israelita Albert Einstein, São Paulo, Brazil (R.H.B.); Department of Radiology, Brigham and Women's Hospital/Dana-Farber Cancer Institute, Harvard Medical School, Boston, Mass (A.S.); and Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass (S.G.S.)
| | - Satheesh Krishna
- From the Department of Medical Imaging, The Ottawa Hospital, University of Ottawa, 1053 Carling Ave, Ottawa, ON, Canada K1H 1H6 (N.S.); Departments of Radiology (M.S.D., N.E.C.) and Urology (M.S.D.), Michigan Medicine, University of Michigan, Ann Arbor, Mich; Joint Department of Medical Imaging, University Health Network, Mount Sinai Hospital and Women's College Hospital, University of Toronto, Toronto, ON, Canada (S.K.); Department of Radiology, University of Nebraska Medical Center, Omaha, Neb (E.A.E.); Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (I.P.); Department of Radiology, New York University Langone Medical Center, New York, NY (N.H.); Department of Radiology and Diagnostic Imaging, Hospital Israelita Albert Einstein, São Paulo, Brazil (R.H.B.); Department of Radiology, Brigham and Women's Hospital/Dana-Farber Cancer Institute, Harvard Medical School, Boston, Mass (A.S.); and Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass (S.G.S.)
| | - Elizabeth A Edney
- From the Department of Medical Imaging, The Ottawa Hospital, University of Ottawa, 1053 Carling Ave, Ottawa, ON, Canada K1H 1H6 (N.S.); Departments of Radiology (M.S.D., N.E.C.) and Urology (M.S.D.), Michigan Medicine, University of Michigan, Ann Arbor, Mich; Joint Department of Medical Imaging, University Health Network, Mount Sinai Hospital and Women's College Hospital, University of Toronto, Toronto, ON, Canada (S.K.); Department of Radiology, University of Nebraska Medical Center, Omaha, Neb (E.A.E.); Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (I.P.); Department of Radiology, New York University Langone Medical Center, New York, NY (N.H.); Department of Radiology and Diagnostic Imaging, Hospital Israelita Albert Einstein, São Paulo, Brazil (R.H.B.); Department of Radiology, Brigham and Women's Hospital/Dana-Farber Cancer Institute, Harvard Medical School, Boston, Mass (A.S.); and Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass (S.G.S.)
| | - Ivan Pedrosa
- From the Department of Medical Imaging, The Ottawa Hospital, University of Ottawa, 1053 Carling Ave, Ottawa, ON, Canada K1H 1H6 (N.S.); Departments of Radiology (M.S.D., N.E.C.) and Urology (M.S.D.), Michigan Medicine, University of Michigan, Ann Arbor, Mich; Joint Department of Medical Imaging, University Health Network, Mount Sinai Hospital and Women's College Hospital, University of Toronto, Toronto, ON, Canada (S.K.); Department of Radiology, University of Nebraska Medical Center, Omaha, Neb (E.A.E.); Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (I.P.); Department of Radiology, New York University Langone Medical Center, New York, NY (N.H.); Department of Radiology and Diagnostic Imaging, Hospital Israelita Albert Einstein, São Paulo, Brazil (R.H.B.); Department of Radiology, Brigham and Women's Hospital/Dana-Farber Cancer Institute, Harvard Medical School, Boston, Mass (A.S.); and Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass (S.G.S.)
| | - Nicole Hindman
- From the Department of Medical Imaging, The Ottawa Hospital, University of Ottawa, 1053 Carling Ave, Ottawa, ON, Canada K1H 1H6 (N.S.); Departments of Radiology (M.S.D., N.E.C.) and Urology (M.S.D.), Michigan Medicine, University of Michigan, Ann Arbor, Mich; Joint Department of Medical Imaging, University Health Network, Mount Sinai Hospital and Women's College Hospital, University of Toronto, Toronto, ON, Canada (S.K.); Department of Radiology, University of Nebraska Medical Center, Omaha, Neb (E.A.E.); Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (I.P.); Department of Radiology, New York University Langone Medical Center, New York, NY (N.H.); Department of Radiology and Diagnostic Imaging, Hospital Israelita Albert Einstein, São Paulo, Brazil (R.H.B.); Department of Radiology, Brigham and Women's Hospital/Dana-Farber Cancer Institute, Harvard Medical School, Boston, Mass (A.S.); and Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass (S.G.S.)
| | - Ronaldo H Baroni
- From the Department of Medical Imaging, The Ottawa Hospital, University of Ottawa, 1053 Carling Ave, Ottawa, ON, Canada K1H 1H6 (N.S.); Departments of Radiology (M.S.D., N.E.C.) and Urology (M.S.D.), Michigan Medicine, University of Michigan, Ann Arbor, Mich; Joint Department of Medical Imaging, University Health Network, Mount Sinai Hospital and Women's College Hospital, University of Toronto, Toronto, ON, Canada (S.K.); Department of Radiology, University of Nebraska Medical Center, Omaha, Neb (E.A.E.); Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (I.P.); Department of Radiology, New York University Langone Medical Center, New York, NY (N.H.); Department of Radiology and Diagnostic Imaging, Hospital Israelita Albert Einstein, São Paulo, Brazil (R.H.B.); Department of Radiology, Brigham and Women's Hospital/Dana-Farber Cancer Institute, Harvard Medical School, Boston, Mass (A.S.); and Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass (S.G.S.)
| | - Nicole E Curci
- From the Department of Medical Imaging, The Ottawa Hospital, University of Ottawa, 1053 Carling Ave, Ottawa, ON, Canada K1H 1H6 (N.S.); Departments of Radiology (M.S.D., N.E.C.) and Urology (M.S.D.), Michigan Medicine, University of Michigan, Ann Arbor, Mich; Joint Department of Medical Imaging, University Health Network, Mount Sinai Hospital and Women's College Hospital, University of Toronto, Toronto, ON, Canada (S.K.); Department of Radiology, University of Nebraska Medical Center, Omaha, Neb (E.A.E.); Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (I.P.); Department of Radiology, New York University Langone Medical Center, New York, NY (N.H.); Department of Radiology and Diagnostic Imaging, Hospital Israelita Albert Einstein, São Paulo, Brazil (R.H.B.); Department of Radiology, Brigham and Women's Hospital/Dana-Farber Cancer Institute, Harvard Medical School, Boston, Mass (A.S.); and Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass (S.G.S.)
| | - Atul Shinagare
- From the Department of Medical Imaging, The Ottawa Hospital, University of Ottawa, 1053 Carling Ave, Ottawa, ON, Canada K1H 1H6 (N.S.); Departments of Radiology (M.S.D., N.E.C.) and Urology (M.S.D.), Michigan Medicine, University of Michigan, Ann Arbor, Mich; Joint Department of Medical Imaging, University Health Network, Mount Sinai Hospital and Women's College Hospital, University of Toronto, Toronto, ON, Canada (S.K.); Department of Radiology, University of Nebraska Medical Center, Omaha, Neb (E.A.E.); Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (I.P.); Department of Radiology, New York University Langone Medical Center, New York, NY (N.H.); Department of Radiology and Diagnostic Imaging, Hospital Israelita Albert Einstein, São Paulo, Brazil (R.H.B.); Department of Radiology, Brigham and Women's Hospital/Dana-Farber Cancer Institute, Harvard Medical School, Boston, Mass (A.S.); and Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass (S.G.S.)
| | - Stuart G Silverman
- From the Department of Medical Imaging, The Ottawa Hospital, University of Ottawa, 1053 Carling Ave, Ottawa, ON, Canada K1H 1H6 (N.S.); Departments of Radiology (M.S.D., N.E.C.) and Urology (M.S.D.), Michigan Medicine, University of Michigan, Ann Arbor, Mich; Joint Department of Medical Imaging, University Health Network, Mount Sinai Hospital and Women's College Hospital, University of Toronto, Toronto, ON, Canada (S.K.); Department of Radiology, University of Nebraska Medical Center, Omaha, Neb (E.A.E.); Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (I.P.); Department of Radiology, New York University Langone Medical Center, New York, NY (N.H.); Department of Radiology and Diagnostic Imaging, Hospital Israelita Albert Einstein, São Paulo, Brazil (R.H.B.); Department of Radiology, Brigham and Women's Hospital/Dana-Farber Cancer Institute, Harvard Medical School, Boston, Mass (A.S.); and Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass (S.G.S.)
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Adequacy of Unenhanced MRI for Surveillance of Small (Clinical T1a) Solid Renal Masses. AJR Am J Roentgenol 2021; 216:960-966. [PMID: 33594909 DOI: 10.2214/ajr.20.23458] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
OBJECTIVE. The purpose of this study was to determine if contrast enhancement is necessary for MRI surveillance of clinical T1a (cT1a) solid renal masses. MATERIALS AND METHODS. With institutional review board approval, 36 patients who underwent two or more contrast-enhanced (CE) MRI examinations (median, four examinations; range, two to 10 examinations) for surveillance of 39 cT1a solid renal masses between 2009 and 2019 (median time between scans, 2 years; range, 1-7 years) were evaluated. Two radiologists independently measured renal mass size and assessed tumor stage in two sessions for baseline and follow-up examinations using T1-weighted nephrographic phase CE-MRI and unenhanced single-shot T2-weighted MRI in mixed order with a 4-week washout period. Comparisons were performed using the Wilcoxon sign-rank test and Pearson correlation. Bland-Altman and intraclass correlation determined interobserver agreement. RESULTS. Mean size ± SD of renal masses on CE-MRI and T2-weighted MRI were 18 ± 5 mm (range, 9-37 mm) and 18 ± 5 mm (range, 9-37 mm) for radiologist 1 and 19 ± 7 mm (range, 10-39 mm) and 19 ± 6 mm (range, 10-39 mm) for radiologist 2 with near perfect correlation (for radiologist 1, β = 0.9897; for radiologist 2, β = 0.9317; p < .001). Interob-server agreement for measurements comparing radiologist 1 and radiologist 2 on CEMRI and T2-weighted MRI and intraobserver agreement for measurements on CE-MRI and T2-weighted MRI were excellent. Mean growth rate of renal masses measured on CE-MRI and T2-weighted MRI were 2 ± 2 mm (range, -5 to 8 mm) and 2 ± 3 mm (range, -3 to 8 mm) for radiologist 1 and 3 ± 5 mm (range, -1 to 18 mm) and 3 ± 6 mm (range, -1 to 24 mm) for radiologist 2 with high correlation (for radiologist 1, β = 0.8313 [p < .001]; for radiologist 2, β = 0.848 [p = .002]). At baseline, all tumors were subjectively cT1a on CE-MRI and T2-weighted MRI (p > .99, intraclass correlation coefficient [ICC] = 1). During follow-up, one mass progressed to T3 on CE-MRI and T2-weighted MRI for radiologist 1 and radiologist 2 (p > .99, ICC = 1). CONCLUSION. In this study, size measurements on unenhanced T2-weighted MRI had near perfect correlation to measurements using CE-MRI in cT1a solid renal masses undergoing surveillance, with high agreement between and within observers. Clinical staging did not differ comparing T2-weighted MRI and CE-MRI, with near perfect agreement. Contrast enhancement is not necessary for follow-up size measurements in cT1a solid renal masses with MRI.
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Lai S, Sun L, Wu J, Wei R, Luo S, Ding W, Liu X, Yang R, Zhen X. Multiphase Contrast-Enhanced CT-Based Machine Learning Models to Predict the Fuhrman Nuclear Grade of Clear Cell Renal Cell Carcinoma. Cancer Manag Res 2021; 13:999-1008. [PMID: 33568946 PMCID: PMC7869703 DOI: 10.2147/cmar.s290327] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Accepted: 01/08/2021] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE To investigate the predictive performance of different machine learning models for the discrimination of low and high nuclear grade clear cell renal cell carcinoma (ccRCC) by using multiphase computed tomography (CT)-based radiomic features. MATERIALS AND METHODS A total of 137 consecutive patients with pathologically proven ccRCC (including 96 low-grade [grade 1 or 2] and 41 high-grade [grade 3 or 4] ccRCC) from January 2011 to January 2019 were enrolled in this retrospective study. Target region of interest (ROI) delineation followed by texture extraction was performed on a representative slice with the largest section of the tumor on the four-phase (unenhanced phase [UP], corticomedullary phase [CMP], nephrographic phase [NP] and excretory phase [EP]) CT images. Fifteen concatenations of the four-phase features were fed into 176 classification models (built with 8 classifiers and 22 feature selection methods), the classification performances of the 2640 resultant discriminative models were compared, and the top-ranked features were analyzed. RESULTS Image features extracted from the unenhanced phase (UP) CT images demonstrated a dominant classification performance over features from the other three phases. The discriminative model "Bagging + CMIM" achieved the highest classification AUC of 0.75. The top-ranked features from the UP included one shape-based feature and five first-order statistical features. CONCLUSION Image features extracted from the UP are more effective than other CT phases in differentiating low and high nuclear grade ccRCC based on machine learning-based classification modeling.
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Affiliation(s)
- Shengsheng Lai
- School of Medical Equipment, Guangdong Food and Drug Vocational College, Guangzhou, Guangdong, 510520, People’s Republic of China
| | - Lei Sun
- School of Biomedical Engineering, Southern Medical University, Guangzhou, Guangdong, 510515, People’s Republic of China
| | - Jialiang Wu
- Department of Radiology, The University of Hong Kong Shenzhen Hospital, Shenzhen, Guangdong, 518000, People’s Republic of China
| | - Ruili Wei
- Department of Radiology, Guangzhou First People’s Hospital, School of Medicine, South China University of Technology, Guangzhou, Guangdong, 510180, People’s Republic of China
| | - Shiwei Luo
- Department of Radiology, Guangzhou First People’s Hospital, School of Medicine, South China University of Technology, Guangzhou, Guangdong, 510180, People’s Republic of China
| | - Wenshuang Ding
- Department of Pathology, Guangzhou First People’s Hospital, School of Medicine, South China University of Technology, Guangzhou, Guangdong, 510180, People’s Republic of China
| | - Xilong Liu
- Department of Radiology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, 510515, People’s Republic of China
| | - Ruimeng Yang
- Department of Radiology, Guangzhou First People’s Hospital, School of Medicine, South China University of Technology, Guangzhou, Guangdong, 510180, People’s Republic of China
| | - Xin Zhen
- School of Biomedical Engineering, Southern Medical University, Guangzhou, Guangdong, 510515, People’s Republic of China
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Xiao JM, Hippe DS, Zecevic M, Zamora DA, Cai LM, Toia GV, Chandler AG, Dighe MK, O'Malley RB, Shuman WP, Wang CL, Mileto A. Virtual Unenhanced Dual-Energy CT Images Obtained with a Multimaterial Decomposition Algorithm: Diagnostic Value for Renal Mass and Urinary Stone Evaluation. Radiology 2021; 298:611-619. [PMID: 33464180 DOI: 10.1148/radiol.2021192448] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Background Virtual unenhanced (VUE) images obtained by using a dual-energy CT (DECT) multimaterial decomposition algorithm hold promise for diagnostic use in the abdomen in lieu of true unenhanced (TUE) images. Purpose To assess VUE images obtained from a DECT multimaterial decomposition algorithm in patients undergoing renal mass and urinary stone evaluation. Materials and Methods In this retrospective Health Insurance Portability and Accountability Act-compliant study, DECT was performed in patients undergoing evaluation for renal mass or urinary stone. VUE images were compared quantitatively to TUE images and qualitatively assessed by four independent radiologists. Differences in attenuation between VUE and TUE images were summarized by using 95% limits of agreement. Diagnostic performance in urinary stone detection was summarized by using area under the receiver operating characteristic curve, sensitivity, and specificity. Results A total of 221 patients (mean age ± standard deviation, 61 years ± 14; 129 men) with 273 renal masses were evaluated. Differences in renal mass attenuation between VUE and TUE images were within 3 HU for both enhancing masses (95% limits of agreement, -3.1 HU to 2.7 HU) and nonenhancing cysts (95% limits of agreement, -2.9 HU to 2.5 HU). Renal mass classification as enhancing mass versus nonenhancing cyst did not change (reclassification rate of enhancing masses, 0% [0 of 78]; 95% CI: 0, 5; reclassification rate of nonenhancing cysts, 0% [0 of 193]; 95% CI: 0, 2) with use of VUE in lieu of TUE images. Among 166 urinary stones evaluated, diagnostic performance of VUE images for stone detection was lower compared with that of TUE images (area under the receiver operating characteristic curve, 0.79 [95% CI: 0.73, 0.84] vs 0.93 [95% CI: 0.91, 0.95]; P < .001) due to reduced sensitivity of VUE for detection of stones 3 mm in diameter or less compared with those greater than 3 mm (sensitivity, 23% [25 of 108; 95% CI: 12, 40] vs 88% [126 of 144; 95% CI: 77, 94]; P < .001). Conclusion Compared with true unenhanced images, virtual unenhanced (VUE) images were unlikely to change renal mass classification as enhancing mass versus nonenhancing cyst. Diagnostic performance of VUE images remained suboptimal for urinary stone detection due to subtraction of stones 3 mm or less in diameter. © RSNA, 2021 Online supplemental material is available for this article. See also the editorial by Sosna in this issue.
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Affiliation(s)
- Jennifer M Xiao
- From the Department of Radiology, University of Washington School of Medicine, Box 357115, 1959 NE Pacific St, Seattle, WA 98195 (J.M.X., D.S.H., M.Z., D.A.Z., L.M.C., G.V.T., M.K.D., R.B.O., W.P.S., C.L.W., A.M.); and Global Research Organization, GE Healthcare, Houston, Tex (A.G.C.)
| | - Daniel S Hippe
- From the Department of Radiology, University of Washington School of Medicine, Box 357115, 1959 NE Pacific St, Seattle, WA 98195 (J.M.X., D.S.H., M.Z., D.A.Z., L.M.C., G.V.T., M.K.D., R.B.O., W.P.S., C.L.W., A.M.); and Global Research Organization, GE Healthcare, Houston, Tex (A.G.C.)
| | - Mladen Zecevic
- From the Department of Radiology, University of Washington School of Medicine, Box 357115, 1959 NE Pacific St, Seattle, WA 98195 (J.M.X., D.S.H., M.Z., D.A.Z., L.M.C., G.V.T., M.K.D., R.B.O., W.P.S., C.L.W., A.M.); and Global Research Organization, GE Healthcare, Houston, Tex (A.G.C.)
| | - David A Zamora
- From the Department of Radiology, University of Washington School of Medicine, Box 357115, 1959 NE Pacific St, Seattle, WA 98195 (J.M.X., D.S.H., M.Z., D.A.Z., L.M.C., G.V.T., M.K.D., R.B.O., W.P.S., C.L.W., A.M.); and Global Research Organization, GE Healthcare, Houston, Tex (A.G.C.)
| | - Larry M Cai
- From the Department of Radiology, University of Washington School of Medicine, Box 357115, 1959 NE Pacific St, Seattle, WA 98195 (J.M.X., D.S.H., M.Z., D.A.Z., L.M.C., G.V.T., M.K.D., R.B.O., W.P.S., C.L.W., A.M.); and Global Research Organization, GE Healthcare, Houston, Tex (A.G.C.)
| | - Giuseppe V Toia
- From the Department of Radiology, University of Washington School of Medicine, Box 357115, 1959 NE Pacific St, Seattle, WA 98195 (J.M.X., D.S.H., M.Z., D.A.Z., L.M.C., G.V.T., M.K.D., R.B.O., W.P.S., C.L.W., A.M.); and Global Research Organization, GE Healthcare, Houston, Tex (A.G.C.)
| | - Adam G Chandler
- From the Department of Radiology, University of Washington School of Medicine, Box 357115, 1959 NE Pacific St, Seattle, WA 98195 (J.M.X., D.S.H., M.Z., D.A.Z., L.M.C., G.V.T., M.K.D., R.B.O., W.P.S., C.L.W., A.M.); and Global Research Organization, GE Healthcare, Houston, Tex (A.G.C.)
| | - Manjiri K Dighe
- From the Department of Radiology, University of Washington School of Medicine, Box 357115, 1959 NE Pacific St, Seattle, WA 98195 (J.M.X., D.S.H., M.Z., D.A.Z., L.M.C., G.V.T., M.K.D., R.B.O., W.P.S., C.L.W., A.M.); and Global Research Organization, GE Healthcare, Houston, Tex (A.G.C.)
| | - Ryan B O'Malley
- From the Department of Radiology, University of Washington School of Medicine, Box 357115, 1959 NE Pacific St, Seattle, WA 98195 (J.M.X., D.S.H., M.Z., D.A.Z., L.M.C., G.V.T., M.K.D., R.B.O., W.P.S., C.L.W., A.M.); and Global Research Organization, GE Healthcare, Houston, Tex (A.G.C.)
| | - William P Shuman
- From the Department of Radiology, University of Washington School of Medicine, Box 357115, 1959 NE Pacific St, Seattle, WA 98195 (J.M.X., D.S.H., M.Z., D.A.Z., L.M.C., G.V.T., M.K.D., R.B.O., W.P.S., C.L.W., A.M.); and Global Research Organization, GE Healthcare, Houston, Tex (A.G.C.)
| | - Carolyn L Wang
- From the Department of Radiology, University of Washington School of Medicine, Box 357115, 1959 NE Pacific St, Seattle, WA 98195 (J.M.X., D.S.H., M.Z., D.A.Z., L.M.C., G.V.T., M.K.D., R.B.O., W.P.S., C.L.W., A.M.); and Global Research Organization, GE Healthcare, Houston, Tex (A.G.C.)
| | - Achille Mileto
- From the Department of Radiology, University of Washington School of Medicine, Box 357115, 1959 NE Pacific St, Seattle, WA 98195 (J.M.X., D.S.H., M.Z., D.A.Z., L.M.C., G.V.T., M.K.D., R.B.O., W.P.S., C.L.W., A.M.); and Global Research Organization, GE Healthcare, Houston, Tex (A.G.C.)
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Sistani G, Bjazevic J, Kassam Z, Romsa J, Pautler S. The value of 99mTc-sestamibi single-photon emission computed tomography-computed tomography in the evaluation and risk stratification of renal masses. Can Urol Assoc J 2020; 15:197-201. [PMID: 33212002 DOI: 10.5489/cuaj.6708] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
INTRODUCTION Differentiation of renal cell carcinoma (RCC) from oncocytoma is a common diagnostic dilemma. A few studies have shown that 99mTc-sestamibi (MIBI) imaging has the potential to characterize indeterminate renal masses. This comparative study evaluated the utility of MIBI single-photon emission computed tomography-computed tomography (SPECT-CT) in the assessment and risk stratification of renal masses. METHODS A total of 29 patients with 31 renal masses who had cross-sectional imaging and MIBI SPECT-CT were included. Lesions were categorized as either MIBI-positive or -negative on SPECT-CT. Individual lesion density ranged from 22-56 Hounsfield units (HU) on the non-contrast CT part of SPECT-CT. Quantitative relative MIBI uptake was calculated by measuring tumor to ipsilateral renal parenchymal uptake. The imaging results were correlated with histopathology. RESULTS All oncocytic lesions, including seven oncocytomas and one hybrid oncocytic chromophobe tumor (100%), were positive on MIBI. One chromophobe RCC showed low-grade MIBI uptake. The remaining RCC subtypes, including 15 clear-cell, four papillary, two mixed clear-cell and papillary, and one chromophobe, were MIBI-negative. The quantitative relative tumor uptake showed statistically significant higher uptake in the low-risk/oncocytic lesions compared to RCCs. CONCLUSIONS This study demonstrates that MIBI SPECT-CT is valuable in the characterization of indeterminate renal masses. The combination of MIBI uptake on SPECT and lesion density on non-contrast CT can be used for risk stratification of renal masses. This technique may reduce the need for further imaging (multiphasic CT or magnetic resonance imaging), renal mass biopsy, or surgical resection of low-risk renal masses. Subsequently, more patients could be followed with active surveillance.
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Affiliation(s)
| | | | - Zahra Kassam
- London Health Sciences Centre, London, ON, Canada
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Yamauchi FI, Paiva OA, Mussi TC, Francisco Neto MJ, Baroni RH. A comparative study of ultrasound and cross-sectional imaging for detection of small renal masses: anatomic factors and radiologist's experience. EINSTEIN-SAO PAULO 2020; 18:eAO5576. [PMID: 33206813 PMCID: PMC7647384 DOI: 10.31744/einstein_journal/2020ao5576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Accepted: 06/24/2020] [Indexed: 11/15/2022] Open
Abstract
Objective: To evaluate anatomic factors and radiologist's experience in the detection of solid renal masses on ultrasonography. Methods: We searched for solid renal masses diagnosed on cross-sectional imaging from 2007 to 2017 that also had previous ultrasonography from the past 6 months. The following features were evaluated: nodule size, laterality, location and growth pattern, patient body mass index and radiologist's experience in ultrasound. In surgically resected cases, pathologic reports were evaluated. Unpaired t test and χ2 test were used to evaluate differences among subgroups, using R-statistics. Statistical significance was set at p<0.05. Results: The initial search of renal nodules on cross-sectional imaging resulted in 428 lesions and 266 lesions were excluded. Final cohort included 162 lesions and, of those, 108 (67%) were correctly detected on ultrasonography (Group 1) and 54 (33%) were missed (Group 2). Comparison of Groups 1 and 2 were as follows, respectively: body mass index (27.7 versus 27.1; p=0.496), size (2.58cm versus 1.74cm; p=0.003), laterality (54% versus 59% right sided; p=0.832), location (27% versus 22% upper pole; p=0.869), growth pattern (25% versus 28% endophytic; p=0.131) and radiologist's experience (p=0.300). From surgically resected cases, histology available for Group 1 was clear cell (n=11), papillary (n=15), chromophobe (n=2) renal cell carcinoma, oncocytoma (n=1), and, for Group 2, clear cell (n=7), papillary (n=5) renal cell carcinoma, oncocytoma (n=2), angiomyolipoma, chromophobe renal cell carcinoma, and interstitial pyelonephritis (n=1, each). Conclusion: Size was the only significant parameter related to renal nodule detection on ultrasound.
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Wylie B, Necas M, Heaney A. Visualisation of focal renal lesions on ultrasound: A review of 518 lesions with contrast CT correlation. Australas J Ultrasound Med 2020; 23:248-254. [PMID: 34760603 PMCID: PMC8411720 DOI: 10.1002/ajum.12231] [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] [Received: 08/23/2020] [Accepted: 10/02/2020] [Indexed: 12/22/2022] Open
Abstract
INTRODUCTION Conventional ultrasound (US) is a common imaging investigation of the kidneys; however, the current diagnostic performance of US in the visualisation of focal renal lesions is unknown. METHODS This study was a retrospective sequential review of 518 focal renal lesions (FRLs) in 200 patients aged 50 years or older who received an US of the kidneys followed by contrast-enhanced computed tomography (CECT). RESULTS Patient's age ranged from 50 to 94 years. The majority were hospital inpatients. 518 FRLs were identified on CECT ranging from 3 to 165 mm (median 8 mm). The majority of FRLs (96.1%) were benign. The visualisation rate of FRLs on US was size-dependent: <5 mm, 10.2%; 5-9 mm, 22.3 mm; 10-14 mm, 48.0%; 15-19 mm, 82.1%; and 20-24 mm, 100%. The visualisation of simple cysts was 49.1% and hyperdense lesions 81.8%. Follow-up was available on 58% of lesions. Benign lesions generally remained stable. Seven patients had concerning heterogeneous hyperdense masses on CECT, and US had visualised six of these (85.7%). CONCLUSION Visualisation of FRLs is size-dependent. High rate of visualisation is achieved once the lesion exceeds 15 mm in size. Small FRLs are associated with a low rate of visualisation on ultrasound; however, they are rarely concerning. Hyperdense lesions on CECT that carry high suspicion of malignancy are associated with a high rate of US visualisation.
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Affiliation(s)
- Blanche Wylie
- Department of RadiologyWaikato HospitalHamiltonNew Zealand
| | - Martin Necas
- Department of RadiologyWaikato HospitalHamiltonNew Zealand
| | - Aine Heaney
- Department of RadiologyWaikato HospitalHamiltonNew Zealand
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Wang ZJ, Nikolaidis P, Khatri G, Dogra VS, Ganeshan D, Goldfarb S, Gore JL, Gupta RT, Hartman RP, Heilbrun ME, Lyshchik A, Purysko AS, Savage SJ, Smith AD, Wolfman DJ, Wong-You-Cheong JJ, Lockhart ME. ACR Appropriateness Criteria® Indeterminate Renal Mass. J Am Coll Radiol 2020; 17:S415-S428. [PMID: 33153554 DOI: 10.1016/j.jacr.2020.09.010] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Accepted: 09/01/2020] [Indexed: 12/15/2022]
Abstract
Renal masses are increasingly detected in asymptomatic individuals as incidental findings. CT and MRI with intravenous contrast and a dedicated multiphase protocol are the mainstays of evaluation for indeterminate renal masses. A single-phase postcontrast dual-energy CT can be useful when a dedicated multiphase renal protocol CT is not available. Contrast-enhanced ultrasound with microbubble agents is a useful alternative for characterizing renal masses, especially for patients in whom iodinated CT contrast or gadolinium-based MRI contrast is contraindicated. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
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Affiliation(s)
- Zhen J Wang
- University of California San Francisco School of Medicine, San Francisco, California.
| | | | - Gaurav Khatri
- Panel Vice-Chair, UT Southwestern Medical Center, Dallas, Texas
| | - Vikram S Dogra
- University of Rochester Medical Center, Rochester, New York
| | | | - Stanley Goldfarb
- University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania; American Society of Nephrology
| | - John L Gore
- University of Washington, Seattle, Washington; American Urological Association
| | - Rajan T Gupta
- Duke University Medical Center, Durham, North Carolina
| | | | | | - Andrej Lyshchik
- Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | | | - Stephen J Savage
- Medical University of South Carolina, Charleston, South Carolina; American Urological Association
| | - Andrew D Smith
- University of Alabama at Birmingham, Birmingham, Alabama
| | - Darcy J Wolfman
- Johns Hopkins University School of Medicine, Washington, District of Columbia
| | | | - Mark E Lockhart
- Specialty Chair, University of Alabama at Birmingham, Birmingham, Alabama
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Association of tumor grade, enhancement on multiphasic CT and microvessel density in patients with clear cell renal cell carcinoma. Abdom Radiol (NY) 2020; 45:3184-3192. [PMID: 31650375 DOI: 10.1007/s00261-019-02271-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
PURPOSE Clear cell renal cell carcinoma (ccRCC) comprises nearly 90% of all diagnosed RCC subtypes and has the worst prognosis and highest metastatic potential. The strongest prognostic factors for patients with ccRCC include histological subtype and Fuhrman grade, which are incorporated into prognostic models. Since ccRCC is a highly vascularized tumor, there may be differences in enhancement patterns on multidetector CT (MDCT) due to the hemodynamics and microvessel density (MVD) of the lesions. This may provide a noninvasive method to characterize incidentally detected low- and high-grade ccRCCs on MDCT. The purpose of our study was to determine the correlation between MDCT enhancement parameters, ccRCC MVD, and Fuhrman grade to determine its utility and value in assessing tumor vascularity and grade in vivo. METHODS In this retrospective, HIPAA-compliant, institutional review board-approved study with waiver of informed consent, 127 consecutive patients with 89 low-grade (LG), and 43 high-grade (HG) ccRCCs underwent preoperative four-phase MDCT. A 3D volume of interest (VOI) was obtained for every tumor and absolute enhancement and the wash-in/wash-out of enhancement for each phase was assessed. Immunohistochemistry on resected specimens was used to quantify MVD. Linear regression and Pearson correlation were used to investigate the strength of the association between 3D VOI enhancement and MVD. Stepwise logistic regression analysis determined independent predictors of HG ccRCC. Cut-off values and odds Ratio (OR) with 95% CIs were reported. The clinical, radiomic, and pathologic features with the highest performance in the stepwise logistic regression analysis were evaluated using receiver operator characteristics (ROC) and area under the curve (AUC). RESULTS Absolute enhancement in the nephrographic phase < 52.1 Hounsfield Units (HU) (HR 0.979, 95% CI 0.964-0.994, p value = 0.006), lesion size > 4.3 cm (HR 1.450, 95% CI 1.211-1.738, p value < 0.001), and an intratumoral MVD < 15% (HR 0.932, 95% CI 0.867-1.002, p value = 0.058) were independent predictors of HG ccRCC with an AUC of 0.818 (95% CI 0.725-0.911). HG ccRCCs had a significant association between 3D VOI enhancement and MVD in each post-contrast phase (r2 = 0.238 to 0.455, p < 0.05). CONCLUSIONS Absolute enhancement of the entire lesion obtained from a 3D VOI in the nephrographic phase on preoperative MDCT can provide quantitative data that are a significant, independent predictor of a high-grade clear cell RCC and can be used to assess tumor vascularity and grade in vivo.
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Erdim C, Yardimci AH, Bektas CT, Kocak B, Koca SB, Demir H, Kilickesmez O. Prediction of Benign and Malignant Solid Renal Masses: Machine Learning-Based CT Texture Analysis. Acad Radiol 2020; 27:1422-1429. [PMID: 32014404 DOI: 10.1016/j.acra.2019.12.015] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2019] [Revised: 12/09/2019] [Accepted: 12/16/2019] [Indexed: 02/06/2023]
Abstract
RATIONALE AND OBJECTIVES This study aimed to investigate whether benign and malignant renal solid masses could be distinguished through machine learning (ML)-based computed tomography (CT) texture analysis. MATERIALS AND METHODS Seventy-nine patients with 84 solid renal masses (21 benign; 63 malignant) from a single center were included in this retrospective study. Malignant masses included common renal cell carcinoma (RCC) subtypes: clear cell RCC, papillary cell RCC, and chromophobe RCC. Benign masses are represented by oncocytomas and fat-poor angiomyolipomas. Following preprocessing steps, a total of 271 texture features were extracted from unenhanced and contrast-enhanced CT images. Dimension reduction was done with a reliability analysis and then with a feature selection algorithm. A nested-approach was used for feature selection, model optimization, and validation. Eight ML algorithms were used for the classifications: decision tree, locally weighted learning, k-nearest neighbors, naive Bayes, logistic regression, support vector machine, neural network, and random forest. RESULTS The number of features with good reproducibility was 198 for unenhanced CT and 244 for contrast-enhanced CT. Random forest algorithm demonstrated the best predictive performance using five selected contrast-enhanced CT texture features. The accuracy and area under the curve metrics were 90.5% and 0.915, respectively. Having eliminated the highly collinear features from the analysis, the accuracy and area under the curve values slightly increased to 91.7% and 0.916, respectively. CONCLUSION ML-based contrast-enhanced CT texture analysis might be a potential method for distinguishing benign and malignant solid renal masses with satisfactory performance.
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Affiliation(s)
- Cagri Erdim
- Department of Radiology, Sultangazi Haseki Training and Research Hospital, Sultangazi, Istanbul, Turkey
| | - Aytul Hande Yardimci
- Department of Radiology, Istanbul Training and Research Hospital, Samatya, Istanbul 34098, Turkey
| | - Ceyda Turan Bektas
- Department of Radiology, Istanbul Training and Research Hospital, Samatya, Istanbul 34098, Turkey
| | - Burak Kocak
- Department of Radiology, Istanbul Training and Research Hospital, Samatya, Istanbul 34098, Turkey.
| | - Sevim Baykal Koca
- Department of Pathology, Istanbul Training and Research Hospital, Samatya, Istanbul, Turkey
| | - Hale Demir
- Department of Pathology, Amasya University School of Medicine, Amasya, Turkey
| | - Ozgur Kilickesmez
- Department of Radiology, Istanbul Training and Research Hospital, Samatya, Istanbul 34098, Turkey
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Clinical Importance of Incidental Homogeneous Renal Masses That Measure 10-40 mm and 21-39 HU at Portal Venous Phase CT: A 12-Institution Retrospective Cohort Study. AJR Am J Roentgenol 2020; 217:135-140. [PMID: 32845714 DOI: 10.2214/ajr.20.24245] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
BACKGROUND. Incidental homogeneous renal masses are frequently encountered at portal venous phase CT. The American College of Radiology Incidental Findings Committee's white paper on renal masses recommends additional imaging for incidental homogeneous renal masses greater than 20 HU, but single-center data and the Bosniak classification version 2019 suggest the optimal attenuation threshold for detecting solid masses should be higher. OBJECTIVE. The purpose of this article is to determine the clinical importance of small (10-40 mm) incidentally detected homogeneous renal masses measuring 21-39 HU at portal venous phase CT. METHODS. We performed a 12-institution retrospective cohort study of adult patients who underwent portal venous phase CT for a nonrenal indication. The date of the first CT at each institution ranged from January 1, 2008, to January 1, 2014. Consecutive reports from 12,167 portal venous phase CT examinations were evaluated. Images were reviewed for 4529 CT examinations whose report described a focal renal mass. Eligible masses were 10-40 mm, well-defined, subjectively homogeneous, and 21-39 HU. Of these, masses that were shown to be solid without macroscopic fat; classified as Bosniak IIF, III, or IV; or confirmed to be malignant were considered clinically important. The reference standard was renal mass protocol CT or MRI, ultrasound of definitively benign cysts or solid masses, single-phase contrast-enhanced CT or unenhanced MRI showing no growth or morphologic change for 5 years or more, or clinical follow-up 5 years or greater. A reference standard was available for 346 masses in 300 patients. The 95% CIs were calculated using the binomial exact method. RESULTS. Eligible masses were identified in 4.2% of patients (514/12,167; 95% CI, 3.9-4.6%). Of 346 masses with a reference standard, none were clinically important (0%; 95% CI, 0-0.9%). Mean mass size was 17 mm; 72% (248/346) measured 21-30 HU, and 28% (98/346) measured 31-39 HU. CONCLUSION. Incidental small homogeneous renal masses measuring 21-39 HU at portal venous phase CT are common and highly likely benign. CLINICAL IMPACT. The change in attenuation threshold signifying the need for additional imaging from greater than 20 HU to greater than 30 HU proposed by the Bosniak classification version 2019 is supported.
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Remer EM. Mimics and Pitfalls in Renal Imaging. Radiol Clin North Am 2020; 58:885-896. [PMID: 32792121 DOI: 10.1016/j.rcl.2020.05.001] [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: 10/24/2022]
Abstract
There are several potential pitfalls that radiologists face when interpreting images of the kidneys. Some result from image acquisition and can arise from the imaging equipment or imaging technique, whereas others are patient related. Another category of pitfalls relates to image interpretation. Some difficulties stem from methods to detect enhancement after contrast administration, whereas others are benign entities that can mimic a renal tumor. Finally, interpretation and diagnosis of fat-containing renal masses may be tricky due to the complexities discerning the pattern of fat within a mass and how that translates to an accurate diagnosis.
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Affiliation(s)
- Erick M Remer
- Imaging Institute and Glickman Urological and Kidney Institute, Cleveland Clinic, 9500 Euclid Avenue, A21, Cleveland, OH 44195, USA.
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Zaharie A, Bolboacă SD, Moisoiu T, Burghelea D, Iacob G, Ghervan L, Elec FI. Renal Tumors in Young Adults: Is Preoperative Computer Tomography Imaging Suggestive for the Nature of the Tumors? Diagnostics (Basel) 2020; 10:diagnostics10060380. [PMID: 32517346 PMCID: PMC7345588 DOI: 10.3390/diagnostics10060380] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 05/25/2020] [Accepted: 06/04/2020] [Indexed: 01/20/2023] Open
Abstract
Renal cell carcinoma (RCC) accounts for 2–3% of all adult malignant neoplasms and is even rarer in patients under 45 years old. Clear-cell carcinoma represents most of the pathological subtypes. Our study aimed to investigate the association between preoperative computer tomography imagistic evaluation and histopathological diagnosis of renal tumors in young adults. Patients younger than 45 years old with renal tumors who were referred for medical treatment at the Clinical Institute of Urology and Renal Transplantation Cluj-Napoca from 2012 to 2019 were considered eligible for the study. Medical charts were retrospectively reviewed, and patients with complete data regarding preoperative diagnostic, histopathological evaluation, and follow-up data, regardless of gender, were included in the study. Sixteen patients younger than 45 years fulfilled all the inclusion criteria and were evaluated. With two exceptions, the evaluated patients were in a T1 and T2 stage, with no vascular invasion or of the adjacent organs. Two-thirds of our patients had a clear-cell renal cell carcinoma. None of our patients fitted in the low complexity surgery category of the R.E.N.A.L. Nephrometry Score and 37.5% of them benefited from partial nephrectomy. Half of the suppositions made based on imaging were concordant with the histopathology report. Fifteen of the patients showed no recurrence during the respective follow-up interval. Computer tomography imaging reports showed on our sample a higher concordance with the histopathological report in the more common subtypes (namely Renal Clear Cell RCC), with typical appearances.
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Affiliation(s)
- Andreea Zaharie
- Department of Medical Imaging, “Leon Daniello” Pulmonology Hospital, Cluj-Napoca, Bogdan Petriceicu Hașdeu Street, no. 6, 400332 Cluj-Napoca, Romania
- Correspondence: (A.Z.); (S.D.B.); (F.I.E.); Tel.: +40-762-298-833 (A.Z.); +40-374-834-506 (S.D.B.); +40-722-822-740 (F.I.E.)
| | - Sorana D. Bolboacă
- Department of Medical Informatics and Biostatistics, Iuliu Hațieganu University of Medicine and Pharmacy Cluj-Napoca, Louis Pasteur Str., no. 6, 400349 Cluj-Napoca, Romania
- Correspondence: (A.Z.); (S.D.B.); (F.I.E.); Tel.: +40-762-298-833 (A.Z.); +40-374-834-506 (S.D.B.); +40-722-822-740 (F.I.E.)
| | - Tudor Moisoiu
- Department of Urology, Clinical Institute of Urology and Renal Transplantation, Clinicilor Str., no. 4–6, 400006 Cluj-Napoca, Romania; (T.M.); (D.B.); (L.G.)
| | - Dan Burghelea
- Department of Urology, Clinical Institute of Urology and Renal Transplantation, Clinicilor Str., no. 4–6, 400006 Cluj-Napoca, Romania; (T.M.); (D.B.); (L.G.)
| | - Gheorghita Iacob
- Department of Pathology, Clinical Institute of Urology and Renal Transplantation, Clinicilor Str., no. 4–6, 400006 Cluj-Napoca, Romania;
| | - Liviu Ghervan
- Department of Urology, Clinical Institute of Urology and Renal Transplantation, Clinicilor Str., no. 4–6, 400006 Cluj-Napoca, Romania; (T.M.); (D.B.); (L.G.)
- Department of Urology, Iuliu Hațieganu University of Medicine and Pharmacy Cluj-Napoca, Clinicilor Str., no. 4–6, 400006 Cluj-Napoca, Romania
| | - Florin Ioan Elec
- Department of Urology, Clinical Institute of Urology and Renal Transplantation, Clinicilor Str., no. 4–6, 400006 Cluj-Napoca, Romania; (T.M.); (D.B.); (L.G.)
- Department of Urology, Iuliu Hațieganu University of Medicine and Pharmacy Cluj-Napoca, Clinicilor Str., no. 4–6, 400006 Cluj-Napoca, Romania
- Correspondence: (A.Z.); (S.D.B.); (F.I.E.); Tel.: +40-762-298-833 (A.Z.); +40-374-834-506 (S.D.B.); +40-722-822-740 (F.I.E.)
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Patel BN, Boltyenkov AT, Martinez MG, Mastrodicasa D, Marin D, Jeffrey RB, Chung B, Pandharipande P, Kambadakone A. Cost-effectiveness of dual-energy CT versus multiphasic single-energy CT and MRI for characterization of incidental indeterminate renal lesions. Abdom Radiol (NY) 2020; 45:1896-1906. [PMID: 31894384 DOI: 10.1007/s00261-019-02380-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
PURPOSE To evaluate the cost-effectiveness of DECT versus multiphasic CT and MRI for characterizing small incidentally detected indeterminate renal lesions using a Markov Monte Carlo decision-analytic model. BACKGROUND Incidental renal lesions are commonly encountered due to the increasing utilization of medical imaging and the increasing prevalence of renal lesions with age. Currently recommended imaging modalities to further characterize incidental indeterminate renal lesions have some inherent drawbacks. Single-phase DECT may overcome these limitations, but its cost-effectiveness remains uncertain. MATERIALS AND METHODS A decision-analytic (Markov) model was constructed to estimate life expectancy and lifetime costs for otherwise healthy 64-year-old patients with small (≤ 4 cm) incidentally detected, indeterminate renal lesions on routine imaging (e.g., ultrasound or single-phase CT). Three strategies for evaluating renal lesions for enhancement were compared: multiphase SECT (e.g., true unenhanced and nephrographic phase), multiphasic MRI, and single-phase DECT (nephrographic phase in dual-energy mode). The model incorporated modality-specific diagnostic test performance, incidence, and prevalence of incidental renal cell carcinomas (RCCs), effectiveness, costs, and health outcomes. An incremental cost-effectiveness analysis was performed to identify strategy preference at willingness-to-pay (WTP) thresholds of $50,000 and $100,000 per quality-adjusted life-year (QALY) gained. Deterministic and probabilistic sensitivity analysis were performed. RESULTS In the base case analysis, expected mean costs per patient undergoing characterization of incidental renal lesions were $2567 for single-phase DECT, $3290 for multiphasic CT, and $3751 for multiphasic MRI. Associated quality-adjusted life-years were the highest for single-phase DECT at 0.962, for multiphasic MRI it was 0.940, and was the lowest for multiphasic CT at 0.925. Because of lower associated costs and higher effectiveness, the single-phase DECT strategy dominated the other two strategies. CONCLUSIONS Single-phase DECT is potentially more cost-effective than multiphasic SECT and MRI for evaluating small incidentally detected indeterminate renal lesions.
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Martínez Rodríguez C, Tardáguila de la Fuente G, Villanueva Campos A. Current management of small renal masses. RADIOLOGIA 2020. [DOI: 10.1016/j.rxeng.2020.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Patel SR, Francois S, Bhamber T, Evans H, Gaston K, Riggs SB, Teigland C, Clark PE, Roy OP. Safety and effectiveness of percutaneous renal cryoablation with conscious sedation. Arab J Urol 2020; 18:163-168. [PMID: 33029426 PMCID: PMC7473112 DOI: 10.1080/2090598x.2020.1739382] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/18/2020] [Indexed: 12/04/2022] Open
Abstract
OBJECTIVE To investigate complications and treatment failure rates of percutaneous renal cryoablation (PRC) for small renal masses under local anaesthesia and conscious sedation (LACS), to assess the safety and effectiveness of this approach, as PRC is typically performed under general anaesthesia (GA). PATIENTS AND METHODS We retrospectively reviewed PRC under LACS from 2003 to 2017. We analysed perioperative parameters between patients who successfully underwent PRC under LACS and patients with post-procedural complications or treatment failure (renal mass enhancement after successful intraoperative tumour ablation). Two-sided non-parametric and Fisher's exact tests were performed to compare uncomplicated or disease-free PRC with the complication or treatment failure group, respectively. RESULTS A total of 100 PRCs under LACS were performed during the study period. Of these patients, six patients had at least one postoperative complication (6%), and treatment failure was diagnosed in nine patients (9%) after PRC [mean (SD) follow-up of 42.7 (26.6) months]. The procedural failure rate was 1%. No ablations were converted to GA. The mean tumour size was smaller in patients who had no complications during PRC compared to those who did, at a mean (SD) of 2.2 (0.6) cm vs 3.0 (1.0) cm (P = 0.039). The use of more intraoperative probes during the PRC was also associated with complications, at a mean (SD) 3.0 (1.4) vs 1.8 (0.8) (P = 0.021). CONCLUSIONS PRC under LACS is an effective and safe procedural approach for managing small renal masses with low complication, treatment failure, and procedural failure rates. Larger renal masses and intraoperative use of multiple probes is associated with an increased risk of PRC complications. ABBREVIATIONS BMI: body mass index; CCI: Charlson Comorbidity Index; GA: general anaesthesia; LACS: local anaesthesia and conscious sedation; PRC: percutaneous renal cryoablation; R.E.N.A.L.: Radius, Exophytic/Endophytic, Nearness, Anterior/Posterior, Location.
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Affiliation(s)
- Sagar Rohitkumar Patel
- Department of Urology, Atrium Health, Charlotte, NC, USA
- Department of Urology, University of North Carolina, Chapel Hill, NC, USA
| | - Sean Francois
- Department of Urology, Atrium Health, Charlotte, NC, USA
- Department of Urology, University of North Carolina, Chapel Hill, NC, USA
| | | | - Holt Evans
- Department of Urology, Atrium Health, Charlotte, NC, USA
| | - Kris Gaston
- Department of Urology, Atrium Health, Charlotte, NC, USA
| | | | - Chris Teigland
- Department of Urology, Atrium Health, Charlotte, NC, USA
| | - Peter E. Clark
- Department of Urology, Atrium Health, Charlotte, NC, USA
| | - Ornob P. Roy
- Department of Urology, Atrium Health, Charlotte, NC, USA
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Atwi NE, Sabottke CF, Pitre DM, Smith DL, Danrad R, Dharaiya E, Kambadakone A, Pandharipande PV, Toshav AM. Follow-up Recommendation Rates Associated With Spectral Detector Dual-Energy CT of the Abdomen and Pelvis: A Retrospective Comparison to Single-Energy CT. J Am Coll Radiol 2020; 17:940-950. [PMID: 32032553 DOI: 10.1016/j.jacr.2019.12.029] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Revised: 12/28/2019] [Accepted: 12/30/2019] [Indexed: 12/21/2022]
Abstract
BACKGROUND Dual-energy CT image sets have many applications in abdominopelvic imaging but no demonstrated clinical effect. PURPOSE To determine the effect of dual-energy CT iodine maps on abdominopelvic imaging follow-up recommendation rates. MATERIALS AND METHODS Retrospective study of abdominopelvic CTs acquired from April 2017 through June 2018. CT reports were analyzed for radiologic follow-up recommendation and follow-up recommendation reason. Follow-up MRI reports were analyzed for benign or nonbenign diagnosis. CT scans with iodine maps (CTIMs) and conventional CT scans (CCTs) subgroups were compared using χ2 testing. RESULTS In all, 3,221 abdominopelvic CT scans of 2,401 patients (1,326 men, 1,075 women, mean age 54.1 years) were analyzed; 1,423 were CTIMs and 1,798 were CCTs. Follow-up recommendation rates were not significantly different for CTIMs and CCTs (19.5% and 21.4%, respectively, P = .19). Follow-up recommendations because of incomplete diagnosis were significantly lower in CTIMs (9.1%) than in CCTs (11.9%, P = .01). Follow-up recommendations for MRI and PET/CT were significantly lower in CTIMs (9.6%) than CCTs (13.0%, P = .003). Follow-up MRI outcomes (n = 111) were not different between CTIMs (61.2% benign) and CCTs (59.6%, P = .87). CONCLUSION Dual-energy CT iodine maps are associated with decreased follow-up examinations because of incomplete diagnosis and decreased recommendations for follow-up MRI, suggesting that abdominopelvic iodine maps may benefit patient care and decrease institutional cost.
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Affiliation(s)
- Noah E Atwi
- Department of Radiology, LSU Health Sciences Center New Orleans, New Orleans, Louisiana
| | - Carl F Sabottke
- School of Medicine, LSU Health Sciences Center New Orleans, New Orleans, Louisiana
| | - David M Pitre
- School of Medicine, LSU Health Sciences Center New Orleans, New Orleans, Louisiana
| | - David L Smith
- Department of Radiology, LSU Health Sciences Center New Orleans, New Orleans, Louisiana
| | - Raman Danrad
- Clinical Director of MRI, Academic Director of Cardiac Imaging, Department of Radiology, LSU Health Sciences Center New Orleans, New Orleans, Louisiana
| | - Ekta Dharaiya
- Head of CT Clinical Marketing, Philips Healthcare, Cleveland, Ohio
| | - Avinash Kambadakone
- Medical Director, Martha's Vineyard Hospital Imaging, Chief of CT, Massachusetts General Hospital, Boston, Massachusetts
| | - Pari V Pandharipande
- Director, MGH Institute for Technology Assessment; Associate Chair, Integrated Imaging & Imaging Sciences, MGH Radiology; Executive Director, Clinical Enterprise Integration, Mass General Brigham (MGB) Radiology; Associate Professor of Radiology Harvard Medical School; Radiologist, Abdominal Imaging, Massachusetts General Hospital, Boston, Massachusetts
| | - Aran M Toshav
- Program Director of the diagnostic residency, Department of Radiology, LSU Health Sciences Center, New Orleans, Louisiana.
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Martínez Rodríguez C, Tardáguila de la Fuente G, Villanueva Campos AM. Current management of small renal masses. RADIOLOGIA 2019; 62:167-179. [PMID: 31882171 DOI: 10.1016/j.rx.2019.11.004] [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: 04/10/2019] [Revised: 11/18/2019] [Accepted: 11/22/2019] [Indexed: 12/12/2022]
Abstract
One of the consequences of the growing use of diagnostic imaging techniques is the notable growth in the detection of small renal masses presumably corresponding to localized tumors that are potentially curable with surgical treatment. When faced with the finding of a small renal mass, radiologists must determine whether it is benign or malignant, and if it is malignant, what subtype it belong to, and whether it should be managed with surgical treatment, with ablative techniques, or with watchful waiting with active surveillance. Small renal masses are now a clinical entity that require management different from the approaches used for classical renal cell carcinomas. In this scenario, radiologists are key because they are involved in all aspects of the management of these tumors, including in their diagnosis, treatment, and follow-up.
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Reply to “Follow-Up of Incidental Renal Lesions on Lumbar Spine MRI”. AJR Am J Roentgenol 2019; 213:W148. [DOI: 10.2214/ajr.19.21903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Al Salmi IS, Halperin J, Al-Douri F, Leung V, Patlas M, Alabousi A. Validation of Region of Interest Measurements for the Objective Assessment of Post-Contrast Enhancement of Renal Lesions on MRI. Br J Radiol 2019; 92:20190507. [PMID: 31365281 DOI: 10.1259/bjr.20190507] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE The aim of this study was to validate the use of region of interest (ROI) measurements in MRI to objectively assess for enhancement in suspected solid renal masses and to determine a minimum threshold value for true enhancement. METHODS Contrast-enhanced renal MRI studies performed between January 2015 and December 2017 for patients with a known renal mass who had subsequent biopsy, or partial/radical nephrectomy were included. Two body imaging fellows independently measured the mean ROI values of renal masses, normal renal parenchyma, the ipsilateral psoas muscle and external air on the pre- and post-contrast sequences. The absolute and percentage changes in the mean ROI values were calculated. The readers were blinded to the pathology results. RESULTS 104 patients were included in this study (mean age of 65 years; 58 males and 46 females). 74 patients (71%) had a diagnosis of renal cell carcinoma (RCC). Pathology showed clear-cell RCC in 55%, papillary RCC in 22%, and other RCC subtypes in 23%. There were 30 non-RCC renal lesions (29%), including oncocytoma, renal papillary adenoma, and renal metastasis.The minimum percentage change in ROI values in the pre- versus post-contrast images for all pathology-proven RCCs was 23% (range: 23-437%, mean: 143%); this represents relative enhancement and was referred to as the Signal Intensity Index (SII). The percentage change for normal renal parenchyma ranged from 32-317%. The maximum percentage change in ROI values for pathology proven renal cysts was 13% (range: -5-13%, mean: 3.5%). There was excellent inter observer agreement between the two readers [Intra-class correlation coefficient (r) 0.81]. CONCLUSION The percentage change in ROI values (SII) can be a helpful tool in the objective assessment of true enhancement of renal masses and can supplement subtraction images. The minimum threshold for enhancement in our study was 23%. ADVANCES IN KNOWLEDGE Enhancement of a renal lesion can be determined using the objective tool of ROI measurements in the pre- and post-contrast MR images with a percentage change of 20% or above indicating enhancement. This is an additional objective tool, which in conjunction with the subtraction images may improve detection and appropriate diagnosis of renal lesions. It could also be helpful in cases where the subtraction images are degraded by motion artefact.
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Affiliation(s)
- Ishaq Sulaiman Al Salmi
- Department of Radiology, McMaster University, St. Joseph's Healthcare Hamilton, Hamilton, Canada
| | - Joshua Halperin
- Department of Radiology, McMaster University, St. Joseph's Healthcare Hamilton, Hamilton, Canada
| | - Faten Al-Douri
- Department of Radiology, McMaster University, St. Joseph's Healthcare Hamilton, Hamilton, Canada
| | - Vincent Leung
- Department of Radiology, McMaster University, St. Joseph's Healthcare Hamilton, Hamilton, Canada
| | - Michael Patlas
- Department of Radiology, McMaster University, Hamilton General Hospital, Hamilton, Canada
| | - Abdullah Alabousi
- Department of Radiology, McMaster University, St. Joseph's Healthcare Hamilton, Hamilton, Canada
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Gobara A, Yoshizako T, Yoshida R, Nakamura M, Shiina H, Kitagaki H. T1a renal cell carcinoma on unenhanced CT: analysis of detectability and imaging features. Acta Radiol Open 2019; 8:2058460119849706. [PMID: 31205754 PMCID: PMC6535905 DOI: 10.1177/2058460119849706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Accepted: 04/15/2019] [Indexed: 12/05/2022] Open
Abstract
Background Increasing use of unenhanced computed tomography (CT) has been associated with the increasing incidental detection of renal cell carcinoma (RCC) at an earlier stage. Purpose To evaluate the characteristics in detecting and differentiating T1a RCCs on unenhanced CT. Material and Methods We retrospectively reviewed 68 patients with 68 T1a RCCs and 39 benign regions. Two radiologists interpreted the images on unenhanced axial CT and performed a blinded and independent review of T1a RCCs. The readers evaluated the presence of RCC and differentiated the detected lesions. Results The consensus of two readers detected 53 (78%) RCCs. Of the 53 detected RCCs, 42 (62%) RCCs were correctly diagnosed and 11 (16%) masses were misdiagnosed as benign. Of the 39 benign regions, 29 (74%) cysts were diagnosed correctly, but 10 (26%) cysts were misdiagnosed as malignant. The following values of the radiologists were obtained by consensus: sensitivity = 61.8% (42/68); specificity = 74.4% (29/39); positive predictive value = 80.8% (42/52); negative predictive value = 55.0% (29/55); accuracy = 66.4% (71/107). The receiver operating characteristic curve of consensus was 0.754. Inter-observer correlation was κ = 0.849. There was a significant difference in tumor size (P = 0.019) and the contour type of tumor (P = 0.0207) between correctly diagnosed RCCs and not correctly diagnosed RCCs. Conclusion Our findings showed that tumor size and contour type could affect the detection and differentiation of T1a RCC on unenhanced CT. To detect and differentiate T1a RCC on unenhanced CT is difficult. However, the findings from this study may help detection of RCCs on unenhanced CT.
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Affiliation(s)
- Aiko Gobara
- Department of Radiology, Shimane University Faculty of Medicine, Izumo, Japan
| | - Takeshi Yoshizako
- Department of Radiology, Shimane University Faculty of Medicine, Izumo, Japan
| | - Rika Yoshida
- Department of Radiology, Shimane University Faculty of Medicine, Izumo, Japan
| | - Megumi Nakamura
- Department of Radiology, Shimane University Faculty of Medicine, Izumo, Japan
| | - Hiroaki Shiina
- Department of Urology, Shimane University Faculty of Medicine, Izumo, Japan
| | - Hajime Kitagaki
- Department of Radiology, Shimane University Faculty of Medicine, Izumo, Japan
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Silverman SG, Pedrosa I, Ellis JH, Hindman NM, Schieda N, Smith AD, Remer EM, Shinagare AB, Curci NE, Raman SS, Wells SA, Kaffenberger SD, Wang ZJ, Chandarana H, Davenport MS. Bosniak Classification of Cystic Renal Masses, Version 2019: An Update Proposal and Needs Assessment. Radiology 2019; 292:475-488. [PMID: 31210616 DOI: 10.1148/radiol.2019182646] [Citation(s) in RCA: 249] [Impact Index Per Article: 49.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Cystic renal cell carcinoma (RCC) is almost certainly overdiagnosed and overtreated. Efforts to diagnose and treat RCC at a curable stage result in many benign neoplasms and indolent cancers being resected without clear benefit. This is especially true for cystic masses, which compared with solid masses are more likely to be benign and, when malignant, less aggressive. For more than 30 years, the Bosniak classification has been used to stratify the risk of malignancy in cystic renal masses. Although it is widely used and still effective, the classification does not formally incorporate masses identified at MRI or US or masses that are incompletely characterized but are highly likely to be benign, and it is affected by interreader variability and variable reported malignancy rates. The Bosniak classification system cannot fully differentiate aggressive from indolent cancers and results in many benign masses being resected. This proposed update to the Bosniak classification addresses some of these shortcomings. The primary modifications incorporate MRI, establish definitions for previously vague imaging terms, and enable a greater proportion of masses to enter lower-risk classes. Although the update will require validation, it aims to expand the number of cystic masses to which the Bosniak classification can be applied while improving its precision and accuracy for the likelihood of cancer in each class.
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Affiliation(s)
- Stuart G Silverman
- From the Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass (S.G.S., A.B.S.); Disease-Focused Panel on Renal Cell Carcinoma, Society of Abdominal Radiology, Houston, Tex (S.G.S., I.P., N.M.H., N.S., A.D.S., E.M.R., A.B.S., N.E.C., S.S.R., S.A.W., S.D.K., Z.J.W., H.C., M.S.D.); Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (I.P.); Departments of Radiology and Urology, Michigan Medicine, University of Michigan, 1500 E Medical Center Dr, B2-A209A, Ann Arbor, MI 48109 (J.H.E., N.E.C., S.D.K., M.S.D.); Department of Radiology, New York University Langone Medical Center, New York, NY (N.M.H., H.C.); Department of Radiology, University of Ottawa, Ottawa, Canada (N.S.); Department of Radiology, University of Alabama School of Medicine, Birmingham, Ala (A.D.S.); Imaging Institute and Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio (E.M.R.); Department of Radiology, David Geffen School of Medicine, UCLA Center for the Health Sciences, Los Angeles, Calif (S.S.R.); Department of Radiology, University of Wisconsin Hospital and Clinics, Madison, Wis (S.A.W.); and Department of Radiology, UCSF Medical Center, San Francisco, Calif (Z.J.W.)
| | - Ivan Pedrosa
- From the Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass (S.G.S., A.B.S.); Disease-Focused Panel on Renal Cell Carcinoma, Society of Abdominal Radiology, Houston, Tex (S.G.S., I.P., N.M.H., N.S., A.D.S., E.M.R., A.B.S., N.E.C., S.S.R., S.A.W., S.D.K., Z.J.W., H.C., M.S.D.); Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (I.P.); Departments of Radiology and Urology, Michigan Medicine, University of Michigan, 1500 E Medical Center Dr, B2-A209A, Ann Arbor, MI 48109 (J.H.E., N.E.C., S.D.K., M.S.D.); Department of Radiology, New York University Langone Medical Center, New York, NY (N.M.H., H.C.); Department of Radiology, University of Ottawa, Ottawa, Canada (N.S.); Department of Radiology, University of Alabama School of Medicine, Birmingham, Ala (A.D.S.); Imaging Institute and Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio (E.M.R.); Department of Radiology, David Geffen School of Medicine, UCLA Center for the Health Sciences, Los Angeles, Calif (S.S.R.); Department of Radiology, University of Wisconsin Hospital and Clinics, Madison, Wis (S.A.W.); and Department of Radiology, UCSF Medical Center, San Francisco, Calif (Z.J.W.)
| | - James H Ellis
- From the Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass (S.G.S., A.B.S.); Disease-Focused Panel on Renal Cell Carcinoma, Society of Abdominal Radiology, Houston, Tex (S.G.S., I.P., N.M.H., N.S., A.D.S., E.M.R., A.B.S., N.E.C., S.S.R., S.A.W., S.D.K., Z.J.W., H.C., M.S.D.); Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (I.P.); Departments of Radiology and Urology, Michigan Medicine, University of Michigan, 1500 E Medical Center Dr, B2-A209A, Ann Arbor, MI 48109 (J.H.E., N.E.C., S.D.K., M.S.D.); Department of Radiology, New York University Langone Medical Center, New York, NY (N.M.H., H.C.); Department of Radiology, University of Ottawa, Ottawa, Canada (N.S.); Department of Radiology, University of Alabama School of Medicine, Birmingham, Ala (A.D.S.); Imaging Institute and Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio (E.M.R.); Department of Radiology, David Geffen School of Medicine, UCLA Center for the Health Sciences, Los Angeles, Calif (S.S.R.); Department of Radiology, University of Wisconsin Hospital and Clinics, Madison, Wis (S.A.W.); and Department of Radiology, UCSF Medical Center, San Francisco, Calif (Z.J.W.)
| | - Nicole M Hindman
- From the Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass (S.G.S., A.B.S.); Disease-Focused Panel on Renal Cell Carcinoma, Society of Abdominal Radiology, Houston, Tex (S.G.S., I.P., N.M.H., N.S., A.D.S., E.M.R., A.B.S., N.E.C., S.S.R., S.A.W., S.D.K., Z.J.W., H.C., M.S.D.); Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (I.P.); Departments of Radiology and Urology, Michigan Medicine, University of Michigan, 1500 E Medical Center Dr, B2-A209A, Ann Arbor, MI 48109 (J.H.E., N.E.C., S.D.K., M.S.D.); Department of Radiology, New York University Langone Medical Center, New York, NY (N.M.H., H.C.); Department of Radiology, University of Ottawa, Ottawa, Canada (N.S.); Department of Radiology, University of Alabama School of Medicine, Birmingham, Ala (A.D.S.); Imaging Institute and Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio (E.M.R.); Department of Radiology, David Geffen School of Medicine, UCLA Center for the Health Sciences, Los Angeles, Calif (S.S.R.); Department of Radiology, University of Wisconsin Hospital and Clinics, Madison, Wis (S.A.W.); and Department of Radiology, UCSF Medical Center, San Francisco, Calif (Z.J.W.)
| | - Nicola Schieda
- From the Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass (S.G.S., A.B.S.); Disease-Focused Panel on Renal Cell Carcinoma, Society of Abdominal Radiology, Houston, Tex (S.G.S., I.P., N.M.H., N.S., A.D.S., E.M.R., A.B.S., N.E.C., S.S.R., S.A.W., S.D.K., Z.J.W., H.C., M.S.D.); Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (I.P.); Departments of Radiology and Urology, Michigan Medicine, University of Michigan, 1500 E Medical Center Dr, B2-A209A, Ann Arbor, MI 48109 (J.H.E., N.E.C., S.D.K., M.S.D.); Department of Radiology, New York University Langone Medical Center, New York, NY (N.M.H., H.C.); Department of Radiology, University of Ottawa, Ottawa, Canada (N.S.); Department of Radiology, University of Alabama School of Medicine, Birmingham, Ala (A.D.S.); Imaging Institute and Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio (E.M.R.); Department of Radiology, David Geffen School of Medicine, UCLA Center for the Health Sciences, Los Angeles, Calif (S.S.R.); Department of Radiology, University of Wisconsin Hospital and Clinics, Madison, Wis (S.A.W.); and Department of Radiology, UCSF Medical Center, San Francisco, Calif (Z.J.W.)
| | - Andrew D Smith
- From the Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass (S.G.S., A.B.S.); Disease-Focused Panel on Renal Cell Carcinoma, Society of Abdominal Radiology, Houston, Tex (S.G.S., I.P., N.M.H., N.S., A.D.S., E.M.R., A.B.S., N.E.C., S.S.R., S.A.W., S.D.K., Z.J.W., H.C., M.S.D.); Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (I.P.); Departments of Radiology and Urology, Michigan Medicine, University of Michigan, 1500 E Medical Center Dr, B2-A209A, Ann Arbor, MI 48109 (J.H.E., N.E.C., S.D.K., M.S.D.); Department of Radiology, New York University Langone Medical Center, New York, NY (N.M.H., H.C.); Department of Radiology, University of Ottawa, Ottawa, Canada (N.S.); Department of Radiology, University of Alabama School of Medicine, Birmingham, Ala (A.D.S.); Imaging Institute and Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio (E.M.R.); Department of Radiology, David Geffen School of Medicine, UCLA Center for the Health Sciences, Los Angeles, Calif (S.S.R.); Department of Radiology, University of Wisconsin Hospital and Clinics, Madison, Wis (S.A.W.); and Department of Radiology, UCSF Medical Center, San Francisco, Calif (Z.J.W.)
| | - Erick M Remer
- From the Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass (S.G.S., A.B.S.); Disease-Focused Panel on Renal Cell Carcinoma, Society of Abdominal Radiology, Houston, Tex (S.G.S., I.P., N.M.H., N.S., A.D.S., E.M.R., A.B.S., N.E.C., S.S.R., S.A.W., S.D.K., Z.J.W., H.C., M.S.D.); Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (I.P.); Departments of Radiology and Urology, Michigan Medicine, University of Michigan, 1500 E Medical Center Dr, B2-A209A, Ann Arbor, MI 48109 (J.H.E., N.E.C., S.D.K., M.S.D.); Department of Radiology, New York University Langone Medical Center, New York, NY (N.M.H., H.C.); Department of Radiology, University of Ottawa, Ottawa, Canada (N.S.); Department of Radiology, University of Alabama School of Medicine, Birmingham, Ala (A.D.S.); Imaging Institute and Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio (E.M.R.); Department of Radiology, David Geffen School of Medicine, UCLA Center for the Health Sciences, Los Angeles, Calif (S.S.R.); Department of Radiology, University of Wisconsin Hospital and Clinics, Madison, Wis (S.A.W.); and Department of Radiology, UCSF Medical Center, San Francisco, Calif (Z.J.W.)
| | - Atul B Shinagare
- From the Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass (S.G.S., A.B.S.); Disease-Focused Panel on Renal Cell Carcinoma, Society of Abdominal Radiology, Houston, Tex (S.G.S., I.P., N.M.H., N.S., A.D.S., E.M.R., A.B.S., N.E.C., S.S.R., S.A.W., S.D.K., Z.J.W., H.C., M.S.D.); Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (I.P.); Departments of Radiology and Urology, Michigan Medicine, University of Michigan, 1500 E Medical Center Dr, B2-A209A, Ann Arbor, MI 48109 (J.H.E., N.E.C., S.D.K., M.S.D.); Department of Radiology, New York University Langone Medical Center, New York, NY (N.M.H., H.C.); Department of Radiology, University of Ottawa, Ottawa, Canada (N.S.); Department of Radiology, University of Alabama School of Medicine, Birmingham, Ala (A.D.S.); Imaging Institute and Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio (E.M.R.); Department of Radiology, David Geffen School of Medicine, UCLA Center for the Health Sciences, Los Angeles, Calif (S.S.R.); Department of Radiology, University of Wisconsin Hospital and Clinics, Madison, Wis (S.A.W.); and Department of Radiology, UCSF Medical Center, San Francisco, Calif (Z.J.W.)
| | - Nicole E Curci
- From the Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass (S.G.S., A.B.S.); Disease-Focused Panel on Renal Cell Carcinoma, Society of Abdominal Radiology, Houston, Tex (S.G.S., I.P., N.M.H., N.S., A.D.S., E.M.R., A.B.S., N.E.C., S.S.R., S.A.W., S.D.K., Z.J.W., H.C., M.S.D.); Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (I.P.); Departments of Radiology and Urology, Michigan Medicine, University of Michigan, 1500 E Medical Center Dr, B2-A209A, Ann Arbor, MI 48109 (J.H.E., N.E.C., S.D.K., M.S.D.); Department of Radiology, New York University Langone Medical Center, New York, NY (N.M.H., H.C.); Department of Radiology, University of Ottawa, Ottawa, Canada (N.S.); Department of Radiology, University of Alabama School of Medicine, Birmingham, Ala (A.D.S.); Imaging Institute and Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio (E.M.R.); Department of Radiology, David Geffen School of Medicine, UCLA Center for the Health Sciences, Los Angeles, Calif (S.S.R.); Department of Radiology, University of Wisconsin Hospital and Clinics, Madison, Wis (S.A.W.); and Department of Radiology, UCSF Medical Center, San Francisco, Calif (Z.J.W.)
| | - Steven S Raman
- From the Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass (S.G.S., A.B.S.); Disease-Focused Panel on Renal Cell Carcinoma, Society of Abdominal Radiology, Houston, Tex (S.G.S., I.P., N.M.H., N.S., A.D.S., E.M.R., A.B.S., N.E.C., S.S.R., S.A.W., S.D.K., Z.J.W., H.C., M.S.D.); Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (I.P.); Departments of Radiology and Urology, Michigan Medicine, University of Michigan, 1500 E Medical Center Dr, B2-A209A, Ann Arbor, MI 48109 (J.H.E., N.E.C., S.D.K., M.S.D.); Department of Radiology, New York University Langone Medical Center, New York, NY (N.M.H., H.C.); Department of Radiology, University of Ottawa, Ottawa, Canada (N.S.); Department of Radiology, University of Alabama School of Medicine, Birmingham, Ala (A.D.S.); Imaging Institute and Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio (E.M.R.); Department of Radiology, David Geffen School of Medicine, UCLA Center for the Health Sciences, Los Angeles, Calif (S.S.R.); Department of Radiology, University of Wisconsin Hospital and Clinics, Madison, Wis (S.A.W.); and Department of Radiology, UCSF Medical Center, San Francisco, Calif (Z.J.W.)
| | - Shane A Wells
- From the Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass (S.G.S., A.B.S.); Disease-Focused Panel on Renal Cell Carcinoma, Society of Abdominal Radiology, Houston, Tex (S.G.S., I.P., N.M.H., N.S., A.D.S., E.M.R., A.B.S., N.E.C., S.S.R., S.A.W., S.D.K., Z.J.W., H.C., M.S.D.); Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (I.P.); Departments of Radiology and Urology, Michigan Medicine, University of Michigan, 1500 E Medical Center Dr, B2-A209A, Ann Arbor, MI 48109 (J.H.E., N.E.C., S.D.K., M.S.D.); Department of Radiology, New York University Langone Medical Center, New York, NY (N.M.H., H.C.); Department of Radiology, University of Ottawa, Ottawa, Canada (N.S.); Department of Radiology, University of Alabama School of Medicine, Birmingham, Ala (A.D.S.); Imaging Institute and Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio (E.M.R.); Department of Radiology, David Geffen School of Medicine, UCLA Center for the Health Sciences, Los Angeles, Calif (S.S.R.); Department of Radiology, University of Wisconsin Hospital and Clinics, Madison, Wis (S.A.W.); and Department of Radiology, UCSF Medical Center, San Francisco, Calif (Z.J.W.)
| | - Samuel D Kaffenberger
- From the Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass (S.G.S., A.B.S.); Disease-Focused Panel on Renal Cell Carcinoma, Society of Abdominal Radiology, Houston, Tex (S.G.S., I.P., N.M.H., N.S., A.D.S., E.M.R., A.B.S., N.E.C., S.S.R., S.A.W., S.D.K., Z.J.W., H.C., M.S.D.); Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (I.P.); Departments of Radiology and Urology, Michigan Medicine, University of Michigan, 1500 E Medical Center Dr, B2-A209A, Ann Arbor, MI 48109 (J.H.E., N.E.C., S.D.K., M.S.D.); Department of Radiology, New York University Langone Medical Center, New York, NY (N.M.H., H.C.); Department of Radiology, University of Ottawa, Ottawa, Canada (N.S.); Department of Radiology, University of Alabama School of Medicine, Birmingham, Ala (A.D.S.); Imaging Institute and Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio (E.M.R.); Department of Radiology, David Geffen School of Medicine, UCLA Center for the Health Sciences, Los Angeles, Calif (S.S.R.); Department of Radiology, University of Wisconsin Hospital and Clinics, Madison, Wis (S.A.W.); and Department of Radiology, UCSF Medical Center, San Francisco, Calif (Z.J.W.)
| | - Zhen J Wang
- From the Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass (S.G.S., A.B.S.); Disease-Focused Panel on Renal Cell Carcinoma, Society of Abdominal Radiology, Houston, Tex (S.G.S., I.P., N.M.H., N.S., A.D.S., E.M.R., A.B.S., N.E.C., S.S.R., S.A.W., S.D.K., Z.J.W., H.C., M.S.D.); Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (I.P.); Departments of Radiology and Urology, Michigan Medicine, University of Michigan, 1500 E Medical Center Dr, B2-A209A, Ann Arbor, MI 48109 (J.H.E., N.E.C., S.D.K., M.S.D.); Department of Radiology, New York University Langone Medical Center, New York, NY (N.M.H., H.C.); Department of Radiology, University of Ottawa, Ottawa, Canada (N.S.); Department of Radiology, University of Alabama School of Medicine, Birmingham, Ala (A.D.S.); Imaging Institute and Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio (E.M.R.); Department of Radiology, David Geffen School of Medicine, UCLA Center for the Health Sciences, Los Angeles, Calif (S.S.R.); Department of Radiology, University of Wisconsin Hospital and Clinics, Madison, Wis (S.A.W.); and Department of Radiology, UCSF Medical Center, San Francisco, Calif (Z.J.W.)
| | - Hersh Chandarana
- From the Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass (S.G.S., A.B.S.); Disease-Focused Panel on Renal Cell Carcinoma, Society of Abdominal Radiology, Houston, Tex (S.G.S., I.P., N.M.H., N.S., A.D.S., E.M.R., A.B.S., N.E.C., S.S.R., S.A.W., S.D.K., Z.J.W., H.C., M.S.D.); Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (I.P.); Departments of Radiology and Urology, Michigan Medicine, University of Michigan, 1500 E Medical Center Dr, B2-A209A, Ann Arbor, MI 48109 (J.H.E., N.E.C., S.D.K., M.S.D.); Department of Radiology, New York University Langone Medical Center, New York, NY (N.M.H., H.C.); Department of Radiology, University of Ottawa, Ottawa, Canada (N.S.); Department of Radiology, University of Alabama School of Medicine, Birmingham, Ala (A.D.S.); Imaging Institute and Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio (E.M.R.); Department of Radiology, David Geffen School of Medicine, UCLA Center for the Health Sciences, Los Angeles, Calif (S.S.R.); Department of Radiology, University of Wisconsin Hospital and Clinics, Madison, Wis (S.A.W.); and Department of Radiology, UCSF Medical Center, San Francisco, Calif (Z.J.W.)
| | - Matthew S Davenport
- From the Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass (S.G.S., A.B.S.); Disease-Focused Panel on Renal Cell Carcinoma, Society of Abdominal Radiology, Houston, Tex (S.G.S., I.P., N.M.H., N.S., A.D.S., E.M.R., A.B.S., N.E.C., S.S.R., S.A.W., S.D.K., Z.J.W., H.C., M.S.D.); Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (I.P.); Departments of Radiology and Urology, Michigan Medicine, University of Michigan, 1500 E Medical Center Dr, B2-A209A, Ann Arbor, MI 48109 (J.H.E., N.E.C., S.D.K., M.S.D.); Department of Radiology, New York University Langone Medical Center, New York, NY (N.M.H., H.C.); Department of Radiology, University of Ottawa, Ottawa, Canada (N.S.); Department of Radiology, University of Alabama School of Medicine, Birmingham, Ala (A.D.S.); Imaging Institute and Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio (E.M.R.); Department of Radiology, David Geffen School of Medicine, UCLA Center for the Health Sciences, Los Angeles, Calif (S.S.R.); Department of Radiology, University of Wisconsin Hospital and Clinics, Madison, Wis (S.A.W.); and Department of Radiology, UCSF Medical Center, San Francisco, Calif (Z.J.W.)
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Update on Indications for Percutaneous Renal Mass Biopsy in the Era of Advanced CT and MRI. AJR Am J Roentgenol 2019; 212:1187-1196. [PMID: 30917018 DOI: 10.2214/ajr.19.21093] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVE. The objective of this article is to review the burgeoning role of percutaneous renal mass biopsy (RMB). CONCLUSION. Percutaneous RMB is safe, accurate, and indicated for an expanded list of clinical scenarios. The chief scenarios among them are to prevent treatment of benign masses and help select patients for active surveillance (AS). Imaging characterization of renal masses has improved; however, management decisions often depend on a histologic diagnosis and an assessment of biologic behavior of renal cancers, both of which are currently best achieved with RMB.
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Comparison of Iodine Quantification and Conventional Attenuation Measurements for Differentiating Small, Truly Enhancing Renal Masses From High-Attenuation Nonenhancing Renal Lesions With Dual-Energy CT. AJR Am J Roentgenol 2019; 213:W26-W37. [PMID: 30917024 DOI: 10.2214/ajr.18.20547] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [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 determine whether iodine quantification techniques from contrast-enhanced dual-energy CT (DECT) data allow equal differentiation of small enhancing renal masses from high-attenuation (> 20 HU of unenhanced attenuation) nonenhancing lesions, compared with conventional attenuation measurements. MATERIALS AND METHODS. A total of 220 nonconsecutive patients (mean [± SD] age, 66 ± 13 years; 130 men and 90 women) with 265 high-attenuation renal lesions (mean attenuation, 54 ± 33 HU; 91 enhancing lesions) were included. Each patient underwent single-energy unenhanced CT followed by DECT during the nephrographic phase using one of four different high-end DECT platforms (first- and second-generation rapid-kilovoltage-switching DECT platforms and second- and third-generation dual-source DECT platforms). Iodine quantification measurements and conventional attenuation change measurements were calculated for each lesion. Diagnostic accuracy was determined by pathologic analysis, confirmation with another imaging modality, or greater than 24 months of imaging follow-up as the reference standard. RESULTS. The diagnostic accuracy for differentiating enhancing from nonenhancing renal lesions was significantly higher for conventional attenuation change measurements, compared with iodine quantification measurements (AUC values, 0.973 vs 0.875; p < 0.0001). The diagnostic performance of iodine quantification measurements improved only marginally with the utilization of DECT platform-specific optimized iodine quantification thresholds, yielding AUC values of 0.907 and 0.893 for the rapid-kilovoltage-switching DECT and dual-source DECT platforms, respectively. Unenhanced lesion attenuation (p = 0.0010) and intraparenchymal location (p = 0.0249) significantly influenced the diagnostic accuracy of the iodine quantification techniques. CONCLUSION. Iodine quantification from DECT data yields inferior diagnostic accuracy when compared with conventional attenuation change measurements for differentiating small, truly enhancing renal masses and high-attenuation renal lesions.
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Wasnik AP, Higgins EJ, Fox GA, Caoili EM, Davenport MS. Yield of Routine Image-Guided Biopsy of Renal Mass Thermal Ablation Zones: 11-Year Experience. Acad Radiol 2019; 26:232-238. [PMID: 29934021 DOI: 10.1016/j.acra.2018.05.016] [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: 04/11/2018] [Revised: 05/25/2018] [Accepted: 05/27/2018] [Indexed: 10/28/2022]
Abstract
PURPOSE To determine the yield of routine image-guided core biopsy of renal cell carcinoma (RCC) thermal ablation zones. METHODS Institutional review board approval was obtained for this Health Insurance Portability and Accountability Act-compliant quality improvement effort. Routine core biopsy of RCC ablation zones was performed 2 months postablation from July 2003 to December 2014. Routine nicotinamide adenine dinucleotide staining was performed by specialized genitourinary pathologists to assess cell viability. The original purpose of performing routine postablation biopsy was to verify, in addition to imaging, whether the mass was completely treated. Imaging was stratified as negative, indeterminate, or positive for viable malignancy. Histology was stratified as negative, indeterminate, positive, or nondiagnostic for viable malignancy. Histology results were compared to prebiopsy imaging findings. RESULTS Routine ablation zone biopsy was performed after 50% (146/292) of index ablations (24 cryoablations, 122 radiofrequency ablations), and postablation imaging was performed more often with multiphasic computed tomography than magnetic resonance imaging (100 vs 46, p < 0.0001). When imaging was negative (n = 117), biopsy added no additional information (92% [n = 108] negative, 0.9% [n = 1] indeterminate, 7% [n = 8] nondiagnostic). When imaging was indeterminate (n = 19), 11% (n = 2) of biopsies had viable RCC and 89% (n = 17) were negative. When imaging was positive, biopsy detected viable neoplasm in only 10% (1/10) of cases; 80% (8/10) were negative and 10% (1/10) were nondiagnostic. CONCLUSION Routine biopsy of renal ablation zones to validate postablation imaging results was not value-added and therefore was discontinued at the study institution.
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