1
|
Toide M, Tanaka H, Kobayashi M, Fujiwara M, Nakamura Y, Fukuda S, Kimura K, Waseda Y, Yoshida S, Tateishi U, Fujii Y. Stepwise algorithm using computed tomography and magnetic resonance imaging for differential diagnosis of fat-poor angiomyolipoma in small renal masses: A prospective validation study. Int J Urol 2024; 31:778-784. [PMID: 38632863 DOI: 10.1111/iju.15464] [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: 09/19/2023] [Accepted: 03/28/2024] [Indexed: 04/19/2024]
Abstract
OBJECTIVES To validate the diagnostic accuracy of a stepwise algorithm to differentiate fat-poor angiomyolipoma (fp-AML) from renal cancer in small renal masses (SRMs). METHODS We prospectively enrolled 223 patients with solid renal masses <4 cm and no visible fat on unenhanced computed tomography (CT). Patients were assessed using an algorithm that utilized the dynamic CT and MRI findings in a stepwise manner. The diagnostic accuracy of the algorithm was evaluated in patients whose histology was confirmed through surgery or biopsy. The clinical course of the patients was further analyzed. RESULTS The algorithm classified 151 (68%)/42 (19%)/30 (13%) patients into low/intermediate/high AML probability groups, respectively. Pathological diagnosis was made for 183 patients, including 10 (5.5%) with fp-AML. Of these, 135 (74%)/36 (20%)/12 (6.6%) were classified into the low/intermediate/high AML probability groups, and each group included 1 (0.7%)/3 (8.3%)/6 (50%) fp-AMLs, respectively, leading to the area under the curve for predicting AML of 0.889. Surgery was commonly opted in the low and intermediate AML probability groups (84% and 64%, respectively) for initial management, while surveillance was selected in the high AML probability group (63%). During the 56-month follow-up, 36 (82%) of 44 patients initially surveyed, including 13 of 18 (72%), 6 of 7 (86%), and 17 of 19 (89%) in the low/intermediate/high AML probability groups, respectively, continued surveillance without any progression. CONCLUSIONS This study confirmed the high diagnostic accuracy for differentiating fp-AMLs. These findings may help in the management of patients with SRMs.
Collapse
Affiliation(s)
- Masahiro Toide
- Department of Urology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Hajime Tanaka
- Department of Urology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Masaki Kobayashi
- Department of Urology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Motohiro Fujiwara
- Department of Urology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Yuki Nakamura
- Department of Urology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Shohei Fukuda
- Department of Urology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Koichiro Kimura
- Department of Radiology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Yuma Waseda
- Department of Urology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Soichiro Yoshida
- Department of Urology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Ukihide Tateishi
- Department of Radiology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Yasuhisa Fujii
- Department of Urology, Tokyo Medical and Dental University, Tokyo, Japan
| |
Collapse
|
2
|
Dai C, Xiong Y, Zhu P, Yao L, Lin J, Yao J, Zhang X, Huang R, Wang R, Hou J, Wang K, Shi Z, Chen F, Guo J, Zeng M, Zhou J, Wang S. Deep Learning Assessment of Small Renal Masses at Contrast-enhanced Multiphase CT. Radiology 2024; 311:e232178. [PMID: 38742970 DOI: 10.1148/radiol.232178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2024]
Abstract
Background Accurate characterization of suspicious small renal masses is crucial for optimized management. Deep learning (DL) algorithms may assist with this effort. Purpose To develop and validate a DL algorithm for identifying benign small renal masses at contrast-enhanced multiphase CT. Materials and Methods Surgically resected renal masses measuring 3 cm or less in diameter at contrast-enhanced CT were included. The DL algorithm was developed by using retrospective data from one hospital between 2009 and 2021, with patients randomly allocated in a training and internal test set ratio of 8:2. Between 2013 and 2021, external testing was performed on data from five independent hospitals. A prospective test set was obtained between 2021 and 2022 from one hospital. Algorithm performance was evaluated by using the area under the receiver operating characteristic curve (AUC) and compared with the results of seven clinicians using the DeLong test. Results A total of 1703 patients (mean age, 56 years ± 12 [SD]; 619 female) with a single renal mass per patient were evaluated. The retrospective data set included 1063 lesions (874 in training set, 189 internal test set); the multicenter external test set included 537 lesions (12.3%, 66 benign) with 89 subcentimeter (≤1 cm) lesions (16.6%); and the prospective test set included 103 lesions (13.6%, 14 benign) with 20 (19.4%) subcentimeter lesions. The DL algorithm performance was comparable with that of urological radiologists: for the external test set, AUC was 0.80 (95% CI: 0.75, 0.85) versus 0.84 (95% CI: 0.78, 0.88) (P = .61); for the prospective test set, AUC was 0.87 (95% CI: 0.79, 0.93) versus 0.92 (95% CI: 0.86, 0.96) (P = .70). For subcentimeter lesions in the external test set, the algorithm and urological radiologists had similar AUC of 0.74 (95% CI: 0.63, 0.83) and 0.81 (95% CI: 0.68, 0.92) (P = .78), respectively. Conclusion The multiphase CT-based DL algorithm showed comparable performance with that of radiologists for identifying benign small renal masses, including lesions of 1 cm or less. Published under a CC BY 4.0 license. Supplemental material is available for this article.
Collapse
Affiliation(s)
- Chenchen Dai
- From the Departments of Radiology (C.D., P.Z., Z.S., M.Z., J.Z.), Urology (Y.X., J.G.), and Pathology (J.H.), Zhongshan Hospital, Fudan University, Shanghai, China; Shanghai Institute of Medical Imaging, Shanghai, China (C.D., P.Z., Z.S., M.Z.); Department of Radiology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China (L.Y., F.C.); Departments of Urology (J.L.) and Radiology (J.Z.), Xiamen Branch, Zhongshan Hospital, Fudan University, 668 Jinhu Road, Huli District, Xiamen 361015, China; Department of Urology, Zhangye People's Hospital affiliated to Hexi University, Zhangye, China (J.Y.); Department of Radiology, the First People's Hospital of Lianyungang, Lianyungang, China (X.Z.); Department of Radiology, Quanzhou First Hospital, Fujian Medical University, Quanzhou, China (R.H.); Department of Pathology, Sir Run Run Shaw Hospital, Hangzhou, China (R.W.); Digital Medical Research Center, School of Basic Medical Sciences, Fudan University, Shanghai, China (K.W., S.W.); Shanghai Key Laboratory of MICCAI, Shanghai, China (K.W., S.W.); Xiamen Municipal Clinical Research Center for Medical Imaging, Xiamen, China (J.Z.); and Xiamen Key Clinical Specialty, Xiamen, China (J.Z.)
| | - Ying Xiong
- From the Departments of Radiology (C.D., P.Z., Z.S., M.Z., J.Z.), Urology (Y.X., J.G.), and Pathology (J.H.), Zhongshan Hospital, Fudan University, Shanghai, China; Shanghai Institute of Medical Imaging, Shanghai, China (C.D., P.Z., Z.S., M.Z.); Department of Radiology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China (L.Y., F.C.); Departments of Urology (J.L.) and Radiology (J.Z.), Xiamen Branch, Zhongshan Hospital, Fudan University, 668 Jinhu Road, Huli District, Xiamen 361015, China; Department of Urology, Zhangye People's Hospital affiliated to Hexi University, Zhangye, China (J.Y.); Department of Radiology, the First People's Hospital of Lianyungang, Lianyungang, China (X.Z.); Department of Radiology, Quanzhou First Hospital, Fujian Medical University, Quanzhou, China (R.H.); Department of Pathology, Sir Run Run Shaw Hospital, Hangzhou, China (R.W.); Digital Medical Research Center, School of Basic Medical Sciences, Fudan University, Shanghai, China (K.W., S.W.); Shanghai Key Laboratory of MICCAI, Shanghai, China (K.W., S.W.); Xiamen Municipal Clinical Research Center for Medical Imaging, Xiamen, China (J.Z.); and Xiamen Key Clinical Specialty, Xiamen, China (J.Z.)
| | - Pingyi Zhu
- From the Departments of Radiology (C.D., P.Z., Z.S., M.Z., J.Z.), Urology (Y.X., J.G.), and Pathology (J.H.), Zhongshan Hospital, Fudan University, Shanghai, China; Shanghai Institute of Medical Imaging, Shanghai, China (C.D., P.Z., Z.S., M.Z.); Department of Radiology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China (L.Y., F.C.); Departments of Urology (J.L.) and Radiology (J.Z.), Xiamen Branch, Zhongshan Hospital, Fudan University, 668 Jinhu Road, Huli District, Xiamen 361015, China; Department of Urology, Zhangye People's Hospital affiliated to Hexi University, Zhangye, China (J.Y.); Department of Radiology, the First People's Hospital of Lianyungang, Lianyungang, China (X.Z.); Department of Radiology, Quanzhou First Hospital, Fujian Medical University, Quanzhou, China (R.H.); Department of Pathology, Sir Run Run Shaw Hospital, Hangzhou, China (R.W.); Digital Medical Research Center, School of Basic Medical Sciences, Fudan University, Shanghai, China (K.W., S.W.); Shanghai Key Laboratory of MICCAI, Shanghai, China (K.W., S.W.); Xiamen Municipal Clinical Research Center for Medical Imaging, Xiamen, China (J.Z.); and Xiamen Key Clinical Specialty, Xiamen, China (J.Z.)
| | - Linpeng Yao
- From the Departments of Radiology (C.D., P.Z., Z.S., M.Z., J.Z.), Urology (Y.X., J.G.), and Pathology (J.H.), Zhongshan Hospital, Fudan University, Shanghai, China; Shanghai Institute of Medical Imaging, Shanghai, China (C.D., P.Z., Z.S., M.Z.); Department of Radiology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China (L.Y., F.C.); Departments of Urology (J.L.) and Radiology (J.Z.), Xiamen Branch, Zhongshan Hospital, Fudan University, 668 Jinhu Road, Huli District, Xiamen 361015, China; Department of Urology, Zhangye People's Hospital affiliated to Hexi University, Zhangye, China (J.Y.); Department of Radiology, the First People's Hospital of Lianyungang, Lianyungang, China (X.Z.); Department of Radiology, Quanzhou First Hospital, Fujian Medical University, Quanzhou, China (R.H.); Department of Pathology, Sir Run Run Shaw Hospital, Hangzhou, China (R.W.); Digital Medical Research Center, School of Basic Medical Sciences, Fudan University, Shanghai, China (K.W., S.W.); Shanghai Key Laboratory of MICCAI, Shanghai, China (K.W., S.W.); Xiamen Municipal Clinical Research Center for Medical Imaging, Xiamen, China (J.Z.); and Xiamen Key Clinical Specialty, Xiamen, China (J.Z.)
| | - Jinglai Lin
- From the Departments of Radiology (C.D., P.Z., Z.S., M.Z., J.Z.), Urology (Y.X., J.G.), and Pathology (J.H.), Zhongshan Hospital, Fudan University, Shanghai, China; Shanghai Institute of Medical Imaging, Shanghai, China (C.D., P.Z., Z.S., M.Z.); Department of Radiology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China (L.Y., F.C.); Departments of Urology (J.L.) and Radiology (J.Z.), Xiamen Branch, Zhongshan Hospital, Fudan University, 668 Jinhu Road, Huli District, Xiamen 361015, China; Department of Urology, Zhangye People's Hospital affiliated to Hexi University, Zhangye, China (J.Y.); Department of Radiology, the First People's Hospital of Lianyungang, Lianyungang, China (X.Z.); Department of Radiology, Quanzhou First Hospital, Fujian Medical University, Quanzhou, China (R.H.); Department of Pathology, Sir Run Run Shaw Hospital, Hangzhou, China (R.W.); Digital Medical Research Center, School of Basic Medical Sciences, Fudan University, Shanghai, China (K.W., S.W.); Shanghai Key Laboratory of MICCAI, Shanghai, China (K.W., S.W.); Xiamen Municipal Clinical Research Center for Medical Imaging, Xiamen, China (J.Z.); and Xiamen Key Clinical Specialty, Xiamen, China (J.Z.)
| | - Jiaxi Yao
- From the Departments of Radiology (C.D., P.Z., Z.S., M.Z., J.Z.), Urology (Y.X., J.G.), and Pathology (J.H.), Zhongshan Hospital, Fudan University, Shanghai, China; Shanghai Institute of Medical Imaging, Shanghai, China (C.D., P.Z., Z.S., M.Z.); Department of Radiology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China (L.Y., F.C.); Departments of Urology (J.L.) and Radiology (J.Z.), Xiamen Branch, Zhongshan Hospital, Fudan University, 668 Jinhu Road, Huli District, Xiamen 361015, China; Department of Urology, Zhangye People's Hospital affiliated to Hexi University, Zhangye, China (J.Y.); Department of Radiology, the First People's Hospital of Lianyungang, Lianyungang, China (X.Z.); Department of Radiology, Quanzhou First Hospital, Fujian Medical University, Quanzhou, China (R.H.); Department of Pathology, Sir Run Run Shaw Hospital, Hangzhou, China (R.W.); Digital Medical Research Center, School of Basic Medical Sciences, Fudan University, Shanghai, China (K.W., S.W.); Shanghai Key Laboratory of MICCAI, Shanghai, China (K.W., S.W.); Xiamen Municipal Clinical Research Center for Medical Imaging, Xiamen, China (J.Z.); and Xiamen Key Clinical Specialty, Xiamen, China (J.Z.)
| | - Xue Zhang
- From the Departments of Radiology (C.D., P.Z., Z.S., M.Z., J.Z.), Urology (Y.X., J.G.), and Pathology (J.H.), Zhongshan Hospital, Fudan University, Shanghai, China; Shanghai Institute of Medical Imaging, Shanghai, China (C.D., P.Z., Z.S., M.Z.); Department of Radiology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China (L.Y., F.C.); Departments of Urology (J.L.) and Radiology (J.Z.), Xiamen Branch, Zhongshan Hospital, Fudan University, 668 Jinhu Road, Huli District, Xiamen 361015, China; Department of Urology, Zhangye People's Hospital affiliated to Hexi University, Zhangye, China (J.Y.); Department of Radiology, the First People's Hospital of Lianyungang, Lianyungang, China (X.Z.); Department of Radiology, Quanzhou First Hospital, Fujian Medical University, Quanzhou, China (R.H.); Department of Pathology, Sir Run Run Shaw Hospital, Hangzhou, China (R.W.); Digital Medical Research Center, School of Basic Medical Sciences, Fudan University, Shanghai, China (K.W., S.W.); Shanghai Key Laboratory of MICCAI, Shanghai, China (K.W., S.W.); Xiamen Municipal Clinical Research Center for Medical Imaging, Xiamen, China (J.Z.); and Xiamen Key Clinical Specialty, Xiamen, China (J.Z.)
| | - Risheng Huang
- From the Departments of Radiology (C.D., P.Z., Z.S., M.Z., J.Z.), Urology (Y.X., J.G.), and Pathology (J.H.), Zhongshan Hospital, Fudan University, Shanghai, China; Shanghai Institute of Medical Imaging, Shanghai, China (C.D., P.Z., Z.S., M.Z.); Department of Radiology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China (L.Y., F.C.); Departments of Urology (J.L.) and Radiology (J.Z.), Xiamen Branch, Zhongshan Hospital, Fudan University, 668 Jinhu Road, Huli District, Xiamen 361015, China; Department of Urology, Zhangye People's Hospital affiliated to Hexi University, Zhangye, China (J.Y.); Department of Radiology, the First People's Hospital of Lianyungang, Lianyungang, China (X.Z.); Department of Radiology, Quanzhou First Hospital, Fujian Medical University, Quanzhou, China (R.H.); Department of Pathology, Sir Run Run Shaw Hospital, Hangzhou, China (R.W.); Digital Medical Research Center, School of Basic Medical Sciences, Fudan University, Shanghai, China (K.W., S.W.); Shanghai Key Laboratory of MICCAI, Shanghai, China (K.W., S.W.); Xiamen Municipal Clinical Research Center for Medical Imaging, Xiamen, China (J.Z.); and Xiamen Key Clinical Specialty, Xiamen, China (J.Z.)
| | - Run Wang
- From the Departments of Radiology (C.D., P.Z., Z.S., M.Z., J.Z.), Urology (Y.X., J.G.), and Pathology (J.H.), Zhongshan Hospital, Fudan University, Shanghai, China; Shanghai Institute of Medical Imaging, Shanghai, China (C.D., P.Z., Z.S., M.Z.); Department of Radiology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China (L.Y., F.C.); Departments of Urology (J.L.) and Radiology (J.Z.), Xiamen Branch, Zhongshan Hospital, Fudan University, 668 Jinhu Road, Huli District, Xiamen 361015, China; Department of Urology, Zhangye People's Hospital affiliated to Hexi University, Zhangye, China (J.Y.); Department of Radiology, the First People's Hospital of Lianyungang, Lianyungang, China (X.Z.); Department of Radiology, Quanzhou First Hospital, Fujian Medical University, Quanzhou, China (R.H.); Department of Pathology, Sir Run Run Shaw Hospital, Hangzhou, China (R.W.); Digital Medical Research Center, School of Basic Medical Sciences, Fudan University, Shanghai, China (K.W., S.W.); Shanghai Key Laboratory of MICCAI, Shanghai, China (K.W., S.W.); Xiamen Municipal Clinical Research Center for Medical Imaging, Xiamen, China (J.Z.); and Xiamen Key Clinical Specialty, Xiamen, China (J.Z.)
| | - Jun Hou
- From the Departments of Radiology (C.D., P.Z., Z.S., M.Z., J.Z.), Urology (Y.X., J.G.), and Pathology (J.H.), Zhongshan Hospital, Fudan University, Shanghai, China; Shanghai Institute of Medical Imaging, Shanghai, China (C.D., P.Z., Z.S., M.Z.); Department of Radiology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China (L.Y., F.C.); Departments of Urology (J.L.) and Radiology (J.Z.), Xiamen Branch, Zhongshan Hospital, Fudan University, 668 Jinhu Road, Huli District, Xiamen 361015, China; Department of Urology, Zhangye People's Hospital affiliated to Hexi University, Zhangye, China (J.Y.); Department of Radiology, the First People's Hospital of Lianyungang, Lianyungang, China (X.Z.); Department of Radiology, Quanzhou First Hospital, Fujian Medical University, Quanzhou, China (R.H.); Department of Pathology, Sir Run Run Shaw Hospital, Hangzhou, China (R.W.); Digital Medical Research Center, School of Basic Medical Sciences, Fudan University, Shanghai, China (K.W., S.W.); Shanghai Key Laboratory of MICCAI, Shanghai, China (K.W., S.W.); Xiamen Municipal Clinical Research Center for Medical Imaging, Xiamen, China (J.Z.); and Xiamen Key Clinical Specialty, Xiamen, China (J.Z.)
| | - Kang Wang
- From the Departments of Radiology (C.D., P.Z., Z.S., M.Z., J.Z.), Urology (Y.X., J.G.), and Pathology (J.H.), Zhongshan Hospital, Fudan University, Shanghai, China; Shanghai Institute of Medical Imaging, Shanghai, China (C.D., P.Z., Z.S., M.Z.); Department of Radiology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China (L.Y., F.C.); Departments of Urology (J.L.) and Radiology (J.Z.), Xiamen Branch, Zhongshan Hospital, Fudan University, 668 Jinhu Road, Huli District, Xiamen 361015, China; Department of Urology, Zhangye People's Hospital affiliated to Hexi University, Zhangye, China (J.Y.); Department of Radiology, the First People's Hospital of Lianyungang, Lianyungang, China (X.Z.); Department of Radiology, Quanzhou First Hospital, Fujian Medical University, Quanzhou, China (R.H.); Department of Pathology, Sir Run Run Shaw Hospital, Hangzhou, China (R.W.); Digital Medical Research Center, School of Basic Medical Sciences, Fudan University, Shanghai, China (K.W., S.W.); Shanghai Key Laboratory of MICCAI, Shanghai, China (K.W., S.W.); Xiamen Municipal Clinical Research Center for Medical Imaging, Xiamen, China (J.Z.); and Xiamen Key Clinical Specialty, Xiamen, China (J.Z.)
| | - Zhang Shi
- From the Departments of Radiology (C.D., P.Z., Z.S., M.Z., J.Z.), Urology (Y.X., J.G.), and Pathology (J.H.), Zhongshan Hospital, Fudan University, Shanghai, China; Shanghai Institute of Medical Imaging, Shanghai, China (C.D., P.Z., Z.S., M.Z.); Department of Radiology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China (L.Y., F.C.); Departments of Urology (J.L.) and Radiology (J.Z.), Xiamen Branch, Zhongshan Hospital, Fudan University, 668 Jinhu Road, Huli District, Xiamen 361015, China; Department of Urology, Zhangye People's Hospital affiliated to Hexi University, Zhangye, China (J.Y.); Department of Radiology, the First People's Hospital of Lianyungang, Lianyungang, China (X.Z.); Department of Radiology, Quanzhou First Hospital, Fujian Medical University, Quanzhou, China (R.H.); Department of Pathology, Sir Run Run Shaw Hospital, Hangzhou, China (R.W.); Digital Medical Research Center, School of Basic Medical Sciences, Fudan University, Shanghai, China (K.W., S.W.); Shanghai Key Laboratory of MICCAI, Shanghai, China (K.W., S.W.); Xiamen Municipal Clinical Research Center for Medical Imaging, Xiamen, China (J.Z.); and Xiamen Key Clinical Specialty, Xiamen, China (J.Z.)
| | - Feng Chen
- From the Departments of Radiology (C.D., P.Z., Z.S., M.Z., J.Z.), Urology (Y.X., J.G.), and Pathology (J.H.), Zhongshan Hospital, Fudan University, Shanghai, China; Shanghai Institute of Medical Imaging, Shanghai, China (C.D., P.Z., Z.S., M.Z.); Department of Radiology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China (L.Y., F.C.); Departments of Urology (J.L.) and Radiology (J.Z.), Xiamen Branch, Zhongshan Hospital, Fudan University, 668 Jinhu Road, Huli District, Xiamen 361015, China; Department of Urology, Zhangye People's Hospital affiliated to Hexi University, Zhangye, China (J.Y.); Department of Radiology, the First People's Hospital of Lianyungang, Lianyungang, China (X.Z.); Department of Radiology, Quanzhou First Hospital, Fujian Medical University, Quanzhou, China (R.H.); Department of Pathology, Sir Run Run Shaw Hospital, Hangzhou, China (R.W.); Digital Medical Research Center, School of Basic Medical Sciences, Fudan University, Shanghai, China (K.W., S.W.); Shanghai Key Laboratory of MICCAI, Shanghai, China (K.W., S.W.); Xiamen Municipal Clinical Research Center for Medical Imaging, Xiamen, China (J.Z.); and Xiamen Key Clinical Specialty, Xiamen, China (J.Z.)
| | - Jianming Guo
- From the Departments of Radiology (C.D., P.Z., Z.S., M.Z., J.Z.), Urology (Y.X., J.G.), and Pathology (J.H.), Zhongshan Hospital, Fudan University, Shanghai, China; Shanghai Institute of Medical Imaging, Shanghai, China (C.D., P.Z., Z.S., M.Z.); Department of Radiology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China (L.Y., F.C.); Departments of Urology (J.L.) and Radiology (J.Z.), Xiamen Branch, Zhongshan Hospital, Fudan University, 668 Jinhu Road, Huli District, Xiamen 361015, China; Department of Urology, Zhangye People's Hospital affiliated to Hexi University, Zhangye, China (J.Y.); Department of Radiology, the First People's Hospital of Lianyungang, Lianyungang, China (X.Z.); Department of Radiology, Quanzhou First Hospital, Fujian Medical University, Quanzhou, China (R.H.); Department of Pathology, Sir Run Run Shaw Hospital, Hangzhou, China (R.W.); Digital Medical Research Center, School of Basic Medical Sciences, Fudan University, Shanghai, China (K.W., S.W.); Shanghai Key Laboratory of MICCAI, Shanghai, China (K.W., S.W.); Xiamen Municipal Clinical Research Center for Medical Imaging, Xiamen, China (J.Z.); and Xiamen Key Clinical Specialty, Xiamen, China (J.Z.)
| | - Mengsu Zeng
- From the Departments of Radiology (C.D., P.Z., Z.S., M.Z., J.Z.), Urology (Y.X., J.G.), and Pathology (J.H.), Zhongshan Hospital, Fudan University, Shanghai, China; Shanghai Institute of Medical Imaging, Shanghai, China (C.D., P.Z., Z.S., M.Z.); Department of Radiology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China (L.Y., F.C.); Departments of Urology (J.L.) and Radiology (J.Z.), Xiamen Branch, Zhongshan Hospital, Fudan University, 668 Jinhu Road, Huli District, Xiamen 361015, China; Department of Urology, Zhangye People's Hospital affiliated to Hexi University, Zhangye, China (J.Y.); Department of Radiology, the First People's Hospital of Lianyungang, Lianyungang, China (X.Z.); Department of Radiology, Quanzhou First Hospital, Fujian Medical University, Quanzhou, China (R.H.); Department of Pathology, Sir Run Run Shaw Hospital, Hangzhou, China (R.W.); Digital Medical Research Center, School of Basic Medical Sciences, Fudan University, Shanghai, China (K.W., S.W.); Shanghai Key Laboratory of MICCAI, Shanghai, China (K.W., S.W.); Xiamen Municipal Clinical Research Center for Medical Imaging, Xiamen, China (J.Z.); and Xiamen Key Clinical Specialty, Xiamen, China (J.Z.)
| | - Jianjun Zhou
- From the Departments of Radiology (C.D., P.Z., Z.S., M.Z., J.Z.), Urology (Y.X., J.G.), and Pathology (J.H.), Zhongshan Hospital, Fudan University, Shanghai, China; Shanghai Institute of Medical Imaging, Shanghai, China (C.D., P.Z., Z.S., M.Z.); Department of Radiology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China (L.Y., F.C.); Departments of Urology (J.L.) and Radiology (J.Z.), Xiamen Branch, Zhongshan Hospital, Fudan University, 668 Jinhu Road, Huli District, Xiamen 361015, China; Department of Urology, Zhangye People's Hospital affiliated to Hexi University, Zhangye, China (J.Y.); Department of Radiology, the First People's Hospital of Lianyungang, Lianyungang, China (X.Z.); Department of Radiology, Quanzhou First Hospital, Fujian Medical University, Quanzhou, China (R.H.); Department of Pathology, Sir Run Run Shaw Hospital, Hangzhou, China (R.W.); Digital Medical Research Center, School of Basic Medical Sciences, Fudan University, Shanghai, China (K.W., S.W.); Shanghai Key Laboratory of MICCAI, Shanghai, China (K.W., S.W.); Xiamen Municipal Clinical Research Center for Medical Imaging, Xiamen, China (J.Z.); and Xiamen Key Clinical Specialty, Xiamen, China (J.Z.)
| | - Shuo Wang
- From the Departments of Radiology (C.D., P.Z., Z.S., M.Z., J.Z.), Urology (Y.X., J.G.), and Pathology (J.H.), Zhongshan Hospital, Fudan University, Shanghai, China; Shanghai Institute of Medical Imaging, Shanghai, China (C.D., P.Z., Z.S., M.Z.); Department of Radiology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China (L.Y., F.C.); Departments of Urology (J.L.) and Radiology (J.Z.), Xiamen Branch, Zhongshan Hospital, Fudan University, 668 Jinhu Road, Huli District, Xiamen 361015, China; Department of Urology, Zhangye People's Hospital affiliated to Hexi University, Zhangye, China (J.Y.); Department of Radiology, the First People's Hospital of Lianyungang, Lianyungang, China (X.Z.); Department of Radiology, Quanzhou First Hospital, Fujian Medical University, Quanzhou, China (R.H.); Department of Pathology, Sir Run Run Shaw Hospital, Hangzhou, China (R.W.); Digital Medical Research Center, School of Basic Medical Sciences, Fudan University, Shanghai, China (K.W., S.W.); Shanghai Key Laboratory of MICCAI, Shanghai, China (K.W., S.W.); Xiamen Municipal Clinical Research Center for Medical Imaging, Xiamen, China (J.Z.); and Xiamen Key Clinical Specialty, Xiamen, China (J.Z.)
| |
Collapse
|
3
|
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.
Collapse
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
| |
Collapse
|
4
|
Tabbara MM, Riella J, Gonzalez J, Gaynor JJ, Guerra G, Alvarez A, Ciancio G. Optimizing the kidney donor pool: transplanting donor kidneys after partial nephrectomy of masses or cysts. Front Surg 2024; 11:1391971. [PMID: 38726469 PMCID: PMC11080618 DOI: 10.3389/fsurg.2024.1391971] [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] [Received: 02/26/2024] [Accepted: 04/08/2024] [Indexed: 05/12/2024] Open
Abstract
Background A limiting factor in expanding the kidney donor pool is donor kidneys with renal tumors or cysts. Partial nephrectomy (PN) to remove these lesions prior to transplantation may help optimize organ usage without recurrence of malignancy or increased risk of complications. Methods We retrospectively analyzed all recipients of a living or deceased donor graft between February 2009 and October 2022 in which a PN was performed prior to transplant due to the presence of one or more concerning growths. Donor and recipient demographics, perioperative data, donor allograft pathology, and recipient outcomes were obtained. Results Thirty-six recipients received a graft in which a PN was performed to remove suspicious masses or cysts prior to transplant. Majority of pathologies turned out to be a simple renal cyst (65%), followed by renal cell carcinoma (15%), benign multilocular cystic renal neoplasm (7.5%), angiomyolipoma (5%), benign renal tissue (5%), and papillary adenoma (2.5%). No renal malignancy recurrences were observed during the study period (median follow-up: 67.2 months). Fourteen complications occurred among 11 patients (30.6% overall) during the first 6mo post-transplant. Mean eGFR (± standard error) at 36 months post-transplant was 51.9 ± 4.2 ml/min/1.73 m2 (N = 23). Three death-censored graft losses and four deaths with a functioning graft and were observed. Conclusion PN of renal grafts with suspicious looking masses or cysts is a safe option to optimize organ usage and decrease the kidney non-use rate, with no observed recurrence of malignancy or increased risk of complications.
Collapse
Affiliation(s)
- Marina M. Tabbara
- Department of Surgery, University of Miami Miller School of Medicine, Miami, FL, United States
- Miami Transplant Institute, University of Miami Miller School of Medicine, Jackson Memorial Hospital, Miami, FL, United States
| | - Juliano Riella
- Department of Surgery, University of Miami Miller School of Medicine, Miami, FL, United States
- Miami Transplant Institute, University of Miami Miller School of Medicine, Jackson Memorial Hospital, Miami, FL, United States
| | - Javier Gonzalez
- Servicio de Urología, Unidad de Trasplante Renal, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Jeffrey J. Gaynor
- Department of Surgery, University of Miami Miller School of Medicine, Miami, FL, United States
- Miami Transplant Institute, University of Miami Miller School of Medicine, Jackson Memorial Hospital, Miami, FL, United States
| | - Giselle Guerra
- Miami Transplant Institute, University of Miami Miller School of Medicine, Jackson Memorial Hospital, Miami, FL, United States
- Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Angel Alvarez
- Miami Transplant Institute, University of Miami Miller School of Medicine, Jackson Memorial Hospital, Miami, FL, United States
| | - Gaetano Ciancio
- Department of Surgery, University of Miami Miller School of Medicine, Miami, FL, United States
- Miami Transplant Institute, University of Miami Miller School of Medicine, Jackson Memorial Hospital, Miami, FL, United States
- Department of Urology, University of Miami Miller School of Medicine, Miami, FL, United States
| |
Collapse
|
5
|
Zafar S, Elbanna KY, Todd AWM, Guimaraes L, O'Brien C, Goel A, Kim TK, Khalili K. Can absolute arterial phase hyperenhancement improve sensitivity of detection of hepatocellular carcinoma in indeterminate nodules on CT? Eur Radiol 2024; 34:2256-2268. [PMID: 37775590 DOI: 10.1007/s00330-023-10237-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 07/06/2023] [Accepted: 07/20/2023] [Indexed: 10/01/2023]
Abstract
OBJECTIVES To determine if quantitative assessment of relative (R) and absolute (A) arterial phase hyperenhancement (APHE) and washout (WO) applied to indeterminate nodules on CT would improve the overall sensitivity of detection of hepatocellular carcinoma (HCC). METHODS One-hundred and fourteen patients (90 male; mean age, 65 years) with 210 treatment-naïve HCC nodules (190 HCCs, 20 benign) who underwent 4-phase CT were included in this retrospective study. Four radiologists independently assigned a qualitative LR (LI-RADS) category per nodule. LR-3/4 nodules were then quantitatively analyzed by the 4 readers, placing ROIs within nodules and adjacent liver parenchyma. A/R-APHE and WO were calculated, and per-reader sensitivity and specificity updated. Interobserver agreement and AUCs were calculated per reader. RESULTS Qualitative readers 1-4 categorized 57, 69, 57, and 63 nodules as LR-3/4 respectively with moderate to substantial agreement in LR category (kappa 0.56-0.69, p < 0.0001); their diagnostic performances in the detection of HCC were 80%, 73.2%, 77.4%, and 77.4% sensitivity, and 100%, 95%, 70%, and 100% specificity, respectively. A threshold of ≥ 20 HU for A-APHE increased overall sensitivity of HCC detection by 0.5-3.1% without changing specificity for the subset of nodules APHE - /WO + on qualitative read, with 2, 6, 6, and 1 additional HCC detected by readers 1-4. Relative and various A-WO formulae and thresholds all increased sensitivity, but with a drop in specificity for some/all readers. CONCLUSION Quantitatively assessed A-APHE showed potential to increase sensitivity and maintain specificity of HCC diagnosis when selectively applied to indeterminate nodules demonstrating WO without subjective APHE. Quantitatively assessed R and A-WO increased sensitivity, however reduced specificity. CLINICAL RELEVANCE STATEMENT A workflow using selective quantification of absolute arterial enhancement is routinely employed in the CT assessment of renal and adrenal nodules. Quantitatively assessed absolute arterial enhancement is a simple tool which may be used as an adjunct to help increase sensitivity and maintain specificity of HCC diagnosis in indeterminate nodules demonstrating WO without subjective APHE. KEY POINTS • In indeterminate nodules categorized as LI-RADS 3/4 due to absent subjective arterial phase hyperenhancement, a cut-off for absolute arterial phase hyperenhancement of ≥ 20 HU may increase the overall sensitivity of detection of HCC by 0.5-3.1% without affecting specificity. • Relative and various absolute washout formulae and cut-offs increased sensitivity of HCC detection, but with a drop in specificity for some/all readers.
Collapse
Affiliation(s)
- Sara Zafar
- Department of Medical Imaging, University of Toronto Joint Department of Medical Imaging, University Health Network, Princess Margaret Hospital, 610 University Avenue, Room 3-964, Toronto, Ontario, M5G 2M9, Canada
| | - Khaled Y Elbanna
- Department of Medical Imaging, University of Toronto Joint Department of Medical Imaging, University Health Network, Princess Margaret Hospital, 610 University Avenue, Room 3-964, Toronto, Ontario, M5G 2M9, Canada
| | - Andrew W M Todd
- Department of Medical Imaging, University of Toronto Joint Department of Medical Imaging, University Health Network, Princess Margaret Hospital, 610 University Avenue, Room 3-964, Toronto, Ontario, M5G 2M9, Canada
| | - Luis Guimaraes
- Department of Medical Imaging, University of Toronto Joint Department of Medical Imaging, University Health Network, Princess Margaret Hospital, 610 University Avenue, Room 3-964, Toronto, Ontario, M5G 2M9, Canada
| | - Ciara O'Brien
- Department of Medical Imaging, University of Toronto Joint Department of Medical Imaging, University Health Network, Princess Margaret Hospital, 610 University Avenue, Room 3-964, Toronto, Ontario, M5G 2M9, Canada
| | - Ankur Goel
- Department of Medical Imaging, University of Toronto Joint Department of Medical Imaging, University Health Network, Princess Margaret Hospital, 610 University Avenue, Room 3-964, Toronto, Ontario, M5G 2M9, Canada
| | - Tae Kyoung Kim
- Department of Medical Imaging, University of Toronto Joint Department of Medical Imaging, University Health Network, Princess Margaret Hospital, 610 University Avenue, Room 3-964, Toronto, Ontario, M5G 2M9, Canada
| | - Korosh Khalili
- Department of Medical Imaging, University of Toronto Joint Department of Medical Imaging, University Health Network, Princess Margaret Hospital, 610 University Avenue, Room 3-964, Toronto, Ontario, M5G 2M9, Canada.
| |
Collapse
|
6
|
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.
Collapse
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
| |
Collapse
|
7
|
Brandi N, Mosconi C, Giampalma E, Renzulli M. Bosniak Classification of Cystic Renal Masses: Looking Back, Looking Forward. Acad Radiol 2024:S1076-6332(23)00694-3. [PMID: 38199901 DOI: 10.1016/j.acra.2023.12.019] [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: 10/31/2023] [Revised: 11/22/2023] [Accepted: 12/12/2023] [Indexed: 01/12/2024]
Abstract
RATIONALE AND OBJECTIVES According to the 2019 update of the Bosniak classification, the main imaging features that need to be evaluated to achieve a correct characterization of renal cystic masses include the thickness of walls and septa, the number of septa, the appearance of walls and septa, the attenuation/intensity on non-contrast CT/MRI and the presence of unequivocally perceived or measurable enhancement of walls and septa. Despite the improvement deriving from a quantitative evaluation of imaging features, certain limitations seem to persist and some possible scenarios that can be encountered in clinical practice are still missing. MATERIALS AND METHODS A deep analysis of the 2019 update of the Bosniak classification was performed. RESULTS The most notable potential flaws concern: (1) the quantitative measurement of the walls and septa; (2) the fact that walls and septa > 2 mm are always referred to as "enhancing", not considering the alternative scenario; (3) the description of some class II masses partially overlaps with each other and with the definition of class I masses and (4) the morphological variations of cystic masses over time is not considered. CONCLUSION The present paper analyzes in detail the limitations of the 2019 Bosniak classification to improve this important tool and facilitate its use in daily radiological practice.
Collapse
Affiliation(s)
- Nicolò Brandi
- Department of Radiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Albertoni 15, Bologna, Italy (N.B., C.M., M.R.).
| | - Cristina Mosconi
- Department of Radiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Albertoni 15, Bologna, Italy (N.B., C.M., M.R.); Department of Radiology, Alma Mater Studiorum University of Bologna, Bologna, Italy (C.M.)
| | - Emanuela Giampalma
- Radiology Unit, Morgagni-Pierantoni Hospital, AUSL Romagna, Forlì, Italy (E.G.)
| | - Matteo Renzulli
- Department of Radiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Albertoni 15, Bologna, Italy (N.B., C.M., M.R.)
| |
Collapse
|
8
|
Lennartz S, Zopfs D, Große Hokamp N. Dual-energy CT revisited: a focused review of clinical use cases. ROFO-FORTSCHR RONTG 2024. [PMID: 38176436 DOI: 10.1055/a-2203-2945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2024]
Abstract
BACKGROUND Dual-energy CT (DECT) has been available for more than 15 years and has undergone continuous technical development and refinement. Recently, the first photon-counting CT scanner became clinically available and has the potential to further expand the possibilities of spectral imaging. Numerous studies on DECT have been published since its creation, highlighting the clinical applications of the various reconstructions enabled by DECT. METHODS The aim of this focused review is to succinctly summarize basic principles and available technical concepts of DECT and to discuss established applications relevant to the daily clinical routine. RESULTS/CONCLUSION DECT is instrumental for a broad variety of clinical use cases. While some DECT applications can enhance day-to-day clinical practice, others are still subject to broad-scale validation and should therefore be handled with restraint in the clinical routine. KEY POINTS · Virtual monoenergetic images, virtual unenhanced images, and iodine maps are the most well-investigated and relevant dual-energy CT reconstructions for clinical application.. · Low-keV virtual monoenergetic images (VMIs) yield superior image and iodine contrast, which can be leveraged for improved vessel assessment and lesion conspicuity, or to reduce contrast media or radiation dose. VMIs at intermediate energies can serve as a replacement for conventional grey-scale images. VMIs at high keV enable efficient artifact reduction, which can be further optimized in combination with dedicated metal artifact reduction algorithms.. · Iodine maps and virtual unenhanced images can improve lesion detection in oncologic imaging and enable lesion assessment in monophasic CT examinations, which may allow a reduction of correlative and follow-up imaging..
Collapse
Affiliation(s)
- Simon Lennartz
- Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - David Zopfs
- Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Nils Große Hokamp
- Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| |
Collapse
|
9
|
Das CJ, Agarwal K, Sharma S, Seth A. Role of Contrast-Enhanced Ultrasound in Evaluation of Cystic Renal Mass. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2023; 42:2873-2881. [PMID: 37676901 DOI: 10.1002/jum.16328] [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: 03/09/2023] [Revised: 08/20/2023] [Accepted: 08/21/2023] [Indexed: 09/09/2023]
Abstract
OBJECTIVES Contrast-enhanced ultrasound (CEUS) allows excellent delineation of perfusion in septa and nodules without exposure to ionizing radiation or nephrotoxic contrast media. The aim of our study was to evaluate the role of CEUS for the assessment of cystic renal masses and compare its diagnostic performance with that of CECT. METHODS Exactly 40 patients diagnosed to have cystic renal masses on CECT scan were prospectively evaluated with CEUS and were assigned a Bosniak class. Based on results of final histopathology and clinical follow-up, internal validity of both CEUS and CECT was evaluated, including agreement between these two modalities. RESULTS Out of the 40 patients (mean size 3.1 ± 2.5 cm), 23 patients had benign lesions and 17 patients had malignant lesions. For CEUS, the sensitivity and negative predictive value was 100%, the specificity and positive predictive value was 73.9%. For CECT, the sensitivity and negative predictive value were 88.2 and 83.3%, respectively, whereas the specificity and positive predictive value was 87 and 90.9%, respectively. Both imaging modalities had similar accuracy with fair to good agreement with the final diagnosis (Κ = 0.71 and 0.75 for CEUS and CECT, respectively). Concordance between CEUS and CECT was seen in 29 patients (72.5%) with fair agreement between the two modalities (K = 0.66). CONCLUSION CEUS has comparable accuracy with CECT and could be used as screening modality to rule out the presence of complex cystic renal masses without exposure of nephrotoxic contrast media and ionizing radiation.
Collapse
Affiliation(s)
- Chandan J Das
- Department of Radiodiagnosis and Interventional Radiology, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Keshav Agarwal
- Department of Urology, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Sanjay Sharma
- Department of Radiodiagnosis, RP Centre, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Amlesh Seth
- Department of Radiodiagnosis and Interventional Radiology, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| |
Collapse
|
10
|
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.
Collapse
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
| |
Collapse
|
11
|
Chau M, Thia I, Saluja M. The Utility of Renal Mass Biopsy in Large Renal Masses. Res Rep Urol 2023; 15:403-408. [PMID: 37663006 PMCID: PMC10474854 DOI: 10.2147/rru.s404998] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Accepted: 03/15/2023] [Indexed: 09/05/2023] Open
Abstract
Objectives The role of needle core renal biopsy in large renal masses, defined as lesions larger than 4 cm, is debatable, as larger renal masses are associated with malignant histology. We aim to review the safety and impact of renal biopsy on the management of large renal masses. Methods A retrospective, single-center review of all renal biopsies performed between January 2011 and December 2020 at Royal Perth Hospital was conducted. Indications for biopsy, complications and final management plans were correlated to assess the value of biopsies in large renal masses. Results In total, 126 biopsies were performed. Indeterminate imaging findings and comorbidities were the main indications for biopsies. We identified 116 (92.1%) diagnostic biopsies and 10 (8.0%) non-diagnostic biopsies due to insufficient samples or inflammatory tissue. Of the diagnostic biopsies, 99 (78.6%) were malignant and 17 (13.5%) were benign. Unnecessary extirpative surgery was avoided in 17 patients. Histology included renal cell carcinoma (96%) and other malignancies such as urothelial carcinoma (3%) and non-Hodgkin's lymphoma (1%). Benign biopsies identified histology including angiomyolipoma (35.3%) and oncocytoma (52.5%). The median follow-up time was 68 months (range 19-132 months). Conclusion Renal biopsies in large renal masses may aid in preventing unnecessary surgery, especially in situations where imaging findings are equivocal or in patients with many comorbidities.
Collapse
Affiliation(s)
- Matthew Chau
- Royal Perth Hospital, Perth, Western Australia, Australia
| | - Ivan Thia
- Royal Perth Hospital, Perth, Western Australia, Australia
| | - Manmeet Saluja
- Royal Perth Hospital, Perth, Western Australia, Australia
| |
Collapse
|
12
|
Shetty AS, Fraum TJ, Ballard DH, Hoegger MJ, Itani M, Rajput MZ, Lanier MH, Cusworth BM, Mehrsheikh AL, Cabrera-Lebron JA, Chu J, Cunningham CR, Hirschi RS, Mokkarala M, Unteriner JG, Kim EH, Siegel CL, Ludwig DR. Renal Mass Imaging with MRI Clear Cell Likelihood Score: A User's Guide. Radiographics 2023; 43:e220209. [PMID: 37319026 DOI: 10.1148/rg.220209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
Small solid renal masses (SRMs) are frequently detected at imaging. Nearly 20% are benign, making careful evaluation with MRI an important consideration before deciding on management. Clear cell renal cell carcinoma (ccRCC) is the most common renal cell carcinoma subtype with potentially aggressive behavior. Thus, confident identification of ccRCC imaging features is a critical task for the radiologist. Imaging features distinguishing ccRCC from other benign and malignant renal masses are based on major features (T2 signal intensity, corticomedullary phase enhancement, and the presence of microscopic fat) and ancillary features (segmental enhancement inversion, arterial-to-delayed enhancement ratio, and diffusion restriction). The clear cell likelihood score (ccLS) system was recently devised to provide a standardized framework for categorizing SRMs, offering a Likert score of the likelihood of ccRCC ranging from 1 (very unlikely) to 5 (very likely). Alternative diagnoses based on imaging appearance are also suggested by the algorithm. Furthermore, the ccLS system aims to stratify which patients may or may not benefit from biopsy. The authors use case examples to guide the reader through the evaluation of major and ancillary MRI features of the ccLS algorithm for assigning a likelihood score to an SRM. The authors also discuss patient selection, imaging parameters, pitfalls, and areas for future development. The goal is for radiologists to be better equipped to guide management and improve shared decision making between the patient and treating physician. © RSNA, 2023 Quiz questions for this article are available in the supplemental material. See the invited commentary by Pedrosa in this issue.
Collapse
Affiliation(s)
- Anup S Shetty
- From the Mallinckrodt Institute of Radiology (A.S.S., T.J.F., D.H.B., M.J.H., M.I., M.Z.R., M.H.L., B.M.C., A.L.M., J.A.C.L., J.C., C.R.C., R.S.H., M.M., J.G.U., C.L.S., D.R.L.) and Division of Urologic Surgery (E.H.K.), Washington University School of Medicine, 510 S Kingshighway Blvd, Campus Box 8131, St Louis, MO 63110
| | - Tyler J Fraum
- From the Mallinckrodt Institute of Radiology (A.S.S., T.J.F., D.H.B., M.J.H., M.I., M.Z.R., M.H.L., B.M.C., A.L.M., J.A.C.L., J.C., C.R.C., R.S.H., M.M., J.G.U., C.L.S., D.R.L.) and Division of Urologic Surgery (E.H.K.), Washington University School of Medicine, 510 S Kingshighway Blvd, Campus Box 8131, St Louis, MO 63110
| | - David H Ballard
- From the Mallinckrodt Institute of Radiology (A.S.S., T.J.F., D.H.B., M.J.H., M.I., M.Z.R., M.H.L., B.M.C., A.L.M., J.A.C.L., J.C., C.R.C., R.S.H., M.M., J.G.U., C.L.S., D.R.L.) and Division of Urologic Surgery (E.H.K.), Washington University School of Medicine, 510 S Kingshighway Blvd, Campus Box 8131, St Louis, MO 63110
| | - Mark J Hoegger
- From the Mallinckrodt Institute of Radiology (A.S.S., T.J.F., D.H.B., M.J.H., M.I., M.Z.R., M.H.L., B.M.C., A.L.M., J.A.C.L., J.C., C.R.C., R.S.H., M.M., J.G.U., C.L.S., D.R.L.) and Division of Urologic Surgery (E.H.K.), Washington University School of Medicine, 510 S Kingshighway Blvd, Campus Box 8131, St Louis, MO 63110
| | - Malak Itani
- From the Mallinckrodt Institute of Radiology (A.S.S., T.J.F., D.H.B., M.J.H., M.I., M.Z.R., M.H.L., B.M.C., A.L.M., J.A.C.L., J.C., C.R.C., R.S.H., M.M., J.G.U., C.L.S., D.R.L.) and Division of Urologic Surgery (E.H.K.), Washington University School of Medicine, 510 S Kingshighway Blvd, Campus Box 8131, St Louis, MO 63110
| | - Mohamed Z Rajput
- From the Mallinckrodt Institute of Radiology (A.S.S., T.J.F., D.H.B., M.J.H., M.I., M.Z.R., M.H.L., B.M.C., A.L.M., J.A.C.L., J.C., C.R.C., R.S.H., M.M., J.G.U., C.L.S., D.R.L.) and Division of Urologic Surgery (E.H.K.), Washington University School of Medicine, 510 S Kingshighway Blvd, Campus Box 8131, St Louis, MO 63110
| | - Michael H Lanier
- From the Mallinckrodt Institute of Radiology (A.S.S., T.J.F., D.H.B., M.J.H., M.I., M.Z.R., M.H.L., B.M.C., A.L.M., J.A.C.L., J.C., C.R.C., R.S.H., M.M., J.G.U., C.L.S., D.R.L.) and Division of Urologic Surgery (E.H.K.), Washington University School of Medicine, 510 S Kingshighway Blvd, Campus Box 8131, St Louis, MO 63110
| | - Brian M Cusworth
- From the Mallinckrodt Institute of Radiology (A.S.S., T.J.F., D.H.B., M.J.H., M.I., M.Z.R., M.H.L., B.M.C., A.L.M., J.A.C.L., J.C., C.R.C., R.S.H., M.M., J.G.U., C.L.S., D.R.L.) and Division of Urologic Surgery (E.H.K.), Washington University School of Medicine, 510 S Kingshighway Blvd, Campus Box 8131, St Louis, MO 63110
| | - Amanda L Mehrsheikh
- From the Mallinckrodt Institute of Radiology (A.S.S., T.J.F., D.H.B., M.J.H., M.I., M.Z.R., M.H.L., B.M.C., A.L.M., J.A.C.L., J.C., C.R.C., R.S.H., M.M., J.G.U., C.L.S., D.R.L.) and Division of Urologic Surgery (E.H.K.), Washington University School of Medicine, 510 S Kingshighway Blvd, Campus Box 8131, St Louis, MO 63110
| | - Jorge A Cabrera-Lebron
- From the Mallinckrodt Institute of Radiology (A.S.S., T.J.F., D.H.B., M.J.H., M.I., M.Z.R., M.H.L., B.M.C., A.L.M., J.A.C.L., J.C., C.R.C., R.S.H., M.M., J.G.U., C.L.S., D.R.L.) and Division of Urologic Surgery (E.H.K.), Washington University School of Medicine, 510 S Kingshighway Blvd, Campus Box 8131, St Louis, MO 63110
| | - Jia Chu
- From the Mallinckrodt Institute of Radiology (A.S.S., T.J.F., D.H.B., M.J.H., M.I., M.Z.R., M.H.L., B.M.C., A.L.M., J.A.C.L., J.C., C.R.C., R.S.H., M.M., J.G.U., C.L.S., D.R.L.) and Division of Urologic Surgery (E.H.K.), Washington University School of Medicine, 510 S Kingshighway Blvd, Campus Box 8131, St Louis, MO 63110
| | - Christopher R Cunningham
- From the Mallinckrodt Institute of Radiology (A.S.S., T.J.F., D.H.B., M.J.H., M.I., M.Z.R., M.H.L., B.M.C., A.L.M., J.A.C.L., J.C., C.R.C., R.S.H., M.M., J.G.U., C.L.S., D.R.L.) and Division of Urologic Surgery (E.H.K.), Washington University School of Medicine, 510 S Kingshighway Blvd, Campus Box 8131, St Louis, MO 63110
| | - Ryan S Hirschi
- From the Mallinckrodt Institute of Radiology (A.S.S., T.J.F., D.H.B., M.J.H., M.I., M.Z.R., M.H.L., B.M.C., A.L.M., J.A.C.L., J.C., C.R.C., R.S.H., M.M., J.G.U., C.L.S., D.R.L.) and Division of Urologic Surgery (E.H.K.), Washington University School of Medicine, 510 S Kingshighway Blvd, Campus Box 8131, St Louis, MO 63110
| | - Mahati Mokkarala
- From the Mallinckrodt Institute of Radiology (A.S.S., T.J.F., D.H.B., M.J.H., M.I., M.Z.R., M.H.L., B.M.C., A.L.M., J.A.C.L., J.C., C.R.C., R.S.H., M.M., J.G.U., C.L.S., D.R.L.) and Division of Urologic Surgery (E.H.K.), Washington University School of Medicine, 510 S Kingshighway Blvd, Campus Box 8131, St Louis, MO 63110
| | - Jackson G Unteriner
- From the Mallinckrodt Institute of Radiology (A.S.S., T.J.F., D.H.B., M.J.H., M.I., M.Z.R., M.H.L., B.M.C., A.L.M., J.A.C.L., J.C., C.R.C., R.S.H., M.M., J.G.U., C.L.S., D.R.L.) and Division of Urologic Surgery (E.H.K.), Washington University School of Medicine, 510 S Kingshighway Blvd, Campus Box 8131, St Louis, MO 63110
| | - Eric H Kim
- From the Mallinckrodt Institute of Radiology (A.S.S., T.J.F., D.H.B., M.J.H., M.I., M.Z.R., M.H.L., B.M.C., A.L.M., J.A.C.L., J.C., C.R.C., R.S.H., M.M., J.G.U., C.L.S., D.R.L.) and Division of Urologic Surgery (E.H.K.), Washington University School of Medicine, 510 S Kingshighway Blvd, Campus Box 8131, St Louis, MO 63110
| | - Cary L Siegel
- From the Mallinckrodt Institute of Radiology (A.S.S., T.J.F., D.H.B., M.J.H., M.I., M.Z.R., M.H.L., B.M.C., A.L.M., J.A.C.L., J.C., C.R.C., R.S.H., M.M., J.G.U., C.L.S., D.R.L.) and Division of Urologic Surgery (E.H.K.), Washington University School of Medicine, 510 S Kingshighway Blvd, Campus Box 8131, St Louis, MO 63110
| | - Daniel R Ludwig
- From the Mallinckrodt Institute of Radiology (A.S.S., T.J.F., D.H.B., M.J.H., M.I., M.Z.R., M.H.L., B.M.C., A.L.M., J.A.C.L., J.C., C.R.C., R.S.H., M.M., J.G.U., C.L.S., D.R.L.) and Division of Urologic Surgery (E.H.K.), Washington University School of Medicine, 510 S Kingshighway Blvd, Campus Box 8131, St Louis, MO 63110
| |
Collapse
|
13
|
Barr RG, Cestone A, Peterson C, De Silvestri A. Long-Term Follow-Up of Non-Enhancing Renal Masses on CEUS. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2023; 42:963-968. [PMID: 36634009 DOI: 10.1002/jum.16182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 01/02/2023] [Accepted: 01/03/2023] [Indexed: 06/17/2023]
Abstract
PURPOSE To determine the natural history and necessity of long-term follow-up of renal masses that do not demonstrate enhancement on contrast-enhanced ultrasound (CEUS). METHODS This retrospective single-center study was approved by our local IRB and is HIPAA compliant. Exactly 405 patients with 620 non-enhancing renal masses on CEUS from a previously reported study were followed for up to 10 years. Techniques and equipment are described in the original manuscript. Patient charts and imaging studies were reviewed for the change in features. There were 117 (18.6%) patients lost to follow-up leading to 341 patients with 512 lesions. The lesion size, patient age, number of lesions per patient, and Bosniak class assigned at the initial examination was recorded. RESULTS Mean patient age was 66 ± 12.6 years (range 17-95 years). Average time of follow-up was 58.9 ± 41.7 months (range 1-207 months). There was a mean of 1.5 ± 1.0 lesions per patient (range 1-7 lesions). Lesion size was 24.9 ± 18.2 mm (range 3-161 mm). There were 276 (53.9%) patients with >5-year follow-up and 78 (15.2%) patients with >10-year follow-up. The probability of change within 5 years was 0% (95% CI: 0-0.37 per 100PY) and 10 years 0% (95% CI: 0.0-0.18 per 100PY). Two lesions (0.4%) resolved by 60 months. Five lesions (1.0%) decreased in size. Four lesions (0.8%) increased in size >20% during the follow-up period but remained benign on subsequent imaging. CONCLUSION Any non-enhancing renal mass on CEUS can be classified as benign.
Collapse
Affiliation(s)
- Richard G Barr
- Department of Radiology, Southwoods Imaging, Youngstown, Ohio, USA
- Department of Radiology, Northeastern Ohio Medical University, Rootstown, Ohio, USA
| | | | - Cynthia Peterson
- Department of Radiology, Southwoods Imaging, Youngstown, Ohio, USA
- Department of Radiology, Kent State University - Salem Campus, Salem, Ohio, USA
| | - Annalisa De Silvestri
- Clinical Epidemiology and Biometeric Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| |
Collapse
|
14
|
Kim MJ, Kang KA, Kim CK, Park SY. Inter-method agreement between wash-in and wash-out computed tomography for characterizing hyperattenuating adrenal lesions as adenomas or non-adenomas. Eur Radiol 2023; 33:2218-2226. [PMID: 36173446 DOI: 10.1007/s00330-022-09144-0] [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: 04/05/2022] [Revised: 08/21/2022] [Accepted: 09/05/2022] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To investigate inter-method agreement between wash-out and wash-in computed tomography (CT) to determine whether hyperattenuating adrenal lesions are characterized as adenomas or non-adenomas. METHODS We evaluated 243 patients who underwent wash-out CT for a solid enhancing hyperattenuating (i.e., > 10 Hounsfield unit [HU]) adrenal mass of ≥ 1 to < 4 cm. Wash-out (absolute percentage wash-out [APW]; relative percentage wash-out [RPW]) and wash-in values (enhancement ratio [ER]; relative enhancement ratio [RER]) were analyzed by two independent readers. Diagnostic criteria of wash-out CT for adenoma were APW ≥ 60% or RPW ≥ 40% (conventional method). Three different criteria for wash-in CT were set: ER ≥ 3.0; RER ≥ 200%; and RER ≥ 210%. Concordance rate and inter-method agreement between wash-out and wash-in CT were investigated using Gwet's AC1. RESULTS For all lesions, concordance rates between wash-out and wash-in CT were > 83%. AC1 between conventional method and ER ≥ 3.0 or between conventional method and RER ≥ 200% were identically 0.843 for reader 1 and 0.776 for reader 2. AC1 between conventional method and RER ≥ 210% were 0.780 for reader 1 and 0.737 for reader 2. For lesions of > 10 to ≤ 30 HU, concordance rates between wash-out and wash-in CT were > 89%. AC1 between conventional method and ER ≥ 3.0 or between conventional method and RER ≥ 200% were identically 0.914 for reader 1 and 0.866 for reader 2. AC1 between conventional method and RER ≥ 210% were 0.888 for reader 1 and 0.874 for reader 2. CONCLUSION In approximately 90% of patients with a hyperattenuating adrenal lesion of ≥ 1 to < 4 cm and >10 to ≤ 30 HU, wash-out CT with 15-min contrast-enhanced images may be replaced by wash-in CT. KEY POINTS • An enhancement ratio of ≥ 3.0 or a relative enhancement ratio of ≥ 200% appears to be appropriate as the threshold of wash-in computed tomography (CT) comprising unenhanced and 1-min contrast-enhanced CT. • Measurement of enhancement ratio or relative enhancement ratio was reproducible. • We found good agreement between wash-in and wash-out CT for determining whether hyperattenuating adrenal lesions of ≥ 1 to < 4 cm and >10 to ≤ 30 Hounsfield unit would be characterized as adenomas.
Collapse
Affiliation(s)
- Min Ju Kim
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea
| | - Kyung A Kang
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea
| | - Chan Kyo Kim
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea
| | - Sung Yoon Park
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea.
| |
Collapse
|
15
|
Differentiating Benign From Malignant Cystic Renal Masses: A Feasibility Study of Computed Tomography Texture-Based Machine Learning Algorithms. J Comput Assist Tomogr 2023; 47:376-381. [PMID: 36790878 DOI: 10.1097/rct.0000000000001433] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
OBJECTIVE The Bosniak classification attempts to predict the likelihood of renal cell carcinoma (RCC) among cystic renal masses but is subject to interobserver variability and often requires multiphase imaging. Artificial intelligence may provide a more objective assessment. We applied computed tomography texture-based machine learning algorithms to differentiate benign from malignant cystic renal masses. METHODS This is an institutional review board-approved, Health Insurance Portability and Accountability Act-compliant retrospective study of 147 patients (mean age, 62.4 years; range, 28-89 years; 94 men) with 144 cystic renal masses (93 benign, 51 RCC); 69 were pathology proven (51 RCC, 18 benign), and 75 were considered benign based on more than 4 years of stability at follow-up imaging. Using a single image from a contrast-enhanced abdominal computed tomography scan, mean, SD, mean value of positive pixels, entropy, skewness, and kurtosis radiomics features were extracted. Random forest, multivariate logistic regression, and support vector machine models were used to classify each mass as benign or malignant with 10-fold cross validation. Receiver operating characteristic curves assessed algorithm performance in the aggregated test data. RESULTS For the detection of malignancy, sensitivity, specificity, positive predictive value, negative predictive value, and area under the curve were 0.61, 0.87, 0.72, 0.80, and 0.79 for the random forest model; 0.59, 0.87, 0.71, 0.79, and 0.80 for the logistic regression model; and 0.55, 0.86, 0.68, 0.78, and 0.76 for the support vector machine model. CONCLUSION Computed tomography texture-based machine learning algorithms show promise in differentiating benign from malignant cystic renal masses. Once validated, these may serve as an adjunct to radiologists' assessments.
Collapse
|
16
|
Almalki YE, Basha MAA, Refaat R, Alduraibi SK, Abdalla AAEHM, Yousef HY, Zaitoun MMA, Elsayed SB, Mahmoud NEM, Alayouty NA, Ali SA, Alnaggar AA, Saber S, El-Maghraby AM, Elsheikh AM, Radwan MHSS, Abdelmegid AGI, Aly SA, Shanab WSA, Obaya AA, Abdelhai SF, Elshorbagy S, Haggag YM, Mokhtar HM, Sabry NM, Altohamy JI, Abouelkheir RT, Omran T, Shalan A, Algazzar YH, Metwally MI. Bosniak classification version 2019: a prospective comparison of CT and MRI. Eur Radiol 2023; 33:1286-1296. [PMID: 35962816 DOI: 10.1007/s00330-022-09044-3] [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] [Received: 03/25/2022] [Revised: 06/13/2022] [Accepted: 07/19/2022] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To assess the diagnostic accuracy and agreement of CT and MRI in terms of the Bosniak classification version 2019 (BCv2019). MATERIALS AND METHODS A prospective multi-institutional study enrolled 63 patients with 67 complicated cystic renal masses (CRMs) discovered during ultrasound examination. All patients underwent CT and MRI scans and histopathology. Three radiologists independently assessed CRMs using BCv2019 and assigned Bosniak class to each CRM using CT and MRI. The final analysis included 60 histopathologically confirmed CRMs (41 were malignant and 19 were benign). RESULTS Discordance between CT and MRI findings was noticed in 50% (30/60) CRMs when data were analyzed in terms of the Bosniak classes. Of these, 16 (53.3%) were malignant. Based on consensus reviewing, there was no difference in the sensitivity, specificity, and accuracy of the BCv2019 with MRI and BCv2019 with CT (87.8%; 95% CI = 73.8-95.9% versus 75.6%; 95% CI = 59.7-87.6%; p = 0.09, 84.2%; 95% CI = 60.4-96.6% versus 78.9%; 95% CI = 54.4-93.9%; p = 0.5, and 86.7%; 95% CI = 64.0-86.6% versus 76.7%; 95% CI = 75.4-94.1%; p = 0.1, respectively). The number and thickness of septa and the presence of enhanced nodules accounted for the majority of variations in Bosniak classes between CT and MRI. The inter-reader agreement (IRA) was substantial for determining the Bosniak class in CT and MRI (k = 0.66; 95% CI = 0.54-0.76, k = 0.62; 95% CI = 0.50-0.73, respectively). The inter-modality agreement of the BCv219 between CT and MRI was moderate (κ = 0.58). CONCLUSION In terms of BCv2019, CT and MRI are comparable in the classification of CRMs with no significant difference in diagnostic accuracy and reliability. KEY POINTS • There is no significant difference in the sensitivity, specificity, and accuracy of the BCv2019 with MRI and BCv2019 with CT. • The number of septa and their thickness and the presence of enhanced nodules accounted for the majority of variations in Bosniak classes between CT and MRI. • The inter-reader agreement was substantial for determining the Bosniak class in CT and MRI and the inter-modality agreement of the BCv219 between CT and MRI was moderate.
Collapse
Affiliation(s)
- Yassir Edrees Almalki
- Division of Radiology, Department of Internal Medicine, Medical College, Najran University, Najran, Kingdom of Saudi Arabia
| | | | - Rania Refaat
- Department of Diagnostic Radiology, Intervention and Molecular Imaging, Faculty of Human Medicine, Ain Shams University, Cairo, Egypt
| | - Sharifa Khalid Alduraibi
- Department of Radiology, College of Medicine, Qassim University, Buraidah, Kingdom of Saudi Arabia
| | | | - Hala Y Yousef
- Department of Diagnostic Radiology, Faculty of Human Medicine, Zagazig University, Zagazig, Egypt
| | - Mohamed M A Zaitoun
- Department of Diagnostic Radiology, Faculty of Human Medicine, Zagazig University, Zagazig, Egypt
| | - Saeed Bakry Elsayed
- Department of Diagnostic Radiology, Faculty of Human Medicine, Zagazig University, Zagazig, Egypt
| | - Nader E M Mahmoud
- Department of Diagnostic Radiology, Faculty of Human Medicine, Zagazig University, Zagazig, Egypt
| | - Nader Ali Alayouty
- Department of Diagnostic Radiology, Faculty of Human Medicine, Zagazig University, Zagazig, Egypt
| | - Susan Adil Ali
- Department of Diagnostic Radiology, Intervention and Molecular Imaging, Faculty of Human Medicine, Ain Shams University, Cairo, Egypt
| | - Ahmad Abdullah Alnaggar
- Department of Diagnostic Radiology, Faculty of Human Medicine, Zagazig University, Zagazig, Egypt
| | - Sameh Saber
- Department of Diagnostic Radiology, Faculty of Human Medicine, Zagazig University, Zagazig, Egypt
| | | | - Amgad M Elsheikh
- Department of Diagnostic Radiology, Faculty of Human Medicine, Zagazig University, Zagazig, Egypt
| | | | | | - Sameh Abdelaziz Aly
- Department of Diagnostic Radiology, Faculty of Human Medicine, Benha University, Benha, Egypt
| | - Waleed S Abo Shanab
- Department of Diagnostic Radiology, Faculty of Human Medicine, Port Said University, Port Said, Egypt
| | - Ahmed Ali Obaya
- Department of Clinical Oncology, Faculty of Human Medicine, Zagazig University, Zagazig, Egypt
| | - Shaimaa Farouk Abdelhai
- Department of Clinical Oncology, Faculty of Human Medicine, Zagazig University, Zagazig, Egypt
| | - Shereen Elshorbagy
- Department of Medical Oncology, Faculty of Human Medicine, Zagazig University, Zagazig, Egypt
| | - Yasser M Haggag
- Department of Urology, Faculty of Human Medicine, Al Azhar University, Cairo, Egypt
| | - Hwaida M Mokhtar
- Department of Diagnostic Radiology, Faculty of Human Medicine, Tanta University, Tanta, Egypt
| | - Nesreen M Sabry
- Department of Clinical Oncology, Faculty of Human Medicine, Tanta University, Tanta, Egypt
| | - Jehan Ibrahim Altohamy
- Department of Diagnostic Radiology, National Institute of Urology and Nephrology, Cairo, Egypt
| | - Rasha Taha Abouelkheir
- Department of Diagnostic Radiology, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt
| | - Tawfik Omran
- Department of Diagnostic Radiology, Faculty of Human Medicine, Helwan University, Cairo, Egypt
| | - Ahmed Shalan
- Department of Diagnostic Radiology, Faculty of Human Medicine, Benha University, Benha, Egypt
| | | | - Maha Ibrahim Metwally
- Department of Diagnostic Radiology, Faculty of Human Medicine, Zagazig University, Zagazig, Egypt
| |
Collapse
|
17
|
Parihar AS, Mhlanga J, Ronstrom C, Schmidt LR, Figenshau RS, Dehdashti F, Wahl RL. Diagnostic Accuracy of 99mTc-Sestamibi SPECT/CT for Characterization of Solid Renal Masses. J Nucl Med 2023; 64:90-95. [PMID: 35772963 DOI: 10.2967/jnumed.122.264329] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 06/22/2022] [Accepted: 06/22/2022] [Indexed: 01/06/2023] Open
Abstract
Our objective was to assess the diagnostic accuracy of 99mTc-sestamibi SPECT/CT for characterizing solid renal masses. Methods: Imaging and clinical records of patients who underwent 99mTc-sestamibi SPECT/CT for clinical work-up of their solid renal masses from September 2018 to October 2021 were retrospectively reviewed. Histopathology formed the reference standard, and the diagnoses were categorized as malignant/concerning (renal cell carcinomas [RCCs] other than chromophobe histology) and benign/nonconcerning (oncocytic tumors including chromophobe RCC, other benign diagnoses) to calculate the sensitivity and specificity of 99mTc-sestamibi SPECT/CT and contrast-enhanced CT (ceCT). The clinical reads of the SPECT/CT images were used for visual classification of the lesions. Additionally, the SPECT images were manually segmented to obtain the maximum and mean counts of the lesion and adjacent renal cortex and maximum and mean lesion Hounsfield units. Results: 99mTc-sestamibi SPECT/CT was performed on 42 patients with 62 renal masses. A histopathologic diagnosis was available for 27 patients (18 male, 9 female) with 36 solid renal masses. ceCT findings were available for 20 of these patients. The most commonly identified single histologic type was clear cell RCC (13/36; 36.1%). Oncocytic tumors were the most common group of nonconcerning lesions (15/36), with oncocytoma as the predominant histologic type (n = 6). The sensitivity and specificity of SPECT/CT for diagnosing a nonconcerning lesion were 66.7% and 89.5%, respectively, compared with 10% and 75%, respectively, for ceCT. The lesion-to-kidney ratios for maximum and mean counts and maximum lesion Hounsfield units showed significant differences between the 2 groups (P < 0.05). The lesion-to-kidney mean count ratio at a cutoff of 0.46 showed a sensitivity and specificity of 87.5% and 86.67%, respectively, for detecting nonconcerning lesions, which was significantly higher than that of ceCT. Conclusion: The current literature on the utility of 99mTc-sestamibi SPECT/CT for characterization of solid renal masses is limited. We offer additional evidence of the incremental value of 99mTc-sestamibi SPECT/CT over ceCT for differentiating malignant or aggressive renal tumors from benign or indolent ones, thereby potentially avoiding overtreatment and its associated complications. Quantitative assessment can further increase the diagnostic accuracy of SPECT/CT and may be used in conjunction with visual interpretation.
Collapse
Affiliation(s)
- Ashwin Singh Parihar
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri
| | - Joyce Mhlanga
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri.,Siteman Cancer Centre, Washington University School of Medicine, St. Louis, Missouri; and
| | - Carrie Ronstrom
- Siteman Cancer Centre, Washington University School of Medicine, St. Louis, Missouri; and.,Division of Urology, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Lisa R Schmidt
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri
| | - Robert S Figenshau
- Siteman Cancer Centre, Washington University School of Medicine, St. Louis, Missouri; and.,Division of Urology, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Farrokh Dehdashti
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri.,Siteman Cancer Centre, Washington University School of Medicine, St. Louis, Missouri; and
| | - Richard L Wahl
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri; .,Siteman Cancer Centre, Washington University School of Medicine, St. Louis, Missouri; and
| |
Collapse
|
18
|
Hong B, Zhao Q, Ji Y, Yang Y, Zhang N. The safety and efficacy of laparoscopic microwave ablation-assisted partial nephrectomy: a new avenue for the treatment of cystic renal tumors. Int J Hyperthermia 2022; 40:2157499. [PMID: 36576108 DOI: 10.1080/02656736.2022.2157499] [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: 12/29/2022] Open
Abstract
PURPOSE Clinically, the management of cystic renal masses is tricky. The study aims to evaluate the safety and efficacy of laparoscopic microwave ablation-assisted partial nephrectomy (LMAPN) for cystic renal tumors. METHODS AND MATERIALS Between November 2017 and January 2022, LMAPN was performed on 43 patients (29 men and 14 women; age range: 22-80 years; median age 54 years) with Bosniak category III (n = 15) or IV (n = 28) cystic renal tumors (size range: 1.2-5.0 cm; mean size 2.8 cm). The median follow-up period was 26 months (range: 7-56 months). Baseline and perioperative data, pathological features, renal function, postoperative complications and oncologic outcomes were collected and evaluated. RESULTS Forty-three cystic renal tumors were successfully managed by LMAPN. The mean operating time was 79 min (range: 40-130 min). The mean time of renal pedicle clamping was 19 min (range: 12-25 min). Mean intraoperative blood loss was 28.4 mL (range: 10-80 mL). The mean postoperative hospitalization duration was 4 days (range: 2-6 days). Negative surgical margins were diagnosed in all cases. During the follow-up, no patient appeared with distant metastasis, wound or peritoneal cavity implantation. No major but minor complications of Clavien-Dindo grade I were encountered after the operation. The 1-, 3- and 4-year overall survival rate was 100%, 96.6% and 88.5%, respectively. CONCLUSION This is the first study focusing on LMAPN for cystic renal tumors, demonstrating its favorable feasibility, safety and disease control. Long-term follow-up is necessary to draw conclusions on the preference and advantages of the new therapeutic approach.
Collapse
Affiliation(s)
- Baoan Hong
- Department of Urology, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital & Institute, Beijing, P. R. China
| | - Qiang Zhao
- Department of Urology, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital & Institute, Beijing, P. R. China
| | - Yongpeng Ji
- Department of Urology, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital & Institute, Beijing, P. R. China
| | - Yong Yang
- Department of Urology, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital & Institute, Beijing, P. R. China
| | - Ning Zhang
- Department of Urology, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital & Institute, Beijing, P. R. China.,Department of Urology, Beijing Anzhen Hospital, Capital Medical University, Beijing, P. R. China
| |
Collapse
|
19
|
Contemporary Clinical Definitions, Differential Diagnosis, and Novel Predictive Tools for Renal Cell Carcinoma. Biomedicines 2022; 10:biomedicines10112926. [PMID: 36428491 PMCID: PMC9687297 DOI: 10.3390/biomedicines10112926] [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: 09/20/2022] [Revised: 10/26/2022] [Accepted: 11/11/2022] [Indexed: 11/16/2022] Open
Abstract
Despite significant progress regarding clinical detection/imaging evaluation modalities and genetic/molecular characterization of pathogenesis, advanced renal cell carcinoma (RCC) remains an incurable disease and overall RCC mortality has been steadily rising for decades. Concomitantly, clinical definitions have been greatly nuanced and refined. RCCs are currently viewed as a heterogeneous series of cancers, with the same anatomical origin, but fundamentally different metabolisms and clinical behaviors. Thus, RCC pathological diagnosis/subtyping guidelines have become increasingly intricate and cumbersome, routinely requiring ancillary studies, mainly immunohistochemistry. Meanwhile, RCC-associated-antigen targeted systemic therapy has been greatly diversified and emerging, novel clinical applications for RCC immunotherapy have already reported significant survival benefits, at least in the adjuvant setting. Even so, systemically disseminated RCCs still associate very poor clinical outcomes, with currently available therapeutic modalities only being able to prolong survival. In lack of a definitive cure for advanced RCCs, integration of the amounting scientific knowledge regarding RCC pathogenesis into RCC clinical management has been paramount for improving patient outcomes. The current review aims to offer an integrative perspective regarding contemporary RCC clinical definitions, proper RCC clinical work-up at initial diagnosis (semiology and multimodal imaging), RCC pathological evaluation, differential diagnosis/subtyping protocols, and novel clinical tools for RCC screening, risk stratification and therapeutic response prediction.
Collapse
|
20
|
Al Aradi A, Al Rashed AA, Mubarak M, Hasan O, Al Arayedh A, Isa QM, Alaradi H. Renal Carcinoma Patterns and Prevalence in Bahrain: A Descriptive Study. Cureus 2022; 14:e31443. [DOI: 10.7759/cureus.31443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/13/2022] [Indexed: 11/15/2022] Open
|
21
|
Nagata C, Fujimori M, Yamanaka T, Sugino Y, Matsushita N, Kishi S, Fukui H, Omori Y, Nishikawa K, Sakuma H. Percutaneous Thermal Ablation for Managing Small Renal Metastatic Tumors. INTERVENTIONAL RADIOLOGY (HIGASHIMATSUYAMA-SHI (JAPAN) 2022; 7:85-92. [PMID: 36483663 PMCID: PMC9719821 DOI: 10.22575/interventionalradiology.2021-0032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 05/12/2022] [Indexed: 06/17/2023]
Abstract
PURPOSE To retrospectively evaluate the treatment outcomes of thermal ablation for renal metastatic tumors. MATERIALS AND METHODS Thirteen consecutive patients with small renal metastatic tumors (≤3 cm), who underwent thermal ablation between 2009 and 2020, were included in this study. Eight patients had extra-renal tumors during renal ablation. The primary tumors were adenoid cystic carcinoma in four patients, lung cancer in three, hemangiopericytoma in three, leiomyosarcoma in two, and thyroid cancer in one. The therapeutic effects, safety, survival rate, prognostic factor, and renal function were evaluated. RESULTS We performed 18 ablation sessions (cryoablation, n = 13; radiofrequency ablation, n = 5) on 19 renal metastases with a mean diameter of 1.7 cm, which resulted in a primary technique efficacy rate of 100% without procedure-related deaths or major complications. Renal function significantly declined 6 months after ablation (P = 0.0039). During the mean follow-up period of 31.2 ± 22.4 months (range, 2.7-71.4 months), one patient had local tumor progression at 11.9 months following radiofrequency ablation. The overall survival rates at 1 and 3 years after ablation were 76.9% (95% confidence interval [CI], 54.0%-99.8%) and 59.3% (95% CI, 31.3%-87.3%), respectively. Tumor size ≥ 2 cm (P = 0.02) and metastasis from non-small cell lung cancer (P = 0.001) were significant worse prognostic factors in univariate analysis, and metastasis from non-small cell lung cancer (P = 0.01) was significant in multivariate analysis. CONCLUSIONS Percutaneous thermal ablation for small renal metastases is safe and feasible and can control local tumors.
Collapse
Affiliation(s)
- Chisami Nagata
- Department of Radiology, Mie University School of Medicine, Japan
| | - Masashi Fujimori
- Department of Radiology, Mie University School of Medicine, Japan
| | - Takashi Yamanaka
- Department of Radiology, Mie University School of Medicine, Japan
| | - Yuichi Sugino
- Department of Radiology, Mie University School of Medicine, Japan
| | | | - Seiya Kishi
- Department of Radiology, Mie University School of Medicine, Japan
| | - Hikari Fukui
- Department of Radiology, Mie University School of Medicine, Japan
| | - Yuki Omori
- Department of Radiology, Mie University School of Medicine, Japan
| | - Kohei Nishikawa
- Department of Nephro-Urologic Surgery and Andrology, Mie University School of Medicine, Japan
| | - Hajime Sakuma
- Department of Radiology, Mie University School of Medicine, Japan
| |
Collapse
|
22
|
Capuano I, Buonanno P, Riccio E, Crocetto F, Pisani A. Parapelvic Cysts: An Imaging Marker of Kidney Disease Potentially Leading to the Diagnosis of Treatable Rare Genetic Disorders? A Narrative Review of the Literature. J Nephrol 2022; 35:2035-2046. [PMID: 35749008 DOI: 10.1007/s40620-022-01375-0] [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: 01/06/2022] [Accepted: 06/02/2022] [Indexed: 11/25/2022]
Abstract
Simple renal cysts are a common finding during abdominal imaging assessment. The incidence increases with age and it is higher in male gender. Parapelvic cysts are a subset of simple cysts that arise within the renal parenchyma, adjacent to the renal sinus, characterized by being generally single, larger, and incompletely surrounded by renal parenchyma. Noteworthy, parapelvic cysts are a rare and understudied condition which, although considered clinically insignificant due to the absence of influence on renal function, still have a controversial aetiopathogenesis. On the other hand, urological management and differential diagnosis have been thoroughly investigated. The aim of our review is to provide an overall vision on this rare condition, usually misdiagnosed and underestimated, on the basis of more recent data. An accurate differential diagnosis of parapelvic cysts can lead to the identification of treatable conditions such as Fabry disease, autosomal dominant polycystic kidney disease, polycystic liver disease and tuberous sclerosis complex disease.
Collapse
Affiliation(s)
- Ivana Capuano
- Department of Public Health, Chair of Nephrology "Federico II", University of Naples, Via Sergio Pansini, 5, 80131, Naples, Italy.
| | - Pasquale Buonanno
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples "Federico II", Naples, Italy
| | - Eleonora Riccio
- Institute for Biomedical Research and Innovation, National Research Council of Italy, Palermo, Italy
| | - Felice Crocetto
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples "Federico II", Naples, Italy
| | - Antonio Pisani
- Department of Public Health, Chair of Nephrology "Federico II", University of Naples, Via Sergio Pansini, 5, 80131, Naples, Italy
| |
Collapse
|
23
|
The value of CT features and demographic data in the differential diagnosis of type 2 papillary renal cell carcinoma from fat-poor angiomyolipoma and oncocytoma. ABDOMINAL RADIOLOGY (NEW YORK) 2022; 47:3838-3846. [PMID: 36085376 DOI: 10.1007/s00261-022-03644-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Revised: 07/30/2022] [Accepted: 08/01/2022] [Indexed: 01/18/2023]
Abstract
PURPOSES To determine the CT features and demographic data predictive of type 2 papillary renal cell carcinoma (PRCC) that can help distinguish this neoplasm from fat-poor angiomyolipoma (fpAML) and oncocytoma. METHODS Fifty-four patients with type 2 PRCC, 48 with fpAML, and 47 with oncocytoma in the kidney from multiple centers were retrospectively reviewed. The demographic data and CT features of type 2 PRCC were analyzed and compared with those of fpAML and oncocytoma by univariate analysis and multiple logistic regression analysis to determine the predictive factors for differential diagnosis. Then, receiver operating characteristic (ROC) curve analysis was performed to further assess the logistic regression model and set the threshold level values of the numerical parameters. RESULTS Older age (≥ 46.5 years), unenhanced lesion-to-renal cortex attenuation (RLRCA) < 1.21, corticomedullary ratio of lesion to renal cortex net enhancement (RLRCNE) < 0.32, and size ≥ 30.1 mm were independent predictors for distinguishing type 2 PRCC from fpAML (OR 14.155, 8.332, and 57.745, respectively, P < 0.05 for all). The area under the curve (AUC) of the multiple logistic regression model in the ROC curve analysis was 0.970. In the combined evaluation, the four independent predictors had a sensitivity and specificity of 0.896 and 0.889, respectively. A corticomedullary RLRCNE < 0.61, irregular shape, and male sex were independent predictors for the differential diagnosis of type 2 PRCC from oncocytoma (OR 15.714, 12.158, and 6.175, respectively, P < 0.05 for all). In the combined evaluation, the three independent predictors had a sensitivity and specificity of 0.889 and 0.979, respectively. The AUC of the multiple logistic regression model in the ROC curve analysis was 0.964. CONCLUSION The combined application of CT features and demographic data had good ability in distinguishing type 2 PRCC from fpAML and oncocytoma, respectively.
Collapse
|
24
|
Sanchez NG, Ávila Romay AA, Martínez Luna E, Padilla Rodríguez AL. Cutaneous Angiomyolipoma-A Distinct Entity That Should Be Separated From Classic Angiomyolipoma: Complete Review of Existing Cases and Defining Fundamental Features. JMIR DERMATOLOGY 2022; 5:e40168. [PMID: 37632898 PMCID: PMC10334929 DOI: 10.2196/40168] [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: 06/09/2022] [Revised: 09/07/2022] [Accepted: 09/17/2022] [Indexed: 11/13/2022] Open
Abstract
Cutaneous angiomyolipoma is a rare mesenchymal tumor that is demographically, clinically, and immunohistochemically distinct from its renal and extrarenal counterparts. We present a case of cutaneous angiomyolipoma in the right retroauricular area of a 35-year-old male patient and provide a broad systematic review of the literature and the largest compilation of cutaneous angiomyolipomas reported to date. According to the findings presented in this review, we conclude that cutaneous angiomyolipoma should be completely separated from renal and extrarenal angiomyolipomas and therefore be considered a distinct entity in the classification of skin tumors.
Collapse
Affiliation(s)
- Natalia Gabriela Sanchez
- DIGIPATH: Digital Pathology Laboratory, Mexico City, Mexico
- Instituto Tecnológico y de Estudios Superiores De Monterrey Campus Ciudad de México, Mexico City, Mexico
| | | | | | - Alvaro Lezid Padilla Rodríguez
- DIGIPATH: Digital Pathology Laboratory, Mexico City, Mexico
- Instituto Tecnológico y de Estudios Superiores De Monterrey Campus Ciudad de México, Mexico City, Mexico
- Escuela de Medicina Universidad Panamericana Campus Ciudad de México, Mexico City, Mexico
| |
Collapse
|
25
|
Direct Comparison of Diagnostic Accuracy of Fast Kilovoltage Switching Dual-Energy Computed Tomography and Magnetic Resonance Imaging for Detection of Enhancement in Renal Masses. J Comput Assist Tomogr 2022; 46:862-870. [DOI: 10.1097/rct.0000000000001361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
|
26
|
Ding Y, Meyer M, Lyu P, Rigiroli F, Ramirez-Giraldo JC, Lafata K, Yang S, Marin D. Can radiomic analysis of a single-phase dual-energy CT improve the diagnostic accuracy of differentiating enhancing from non-enhancing small renal lesions? Acta Radiol 2022; 63:828-838. [PMID: 33878931 DOI: 10.1177/02841851211010396] [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: 11/16/2022]
Abstract
BACKGROUND The value of dual-energy computed tomography (DECT)-based radiomics in renal lesions is unknown. PURPOSE To develop DECT-based radiomic models and assess their incremental values in comparison to conventional measurements for differentiating enhancing from non-enhancing small renal lesions. MATERIAL AND METHODS A total of 349 patients with 519 small renal lesions (390 non-enhancing, 129 enhancing) who underwent contrast-enhanced nephrographic phase DECT examinations between June 2013 and January 2020 on multiple DECT platforms were retrospectively recruited. Cohort A included all lesions, while cohort B included Bosniak II-IV and solid enhancing renal lesions. Radiomic models were built with features selected by the least absolute shrinkage and selection operator regression (LASSO). ROC analyses were performed to compare the diagnostic accuracy among conventional and radiomic models for predicting enhancing renal lesions. RESULTS The individual iodine concentration (IC), normalized IC, mean attenuation on 75-keV images, radiomic model of iodine images, 75-keV images and a combined model integrating all the above-mentioned features all demonstrated high AUCs for predicting renal lesion enhancement in cohort A (AUCs = 0.934-0.979) as well as in the test dataset (AUCs = 0.892-0.962) of cohort B (P values with Bonferroni correction >0.003). The AUC (0.864) of mean attenuation on 75-keV images was significantly lower than those of other models (all P values ≤0.001) except the radiomic model of 75-keV images (P = 0.038) in the training dataset of cohort B. CONCLUSION No incremental value was found by adding radiomic and machine learning analyses to iodine images for differentiating enhancing from non-enhancing renal lesions.
Collapse
Affiliation(s)
- Yuqin Ding
- Department of Radiology, Duke University Medical Center, Durham, NC, USA
- Department of Radiology, Zhongshan Hospital, Fudan University; Shanghai Institute of Medical Imaging, Shanghai, PR China
| | - Mathias Meyer
- Department of Radiology, Duke University Medical Center, Durham, NC, USA
| | - Peijie Lyu
- Department of Radiology, Duke University Medical Center, Durham, NC, USA
- Department of Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, PR China
| | - Francesca Rigiroli
- Department of Radiology, Duke University Medical Center, Durham, NC, USA
| | | | - Kyle Lafata
- Department of Radiology, Duke University Medical Center, Durham, NC, USA
- Department of Radiation Oncology, Duke University Medical Center, Durham, NC, USA
| | - Siyun Yang
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC, USA
| | - Daniele Marin
- Department of Radiology, Duke University Medical Center, Durham, NC, USA
| |
Collapse
|
27
|
Kang H, Xu W, Chang S, Yuan J, Bai X, Zhang J, Guo H, Ye H, Wang H. Mucinous tubular and spindle cell carcinomas of the kidney (MTSCC-Ks): CT and MR imaging characteristics. Jpn J Radiol 2022; 40:1175-1185. [PMID: 35644814 DOI: 10.1007/s11604-022-01294-x] [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: 10/21/2021] [Accepted: 05/07/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE To strengthen the recognition of mucinous tubular and spindle cell carcinomas of the kidney (MTSCC-Ks) by analyzing CT and MR imaging findings of MTSCC-Ks. MATERIALS AND METHODS This study retrospectively enrolled ten patients with pathologically confirmed MTSCC-Ks from 2007 to 2020. The main observed imaging characteristics included growth pattern, signal characteristics on T2-weighted imaging (T2WI) and diffusion-weighted imaging (DWI), hemorrhage, necrosis, cystic degeneration, lipid component, pseudocapsule and the enhancement pattern. Apparent diffusion coefficient (ADC) value of MTSCC-Ks and normal renal cortex were measured, respectively. All imaging features were evaluated in consensus by two genitourinary radiologists. RESULTS All patients (53.1 ± 6.5 years, male to female, 3:7) presented with a solitary renal tumor with the mean diameter of 3.5 ± 0.4 cm. All lesions showed iso- or slight hypoattenuation on non-contrast CT with no hemorrhage but cystic degeneration (10%) and necrosis (10%). On T2WI, all lesions showed predominantly slight hypointensity with focal hyperintensity. The ADC value of MTSCC-Ks was 0.845 ± 0.017 × 10-3 mm2/s, and ADCtumor-to-ADCrenal cortex value was 0.376 ± 0.084. Pseudocapsules existed in all MTSCC-Ks on MRI. There were seven lesions showed heterogeneous enhancement, while three lesions showed homogeneous enhancement. Among them, six MTSCC-Ks showed slight multiple patchy enhancement (60%) in the corticomedullary phase, while the remaining MTSCC-Ks showed homogeneously slight enhancement (30%) or slightly stratified enhancement (10%). All MTSCC-Ks exhibited slow and progressive enhancement in the late phases. CONCLUSION Iso- or slight hypoattenuation on CT, slight hypointensity with focal hyperintensity on T2WI, marked diffusion restriction on DWI and ADC map, slight multiple patchy enhancement in the corticomedullary phase, and slow and progressive enhancement in the late phases are the imaging features of MTSCC-Ks, which may facilitate the diagnosis of MTSCC-Ks.
Collapse
Affiliation(s)
- Huanhuan Kang
- Medical School of Chinese PLA, Beijing, 100853, China.,Department of Radiology, The First Medical Center of Chinese PLA General Hospital, 28 Fuxing Road, Haidian District, Beijing, 100853, China
| | - Wei Xu
- Department of Radiology, The First Medical Center of Chinese PLA General Hospital, 28 Fuxing Road, Haidian District, Beijing, 100853, China
| | - Shuxiang Chang
- Department of Radiology, The First Medical Center of Chinese PLA General Hospital, 28 Fuxing Road, Haidian District, Beijing, 100853, China
| | - Jing Yuan
- Department of Pathology, The First Medical Center of Chinese PLA General Hospital, Beijing, 100853, China
| | - Xu Bai
- Department of Radiology, The Fifth Medical Center of Chinese PLA General Hospital, Beijing, 100039, China
| | - Jing Zhang
- Department of Radiology, The First Medical Center of Chinese PLA General Hospital, 28 Fuxing Road, Haidian District, Beijing, 100853, China
| | - Huiping Guo
- Department of Radiology, The First Medical Center of Chinese PLA General Hospital, 28 Fuxing Road, Haidian District, Beijing, 100853, China
| | - Huiyi Ye
- Department of Radiology, The First Medical Center of Chinese PLA General Hospital, 28 Fuxing Road, Haidian District, Beijing, 100853, China
| | - Haiyi Wang
- Department of Radiology, The First Medical Center of Chinese PLA General Hospital, 28 Fuxing Road, Haidian District, Beijing, 100853, China.
| |
Collapse
|
28
|
[Incidental and leave me alone findings of abdominal organs-part 2 : Spleen, kidneys and adrenal glands and efferent urinary tracts]. Radiologe 2022; 62:439-450. [PMID: 35441883 DOI: 10.1007/s00117-022-00998-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/17/2022] [Indexed: 10/18/2022]
Abstract
For masses of the spleen, which are mostly benign, accessory spleens, cysts and hemangiomas should be radiologically described; however, if confirmed further follow-up control is unnecessary. In the case of disseminated small masses, chronic inflammation and granulomatous diseases, such as tuberculosis and sarcoidosis should be considered in the differential diagnostics. Solid masses in the kidneys should always be further clarified, with the exception of a fat-rich angiomyolipoma. For cystic masses of the kidneys, the modified Bosniak classification for computed tomography or magnetic resonance imaging should be used. Masses of the adrenal glands greater than 10mm in size should be clarified further as well as those where fat is not detected, independent of the size and evidence of malignancy.
Collapse
|
29
|
Büttner T, Ritter M. Sonographie von Nieren, Retroperitoneum und Harnblase. Urologe A 2022; 61:357-364. [DOI: 10.1007/s00120-022-01791-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/07/2022] [Indexed: 10/18/2022]
|
30
|
Atri M, Jang HJ, Kim TK, Khalili K. Contrast-enhanced US of the Liver and Kidney: A Problem-solving Modality. Radiology 2022; 303:11-25. [PMID: 35191740 DOI: 10.1148/radiol.211347] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Contrast-enhanced US (CEUS) has an important role as a supplement to CT or MRI in clinical practice. The main established utilizations are in the liver and the kidney. The primary advantages of CEUS compared with contrast-enhanced CT or MRI relate to its superior contrast resolution, real-time continuous scanning, pure intravascular nature, portability, and safety-especially in patients with renal impairment or CT or MRI contrast agent allergy. This article focuses on the use of CEUS in the liver and kidney.
Collapse
Affiliation(s)
- Mostafa Atri
- From the Joint Department of Medical Imaging, University Health Network, Mount Sinai Hospital, Women's College Hospital, University of Toronto, Toronto General Hospital, 585 University Ave, Toronto, ON, Canada M5G 2N2
| | - Hyun-Jung Jang
- From the Joint Department of Medical Imaging, University Health Network, Mount Sinai Hospital, Women's College Hospital, University of Toronto, Toronto General Hospital, 585 University Ave, Toronto, ON, Canada M5G 2N2
| | - Tae Kyoung Kim
- From the Joint Department of Medical Imaging, University Health Network, Mount Sinai Hospital, Women's College Hospital, University of Toronto, Toronto General Hospital, 585 University Ave, Toronto, ON, Canada M5G 2N2
| | - Korosh Khalili
- From the Joint Department of Medical Imaging, University Health Network, Mount Sinai Hospital, Women's College Hospital, University of Toronto, Toronto General Hospital, 585 University Ave, Toronto, ON, Canada M5G 2N2
| |
Collapse
|
31
|
The value of sestamibi single-photon emission computed tomography/computed tomography in differentiating and staging renal cell carcinomas. Curr Urol 2022; 16:32-37. [PMID: 35633856 PMCID: PMC9132183 DOI: 10.1097/cu9.0000000000000089] [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: 02/21/2021] [Accepted: 03/02/2021] [Indexed: 11/26/2022] Open
Abstract
Misdiagnosis of benign renal neoplasms can lead to unnecessary surgical resections, which increases the risk of other morbidities and mortality. Therefore, it is crucial to find a diagnostic modality for differentiation between benign and malignant renal masses. In the current study, we summarized published pieces of evidence concerning the use of technetium-99m (99mTc)-sestamibi single-photon emission computed tomography/computed tomography (SPECT/CT) as a promising diagnostic nuclear imaging modality for the differentiation of renal neoplasms. The study was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement for Systematic Reviews and Meta-Analyses. We conducted a systematic electronic database search for suitable studies from inception till February 20, 2020 in 9 databases. The risk of bias was assessed for the included studies using the Quality Assessment of Diagnostic Accuracy Studies-2 tool. We identified 9373 records after exclusion of 8978 duplicates using EndNote software. Title and abstract screening resulted in 761 records for further full-text screening. Finally, four studies were included with total sample size of 80 patients. The overall risk of bias was low to moderate. The results of all the included studies supported using 99mTc-sestamibi SPECT/CT for the differentiation between benign and malignant renal neoplasms. The use of 99mTc-sestamibi SPECT/CT could be a rapid, less invasive, promising diagnostic modality for histological diagnosis and staging of renal neoplasm, as well as monitoring post-therapy tumor's response. However, more studies with large sample sizes are essential to confirm the reliability and accuracy of this modality for usage.
Collapse
|
32
|
Zhao S, Shi J, Yang R, Zhang X, Zhao W, Sun Z. Ultrasonography findings for the diagnosis of renal oncocytoma. J Med Ultrason (2001) 2022; 49:211-216. [PMID: 35083534 DOI: 10.1007/s10396-021-01179-y] [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: 06/27/2021] [Accepted: 10/21/2021] [Indexed: 10/19/2022]
Abstract
Renal oncocytomas are rare benign epithelial tumors of the kidney. However, they are easily misdiagnosed as renal cancers, resulting in unnecessary radical nephrectomy. This review summarizes the use of ultrasound for the diagnosis of renal oncocytomas. On two-dimensional grayscale ultrasound, renal oncocytomas appear as solid, well-defined, round or oval, and relatively isoechoic or slightly hyperechoic masses. On color Doppler flow imaging, the "spoke-wheel" sign is evident. On power Doppler flow imaging, renal oncocytomas show mixed penetrating and peripheral patterns. Renal oncocytomas usually appear as highly enhanced on contrast-enhanced ultrasound images, and irregular nonenhanced areas in larger tumors. This review will help sonographers recognize renal oncocytomas.
Collapse
Affiliation(s)
- Shengnan Zhao
- Department of Ultrasound, China-Japan Union Hospital of Jilin University, No. 126 Xiantai Street, Changchun, 130033, Jilin Province, China
| | - Jiahong Shi
- Department of Ultrasound, China-Japan Union Hospital of Jilin University, No. 126 Xiantai Street, Changchun, 130033, Jilin Province, China
| | - Ran Yang
- Department of Ultrasound, China-Japan Union Hospital of Jilin University, No. 126 Xiantai Street, Changchun, 130033, Jilin Province, China
| | - Xiujuan Zhang
- Department of Ultrasound, China-Japan Union Hospital of Jilin University, No. 126 Xiantai Street, Changchun, 130033, Jilin Province, China
| | - Wei Zhao
- Department of Ultrasound, China-Japan Union Hospital of Jilin University, No. 126 Xiantai Street, Changchun, 130033, Jilin Province, China
| | - Zhixia Sun
- Department of Ultrasound, China-Japan Union Hospital of Jilin University, No. 126 Xiantai Street, Changchun, 130033, Jilin Province, China.
| |
Collapse
|
33
|
Barr RG. Use of lumason/sonovue in contrast-enhanced ultrasound of the kidney for characterization of renal masses-a meta-analysis. Abdom Radiol (NY) 2022; 47:272-287. [PMID: 34623494 DOI: 10.1007/s00261-021-03295-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 09/20/2021] [Accepted: 09/22/2021] [Indexed: 01/04/2023]
Abstract
Indeterminate renal masses are a common clinical problem. CEUS has several advantages to characterize both cystic and solid renal masses including thin slice thickness, excellent background subtraction, and real-time imaging with a high frame rate. The ultrasound contrast agents are not nephrotoxic and can be used in patients with renal insufficiency and obstruction. The Bosniak classification has been developed for use in CT and MRI. A CEUS Bosniak classification has not yet been developed. This meta-analysis reviews the results of renal mass characterization using Lumason/Sonovue in characterizing renal solid and cystic masses. For complex cystic renal lesions (419 patients; 436 lesions), the pooled sensitivity and specificity of CEUS were 95% (95% CI: 91%, 99%) and 84% (95% CI: 77%, 90%) and for solid lesions (331 patients; 341 lesions), the pooled sensitivity and specificity of CEUS were 98% (95% CI: 95%, 100%) and 78% (95% CI: 68%, 88%), respectively.
Collapse
|
34
|
The Benign Renal Masses that Were Exposed after Nephron-Sparing Surgery: "Postsurgical Fatty Tumor." Is It Related to the Surgical Technique? J Kidney Cancer VHL 2021; 9:1-8. [PMID: 34888127 PMCID: PMC8571989 DOI: 10.15586/jkcvhl.v9i1.195] [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: 06/17/2021] [Accepted: 10/18/2021] [Indexed: 11/24/2022] Open
Abstract
After nephron-sparing surgery (NSS), postsurgical fatty tumor could be mistakenly reported as angiomyolipoma during radiologic imaging of some patients. In the present paper, we studied the postsurgical fatty tumor detected after NSS but not covered before in the literature. In addition, we also evaluated whether the postsurgical fatty tumor was related to the surgical technique employed. Patients admitted to the urology department of our university hospital from 2014 to 2019 and operated with open NSS were evaluated retrospectively. We detected those 156 patients were operated with NSS. Nine patients with angiomyolipoma as primary pathology and four patients with surgical border positivity were excluded from the study. The patients were divided into two groups based on the repair of tumor extraction region. In Group 1, fatty tissue was used for repair, and Group 2 is the primary repair group. In all, 143 patients (Group 1 = 79, and Group 2 = 64) were included in the study. No demographic and radiologic differences, such as number of patients, age, gender, positioning of tumor, mass localization, tumor diameter, and RENAL nephrometry scoring system, were detected between the two groups. Postsurgical fatty tumors were detected in 28 patients in Group 1 and in two patients in Group 2 (P < 0.001). In patients with negative surgical margins after partial nephrectomy, lesions that were radiologically detected mimicking as angiomyolipoma were defined as “postsurgical fatty tumor.” This mass containing adipose tissue only neither depicted vascularization and enhancement nor increase in size for at least 1 year. We assumed that these lesions must be followed as benign lesions not requiring additional treatment.
Collapse
|
35
|
The Effects of Chinese Herbal Decoction Combined with Recombinant Human Interferon α2b on MRI Imaging, Tumor Markers, and Immune Function in Patients with Renal Cell Carcinoma. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2021; 2021:8106974. [PMID: 34733345 PMCID: PMC8560232 DOI: 10.1155/2021/8106974] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Accepted: 10/09/2021] [Indexed: 01/04/2023]
Abstract
Background To explore the clinical efficacy of traditional Chinese medicine decoction combined with recombinant human interferon α2b in the treatment of renal cell carcinoma (RCC). Methods 68 RCC patients were divided into the control group and treatment group (n = 34). The control group was treated with recombinant human interferon α2b, and the treatment group was treated with traditional Chinese medicine decoction on the basis of the control group. The clinical efficacy and life quality were observed. At the same time, the changes of immune function before and after treatment were compared. Results After one course of treatment, the effective rate and clinical benefit rate of the treatment group were higher than those of the control group. The Karnofsky score in the treatment group was better than that in the control group. In improving the immune function, the treatment group was better than the control group in increasing CD3+ and CD4+ and reducing CD8+. Conclusion Traditional Chinese medicine decoction combined with recombinant human interferon α2b has a good effect on the treatment of RCC. It can not only improve the common clinical symptoms of patients but also improve the quality of life and cellular immune function of patients.
Collapse
|
36
|
Como G, Valotto C, Tulipano Di Franco F, Giannarini G, Cereser L, Girometti R, Zuiani C. Role of contrast-enhanced ultrasound in assessing indeterminate renal lesions and Bosniak ≥2F complex renal cysts found incidentally on CT or MRI. Br J Radiol 2021; 94:20210707. [PMID: 34432542 PMCID: PMC8553198 DOI: 10.1259/bjr.20210707] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Objective: To investigate the impact of contrast-enhanced ultrasound (CEUS) in reclassifying incidental renal findings categorized as indeterminate lesions (IL) or Bosniak ≥ 2F complex renal cysts (CRC) on CT or MRI. Methods: We retrospectively included 44 subjects who underwent CEUS between 2016 and 2019 to assess 48 IL (n = 12) and CRC (n = 36) incidentally found on CT or MRI. CEUS was performed by one radiologist with 10 year of experience with a sulfur hexafluoride-filled microbubble contrast agent. The same radiologist, blinded to clinical information and previous CT/MRIs, retrospectively reviewed CEUS images/videos, categorizing renal findings with Bosniak-derived imaging categories ranging from 0 (indeterminate) to 5 (solid lesion). CEUS-related reclassification rate was calculated (proportion of IL reclassified with an imaging category >0, or CRC reclassified below or above imaging category >2F). Using histological examination or a ≥ 24 months follow-up as the standard of reference, we also estimated per-lesion sensitivity/specificity for malignancy. Results: CEUS reclassified 24/48 findings (50.0%; 95% C.I. 35.2–64.7), including 12/12 IL (100%; 95% CI 73.5–100) and 12/36 CRC (33.3%; 95% C.I. 18.5–50.9), mostly above category >2F (66.7%). CEUS and CT/MRI showed 96.0% (95%CI 79.7–99.9) vs 44.0% (95%CI 24.4–65.1) sensitivity, and 82.6% (95%CI 61.2–95.1) vs 60.9% (95%CI 38.5–80.3%) specificity. Conclusion: CEUS provided substantial and accurate reclassification of CT/MRI incidental findings. Advances in knowledge: Previous studies included Bosniak 2 incidental findings, thus possibly underestimating CEUS-induced reclassification rates. Using a more meaningful cut-off (Bosniak ≥2F), problem-solving CEUS was effective as well, with higher reclassification rates for CRC than in literature.
Collapse
Affiliation(s)
- Giuseppe Como
- Institute of Radiology, Department of Medicine, University of udine, University Hospital S. Maria della Misericordia, Udine, Italy
| | - Claudio Valotto
- Urology Unit, University Hospital S. Maria della Misericordia, Udine, Italy
| | - Francesco Tulipano Di Franco
- Institute of Radiology, Department of Medicine, University of udine, University Hospital S. Maria della Misericordia, Udine, Italy
| | | | - Lorenzo Cereser
- Institute of Radiology, Department of Medicine, University of udine, University Hospital S. Maria della Misericordia, Udine, Italy
| | - Rossano Girometti
- Institute of Radiology, Department of Medicine, University of udine, University Hospital S. Maria della Misericordia, Udine, Italy
| | - Chiara Zuiani
- Institute of Radiology, Department of Medicine, University of udine, University Hospital S. Maria della Misericordia, Udine, Italy
| |
Collapse
|
37
|
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.
Collapse
|
38
|
Evaluation of radiomics and machine learning in identification of aggressive tumor features in renal cell carcinoma (RCC). Abdom Radiol (NY) 2021; 46:4278-4288. [PMID: 33855609 DOI: 10.1007/s00261-021-03083-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Revised: 03/22/2021] [Accepted: 03/31/2021] [Indexed: 12/11/2022]
Abstract
PURPOSE The purpose of this study was to evaluate the use of CT radiomics features and machine learning analysis to identify aggressive tumor features, including high nuclear grade (NG) and sarcomatoid (sarc) features, in large renal cell carcinomas (RCCs). METHODS CT-based volumetric radiomics analysis was performed on non-contrast (NC) and portal venous (PV) phase multidetector computed tomography images of large (> 7 cm) untreated RCCs in 141 patients (46W/95M, mean age 60 years). Machine learning analysis was applied to the extracted radiomics data to evaluate for association with high NG (grade 3-4), with multichannel analysis for NG performed in a subset of patients (n = 80). A similar analysis was performed in a sarcomatoid rich cohort (n = 43, 31M/12F, mean age 63.7 years) using size-matched non-sarcomatoid controls (n = 49) for identification of sarcomatoid change. RESULTS The XG Boost Model performed best on the tested data. After manual and machine feature extraction, models consisted of 3, 7, 5, 10 radiomics features for NC sarc, PV sarc, NC NG and PV NG, respectively. The area under the receiver operating characteristic curve (AUC) for these models was 0.59, 0.65, 0.69 and 0.58 respectively. The multichannel NG model extracted 6 radiomic features using the feature selection strategy and showed an AUC of 0.67. CONCLUSIONS Statistically significant but weak associations between aggressive tumor features (high nuclear grade, sarcomatoid features) in large RCC were identified using 3D radiomics and machine learning analysis.
Collapse
|
39
|
Park BK, Shen SH, Fujimori M, Wang Y. Thermal Ablation for Renal Cell Carcinoma: Expert Consensus from the Asian Conference on Tumor Ablation. Korean J Radiol 2021; 22:1490-1496. [PMID: 34448380 PMCID: PMC8390817 DOI: 10.3348/kjr.2020.1080] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 03/16/2021] [Accepted: 03/19/2021] [Indexed: 01/20/2023] Open
Affiliation(s)
- Byung Kwan Park
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
| | - Shu-Huei Shen
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Masashi Fujimori
- Department of Radiology, Mie University School of Medicine, Tsu, Japan
| | - Yi Wang
- Department of Urology, Peking University Wujieping Urology Center, Peking University Shougang Hospital, Beijing, China
| |
Collapse
|
40
|
Marko J, Craig R, Nguyen A, Udager AM, Wolfman DJ. Chromophobe Renal Cell Carcinoma with Radiologic-Pathologic Correlation. Radiographics 2021; 41:1408-1419. [PMID: 34388049 DOI: 10.1148/rg.2021200206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Renal cell carcinoma (RCC) is a heterogeneous group of neoplasms derived from the renal tubular epithelial cells. Chromophobe RCC (chRCC) is the third most common subtype of RCC, accounting for 5% of cases. chRCC may be detected as an incidental finding or less commonly may manifest with clinical symptoms. The mainstay of therapy for chRCC is surgical resection. chRCC has a better prognosis compared with the more common clear cell RCC. At gross pathologic analysis, chRCC is a solid well-defined mass with lobulated borders. Histologic findings vary by subtype but include large pale polygonal cells with abundant transparent cytoplasm, crinkled "raisinoid" nuclei with perinuclear halos, and prominent cell membranes. Pathologic analysis reveals only moderate vascularity. The most common imaging pattern is a predominantly solid renal mass with circumscribed margins and enhancement less than that of the renal cortex. The authors discuss chRCC with emphasis on correlative pathologic findings and illustrate the multimodality imaging appearances of chRCC by using cases from the Radiologic Pathology Archives of the American Institute for Radiologic Pathology. ©RSNA, 2021.
Collapse
Affiliation(s)
- Jamie Marko
- From the Department of Radiology and Imaging Sciences, National Institutes of Health Clinical Center, Bethesda, Md, and American Institute for Radiologic Pathology, Silver Spring, Md (J.M.); F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Md (R.C.); George Washington University School of Medicine and Health Sciences, Washington, DC (A.N.); Department of Pathology, University of Michigan Medical School, Ann Arbor, Mich (A.M.U.); and Department of Radiology, Johns Hopkins Hospital and Health System, 5255 Loughboro Rd NW, Washington, DC 20016 (D.J.W.)
| | - Ryan Craig
- From the Department of Radiology and Imaging Sciences, National Institutes of Health Clinical Center, Bethesda, Md, and American Institute for Radiologic Pathology, Silver Spring, Md (J.M.); F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Md (R.C.); George Washington University School of Medicine and Health Sciences, Washington, DC (A.N.); Department of Pathology, University of Michigan Medical School, Ann Arbor, Mich (A.M.U.); and Department of Radiology, Johns Hopkins Hospital and Health System, 5255 Loughboro Rd NW, Washington, DC 20016 (D.J.W.)
| | - Andrew Nguyen
- From the Department of Radiology and Imaging Sciences, National Institutes of Health Clinical Center, Bethesda, Md, and American Institute for Radiologic Pathology, Silver Spring, Md (J.M.); F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Md (R.C.); George Washington University School of Medicine and Health Sciences, Washington, DC (A.N.); Department of Pathology, University of Michigan Medical School, Ann Arbor, Mich (A.M.U.); and Department of Radiology, Johns Hopkins Hospital and Health System, 5255 Loughboro Rd NW, Washington, DC 20016 (D.J.W.)
| | - Aaron M Udager
- From the Department of Radiology and Imaging Sciences, National Institutes of Health Clinical Center, Bethesda, Md, and American Institute for Radiologic Pathology, Silver Spring, Md (J.M.); F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Md (R.C.); George Washington University School of Medicine and Health Sciences, Washington, DC (A.N.); Department of Pathology, University of Michigan Medical School, Ann Arbor, Mich (A.M.U.); and Department of Radiology, Johns Hopkins Hospital and Health System, 5255 Loughboro Rd NW, Washington, DC 20016 (D.J.W.)
| | - Darcy J Wolfman
- From the Department of Radiology and Imaging Sciences, National Institutes of Health Clinical Center, Bethesda, Md, and American Institute for Radiologic Pathology, Silver Spring, Md (J.M.); F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Md (R.C.); George Washington University School of Medicine and Health Sciences, Washington, DC (A.N.); Department of Pathology, University of Michigan Medical School, Ann Arbor, Mich (A.M.U.); and Department of Radiology, Johns Hopkins Hospital and Health System, 5255 Loughboro Rd NW, Washington, DC 20016 (D.J.W.)
| |
Collapse
|
41
|
Current Imaging Evaluation of Tumor Response to Advanced Medical Treatment in Metastatic Renal-Cell Carcinoma: Clinical Implications. APPLIED SCIENCES-BASEL 2021. [DOI: 10.3390/app11156930] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
The present review is focused on the role of diagnostic tomographic imaging such as computed tomography and magnetic resonance imaging to assess and predict tumor response to advanced medical treatments in metastatic renal cell carcinoma (RCC) patients. In this regard, antiangiogenic agents and immune checkpoint inhibitors (ICIs) have developed as advanced treatment options replacing the conventional therapy based on interferon-alpha and interleuchin-2 which had unfavorable toxicity profile and low response rates. In clinical practice, the imaging evaluation of treatment response in cancer patients is based on dimensional changes of tumor lesions in sequential scans; in particular, Response Evaluation Criteria in Solid Tumors (RECIST) have been defined for this purpose and also applied in patients with metastatic RCC. However, these new drugs with predominant cytostatic effect make RECIST insufficient to realize an adequate response imaging evaluation. Therefore, new imaging criteria (mCHOI and iRECIST) have been proposed to assess tumor response to advanced medical treatments of metastatic RCC, they correlate better than RECIST with the progression-free survival and overall survival. Finally, a potential role of radiomics and machine learning models has been suggested to predict tumor response.
Collapse
|
42
|
Value of Quantitative CTTA in Differentiating Malignant From Benign Bosniak III Renal Lesions on CT Images. J Comput Assist Tomogr 2021; 45:528-536. [PMID: 34176873 DOI: 10.1097/rct.0000000000001181] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
OBJECTIVE The aim of this study was to investigate whether computed tomography texture analysis can differentiate malignant from benign Bosniak III renal lesions on computed tomography (CT) images. METHODS This retrospective case-control study included 45 patients/lesions (22 benign and 23 malignant lesions) with Bosniak III renal lesions who underwent CT examination. Axial image slices in the unenhanced phase, corticomedullary phase, and nephrographic phase were selected and delineated manually. Computed tomography texture analysis was performed on each lesion during these 3 phases. Histogram-based, gray-level co-occurrence matrix, and gray-level run-length matrix features were extracted using open-source software and analyzed. In addition, receiver operating characteristic curve was constructed, and the area under the receiver operating characteristic curve (AUC) of each feature was constructed. RESULTS Of the 33 extracted features, 16 features showed significant differences (P < 0.05). Eight features were significantly different between the 2 groups after Holm-Bonferroni correction, including 3 histogram-based, 4 gray-level co-occurrence matrix, and 1 gray-level run-length matrix features (P < 0.01). The texture features resulted in the highest AUC of 0.769 ± 0.074. Renal cell carcinomas were labeled with a higher degree of lesion gray-level disorder and lower lesion homogeneity, and a model incorporating the 3 most discriminative features resulted in an AUC of 0.846 ± 0.058. CONCLUSIONS The results of this study showed that CT texture features were related to malignancy in Bosniak III renal lesions. Computed tomography texture analysis might help in differentiating malignant from benign Bosniak III renal lesions on CT images.
Collapse
|
43
|
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: 2] [Impact Index Per Article: 0.7] [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.
Collapse
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.
| |
Collapse
|
44
|
Bosniak Classification of Cystic Renal Masses Version 2019: Comparison to Version 2005 for Class Distribution, Diagnostic Performance, and Interreader Agreement Using CT and MRI. AJR Am J Roentgenol 2021; 217:1367-1376. [PMID: 34076460 DOI: 10.2214/ajr.21.25796] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Background: The Bosniak classification system for cystic renal masses (CRMs) was updated in 2019, requiring further investigation. Objective: To compare version 2005 and version 2019 of the Bosniak classification system in terms of class distribution, diagnostic performance, inter-reader agreement, and inter-modality agreement between CT and MRI. Methods: This retrospective study included 100 patients (mean age, 52.4±11.6 years; 68 men, 32 women) with 104 CRMs (74 malignant) who underwent CT, MRI, and resection between 2010 and 2019. Two radiologists independently evaluated CRMs in separate sessions for each combination of version and modality and assigned a Bosniak class. Diagnostic performance was compared using McNemar tests. Inter-reader and inter-modality agreement were analyzed using weighted kappa coefficients. Results: Across readers and modalities, proportion of class IIF was higher for version 2019 than version 2005 (reader 1: 28.8%-30.8% vs 6.7%-12.5%; reader 2: 26.0%-28.8% vs 8.7%-19.2%), although 95% CIs overlapped for reader 2 on CT. Proportion of class III was lower for version 2019 than version 2005 (reader 1: 33.7%-35.6% vs 49%-51.9%; reader 2: 31.7%-40.4% vs 37.5%-52.9%), although 95% CIs overlapped for all comparisons. Version 2019 demonstrated lower sensitivity for malignancy than version 2005 across readers and modalities (all p<.05); for example, using CT, sensitivity was 75.7% for both readers with version 2019, versus 85.1%-87.8% with version 2005. However, version 2019 demonstrated higher specificity than version 2005, which was significant (all p<.05) for reader 1 For example, using CT, specificity was 73.3% (reader 1) and 70.0% (reader 2) with version 2019, versus 50.0% (reader 1) and 56.7% (reader 2) with version 2005. Diagnostic accuracy was not different between versions (version 2005: 76.9%-85.6%; version 2019: 74.0%-78.8%). Inter-reader and inter- modality agreement were substantial for version 2005 (κ=0.676-0.782; 0.711-0.723) and version 2019 (κ=0.756-0.804; 0.704-0.781). Conclusion: Version 2019, versus version 2005, results in shift in CRM assignment from class III to class IIF. Version 2019 results in lower sensitivity, higher specificity, and similar accuracy versus version 2005. Inter-reader and inter-modality agreement are similar between versions. Clinical impact: Version 2019 facilitates recommending imaging surveillance for more CRMs.
Collapse
|
45
|
Edney E, Davenport MS, Curci N, Schieda N, Krishna S, Hindman N, Silverman SG, Pedrosa I. Bosniak classification of cystic renal masses, version 2019: interpretation pitfalls and recommendations to avoid misclassification. Abdom Radiol (NY) 2021; 46:2699-2711. [PMID: 33484283 DOI: 10.1007/s00261-020-02906-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 12/01/2020] [Accepted: 12/06/2020] [Indexed: 12/22/2022]
Abstract
The purpose of this review is to describe the potential sources of variability or discrepancy in interpretation of cystic renal masses under the Bosniak v2019 classification system. Strategies to avoid these pitfalls and clinical examples of diagnostic approaches are also presented. Potential pitfalls in the application of Bosniak v2019 are divided into three categories: interpretative, technical, and mass related. An organized, comprehensive review of possible discrepancies in interpreting Bosniak v2019 cystic masses is presented with pictorial examples of difficult clinical cases and proposed solutions. The scheme provided can guide readers to consistent, precise application of the classification system. Radiologists should be aware of the possible sources of misinterpretation of cystic renal masses when applying Bosniak v2019. Knowing which features and types of cystic masses are prone to interpretive errors, in addition to the inherent trade-offs between the CT and MR techniques used to characterize them, can help radiologists avoid these pitfalls.
Collapse
Affiliation(s)
- Elizabeth Edney
- Department of Radiology, University of Nebraska Medical Center, Omaha, NE, USA.
| | - Matthew S Davenport
- Departments of Radiology and Urology, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Nicole Curci
- Department of Radiology, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Nicola Schieda
- Department of Medical Imaging, The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada
| | - Satheesh Krishna
- Joint Department of Medical Imaging, University Health Network, Mount Sinai Hospital and Women's College Hospital, University of Toronto, Toronto, ON, Canada
| | - Nicole Hindman
- Department of Radiology, New York University Langone Medical Center, New York, USA
| | - Stuart G Silverman
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Ivan Pedrosa
- Department of Radiology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| |
Collapse
|
46
|
Hong Y, Chen X, Wu M, Xi H, Hu J. Percutaneous versus Laparoscopic treatment for simple renal cysts: a meta-analysis. J Endourol 2021; 35:1793-1800. [PMID: 34036798 DOI: 10.1089/end.2021.0264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE To compare the percutaneous and laparoscopic treatment for renal cyst in order to determine the optimal therapy for patients with renal cyst. METHODS A systematic search of PubMed, Cochrane Library, Web of Science, and EMBASE databases was conducted for articles published through Jun 3, 2020 using the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. RESULTS We found 493 studies form databases, and 6 were considered for the evidence synthesis. A total of 1631 cases were included. Of these patients, 488 cases undergone laparoscopic treatment, and 1143 cases undergone percutaneous treatment. Symptomatic and radiologic success were higher for laparoscopic treatment (odd ratio, OR, OR=3.59, 95% confidence interval, CI, 1.45-8.88, P=0.006; and OR=7.46, 95% CI 3.99-13.94, P<0.00001, respectively). Minor or severe complications were similar between the two treatments (OR=1.54, 95% CI 0.40-5.98, P=0.53; OR=3.13, 95% CI 0.03-359.76, P=0.64, respectively). CONCLUSION Laparoscopic treatment for renal cyst was associated with better symptomatic and radiologic success, and its complication was no more than percutaneous treatment.
Collapse
Affiliation(s)
- Yanyan Hong
- First Affiliated Hospital of Nanchang University, 117970, Nursing, Nanchang, China;
| | - Xinpeng Chen
- First Affiliated Hospital of Nanchang University, 117970, Nanchang, China;
| | - Mengjun Wu
- The People's Hospital of Yongxiu County, urology, Yichun, China;
| | - HaiBo Xi
- First Affiliated Hospital of Nanchang University, 117970, urology, Nanchang, Jiangxi, China;
| | - Jieping Hu
- First Affiliated Hospital of Nanchang University, 117970, urology, nanchang, Nanchang, China, 330006.,First Affiliated Hospital of Nanchang University, 117970, urology, yongwaizheng road, Nanchang, China, 330006;
| |
Collapse
|
47
|
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.
Collapse
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.
| |
Collapse
|
48
|
Abstract
Surgical resection of renal cell carcinoma plays a large role in the overall management of the disease. The gold standard for surgical management historically has been open or laparoscopic radical nephrectomy, however, evidence of equivalent oncologic efficacy with improved clinical outcomes has driven the use of nephron-sparing surgeries, especially for smaller and localized renal tumors. A role for surgery remains in metastatic RCC as well, but controversy exists as to which patients may benefit most from surgical intervention in addition to other systemic targeted therapies. This article focuses specifically on renal cell carcinoma, transitional cell carcinoma is not described here.
Collapse
|
49
|
Wang XJ, Qu BQ, Zhou JP, Zhou QM, Lu YF, Pan Y, Xu JX, Miu YY, Wang HQ, Yu RS. A Non-Invasive Scoring System to Differential Diagnosis of Clear Cell Renal Cell Carcinoma (ccRCC) From Renal Angiomyolipoma Without Visible Fat (RAML-wvf) Based on CT Features. Front Oncol 2021; 11:633034. [PMID: 33968732 PMCID: PMC8103199 DOI: 10.3389/fonc.2021.633034] [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: 11/24/2020] [Accepted: 03/31/2021] [Indexed: 11/24/2022] Open
Abstract
Background Renal angiomyolipoma without visible fat (RAML-wvf) and clear cell renal cell carcinoma (ccRCC) have many overlapping features on imaging, which poses a challenge to radiologists. This study aimed to create a scoring system to distinguish ccRCC from RAML-wvf using computed tomography imaging. Methods A total of 202 patients from 2011 to 2019 that were confirmed by pathology with ccRCC (n=123) or RAML (n=79) were retrospectively analyzed by dividing them randomly into a training cohort (n=142) and a validation cohort (n=60). A model was established using logistic regression and weighted to be a scoring system. ROC, AUC, cut-off point, and calibration analyses were performed. The scoring system was divided into three ranges for convenience in clinical evaluations, and the diagnostic probability of ccRCC was calculated. Results Four independent risk factors are included in the system: 1) presence of a pseudocapsule, 2) a heterogeneous tumor parenchyma in pre-enhancement scanning, 3) a non-high CT attenuation in pre-enhancement scanning, and 4) a heterogeneous enhancement in CMP. The prediction accuracy had an ROC of 0.978 (95% CI, 0.956–0.999; P=0.011), similar to the primary model (ROC, 0.977; 95% CI, 0.954–1.000; P=0.012). A sensitivity of 91.4% and a specificity of 93.9% were achieved using 4.5 points as the cutoff value. Validation showed a good result (ROC, 0.922; 95% CI, 0.854–0.991, P=0.035). The number of patients with ccRCC in the three ranges (0 to <2 points; 2–4 points; >4 to ≤11 points) significantly increased with increasing scores. Conclusion This scoring system is convenient for distinguishing between ccRCC and RAML-wvf using four computed tomography features.
Collapse
Affiliation(s)
- Xiao-Jie Wang
- Department of Radiology, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Bai-Qiang Qu
- Department of Radiology, Wenling Hospital of Traditional Chinese Medicine, Taizhou, China
| | - Jia-Ping Zhou
- Department of Radiology, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Qiao-Mei Zhou
- Department of Radiology, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Yuan-Fei Lu
- Department of Radiology, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Yao Pan
- Department of Radiology, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Jian-Xia Xu
- Department of Radiology, The Second Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China
| | - You-You Miu
- Department of Ultrasonic, Wenzhou Central Hospital, Wenzhou, China
| | - Hong-Qing Wang
- Department of Radiology, First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Ri-Sheng Yu
- Department of Radiology, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| |
Collapse
|
50
|
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.
Collapse
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.)
| |
Collapse
|