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Luo HC, Cheng WQ, Ding H, He L. Diagnostic performance of diffusion-weighted imaging and intravoxel incoherent motion for renal lesions: a meta-analysis. Clin Radiol 2023; 78:935-946. [PMID: 37652795 DOI: 10.1016/j.crad.2023.07.024] [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: 10/20/2022] [Revised: 07/06/2023] [Accepted: 07/30/2023] [Indexed: 09/02/2023]
Abstract
AIM To compare the diagnostic performance of diffusion-weighted imaging (DWI) and intravoxel incoherent motion (IVIM) parameters, specifically true diffusion coefficient (D), pseudo diffusion coefficient (D∗), and perfusion fraction (f) for quantitatively differentiating benign and malignant renal lesions. MATERIALS AND METHODS A comprehensive search was conducted in the EMBASE and PubMed databases before September 2022 to identify studies in English investigating the diagnostic accuracy of DWI and IVIM in renal lesions. The quality of the included studies was assessed using the QUADAS-2 tool. Pooled sensitivity, specificity, and area under the curve (AUC) values were estimated for each parameter. RESULTS A total of 19 studies involving 1,860 renal lesions (1,160 malignant and 700 benign), met the inclusion criteria. Among these studies, 15 assessed the apparent diffusion coefficient (ADC), four assessed IVIM, and three evaluated both ADC and IVIM. The pooled sensitivity, specificity, and AUC for ADC were 0.84 (95% confidence interval [Cl], 0.79-0.88), 0.82 (95% Cl, 0.72-0.89), and 0.89 (95% Cl, 0.86-0.92), respectively. The IVIM parameter with the highest diagnostic accuracy was D, with a pooled sensitivity, specificity, and AUC of 0.89 (95% Cl, 0.74-0.96), 0.96 (95% Cl, 0.85-0.99), and 0.98 (95% Cl, 0.96-0.99), respectively. The pooled sensitivity, specificity and AUC for f were 0.67 (95% Cl, 0.55-0.77), 0.81 (95% Cl, 0.30-0.98), and 0.73 (95% Cl, 0.69-0.77), respectively. The pooled sensitivity, specificity, and AUC for D∗ were 0.87 (95% Cl, 0.81-0.91), 0.59 (95% Cl, 0.48-0.70), and 0.82 (95% Cl, 0.78-0.85), respectively. CONCLUSION This meta-analysis indicated that both IVIM and DWI had moderate to high diagnostic accuracy for differentiating benign and malignant renal lesions. Among the IVIM parameter, D exhibited the highest diagnostic accuracy, demonstrating higher sensitivity and specificity than ADC, D∗, and f.
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Affiliation(s)
- H C Luo
- Department of Radiology, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - W Q Cheng
- Department of Radiology, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - H Ding
- Department of Radiology, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - L He
- Department of Radiology, Children's Hospital of Chongqing Medical University, Chongqing, China.
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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.
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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
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Pietersen PI, Lynggård Bo Madsen J, Asmussen J, Lund L, Nielsen TK, Pedersen M, Engvad B, Graumann O. Multiparametric magnetic resonance imaging for characterizing renal tumors: A validation study of the algorithm presented by Cornelis et al. J Clin Imaging Sci 2023; 13:7. [PMID: 36908585 PMCID: PMC9992978 DOI: 10.25259/jcis_124_2022] [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: 10/15/2022] [Accepted: 01/17/2023] [Indexed: 02/05/2023] Open
Abstract
Objectives In the last decade, the incidence of renal cell carcinoma (RCC) has been rising, with the greatest increase observed for solid tumors. Magnetic resonance imaging (MRI) protocols and algorithms have recently been available for classifying RCC subtypes and benign subtypes. The objective of this study was to prospectively validate the MRI algorithm presented by Cornelis et al. for RCC classification. Material and Methods Over a 7-month period, 38 patients with 44 renal tumors were prospectively included in the study and received an MRI examination in addition to the conventional investigation program. The MRI sequences were: T2-weighted, dual chemical shift MRI, diffusion-weighted imaging (DWI), and dynamic contrast-enhanced T1-weighted in wash-in and wash-out phases. The images were evaluated according to the algorithm by two experienced, blinded radiologists, and the histopathological diagnosis served as the gold standard. Results Of 44 tumors in 38 patients, only 8 tumors (18.2%) received the same MRI diagnosis according to the algorithm as the histopathological diagnosis. MRI diagnosed 16 angiomyolipoma, 14 clear cell RCC (ccRCC), 12 chromophobe RCC (chRCC), and two papillary RCC (pRCC), while histopathological examination diagnosed 24 ccRCC, four pRCC, one chRCC, and one mixed tumor of both pRCC and chRCC. Malignant tumors were statistically significantly larger than the benign (3.16 ± 1.34 cm vs. 2.00 ± 1.04 cm, P = 0.006). Conclusion This prospective study could not reproduce Cornelis et al.'s results and does not support differentiating renal masses using multiparametric MRI without percutaneous biopsy in the future. The MRI algorithm showed few promising results to categorize renal tumors, indicating histopathology for clinical decisions and follow-up regimes of renal masses are still required.
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Affiliation(s)
| | - Janni Lynggård Bo Madsen
- Research and Innovation Unit, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Jon Asmussen
- Department of Radiology, Odense University Hospital, Odense, Denmark
| | - Lars Lund
- Department of Urology, Odense University Hospital, Odense, Denmark
| | | | - Michael Pedersen
- Department of Clinical Medicine - Comparative Medicine Lab, Aarhus University Hospital, Aarhus, Denmark
| | - Birte Engvad
- Department of Pathology, Odense University Hospital, Odense, Denmark
| | - Ole Graumann
- Department of Radiology, Odense University Hospital, Odense, Denmark
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68Ga-DOTATATE PET/CT and MRI with Diffusion-Weighted Imaging (DWI) in Short- and Long-Term Assessment of Tumor Response of Neuroendocrine Liver Metastases (NELM) Following Transarterial Radioembolization (TARE). Cancers (Basel) 2021; 13:cancers13174321. [PMID: 34503131 PMCID: PMC8431353 DOI: 10.3390/cancers13174321] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 08/22/2021] [Accepted: 08/23/2021] [Indexed: 01/23/2023] Open
Abstract
Simple Summary TARE with 90Yttrium has become a valuable treatment option for patients with unresectable NELMs. However, early evaluation of therapy response remains challenging as size-based response assessments (such as RECIST) are known to be limited, especially in slow-growing tumors. Alternatives such as quantitative evaluation of SUV of 68Ga-DOTATATE PET/CT and ADC of DWI-MRI have not been compared so far. We found that early percentage changes in SUV tumor-to-organ ratios on first follow-up after TARE could predict longer HPFS in patients with NELM and were superior to ΔSUVmax/SUVmean alone or to ΔADC. Abstract The aim of this study was to evaluate the role of SUV and ADC in assessing early response in patients with NELM following TARE. Thirty-two patients with pre- and postinterventional MRI with DWI and 68Ga-DOTATATE PET/CT were included. ADC and SUV of three target lesions and of tumor-free spleen and liver tissue were determined on baseline and first follow-up imaging, and tumor to spleen (T/S) and tumor to liver (T/L) ratios were calculated. Response was assessed by RECIST 1.1 and mRECIST on first follow-up, and long-term response was defined as hepatic progression-free survival (HPFS) over 6, 12, and <24 months. In responders, intralesional ADC values increased and SUV decreased significantly regardless of standard of reference for response assessment (mRECIST/RECIST/HPFS > 6/12/24 m). Using ROC analysis, ΔSUV T/S ratio (max/max) and ΔSUV T/L ratio (max/mean) were found to be the best and most robust metrics to correlate with longer HPFS and were superior to ΔADC. ΔT/S ratio (max/max) < 23% was identified as an optimal cut-off to discriminate patients with longer HPFS (30.2 m vs. 13.4 m; p = 0.0002). In conclusion, early percentage changes in SUV tumor-to-organ ratios on first follow-up seem to represent a prognostic marker for longer HPFS and may help in assessing therapeutic strategies.
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Xia Q, Yuan X, Huang M, Zhou X, Zhou Z. Contrast-enhanced Ultrasound for Diagnosis of Renal Cystic Mass. Curr Med Imaging 2021; 18:292-298. [PMID: 34825641 DOI: 10.2174/1573405617666210719141831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 05/30/2021] [Accepted: 06/02/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND Cystic Renal Cell Carcinoma (CRCC) is often challenging to differentiate from complex cysts with sonographic manifestations of renal carcinoma. Contrast-Enhanced Ultrasound (CEUS) is a new technology, and its clinical utility in the diagnosis of renal cystic mass has not been established. OBJECTIVE To analyze the characteristics of CEUS of renal cystic masses and to explore the clinical significance and value of CEUS in the diagnosis of CRCC. METHODS This study was a retrospective study. A total of 32 cystic masses from January 2018 to December 2019 were selected. The images of conventional ultrasound (US) and CEUS were confirmed via surgical pathology. The routine US was used to observe the location, shape, size, boundary, cyst wall, internal echo, and blood supply of each cystic mass. CEUS observed contrast enhancement of the cyst wall, cystic septa, and solid nodules of cystic masses. RESULTS There were 26 cases of CRCC, 5 cases of renal cysts, and 1 case of renal tuberculosis. The enhancement pattern, degree of enhancement, and pseudocapsular sign by CEUS in benign and malignant masses had statistically significant differences (P<.05). In the diagnosis of CRCC, the sensitivity, specificity, accuracy, positive predictive value, and negative predictive value were 92.3%, 83.3%, 90.6%, 96.0%, and 71.4% for CEUS; 57.6%, 66.7%, 59.3%, 88.2%, and 26.7% for conventional US, respectively. CEUS had a higher sensitivity and accuracy than the conventional US (P<.05). However, the diagnostic specificity, positive predictive value, and negative predictive value of the two methods were not significantly different (P>.05). CONCLUSION CEUS is more accurate in the diagnosis of renal cystic masses, and it can be used as an effective imaging method.
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Affiliation(s)
- Qingqing Xia
- Department of Ultrasound, The First Affiliated Hospital of Nanchang University. China
| | - Xinchun Yuan
- Department of Ultrasound, The First Affiliated Hospital of Nanchang University, No. 17 YongWai Zheng Street, Nanchang 330006. China
| | - Meifeng Huang
- Department of Ultrasound, The First Affiliated Hospital of Nanchang University. China
| | - Xiling Zhou
- Department of Ultrasound, The First Affiliated Hospital of Nanchang University. China
| | - Zhiyu Zhou
- College of Traditional Chinese Medicine, Jiangxi University of Traditional Chinese Medicine, Nanchang 330004. China
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Chu JS, Wang ZJ. Protocol Optimization for Renal Mass Detection and Characterization. Radiol Clin North Am 2020; 58:851-873. [PMID: 32792119 DOI: 10.1016/j.rcl.2020.05.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Renal masses increasingly are found incidentally, largely due to the frequent use of medical imaging. Computed tomography (CT) and MR imaging are mainstays for renal mass characterization, presurgical planning of renal tumors, and surveillance after surgery or systemic therapy for advanced renal cell carcinomas. CT protocols should be tailored to different clinical indications, balancing diagnostic accuracy and radiation exposure. MR imaging protocols should take advantage of the improved soft tissue contrast for renal tumor diagnosis and staging. Optimized imaging protocols enable analysis of imaging features that help narrow the differential diagnoses and guide management in patients with renal masses.
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Affiliation(s)
- Jason S Chu
- Department of Radiology and Biomedical Imaging, University of California San Francisco, 505 Parnassus Avenue, Box 0628, San Francisco, CA 94143, USA
| | - Zhen J Wang
- Department of Radiology and Biomedical Imaging, University of California San Francisco, 505 Parnassus Avenue, Box 0628, San Francisco, CA 94143, USA.
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Zhang J, Suo S, Liu G, Zhang S, Zhao Z, Xu J, Wu G. Comparison of Monoexponential, Biexponential, Stretched-Exponential, and Kurtosis Models of Diffusion-Weighted Imaging in Differentiation of Renal Solid Masses. Korean J Radiol 2020; 20:791-800. [PMID: 30993930 PMCID: PMC6470087 DOI: 10.3348/kjr.2018.0474] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Accepted: 01/09/2019] [Indexed: 12/13/2022] Open
Abstract
Objective To compare various models of diffusion-weighted imaging including monoexponential apparent diffusion coefficient (ADC), biexponential (fast diffusion coefficient [Df], slow diffusion coefficient [Ds], and fraction of fast diffusion), stretched-exponential (distributed diffusion coefficient and anomalous exponent term [α]), and kurtosis (mean diffusivity and mean kurtosis [MK]) models in the differentiation of renal solid masses. Materials and Methods A total of 81 patients (56 men and 25 women; mean age, 57 years; age range, 30–69 years) with 18 benign and 63 malignant lesions were imaged using 3T diffusion-weighted MRI. Diffusion model selection was investigated in each lesion using the Akaike information criteria. Mann-Whitney U test and receiver operating characteristic (ROC) analysis were used for statistical evaluations. Results Goodness-of-fit analysis showed that the stretched-exponential model had the highest voxel percentages in benign and malignant lesions (90.7% and 51.4%, respectively). ADC, Ds, and MK showed significant differences between benign and malignant lesions (p < 0.05) and between low- and high-grade clear cell renal cell carcinoma (ccRCC) (p < 0.05). α was significantly lower in the benign group than in the malignant group (p < 0.05). All diffusion measures showed significant differences between ccRCC and non-ccRCC (p < 0.05) except Df and α (p = 0.143 and 0.112, respectively). α showed the highest diagnostic accuracy in differentiating benign and malignant lesions with an area under the ROC curve of 0.923, but none of the parameters from these advanced models revealed significantly better performance over ADC in discriminating subtypes or grades of renal cell carcinoma (RCC) (p > 0.05). Conclusion Compared with conventional diffusion parameters, α may provide additional information for differentiating benign and malignant renal masses, while ADC remains the most valuable parameter for differentiation of RCC subtypes and for ccRCC grading.
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Affiliation(s)
- Jianjian Zhang
- Department of Radiology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Shiteng Suo
- Department of Radiology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Guiqin Liu
- Department of Radiology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Shan Zhang
- Department of Radiology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Zizhou Zhao
- Department of Radiology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Jianrong Xu
- Department of Radiology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Guangyu Wu
- Department of Radiology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China.
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Apparent Diffusion Coefficient Distinguishes Malignancy in T1-Hyperintense Small Renal Masses. AJR Am J Roentgenol 2019; 214:114-121. [PMID: 31573857 DOI: 10.2214/ajr.19.21907] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
OBJECTIVE. Small renal masses (< 4 cm) can be difficult to accurately classify as benign or malignant, particularly when they appear T1 hyperintense on MRI. This intrinsic signal, potentially related to intralesional hemorrhage, may limit evaluation of signal intensity on DWI. The purpose of this study was to test whether apparent diffusion coefficient (ADC) measurements may distinguish malignancy. MATERIALS AND METHODS. This single-center retrospective study identified patients with a T1-hyperintense renal mass less than 4 cm on MRI. Malignant lesions were pathologically proven; a benign mass was established by a predefined hierarchy of pathologic proof, follow-up ultrasound, or follow-up imaging showing more than 5 years of stability. T1 hyperintensity, defined as a signal intensity equivalent to or greater than the adjacent renal cortex, was confirmed by a senior abdominal radiologist. Two additional abdominal radiologists independently measured ADC of the lesion, which was normalized to the ADC of the background ipsilateral kidney and represented as ADCratio. RESULTS. The final cohort included 58 benign and 37 malignant renal lesions in 95 patients. Interrater agreement for ADC measurements was almost perfect (κ = 0.836-0.934). ADCratio was significantly lower in malignant compared with benign lesions (0.65 ± 0.29 vs 1.03 ± 0.32; p < 0.001). Malignant lesions were significantly larger than benign lesions (2.66 ± 0.86 cm vs 1.50 ± 0.65 cm; p < 0.001); however, after controlling for lesion size, ADCratio remained a significant predictor of malignancy (p < 0.001). CONCLUSION. ADCratio was highly reproducible for T1-hyperintense small renal masses and was significantly lower in malignant compared with benign renal masses.
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Alis D, Durmaz ESM, Gulsen F, Bas A, Kabasakal L, Sager S, Numan F. Prognostic value of ADC measurements in predicting overall survival in patients undergoing 90Y radioembolization for colorectal cancer liver metastases. Clin Imaging 2019; 57:124-130. [PMID: 31220677 DOI: 10.1016/j.clinimag.2019.05.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2018] [Revised: 05/06/2019] [Accepted: 05/28/2019] [Indexed: 12/14/2022]
Abstract
AIM To assess the ability of diffusion-weighted imaging (DWI) in predicting the overall survival in patients who underwent Yttrium 90 radioembolization (90Y-RE) for colorectal liver metastases (CLM) with other well-established clinical and imaging parameters by comparing the pre- and post-treatment apparent diffusion coefficient (ADC) values of the lesions. METHODS A total of 81 metastatic lesions of 27 consecutive patients who underwent DWI before and after the 90Y-RE session were enrolled in the study. ADC values were calculated from the entire (ADCe) and peripheral (ADCp) tumor on pre- and post-treatment DWI, and any relative increase in ADC >0% accepted as a functional imaging response. The impact of functional imaging response in addition to other well-known parameters including Response Evaluation Criteria in Solid Tumors (RECIST), hepatic tumor burden, Eastern Cooperative Oncology Group performance status (ECOG-PS) and the presence of extrahepatic metastases in predicting overall survival (OS) was assessed using Kaplan-Meier curves and Cox-regression analyses. RESULTS The median OS of the patients was 10 months (range, 6-20 months) while the median OS of the responders being significantly longer than the non-responders for ADCe and ADCp (median 11 vs 7 months, P = 0.003; median 12 vs. 7 months, P < 0.0001, respectively). The RECIST score was also significantly affected the OS (progressive or stable disease median 8 months vs. partial response 15 indent months, P = 0.019). The other parameters including hepatic tumor burden, gender, ECOG score, the involvement of the liver lobes, and the presence of extrahepatic metastases were not associated with the OS. In multivariate analysis, only ADCp remained as an independent predictor of OS (P = 0.003, HR = 19.878). CONCLUSION Any increase in relative ADCp or ADCe values after Y90-RE treatment was associated with longer OS in CLM patients, and DWI seems to be valuable imaging biomarker in predicting OS in CLM patients during the early post-interventional period after 90Y-RE.
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Affiliation(s)
- Deniz Alis
- Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Department of Radiology, Istanbul, Turkey.
| | - Emine Sebnem Memis Durmaz
- Ministry of Health, Buyukcekmece Mimar Sinan Hospital, Buyukcekmece, Department of Radiology, Istanbul, Turkey
| | - Fatih Gulsen
- Istanbul University-Cerrahpasa, Cerrahpasa School of Medicine, Department of Interventional Radiology, Fatih, Istanbul, Turkey
| | - Ahmet Bas
- Istanbul University-Cerrahpasa, Cerrahpasa School of Medicine, Department of Interventional Radiology, Fatih, Istanbul, Turkey
| | - Levent Kabasakal
- Istanbul University-Cerrahpasa, Cerrahpasa School of Medicine, Department of Nuclear Medicine, Fatih, Istanbul, Turkey.
| | - Sait Sager
- Istanbul University-Cerrahpasa, Cerrahpasa School of Medicine, Department of Nuclear Medicine, Fatih, Istanbul, Turkey
| | - Furuzan Numan
- Istanbul University-Cerrahpasa, Cerrahpasa School of Medicine, Department of Interventional Radiology, Fatih, Istanbul, Turkey
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Vogel C, Ziegelmüller B, Ljungberg B, Bensalah K, Bex A, Canfield S, Giles RH, Hora M, Kuczyk MA, Merseburger AS, Powles T, Albiges L, Stewart F, Volpe A, Graser A, Schlemmer M, Yuan C, Lam T, Staehler M. Imaging in Suspected Renal-Cell Carcinoma: Systematic Review. Clin Genitourin Cancer 2019; 17:e345-e355. [DOI: 10.1016/j.clgc.2018.07.024] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Revised: 07/08/2018] [Accepted: 07/30/2018] [Indexed: 01/14/2023]
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Zhang H, Pan J, Shen Y, Bai X, Wang Y, Wang H, Ye H. High signal renal tumors on DWI: the diagnostic value of morphological characteristics. Abdom Radiol (NY) 2019; 44:239-246. [PMID: 30141057 DOI: 10.1007/s00261-018-1728-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
PURPOSE To assess the usefulness of morphological characteristics of diffusion-weighted imaging (DWI) for differentiating malignant renal tumors from benign renal tumors, and clear cell renal cell carcinoma (RCC) from non-clear cell RCC at 3.0 T. METHODS The study included 249 patients with 251 histopathologically confirmed renal tumors that showed high signal on DWI. For each tumor, two radiologists independently evaluated apparent diffusion coefficient (ADC) values and morphological characteristics of DWI. The differences in the quantitative and qualitative magnetic resonance imaging (MRI) features determined by the readers were assessed. The ADC values between malignant and benign renal tumors and between clear cell and non-clear cell RCC were compared using Mann-Whitney tests. The proportional differences of morphological characteristics of DWI between malignant and benign renal tumors and between clear cell and non-clear cell RCC were compared using Chi-square tests. RESULTS There were no significant differences in the quantitative and qualitative MRI features determined by the readers. The ADC values for malignant renal tumors were statistically significantly higher than those for benign renal tumors (p < 0.05), and the ADC values for clear cell RCC were statistically significantly higher than those for non-clear cell RCC (p < 0.05). The proportion of morphological characteristics of DWI between malignant and benign renal tumors was statistically significantly different at ring, nodular, flaky high signal. The proportion of morphological characteristics of DWI between clear cell and non-clear cell RCC was statistically significantly different at uniform high signal. CONCLUSIONS The morphological characteristics of DWI are useful in differentiating renal tumors.
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Affiliation(s)
- Hongtao Zhang
- Department of Radiology, Chinese PLA General Hospital, Fuxing Road 28, Beijing, 100853, China
- Department of Radiology, 307 Hospital, PLA, Beijing, China
| | - Jingjing Pan
- Department of Radiology, Chinese PLA General Hospital, Fuxing Road 28, Beijing, 100853, China
- Department of Radiology, General Hospital of the PLA Rocket Force, Beijing, China
| | - Yanguang Shen
- Department of Radiology, Chinese PLA General Hospital, Fuxing Road 28, Beijing, 100853, China
| | - Xu Bai
- Department of Radiology, Chinese PLA General Hospital, Fuxing Road 28, Beijing, 100853, China
| | - Yingwei Wang
- Department of Radiology, Chinese PLA General Hospital, Fuxing Road 28, Beijing, 100853, China
| | - Haiyi Wang
- Department of Radiology, Chinese PLA General Hospital, Fuxing Road 28, Beijing, 100853, China.
| | - Huiyi Ye
- Department of Radiology, Chinese PLA General Hospital, Fuxing Road 28, Beijing, 100853, China.
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Arif-Tiwari H, Kalb BT, Bisla JK, Martin DR. Classification and Diagnosis of Cystic Renal Tumors: Role of MR Imaging Versus Contrast-Enhanced Ultrasound. Magn Reson Imaging Clin N Am 2018; 27:33-44. [PMID: 30466911 DOI: 10.1016/j.mric.2018.09.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Superior soft tissue and contrast resolution of MR imaging benefits sensitivity to kidney cyst features and classification, which may have an impact on patient management and outcomes. Contrast-enhanced ultrasound (CEUS) may have nearly similar sensitivity for detection of cyst features yet is dependent on patient body habitus and adequacy of visualization windows for the kidneys, which does not have the same impact on MR imaging results. Both MR imaging and CEUS may provide superior kidney cyst assessment compared with contrast-enhanced CT; however, further research is needed, particularly for the identification of role of CEUS.
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Li Y, Wang Y, Qin J, Wu J, Dai X, Xu J. Meta-analysis of diffusion-weighted imaging in the differential diagnosis of renal lesions. Clin Imaging 2018; 52:264-272. [PMID: 30172176 DOI: 10.1016/j.clinimag.2018.08.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2018] [Revised: 07/15/2018] [Accepted: 08/13/2018] [Indexed: 01/30/2023]
Abstract
PURPOSE To assess the diagnostic value of diffusion-weighted imaging (DWI) in distinguishing between renal malignant and benign lesions. MATERIALS AND METHODS Electronic databases were systematically searched to identify original studies evaluating DWI findings on renal lesions from January 2000 through January 2018. Pooled weighted estimates of sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), and diagnostic odds ratio (DOR) were calculated. A summary receiver operator characteristic (sROC) curve was constructed to calculate the area under the sROC curve (AUC). Publication bias was assessed by using Deeks' asymmetry test. RESULTS A total of 15 studies including 1386 renal lesions were eligible in the meta-analysis. The pooled sensitivity and specificity with a corresponding 95% confidence interval (CI) were 0.83 (95% CI: 0.80-0.86) and 0.74 (95% CI: 0.71-0.78), respectively. The PLR, NLR, and DOR were 3.21 (95% CI: 2.39-4.32), 0.24 (95% CI: 0.18-0.30), and 15.95 (95% CI: 11.19-22.71), respectively. The AUC was 0.87 (95% CI: 0.84-0.90). Significant heterogeneity was observed between the included studies. Reference standard, country, and gradient factor were identified as the most important variable sources. No evidence of notable publication bias was reported. CONCLUSIONS DWI is an informative MRI modality in discriminating benign and malignant lesions and exhibits moderately high diagnostic accuracy. However, it remains inconclusive and limited in the absence of an optimal b value and ADC cutoff value. High-quality prospective studies regarding DWI have yet to be conducted to explore optimal imaging parameters and diagnostic thresholds.
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Affiliation(s)
- Yang Li
- Department of General Surgery, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200080, China
| | - Ye Wang
- Department of General Surgery, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200080, China
| | - Jun Qin
- Department of General Surgery, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200080, China
| | - Junyi Wu
- Department of General Surgery, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200080, China
| | - Xueming Dai
- Department of General Surgery, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200080, China
| | - Junming Xu
- Department of General Surgery, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200080, China.
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Hassanen O, Ghieda U, Eltomey MA. Contrast enhanced MRI and Diffusion Weighted Imaging (DWI) in the evaluation of renal cell carcinoma and differentiation of its subtypes. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2017. [DOI: 10.1016/j.ejrnm.2017.03.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Characterization of Incidental Renal Mass With Dual-Energy CT: Diagnostic Accuracy of Effective Atomic Number Maps for Discriminating Nonenhancing Cysts From Enhancing Masses. AJR Am J Roentgenol 2017; 209:W221-W230. [DOI: 10.2214/ajr.16.17325] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
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Imaging features of papillary renal cell carcinoma with cystic change-dominant appearance in the era of the 2016 WHO classification. Abdom Radiol (NY) 2017; 42:1850-1856. [PMID: 28534069 DOI: 10.1007/s00261-017-1189-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
PURPOSE Papillary renal cell carcinoma (P-RCC) typically exhibits a homogeneous, solid hypovascular mass; P-RCC with a cystic appearance is atypical. Tubulocystic RCC (TC-RCC), a newly proposed entity for renal tumors in the 2016 WHO classification, and cystic papillary RCC, may yield similar imaging findings. Therefore, we investigated the incidence of papillary RCC with cystic changes and compared its CT and pathologic features to differentiate between two entities. METHODS We retrospectively evaluated 26 consecutive patients diagnosed with P-RCC. Two radiologists consensually identified dominant masses indicative of cystic changes on CT scans and recorded their Bosniak classification. In addition, two pathologists inspected the whole area of tumors macroscopically, labeled them as solid- or cystic change-dominant tumors, determined the pathogenesis of the cystic components (necrosis or hemorrhage), and recorded their inherent cystic characteristics (with/without TC-RCC components). We defined masses with cystic changes involving more than 50% of the entire tumor as cystic change-dominant tumors. RESULTS Of the 26 tumors, 7 (27%) were diagnosed cystic change-dominant based on imaging and pathologic findings, of these, 2 were classified as Bosniak type III and 5 as Bosniak type IV. The pathologists confirmed that two type IV tumors demonstrated extensive necrosis and one type IV tumor revealed extensive hemorrhage. Four P-RCCs (type III and IV, 2 each) were of a mixed type harboring both solid and cystic components. Only one tumor exhibited a multilocular cystic appearance. All 7 cystic change-dominant P-RCCs were pathologically diagnosed as a pure P-RCC without TC-RCC components. CONCLUSION While P-RCCs may contain cystic features, the multilocular type of cystic P-RCC is rare.
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Zhong Y, Wang H, Shen Y, Guo A, Wang J, Kang S, Ma L, Pan J, Ye H. Diffusion-weighted imaging versus contrast-enhanced MR imaging for the differentiation of renal oncocytomas and chromophobe renal cell carcinomas. Eur Radiol 2017. [DOI: 10.1007/s00330-017-4906-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
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The role of magnetic resonance diffusion tensor imaging in differentiation of benign from malignant focal renal lesions. MARMARA MEDICAL JOURNAL 2017. [DOI: 10.5472/marumj.344825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Prognostic value of pretreatment diffusion-weighted magnetic resonance imaging for outcome prediction of colorectal cancer liver metastases undergoing 90Y-microsphere radioembolization. J Cancer Res Clin Oncol 2017; 143:1531-1541. [PMID: 28317063 DOI: 10.1007/s00432-017-2395-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Accepted: 03/12/2017] [Indexed: 12/15/2022]
Abstract
PURPOSE To investigate the clinical potential of pretreatment apparent diffusion coefficient (ADC) on diffusion-weighted magnetic resonance imaging (DWI) for therapy response and outcome prediction in patients with liver-predominant metastatic colorectal cancer (CRC) undergoing radioembolization with 90Yttrium-microspheres (90Y-RE). METHODS Forty-six consecutive patients with unresectable CRC liver metastases underwent standardized clinical DWI on a 1.5 T MR scanner prior to and 4-6 weeks after 90Y-RE. Pretreatment clinical parameters, ADC values derived from region-of-interest analysis, and the corresponding tumor sizes of three treated liver metastases per subject were recorded. Long-term tumor response to radioembolization was categorized into response (partial remission) and nonresponse (stable disease, progressive disease) according to Response Evaluation Criteria in Solid Tumors v1.1 (RECIST) 3 months after treatment. Associations between long-term tumor response and the clinical and imaging parameters were evaluated. The impact of pretreatment clinical and imaging parameters on progression-free survival (PFS) and overall survival (OS) was further assessed by Kaplan-Meier and multivariate Cox-regression analyses. RESULTS Nonresponders had higher hepatic tumor burden (p = 0.021) and lower ADC values than patients responding to 90Y-RE, both pretreatment (986 ± 215 vs. 1162 ± 178; p = 0.036) and posttreatment (1180 ± 350 vs. 1598 ± 225; p = 0.002). ADC values higher than 935 × 10-6 mm2 (5 vs. 3 months; p = 0.022) and hepatic tumor burden ≤25% (6 vs. 3 months; p = 0.014) were associated with longer median PFS, whereas ADC >935 × 10-6 mm2 (14 vs. 6 months; p = 0.02), hepatic tumor burden ≤25% (14 vs. 6 months; p = 0.048), size of the largest metastasis <4.7 cm (18 vs. 7 months; p = 0.024), and Eastern Cooperative Oncology Group (ECOG) score <1 (8 vs. 5 months; p = 0.045) were associated with longer median OS. On multivariate analysis, ADC >935 × 10-6 mm2 and hepatic tumor burden ≤25% remained prognostic factors for PFS, and ADC >935 × 10-6 mm2 and size of the largest metastasis <4.7 cm were independent predictors of OS. CONCLUSION Pretreatment ADC on DWI represents a valuable prognostic biomarker for predicting both the therapeutic efficacy and survival prognosis in CRC liver metastases treated by 90Y-RE, allowing risk stratification and potentially optimizing further treatment strategies.
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Abstract
PURPOSE The purpose of the study was to assess the diagnostic performance of qualitative and quantitative diffusion-weighted imaging (DWI) in differentiating benign from malignant ovarian and uterine masses. MATERIALS AND METHODS Institutional review board approval was obtained for this HIPAA-compliant retrospective study, with waiver of informed consent. DWI MRIs of 222 women acquired over 1.5 years were evaluated. Reference standard was pathology or follow-up imaging. For qualitative assessment, two radiologists independently reviewed DWI and apparent diffusion coefficient (ADC) images for diffusion restriction. Differences were resolved by consensus. For quantitative assessment, a single reader measured ADC values. Readers were blinded to the reference standard. RESULTS 222 lesions, 121 ovarian (99 benign and 22 malignant) and 101 uterine (54 benign and 47 malignant), were included. Final diagnosis was established with pathology in 129 (58%) or with imaging follow-up in 93 (42%). Mean (range) follow-up interval was 27 (13-48) months. Qualitative assessment yielded sensitivity (ratio, 95% CI), specificity, PPV and NPV of 100% (22/22, 85-100), 68% (68/99, 58-76), 41% (22/54, 27-54), and 100% (68/68, 94-100) for ovarian and 94% (44/47, 83-98), 91% (49/54, 80-96), 90% (44/49, 78-95) and 94% (49/52, 84-98) for uterine malignancies. ADC (mean ± SD) between benign ovarian [(1.11 ± 0.76) × 10-3 mm2/s] vs. malignant [(0.71 ± 0.26) × 10-3 mm2/s] lesions was significantly different (p < 0.001). ADC cutoff value of 1.55 × 10-3 mm2/s for ovarian lesions resulted in 99.9% confidence for the absence of malignancy. ADC (mean ± SD) of benign uterine [(0.64 ± 0.38) × 10-3 mm2/s] vs. malignant [(0.68 ± 0.19) × 10-3 mm2/s] lesions was not significantly different (P < 0.54). CONCLUSION Quantitative and qualitative DWI assessment can be used to confidently characterize a subset of ovarian lesions as benign. With uterine lesions, although DWI is useful in differentiating benign from malignant lesions, the technique does not allow for definitive quantitative characterization.
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Visual Assessment of the Intensity and Pattern of T1 Hyperintensity on MRI to Differentiate Hemorrhagic Renal Cysts From Renal Cell Carcinoma. AJR Am J Roentgenol 2016; 208:337-342. [PMID: 27845847 DOI: 10.2214/ajr.16.16710] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVE The purpose of this study was to apply a visual assessment of the intensity and pattern of T1 hyperintensity at MRI to differentiate hemorrhagic renal cysts from renal cell carcinoma (RCC). MATERIALS AND METHODS A total of 144 T1-hyperintense renal lesions (62 cysts, all showing no enhancement on subtracted contrast-enhanced images and either 2-year stability or unenhanced CT density > 70 HU, and 82 histologically confirmed RCCs) in 144 patients were included. Two radiologists independently characterized qualitative features of the T1 hyperintensity in each lesion on unenhanced T1-weighted images. An additional radiologist placed ROIs to measure lesions' T1 signal intensity normalized to that of the psoas muscle. Chi-square and unpaired t tests were performed to compare the pattern of T1 hyperintensity between groups. RESULTS The T1 hyperintensity was considered marked in 62.9% of cysts and 17.1% of RCCs for reader 1 and in 46.8% of cysts and 8.5% of RCCs for reader 2 (p < 0.001). The T1 hyperintensity exhibited a diffusely homogeneous distribution in 88.7% of cysts and 7.3% of RCCs for reader 1 and in 72.6% of cysts and 4.9% of RCCs for reader 2 (p < 0.001). The combination of both diffusely homogeneous distribution and marked degree of T1 hyperintensity achieved sensitivities of 40.3-56.5%, specificities of 97.6-98.8%, and accuracies of 73.6-79.9% for the diagnosis of T1-hyperintense cysts. The two cases of RCC exhibiting this imaging pattern for at least one reader were both papillary RCCs. Normalized signal intensity was 2.39 ± 0.99 in T1-hyperintense cysts versus 2.12 ± 0.84 in T1-hyperintense RCCs (p = 0.088). CONCLUSION Diffuse T1 hyperintensity, particularly when marked, strongly indicates a hemorrhagic cyst rather than an RCC. Deferral of follow-up imaging may be considered when this imaging appearance is encountered at unenhanced MRI.
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Yamamoto A, Tamada T, Ito K, Sone T, Kanki A, Tanimoto D, Noda Y. Differentiation of subtypes of renal cell carcinoma: dynamic contrast-enhanced magnetic resonance imaging versus diffusion-weighted magnetic resonance imaging. Clin Imaging 2016; 41:53-58. [PMID: 27816876 DOI: 10.1016/j.clinimag.2016.10.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2016] [Revised: 09/16/2016] [Accepted: 10/03/2016] [Indexed: 11/27/2022]
Abstract
OBJECTIVE The objective was to compare the performance of dynamic contrast-enhanced (DCE) and diffusion-weighted (DW) magnetic resonance (MR) imaging in the differentiation of subtypes of renal cell carcinoma (RCC). MATERIALS/METHODS This study included 45 renal tumors of clear cell (n=36) and non-clear-cell (n=9) RCC. The contrast enhancement ratios (CERs) and the apparent diffusion coefficient (ADC) values on MR imaging were compared between the clear cell and non-clear-cell RCC groups. RESULTS In the comparison of diagnostic performance between DCE and DW MR imaging, areas under the curves were 0.968 and 0.797 for the CERs of the corticomedullary and the ADC value. CONCLUSION The CER of the corticomedullary phase was more reliable in distinguishing between clear cell and non-clear-cell RCCs.
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Affiliation(s)
- Akira Yamamoto
- Department of Radiology, Kawasaki Medical School, Kurashiki, Japan.
| | - Tsutomu Tamada
- Department of Radiology, Kawasaki Medical School, Kurashiki, Japan
| | - Katsuyoshi Ito
- Department of Radiology, Kawasaki Medical School, Kurashiki, Japan
| | - Teruki Sone
- Department of Radiology, Kawasaki Medical School, Kurashiki, Japan
| | - Akihiko Kanki
- Department of Radiology, Kawasaki Medical School, Kurashiki, Japan
| | - Daigo Tanimoto
- Department of Radiology, Kawasaki Medical School, Kurashiki, Japan
| | - Yasufumi Noda
- Department of Radiology, Kawasaki Medical School, Kurashiki, Japan
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Zhang H, Gan Q, Wu Y, Liu R, Liu X, Huang Z, Yuan F, Kuang M, Song B. Diagnostic performance of diffusion-weighted magnetic resonance imaging in differentiating human renal lesions (benignity or malignancy): a meta-analysis. Abdom Radiol (NY) 2016; 41:1997-2010. [PMID: 27271218 DOI: 10.1007/s00261-016-0790-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
PURPOSE This study aims to quantitatively evaluate the potential of diffusion-weighted magnetic resonance imaging (DW-MRI) for differentiating malignant and benign human renal lesions. MATERIALS AND METHODS A systematic literature was performed to identify previous research related to the diagnostic performance of DW-MRI for determining whether human renal lesions were benign or malignant. ADC values were extracted from normal renal tissue and different lesion types. Data were extracted to assess the diagnostic performance of DW-MRI for differentiating malignant and benign human renal lesions, as well as running threshold effect and heterogeneity. RESULTS Nine publications with 11 subsets were eligible for data extraction and diagnostic performance calculation. A total of 988 apparent diffusion coefficient (ADC) measurements were included. The differences in ADC values between benign lesions (2.47 ± 0.81 × 10(-3) mm(2)/s) and malignant lesions (1.81 ± 0.41 × 10(-3) mm(2)/s) were statistically significant (P < 0.001). The diagnostic odds ratio, the overall positive, negative likelihood ratios, pooled weighted sensitivity and specificity with 95% CI were 20.05 (95% CI 12.56-32.02), 3.32 (95% CI 2.13-5.18), 0.20 (95% CI 0.15-0.27), 88% (95% CI 0.84-0.91) and 72% (95% CI 0.67-0.76), respectively. The area under the curve of the summary receiver operating characteristic was 0.90. CONCLUSIONS This meta-analysis indicated that DW-MRI had a relatively good diagnostic accuracy in differentiating malignant and benign human renal lesions. We preliminarily recommend that DW-MRI is performed with a maximum b value ranging from 800 to 1000 s/mm(2) at 3.0 T for imaging protocol, and that DW-MRI should be used with caution when the study population includes children.
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Affiliation(s)
- Hanmei Zhang
- Department of Radiology, West China Hospital, Sichuan University, No. 37, Guo Xue Xiang, Chengdu, 610041, Sichuan, China
| | - Qi Gan
- Department of Neurosurgery, West China Hospital, Sichuan University, No. 37, Guo Xue Xiang, Chengdu, 610041, Sichuan, China
| | - Yinghua Wu
- Department of Radiology, The Second Clinical Medicine School, Chengdu University of Traditional Chinese Medicine, No. 15, Section 4 Renmin South Road, Chengdu, 610041, Sichuan, China
| | - Rongbo Liu
- Department of Radiology, West China Hospital, Sichuan University, No. 37, Guo Xue Xiang, Chengdu, 610041, Sichuan, China
| | - Xijiao Liu
- Department of Radiology, West China Hospital, Sichuan University, No. 37, Guo Xue Xiang, Chengdu, 610041, Sichuan, China
| | - Zixing Huang
- Department of Radiology, West China Hospital, Sichuan University, No. 37, Guo Xue Xiang, Chengdu, 610041, Sichuan, China
| | - Fang Yuan
- Department of Radiology, West China Hospital, Sichuan University, No. 37, Guo Xue Xiang, Chengdu, 610041, Sichuan, China
| | - Min Kuang
- Department of Radiology, The Second Clinical Medicine School, Chengdu University of Traditional Chinese Medicine, No. 15, Section 4 Renmin South Road, Chengdu, 610041, Sichuan, China
| | - Bin Song
- Department of Radiology, West China Hospital, Sichuan University, No. 37, Guo Xue Xiang, Chengdu, 610041, Sichuan, China.
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Diffusion-weighted magnetic resonance imaging predicts survival in patients with liver-predominant metastatic colorectal cancer shortly after selective internal radiation therapy. Eur Radiol 2016; 27:966-975. [DOI: 10.1007/s00330-016-4430-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2015] [Revised: 03/15/2016] [Accepted: 05/20/2016] [Indexed: 12/14/2022]
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Inci MF, Kalayci TO, Tan S, Karasu S, Albayrak E, Cakir V, Ocal I, Ozkan F. Diagnostic value of strain elastography for differentiation between renal cell carcinoma and transitional cell carcinoma of kidney. Abdom Radiol (NY) 2016; 41:1152-9. [PMID: 26880174 DOI: 10.1007/s00261-016-0658-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
PURPOSE The objective of our study was to prospectively evaluate the diagnostic performance of strain elastography for differentiation between renal cell carcinomas (RCCs) and transitional cell carcinomas (TCCs) of kidney. METHODS A total of 99 consecutive patients who were referred to our hospital because of a newly diagnosed solid renal mass suspicious for malignancy on radiological screenings were evaluated with sonography, including strain elastography. Strain elastography was used to compare the stiffness of the renal masses and renal cortex. The ratio of strain in a renal mass and nearby renal cortex was defined as the strain index value. Mean strain index values for RCCs and TCCs were compared, and mean strain index values between histological subtypes of RCC were also compared. RESULTS Although TCCs were smaller than RCCs (p < 0.001), there were no significant differences in gender distribution and mean age of the patients, and mean probe-tumor distance between RCC and TCC. The mean strain index value ±SD for TCC (5.18 ± 1.12) was significantly higher than the value for RCC (4.04 ± 0.72; p < 0.001). Mean strain index value for papillary cell carcinomas (4.09 ± 0.45) was slightly higher than that for clear cell carcinomas (3.85 ± 0.78): however, the difference was not statistically significant (p = 0.51). CONCLUSIONS Strain elastography can be used as a valuable imaging technique for preoperative differentiation between RCC and TCC of kidney.
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Affiliation(s)
- Mehmet Fatih Inci
- Department of Radiology, Izmir Katip Çelebi University, School of Medicine, Izmir, Turkey.
- Department of Radiology, Atatürk Training and Research Hospital, Izmir Katip Celebi University, Polat Caddesi, Karabaglar, Izmir, 35160, Turkey.
| | - Tugce Ozlem Kalayci
- Department of Radiology, Atatürk Training and Research Hospital, Izmir Katip Celebi University, Polat Caddesi, Karabaglar, Izmir, 35160, Turkey
| | - Sinan Tan
- Department of Radiology, Kırıkkale University, School of Medicine, Kırıkkale, Turkey
| | - Sebnem Karasu
- Department of Radiology, Atatürk Training and Research Hospital, Izmir Katip Celebi University, Polat Caddesi, Karabaglar, Izmir, 35160, Turkey
| | - Eda Albayrak
- Department of Radiology, Gaziosmanpasa University, School of Medicine, Tokat, Turkey
| | - Volkan Cakir
- Department of Radiology, Izmir Katip Çelebi University, School of Medicine, Izmir, Turkey
| | - Irfan Ocal
- Department of Pathology, Izmir Katip Çelebi University, School of Medicine, Izmir, Turkey
| | - Fuat Ozkan
- Department of Radiology, Okmeydanı Education and Research Hospital, Istanbul, Turkey
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Abstract
PURPOSE The purpose of the study is to provide an update on the imaging evaluation of cystic renal masses, to review benign and malignant etiologies of cystic renal masses, and to review current controversies and future directions in the management of these lesions. CONCLUSIONS Cystic renal masses are relatively common in daily practice. The Bosniak classification is a time-proven method for the imaging classification and management of these lesions. Knowledge of the pathognomonic features of certain benign Bosniak 2F/3 lesions is important to avoid surgery on these lesions (e.g., localized cystic disease, renal abscess). For traditionally surgical Bosniak lesions (Classes 3 and 4), there are evolving data that risk stratification based on patient demographics, imaging size, and appearance may allow for expanded management options including tailored surveillance or ablation, along with the traditional surgical approach.
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Affiliation(s)
- Nicole M Hindman
- Department of Radiology, NYU School of Medicine, 660 First Avenue, New York, NY, 10016, USA.
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Usefulness of diffusion-weighted magnetic resonance imaging for the characterization of benign and malignant renal lesions. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2016. [DOI: 10.1016/j.ejrnm.2015.10.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
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Feng Q, Ma Z, Zhang S, Wu J. Usefulness of diffusion tensor imaging for the differentiation between low-fat angiomyolipoma and clear cell carcinoma of the kidney. SPRINGERPLUS 2016; 5:12. [PMID: 26759751 PMCID: PMC4700039 DOI: 10.1186/s40064-015-1627-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/26/2015] [Accepted: 12/17/2015] [Indexed: 01/03/2023]
Abstract
To investigate the value of apparent diffusion coefficient (ADC) and fractional anisotropy (FA) in differentiating clear-cell renal cell carcinoma (CCRCC) from low-fat renal angiomyolipomas (RAML), and to obtain the optimal b value. Fifty patients, including 30 cases of CCRCC and 20 cases of low-fat RAML, were retrospectively recruited to participate in this study. Before renal nephrectomy, all subjects underwent functional magnetic resonance imaging. For diffusion tensor imaging (DTI), a respiratory-triggered coronal echo planar imaging sequence was performed with three groups of different b values (0 and 400, 600, and 800). The ADC and FA of kidneys were analyzed and compared between different b values using analysis of variance. Receiver operation characteristic analysis was computed to assess the diagnostic performance of ADC and FA in differentiating low-fat RAML from CCRCC and to determine the optimal b values. With either CCRCC or low-fat RAML, the ADC values decreased with increased b values and significant differences were observed (F = 11.34, 23.15, P < 0.05), while the FA values were not significantly different (F = 0.28, 2.80, P > 0.05). The statistical differences in ADC, and the FA values for CCRCC and low-fat RAML were significantly different (P < 0.05). When the b value was 0.800 s/mm2, the cutoff FA value for differentiating CCRCC from low-fat RAML was 0.254 × 10.3 mm2/s, and had a sensitivity of 100 %, and a specificity of 73.3 %. MR-DTI can be used to differentiate CCRCC from low-fat RAML.
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Affiliation(s)
- Qiang Feng
- Department of Radiology, Affiliated Yidu Central Hospital, Weifang Medical University, Weifang, 262500 Shandong People's Republic of China
| | - Zhijun Ma
- Department of Radiology, Affiliated Yidu Central Hospital, Weifang Medical University, Weifang, 262500 Shandong People's Republic of China
| | - Sujuan Zhang
- Department of Radiology, Affiliated Yidu Central Hospital, Weifang Medical University, Weifang, 262500 Shandong People's Republic of China
| | - Jianlin Wu
- Affiliated zhongshan Hospital, Dalian University, No. 6 jiefang Road, Zhongshan District, Dalian, 116001 Liaoning People's Republic of China
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Rona G, Pasaoglu L, Ozkayar N, Ciliz D, Toprak U, Kaya T, Abat G. Functional evaluation of secondary renal amyloidosis with diffusion-weighted MR imaging. Ren Fail 2016; 38:249-55. [PMID: 26727603 DOI: 10.3109/0886022x.2015.1128252] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVES This study evaluated whether diffusion-weighted magnetic resonance imaging (DW-MRI) can be used to diagnose secondary renal amyloidosis looking specifically at the diagnostic efficacy of two apparent diffusion coefficient (ADC) measurement methods as they were used with DW-MRI. METHODS The study included 24 amyloid nephropathy (AN) patients, 20 chronic kidney disease (CKD) patients, and 20 healthy volunteers (HV). ADC values were measured using two different methods: 1) the method of the region of interest indicators (ROIs) and 2) the method of drawing whole renal parenchyma (WP). The correlation between the two methods was evaluated. RESULTS ROIs could differentiate AN-CKD (p = 0.007). ROIs and WP could differentiate AN-HV (p < 0.05). However, none of the methods could differentiate CKD-HV (p > 0.05). The sensitivity and specificity of the ROIs method in differentiating AN from CKD patients for 1.8 × 10(-3) cutoff ADC values were 79% and 60% and for AN-HV patients 79% and 70%. ADC values of AN patients with GFR > 60 mL/min were lower than that of HV (p < 0.01). CONCLUSION DW-MRI is a useful and non-invasive diagnostic tool in diagnosing secondary renal amyloidosis and differentiating renal amyloidosis from other CKDs. ROIs had the highest sensitivity and specificity for assessing the involvement of renal amyloidosis. MRI diagnosis of AN may obviate a renal biopsy for diagnosis.
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Affiliation(s)
- Gunay Rona
- a Ankara Numune Egitim Ve Arastirma Hastanesi , Ankara , Turkey
| | - Lale Pasaoglu
- a Ankara Numune Egitim Ve Arastirma Hastanesi , Ankara , Turkey
| | - Nihal Ozkayar
- a Ankara Numune Egitim Ve Arastirma Hastanesi , Ankara , Turkey
| | - Deniz Ciliz
- a Ankara Numune Egitim Ve Arastirma Hastanesi , Ankara , Turkey
| | - Ugur Toprak
- a Ankara Numune Egitim Ve Arastirma Hastanesi , Ankara , Turkey
| | - Tunca Kaya
- a Ankara Numune Egitim Ve Arastirma Hastanesi , Ankara , Turkey
| | - Gizem Abat
- a Ankara Numune Egitim Ve Arastirma Hastanesi , Ankara , Turkey
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Ye J, Kumar BS, Li XB, Li HM, Zhou YW, Liu LQ. Clinical applications of diffusion-weighted magnetic resonance imaging in diagnosis of renal lesions - a systematic review. Clin Physiol Funct Imaging 2015; 37:459-473. [PMID: 26648310 DOI: 10.1111/cpf.12313] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2015] [Accepted: 09/21/2015] [Indexed: 01/07/2023]
Abstract
Diffusion-weighted magnetic resonance imaging (DW-MRI) is an established technique to detect the changes of the diffusion of water in biological tissues and reflect the pathophysiological process on the molecular level. It is a promising non-invasive imaging modality in detection of microstructural and functional changes in pathologies of kidney. To systematically review the research advancement of the DW-MRI in diagnosis of renal lesions, a systematic literature search was performed up to 8 October 2014 using the MEDLINE/PubMed and Embase databases for articles reporting on DW-MRI in diagnosis of renal lesions. Only articles with full data about DW-MRI application with potential implication in solving usually encountered clinical challenges about renal lesions were finally examined. The clinical application of DW-MRI allows a better understanding of some pathologic conditions of the kidney including renal insufficiency, renal artery stenosis, ureteral obstruction, foetal kidney disease, hydronephrosis and pyonephrosis. In addition, DW-MRI can also provide clinicians with the information of function evaluation of renal allograft and curative effect assessment of renal tumour. In summary, performance of renal DW-MRI, presuming that measurements are high quality, will further boost this modality, particularly for early detection of diffusion renal conditions, as well as more accurate characterization of renal lesions.
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Affiliation(s)
- Jing Ye
- Department of Imaging, Northern Jiangsu People's Hospital, Yangzhou, China
| | | | - Xiao-Bo Li
- Department of Neurology, Northern Jiangsu People's Hospital, Yangzhou, China
| | - Hong-Mei Li
- Department of Imaging, Northern Jiangsu People's Hospital, Yangzhou, China
| | - Ying-Wen Zhou
- Department of Imaging, Northern Jiangsu People's Hospital, Yangzhou, China
| | - Li-Qin Liu
- Department of Oncology, Northern Jiangsu People's Hospital, Yangzhou, China
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Le J, Flusberg M, Rozenblit AM, Chernyak V. T1-hyperintense renal lesions: can high signal predict lack of enhancement? ACTA ACUST UNITED AC 2015; 40:3175-81. [DOI: 10.1007/s00261-015-0539-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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DWI for Renal Mass Characterization: Systematic Review and Meta-Analysis of Diagnostic Test Performance. AJR Am J Roentgenol 2015. [DOI: 10.2214/ajr.14.13930] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
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Comparison of Utility of Histogram Apparent Diffusion Coefficient and R2* for Differentiation of Low-Grade From High-Grade Clear Cell Renal Cell Carcinoma. AJR Am J Roentgenol 2015. [PMID: 26204307 DOI: 10.2214/ajr.14.13802] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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Göya C, Hamidi C, Bozkurt Y, Yavuz A, Kuday S, Gümüş H, Türkçü G, Hattapoğlu S, Bilici A. The Role of Apparent Diffusion Coefficient Quantification in Differentiating Benign and Malignant Renal Masses by 3 Tesla Magnetic Resonance Imaging. Balkan Med J 2015; 32:273-8. [PMID: 26185715 DOI: 10.5152/balkanmedj.2015.15475] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2014] [Accepted: 12/18/2014] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Diffusion-weighted magnetic resonance imaging (DWI) is a widely-accepted diagnostic modality whose efficacy has been investigated by numerous past studies in the differentiation of malignant lesions from benign entities. AIMS The aim of this study was to evaluate the efficiency of diffusion-weighted magnetic resonance imaging in the characterization of renal lesions. STUDY DESIGN Diagnostic accuracy study. METHODS A total of 137 patients with renal lesions were included in this study. The median apparent diffusion coefficient (ADC) values as well as the b 800 and b 1600 signal intensities of normal kidneys, solid components of mixed renal masses, and total cystic lesions were evaluated. RESULTS There were significant differences between the ADC values of lesions and normal renal parenchyma, and between the ADC values of benign and malignant renal lesions on DWIs at b values of 800 and 1600 s/mm(2) (p<0.001 and p<0.001, respectively). There were significant differences between the ADC values of Bosniak Category 1 and 2 cysts and the ADC values of Bosniak Category 1 and 3 cysts on DWIs at b values of 800 s/mm(2) (p<0.001) and 1600 s/mm(2) (p<0.001). A cutoff value of 1.902 × 10(-3) mm(2)/s for the ADC with a b value of 800 s/mm(2) provided 88% sensitivity and 96% specificity for differentiation between benign and malignant renal lesions. A cutoff value of 1.623 × 10(-3) mm(2)/s for the ADC with a b value of 1600 s/mm(2) provided 79% sensitivity and 96% specificity (p<0.001) for the differentiation between benign and malignant renal lesions. CONCLUSION Accurate assessment of renal masses is important for determining the necessity for surgical intervention. DWI provides additional value by differentiating benign from malignant renal tumors and can be added to routine kidney MRI protocols.
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Affiliation(s)
- Cemil Göya
- Department of Radiology, Dicle University Faculty of Medicine, Diyarbakır, Turkey
| | - Cihad Hamidi
- Department of Radiology, Dicle University Faculty of Medicine, Diyarbakır, Turkey
| | - Yaşar Bozkurt
- Department of Urology, Dicle University Faculty of Medicine, Diyarbakır, Turkey
| | - Alpaslan Yavuz
- Department of Radiology, Yüzüncü Yıl University Faculty of Medicine, Van, Turkey
| | - Suzan Kuday
- Department of Radiology, Bismil State Hospital, Diyarbakır, Turkey
| | - Hatice Gümüş
- Department of Radiology, Dicle University Faculty of Medicine, Diyarbakır, Turkey
| | - Gül Türkçü
- Department of Pathology, Dicle University Faculty of Medicine, Diyarbakır, Turkey
| | - Salih Hattapoğlu
- Department of Radiology, Dicle University Faculty of Medicine, Diyarbakır, Turkey
| | - Aslan Bilici
- Department of Radiology, Dicle University Faculty of Medicine, Diyarbakır, Turkey
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Low-dose gadobenate dimeglumine-enhanced MRI of the kidney for the differential diagnosis of localized renal lesions. Radiol Med 2015; 120:1100-11. [PMID: 26088468 PMCID: PMC4646924 DOI: 10.1007/s11547-015-0548-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2015] [Accepted: 04/28/2015] [Indexed: 02/06/2023]
Abstract
Objective To evaluate low-dose gadobenate dimeglumine-enhanced MRI for the differential diagnosis of malignant renal tumors. Methods Sixty-two consecutive patients with unclear diagnosis at MDCT/ultrasound underwent dynamic CE-MRI of the kidneys with 0.05 mmol/kg gadobenate dimeglumine. Retrospective image evaluation was performed by two blinded readers. Lesion diagnosis at CE-MRI was correlated with findings from histology following tumor resection or from imaging follow-up after at least 1 year. Assessments were performed of diagnostic quality and level of diagnostic information. Results Thirty-nine (63 %) patients were correctly diagnosed with malignant lesions (36 with RCC, 2 with renal metastases, 1 with lymphoma) while 14 (22.6 %) patients were correctly diagnosed with benign (n = 12) or no (n = 2) lesions. Eight patients were considered false positive (5 with oncocytoma, 3 with atypical AML) and 1 patient false negative (atypical RCC). The sensitivity, specificity, accuracy, PPV, and NPV for the diagnosis of malignant renal lesions were 97.5 % (39/40), 63.6 % (14/22), 85.5 % (53/62), 83.0 % (39/47), and 93.3 % (14/15), respectively. Images were excellent in 60 and good in 2 patients. Minimal artifacts that did not compromise diagnosis were noted in 4/62 patients. Conclusion Low-dose gadobenate dimeglumine-enhanced MRI is effective for the differential diagnosis of malignant renal tumors.
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Zhang HM, Wu YH, Gan Q, Lyu X, Zhu XL, Kuang M, Liu RB, Huang ZX, Yuan F, Liu XJ, Song B. Diagnostic Utility of Diffusion-weighted Magnetic Resonance Imaging in Differentiating Small Solid Renal Tumors (≤ 4 cm) at 3.0T Magnetic Resonance Imaging. Chin Med J (Engl) 2015; 128:1444-9. [PMID: 26021498 PMCID: PMC4733766 DOI: 10.4103/0366-6999.157648] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND The aim of this study was to assess the performance of apparent diffusion coefficient (ADC) measurement obtained with diffusion-weighted magnetic resonance imaging (DW-MRI) to distinguish renal cell carcinomas (RCCs) from small benign solid renal tumors (≤ 4 cm). METHODS In this cross-sectional study, 49 consecutive patients with histopathologically confirmed small solid renal tumors, and seven healthy volunteers were imaged using nonenhanced MRI and DW-MRI. The ADC map was calculated using the b values of 0, 50, 400, and 600 s/mm 2 and values compared via the Kruskal-Wallis and Mann-Whitney tests. The utility of ADC for differentiating RCCs and benign lesions was assessed using a receiver operating characteristic curve. Multiple nonenhanced MRI features were analyzed by Logistic regression. RESULTS The tumors consisted of 33 cases of clear-cell RCCs (ccRCCs) and 16 cases of benign tumors, including 14 cases of minimal fat angiomyolipomas and 2 cases of oncocytomas. The ADCs showed significant differences among benign tumors ([0.90 ± 0.52] × 10-3 mm 2 /s), ccRCCs ([1.53 ± 0.31] × 10-3 mm 2 /s) and the normal renal parenchyma ([2.22 ± 0.12] × 10-3 mm 2 /s) (P < 0.001). Moreover, there was statistically significant difference between high and low-grade ccRCCs (P = 0.004). Using a cut-off ADC of 1.36 × 10-3 mm 2 /s, DW-MRI resulted in an area under the curve (AUC), sensitivity, and specificity equal to 0.839, 75.8%, and 87.5%, respectively. Nonenhanced MRI alone and the combination of imaging methods led to an AUC, sensitivity and specificity equal to 0.919, 93.9%, and 81.2%, 0.998, 97%, and 100%, respectively. The Logistic regression showed that the location of the center of the tumor (inside the contour of the kidney) and appearance of stiff blood vessel were significantly helpful for diagnosing ccRCCs. CONCLUSIONS DW-MRI has potential in distinguishing ccRCCs from benign lesions in human small solid renal tumors (≤ 4 cm), and in increasing the accuracy for diagnosing ccRCCs when combined with nonenhanced MRI.
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Affiliation(s)
- Han-Mei Zhang
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China
| | - Ying-Hua Wu
- Department of Radiology, The Second Clinical Medicine School, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan 610041, China
| | - Qi Gan
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China
| | - Xiao Lyu
- Department of Urology, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China
| | - Xiang-Lan Zhu
- Department of Pathology, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China
| | - Min Kuang
- Department of Radiology, The Second Clinical Medicine School, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan 610041, China
| | - Rong-Bo Liu
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China
| | - Zi-Xing Huang
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China
| | - Fang Yuan
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China
| | - Xi-Jiao Liu
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China
| | - Bin Song
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China
- Address for correspondence: Dr. Bin Song, Department of Radiology, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China E-Mail:
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Approach to Very Small (< 1.5 cm) Cystic Renal Lesions: Ignore, Observe, or Treat? AJR Am J Roentgenol 2015; 204:1182-9. [DOI: 10.2214/ajr.15.14357] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Diagnostic Significance of Diffusion-Weighted MRI in Renal Cancer. BIOMED RESEARCH INTERNATIONAL 2015; 2015:172165. [PMID: 26064881 PMCID: PMC4430628 DOI: 10.1155/2015/172165] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/28/2014] [Accepted: 01/16/2015] [Indexed: 12/21/2022]
Abstract
Background. This study aimed to investigate whether diffusion-weighted imaging (DWI) could contribute to the discrimination between benign and malignant renal cancer. Methods. We searched the PubMed electronic database for eligible studies. STATA 12.0 software was used for statistical analysis. The SMD and 95% CI were calculated. Results. Decreased ADC signal was seen in all renal cancer patients (cancer tissue versus normal tissue: SMD = 1.63 and 95% CI = 0.96~2.29, P < 0.001; cancer tissue versus benign tissue: SMD = 2.22 and 95% CI = 1.53~2.90 and P < 0.001, resp.). MRI machine type-stratified analysis showed that decreased ADC signal was found by all included MRI machine types in cancer tissues compared with benign cancer tissues (all P < 0.05). The ADC values of renal cancer patients were significantly lower than those of normal controls for all included P values (all P < 0.05), and there was a decreased ADC signal at b-500, b-600, b-1000, b-500, and 1000 gradients compared with benign cancer tissues (all P < 0.05). Conclusion. Our study concluded that decreased ADC signal presented in DWI may be essential for the differential diagnosis of renal cancer.
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Liu JH, Tian SF, Ju Y, Li Y, Chen AL, Chen LH, Liu AL. Apparent diffusion coefficient measurement by diffusion weighted magnetic resonance imaging is a useful tool in differentiating renal tumors. BMC Cancer 2015; 15:292. [PMID: 25886301 PMCID: PMC4403953 DOI: 10.1186/s12885-015-1221-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2014] [Accepted: 03/19/2015] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND To determine the clinical value of apparent diffusion coefficient (ADC) measurement by diffusion weighted magnetic resonance imaging (DW-MRI) in differentiating renal tumors. METHODS Electronic databases were searched using combinations of keywords and free words relating to renal tumor, ADC and DW-MRI. Based on carefully selected inclusion and exclusion criteria, relevant case-control studies were identified and the related clinical data was acquired. Statistical analyses were performed using STATA 12.0 (Stata Corporation, College station, TX). RESULTS Sixteen case-control studies were ultimately included in the present meta-analysis. These 16 high quality studies contained a combined total of 438 normal renal tissues and 832 renal tumor lesions (597 malignant and 235 benign). The results revealed that ADC values of malignant renal tumor tissues were markedly lower than normal renal tissues and benign renal tumor tissues. ADC values of benign renal tumor tissues were also significantly lower than normal renal tissue. CONCLUSIONS ADC measurement by DW-MRI provided clinically useful information on the internal structure of renal tumors and could be an important radiographic index for differentiation of malignant renal tumors from benign renal tumors.
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Affiliation(s)
- Jing-Hong Liu
- Department of Radiology, The First Affiliated Hospital of Dalian Medical University, Zhongshan Road No. 222, Xigang District, Dalian, 116011, P. R China.
| | - Shi-Feng Tian
- Department of Radiology, The First Affiliated Hospital of Dalian Medical University, Zhongshan Road No. 222, Xigang District, Dalian, 116011, P. R China.
| | - Ye Ju
- Department of Radiology, The First Affiliated Hospital of Dalian Medical University, Zhongshan Road No. 222, Xigang District, Dalian, 116011, P. R China.
| | - Ye Li
- Department of Radiology, Dalian Medical University, Dalian, 116044, P. R China.
| | - An-Liang Chen
- Department of Radiology, Dalian Medical University, Dalian, 116044, P. R China.
| | - Li-Hua Chen
- Department of Radiology, Dalian Medical University, Dalian, 116044, P. R China.
| | - Ai-Lian Liu
- Department of Radiology, The First Affiliated Hospital of Dalian Medical University, Zhongshan Road No. 222, Xigang District, Dalian, 116011, P. R China.
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Chavhan GB, Alsabban Z, Babyn PS. Diffusion-weighted imaging in pediatric body MR imaging: principles, technique, and emerging applications. Radiographics 2015; 34:E73-88. [PMID: 24819803 DOI: 10.1148/rg.343135047] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Diffusion-weighted (DW) imaging is an emerging technique in body imaging that provides indirect information about the microenvironment of tissues and lesions and helps detect, characterize, and follow up abnormalities. Two main challenges in the application of DW imaging to body imaging are the decreased signal-to-noise ratio of body tissues compared with neuronal tissues due to their shorter T2 relaxation time, and image degradation related to physiologic motion (eg, respiratory motion). Use of smaller b values and newer motion compensation techniques allow the evaluation of anatomic structures with DW imaging. DW imaging can be performed as a breath-hold sequence or a free-breathing sequence with or without respiratory triggering. Depending on the mobility of water molecules in their microenvironment, different normal tissues have different signals at DW imaging. Some normal tissues (eg, lymph nodes, spleen, ovarian and testicular parenchyma) are diffusion restricted, whereas others (eg, gallbladder, corpora cavernosa, endometrium, cartilage) show T2 shine-through. Epiphyses that contain fatty marrow and bone cortex appear dark on both DW images and apparent diffusion coefficient maps. Current and emerging applications of DW imaging in pediatric body imaging include tumor detection and characterization, assessment of therapy response and monitoring of tumors, noninvasive detection and grading of liver fibrosis and cirrhosis, detection of abscesses, and evaluation of inflammatory bowel disease.
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Affiliation(s)
- Govind B Chavhan
- From the Department of Diagnostic Imaging, The Hospital for Sick Children and University of Toronto, 555 University Ave, Toronto, ON, Canada M5G 1X8 (G.B.C., Z.A.); and Department of Medical Imaging, Royal University Hospital, Saskatoon, Canada (P.S.B.)
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Mytsyk Y, Borys Y, Komnatska I, Dutka I, Shatynska-Mytsyk I. Value of the diffusion-weighted MRI in the differential diagnostics of malignant and benign kidney neoplasms - our clinical experience. Pol J Radiol 2014; 79:290-5. [PMID: 25202435 PMCID: PMC4156335 DOI: 10.12659/pjr.890604] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2014] [Accepted: 03/24/2014] [Indexed: 11/20/2022] Open
Abstract
Background Diffusion-weighted imaging (DWI) is an MRI modality using strong bipolar gradients to create a sensitivity of the signal to the thermally-induced Brownian motions of water molecules and in vivo measurement of molecular diffusion. The apparent diffusion coefficient (ADC) is a quantitative parameter calculated from DWI images which is used as a measure of diffusion. DWI allows to obtain comprehensive information on morphological and functional state of the kidney during a single examination without contrast medium administration. The purpose of the study was to evaluate the value of DWI in differentiating benign and malignant solid kidney tumors based on the initial stage of the study. Material/Methods The study included 19 adult patients with pathologically verified renal tumors: 9 patients with clear cell subtype of the renal cell carcinoma, 5 patients with oncocytoma and 5 patients with angiomyolipoma (AML). In addition, 5 healthy volunteers with completely normal findings according to kidney ultrasound were included into this study and set as reference. All patients underwent renal MR imaging which included DWI with subsequent ADC measurement. MR imaging was performed with a 1.5 T body scanner using an eight-channel phased-array body coil. Results The mean ADC value of ccRCC was significantly lower than that of normal renal parenchyma (2.11±0.25×10−3 mm2/s vs. 3.36±0.41×10−3 mm2/s, p<0.01). There was a significant difference in ADC between the malignant and benign renal lesions: in patients with angiomyolipoma the ADC value was 2.36±0.32×10−3 mm2/s vs. 2.11±0.25×10−3 mm2/s; p<0.05 and in patients with oncocytoma – 2.75±0.27×10−3 mm2/s vs. 2.11±0.25×10−3 mm2/s; p<0.05. The difference in ADC values in patients with high and low ccRCC grades was observed. Conclusions DWI can be used to characterize renal lesions; the ADC of a renal lesion can be potentially used as an additional parameter to help determine the appropriate clinical management.
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Affiliation(s)
- Yulian Mytsyk
- Department of Radiology, Lviv National Medical University, Lviv, Ukraine
| | - Yuriy Borys
- Department of Urology, Lviv National Medical University, Lviv, Ukraine
| | | | - Ihor Dutka
- Euroclinic Medical Center, Lviv, Ukraine
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Abstract
OBJECTIVE Solid renal masses are most often incidentally detected at imaging as small (≤ 4 cm) localized lesions. These lesions comprise a wide spectrum of benign and malignant histologic subtypes, but are largely treated with surgical resection given the limited ability of imaging to differentiate among them with consistency and high accuracy. Numerous studies have thus examined the ability of CT and MRI techniques to separate benign lesions from malignancies and to predict renal cancer histologic grade and subtype. This article synthesizes the evidence regarding renal mass characterization at CT and MRI, provides diagnostic algorithms for evidence-based practice, and highlights areas of further research needed to drive imaging-based management of renal masses. CONCLUSION Despite extensive study of morphologic and quantitative criteria at conventional imaging, no CT or MRI techniques can reliably distinguish solid benign tumors, such as oncocytoma and lipid-poor angiomyolipoma, from malignant renal tumors. Larger studies are required to validate recently developed techniques, such as diffusion-weighted imaging. Evidence-based practice includes MRI to assess renal lesions in situations where CT is limited and to help guide management in patients who are considered borderline surgical candidates.
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Zhang JL, Morrell G, Rusinek H, Sigmund EE, Chandarana H, Lerman LO, Prasad PV, Niles D, Artz N, Fain S, Vivier PH, Cheung AK, Lee VS. New magnetic resonance imaging methods in nephrology. Kidney Int 2014; 85:768-78. [PMID: 24067433 PMCID: PMC3965662 DOI: 10.1038/ki.2013.361] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2013] [Revised: 07/16/2013] [Accepted: 07/17/2013] [Indexed: 02/06/2023]
Abstract
Established as a method to study anatomic changes, such as renal tumors or atherosclerotic vascular disease, magnetic resonance imaging (MRI) to interrogate renal function has only recently begun to come of age. In this review, we briefly introduce some of the most important MRI techniques for renal functional imaging, and then review current findings on their use for diagnosis and monitoring of major kidney diseases. Specific applications include renovascular disease, diabetic nephropathy, renal transplants, renal masses, acute kidney injury, and pediatric anomalies. With this review, we hope to encourage more collaboration between nephrologists and radiologists to accelerate the development and application of modern MRI tools in nephrology clinics.
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Affiliation(s)
- Jeff L Zhang
- Department of Radiology, University of Utah, Salt Lake City, Utah, USA
| | - Glen Morrell
- Department of Radiology, University of Utah, Salt Lake City, Utah, USA
| | - Henry Rusinek
- Department of Radiology, New York University, New York, New York, USA
| | - Eric E Sigmund
- Department of Radiology, New York University, New York, New York, USA
| | - Hersh Chandarana
- Department of Radiology, New York University, New York, New York, USA
| | - Lilach O Lerman
- Department of Nephrology and Hypertension, Mayo Clinic, Rochester, MN, USA
| | | | - David Niles
- Department of Medical Physics, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Nathan Artz
- Department of Medical Physics, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Sean Fain
- Department of Medical Physics, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | | | - Alfred K Cheung
- Division of Nephrology and Hypertension, University of Utah, Salt Lake City, Utah, USA
| | - Vivian S Lee
- Department of Radiology, University of Utah, Salt Lake City, Utah, USA
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Utility of MRI features in differentiation of central renal cell carcinoma and renal pelvic urothelial carcinoma. AJR Am J Roentgenol 2014; 201:1260-7. [PMID: 24261365 DOI: 10.2214/ajr.13.10673] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The purpose of this article is to evaluate the utility of various morphologic and quantitative MRI features in differentiating central renal cell carcinoma (RCC) from renal pelvic urothelial carcinoma. MATERIALS AND METHODS Sixty patients (39 men and 21 women; mean [± SD] age, 65 ± 14 years; 48 with central RCC and 12 with renal pelvic urothelial carcinoma) who underwent MRI, including diffusion-weighted imaging (b values, 0, 400, and 800 s/mm(2)) and dynamic contrast-enhanced imaging, before histopathologic confirmation were included. Tumor T2 signal intensity and apparent diffusion coefficients (ADCs) were measured and normalized to muscle and CSF (hereafter referred to as normalized T2 signal and normalized ADC, respectively) and then were compared using receiver operating characteristic analysis. Also, two blinded radiologists independently assessed all tumors for various qualitative features, which were compared with the Fisher exact test and unpaired Student t test. RESULTS Urothelial carcinoma exhibited significantly lower normalized ADC than did RCC (p = 0.008), but no significant difference was seen in ADC or normalized T2 signal intensity (p = 0.247-0.773). Normalized ADC had the highest area under the curve (0.757); normalized ADC below an optimal threshold of 0.451 was associated with sensitivity of 83% and specificity of 71% for diagnosing urothelial carcinoma. Features that were significantly more prevalent in urothelial carcinoma included global impression of urothelial carcinoma, location centered within the collecting system, collecting system defect, extension to the ureteropelvic junction, preserved renal shape, absence of cystic or necrotic areas, absence of hemorrhage, homogeneous enhancement, and hypovascularity (all p < 0.033). Increased T1 signal intensity suggestive of hemorrhage was significantly more prevalent in RCC (p = 0.02). Interreader agreement for the subjective features ranged from 61.7% to 98.3%. CONCLUSION In addition to various qualitative MRI parameters, normalized ADC has utility in differentiating central RCC from renal pelvic urothelial carcinoma. Such differentiation may assist decisions regarding possible biopsy and treatment planning.
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Chuck NC, Steidle G, Blume I, Fischer MA, Nanz D, Boss A. Diffusion Tensor Imaging of the Kidneys: Influence of b-Value and Number of Encoding Directions on Image Quality and Diffusion Tensor Parameters. J Clin Imaging Sci 2013; 3:53. [PMID: 24404412 PMCID: PMC3883273 DOI: 10.4103/2156-7514.122323] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2013] [Accepted: 08/31/2013] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVES The purpose of this study was to evaluate to which degree investment of acquisition time in more encoding directions leads to better image quality (IQ) and what influence the number of encoding directions and the choice of b-values have on renal diffusion tensor imaging (DTI) parameters. MATERIAL AND METHODS Eight healthy volunteers (32.3 y ± 5.1 y) consented to an examination in a 1.5T whole-body MR scanner. Coronal DTI data sets of the kidneys were acquired with systematic variation of b-values (50, 150, 300, 500, and 700 s/mm(2)) and number of diffusion-encoding directions (6, 15, and 32) using a respiratory-triggered echo-planar sequence (TR/TE 1500 ms/67 ms, matrix size 128 × 128). Additionally, two data sets with more than two b-values were acquired (0, 150, and 300 s/mm(2) and all six b-values). Parametrical maps were calculated on a pixel-by-pixel basis. Image quality was determined with a reader score. RESULTS Best IQ was visually assessed for images acquired with 15 and 32 encoding directions, whereas images acquired with six directions had significantly lower IQ ratings. Image quality, fractional anisotropy, and mean diffusivity only varied insignificantly for b-values between 300 and 500 s/mm(2). In the renal medulla fractional anisotropy (FA) values between 0.43 and 0.46 and mean diffusivity (MD) values between 1.8-2.1 × 10(-3) mm(2)/s were observed. In the renal cortex, the corresponding ranges were 0.24-0.25 (FA) and 2.2-2.8 × 10(-3) mm(2)/s (MD). Including b-values below 300 s/mm(2), notably higher MD values were observed, while FA remained constant. Susceptibility artifacts were more prominent in FA maps than in MD maps. CONCLUSION In DTI of the kidneys at 1.5T, the best compromise between acquisition time and resulting image quality seems the application of 15 encoding directions with b-values between 300 and 500 s/mm(2). Including lower b-values allows for assessment of fast diffusing spin components.
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Affiliation(s)
- Natalie C. Chuck
- Department of Diagnostic and Interventional Radiology, University Hospital Zürich, Switzerland
| | - Günther Steidle
- Section of Experimental Radiology, University Hospital of Tübingen, Germany
| | - Iris Blume
- Department of Diagnostic and Interventional Radiology, University Hospital Zürich, Switzerland
| | - Michael A. Fischer
- Department of Diagnostic and Interventional Radiology, University Hospital Zürich, Switzerland
| | - Daniel Nanz
- Department of Diagnostic and Interventional Radiology, University Hospital Zürich, Switzerland
| | - Andreas Boss
- Department of Diagnostic and Interventional Radiology, University Hospital Zürich, Switzerland
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Thawait GK, Subhawong TK, Tatizawa Shiga NY, Fayad LM. "Cystic"-appearing soft tissue masses: what is the role of anatomic, functional, and metabolic MR imaging techniques in their characterization? J Magn Reson Imaging 2013; 39:504-11. [PMID: 24532375 DOI: 10.1002/jmri.24314] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2012] [Accepted: 06/21/2013] [Indexed: 11/05/2022] Open
Abstract
Although conventional MR imaging with contrast-enhanced T1-weighted sequences is of paramount importance for evaluating soft tissue masses, noncontrast MR sequences have emerged that facilitate their characterization. In this article, the utility and pitfalls of conventional MR imaging with T1-weighted, fluid-sensitive, and contrast-enhanced sequences will be discussed, along with that of functional (diffusion weighted imaging) and metabolic (proton MR spectroscopy) non-contrast-enhanced techniques for the purpose of soft tissue mass characterization. In particular, we discuss the application of these techniques to differentiating neoplastic or inflammatory masses that have high fluid content from benign cysts, as this distinction is a common pitfall of conventional sequences.
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Affiliation(s)
- Gaurav K Thawait
- Department of Radiology and Radiological Science, The Johns Hopkins Medical Institutions, 601 North Wolfe Street, Baltimore, Maryland, USA
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Akita H, Jinzaki M, Akita A, Mikami S, Oya M, Kuribayashi S. Renal cell carcinoma in patients with acquired cystic disease of the kidney: Assessment using a combination of T2-weighted, diffusion-weighted, and chemical-shift MRI without the use of contrast material. J Magn Reson Imaging 2013; 39:924-30. [DOI: 10.1002/jmri.24226] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2012] [Accepted: 04/18/2013] [Indexed: 11/10/2022] Open
Affiliation(s)
- Hirotaka Akita
- Department of Diagnostic Radiology; Keio University School of Medicine; Tokyo Japan
| | - Masahiro Jinzaki
- Department of Diagnostic Radiology; Keio University School of Medicine; Tokyo Japan
| | - Ayano Akita
- Department of Diagnostic Radiology; Keio University School of Medicine; Tokyo Japan
| | - Shuji Mikami
- Division of Diagnostic Pathology; Keio University Hospital; Tokyo Japan
| | - Mototsugu Oya
- Department of Urology; Keio University School of Medicine; Tokyo Japan
| | - Sachio Kuribayashi
- Department of Diagnostic Radiology; Keio University School of Medicine; Tokyo Japan
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