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Dev R, Chauhan U, Nandolia KK. Multifaceted Imaging of Renal Lesions With an Emphasis on Cross-Sectional Imaging. Cureus 2024; 16:e59956. [PMID: 38854236 PMCID: PMC11161908 DOI: 10.7759/cureus.59956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/09/2024] [Indexed: 06/11/2024] Open
Abstract
Introduction Renal lesions are common findings encountered in cross-sectional imaging. Ultrasonography (USG), computed tomography (CT), and magnetic resonance imaging (MRI) are available modalities for evaluating renal lesions. The Bosniak classification system aids in classifying a renal lesion into a particular category based on various imaging characteristics on contrast-enhanced CT (CECT). Materials and methods The CT report archives were searched for the keyword 'Bosniak' lesions, and six illustrative cases were selected to be included in the review. Results Six cases under Bosniak categories I to IV were included in the review. Operative follow-ups were added in cases where patients underwent surgery. Discussion We have reviewed the imaging features of various renal lesions with cross-sectional modalities, namely CT and MRI, with special emphasis on the Bosniak classification system, including its amendments. Conclusion The Bosniak system is widely used to classify and characterize renal lesions. The authors have presented a scoping review of the features of renal lesions and the Bosniak system.
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Affiliation(s)
- Rahul Dev
- Diagnostic and Intervention Radiology, All India Institute of Medical Sciences, Rishikesh, IND
| | - Udit Chauhan
- Diagnostic and Intervention Radiology, All India Institute of Medical Sciences, Rishikesh, IND
| | - Khanak K Nandolia
- Diagnostic and Intervention Radiology, All India Institute of Medical Sciences, Rishikesh, IND
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Wang L, Wu H, Li J, Wang Y, Zhang T, Tan Z, Liu Y, Wang H, Sun L, Xu D, Tu J. Diagnostic value of pseudocapsule ring hyperenhancement in contrast-enhanced ultrasound in renal focal lesions. Ir J Med Sci 2023; 192:1631-1636. [PMID: 36907918 DOI: 10.1007/s11845-023-03320-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Accepted: 02/13/2023] [Indexed: 03/14/2023]
Abstract
OBJECT To investigate the diagnostic value of pseudocapsule ring hyperenhancement in contrast-enhanced ultrasound (CEUS) of focal renal lesions. METHOD Ninety eligible patients admitted were selected as the study subjects. The incidence rate of annular hyperenhancement in different benign and malignant focal lesions during angiography and the shape of annular enhancement were counted. The correlation between the occurrence of benign and malignant renal tumors and annular hyperenhancement and unenhanced areas was also analyzed. RESULTS Capsule enhancement was observed in 56 cases, including 50 cases of malignant tumors (89.3%, 50/56) and 6 cases of benign tumors (10.7%, 6/56). Pearson correlation analysis showed that renal malignancy was positively associated with the occurrence of pseudocapsule ring hyperenhancement (γ = 0.489, P < 0.001). Benign and malignant renal tumors were positively correlated with the occurrence of non-enhancing areas (γ = 0.215, P = 0.042). The thickness and peak intensity of pseudocapsule ring enhancement in renal malignant tumors were significantly higher than those in benign tumors (all P < 0.001), while the time to peak was significantly lower than that in benign tumors (P < 0.001). The results of receiver operating characteristic (ROC) curve showed that the ring enhancement thickness, time to peak, and area under ROC curve of peak intensity of tumor reached more than 0.9. CONCLUSION In CEUS, the pseudocapsule of focal renal lesions is a characteristic feature of renal malignant tumors, which can be used as a differential basis for benign and malignant tumors to improve the accuracy of benign and malignant renal tumors.
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Affiliation(s)
- Ligang Wang
- Cancer Center, Department of Ultrasound Medicine, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, Zhejiang Province, Hangzhou, 310000, People's Republic of China
| | - Hao Wu
- Department of Ultrasound Medicine, The Second Affiliated Hospital of Zhejiang Chinese Medical University, Zhejiang Province, Hangzhou, 310000, People's Republic of China
| | - Jianchun Li
- Cancer Center, Department of Ultrasound Medicine, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, Zhejiang Province, Hangzhou, 310000, People's Republic of China
| | - Ying Wang
- Health Management Center, Health Promotion Center, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, Zhejiang Province, Hangzhou, 310000, People's Republic of China
| | - Tingting Zhang
- Bengbu Medical College, Anhui Province, 230030, Bengbu, People's Republic of China
| | - Zhaowang Tan
- Bengbu Medical College, Anhui Province, 230030, Bengbu, People's Republic of China
| | - Yang Liu
- Cancer Center, Department of Ultrasound Medicine, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, Zhejiang Province, Hangzhou, 310000, People's Republic of China
| | - Han Wang
- Ultrasound Department, Zhejiang Hospital affiliated to Zhejiang, University School of Medicine, Zhejiang Province, Hangzhou, 310013, People's Republic of China
| | - Litao Sun
- Cancer Center, Department of Ultrasound Medicine, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, Zhejiang Province, Hangzhou, 310000, People's Republic of China.
| | - Dong Xu
- Department of Ultrasound Medicine, Cancer HospitalAffiliated to, University of Chinese Academy of Sciences (Zhejiang Cancer Hospital) , Zhejiang Province, Hangzhou, 310000, People's Republic of China.
| | - Jianfeng Tu
- Emergency and Critical Care Center, Department of Emergency Medicine, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, Zhejiang Province, Hangzhou, 310000, People's Republic of China.
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Mohammed EH, Kaddourah A, Al Khori N, Djekidel M. The diagnostic value of DMSA scan in differentiating functional pseudo-tumors from malignancies in scarred kidneys: case series and literature review. BMC Nephrol 2023; 24:148. [PMID: 37237327 DOI: 10.1186/s12882-023-03113-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 02/17/2023] [Indexed: 05/28/2023] Open
Abstract
BACKGROUND The terms "renal regenerating nodule" and "nodular compensatory hypertrophy" are used in the literature to describe functioning pseudo-tumors (FPT) in the setting of an extensively scarred kidney. FPTs are usually discovered incidentally during routine renal imaging. Differentiating these FPTs from renal neoplasms is critical but can be challenging in the setting of chronic kidney disease (CKD) given the limitations related to using contrast-based imaging. CASE SUMMARIES We report a pediatric case series of 5 CKD patients, with history of urinary tract infections, in which tumor-like lesions evolved in scarred kidneys and were incidentally discovered on routine renal imaging. These were diagnosed as FPT by utilizing dimercaptosuccinic acid (DMSA) imaging and showed stable size and appearance upon follow-up with ultrasound and MRI. CONCLUSION FPTs can be picked up on routine imaging of pediatric patients with CKD. Although larger cohort studies are needed to confirm these conclusions, our case series supports the evidence that DMSA scan showing uptake at the site of the mass can be a useful tool to suggest the diagnosis of FPTs in children with kidney scarring, and that SPECT DMSA scan adds more precision in picking up and accurately localizing FPTs compared to planar DMSA.
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Affiliation(s)
- Enas Hussein Mohammed
- Department of Pediatrics, Division of Nephrology and Hypertension, Sidra Medicine, Doha, Qatar.
| | - Ahmad Kaddourah
- Department of Pediatrics, Division of Nephrology and Hypertension, Sidra Medicine, Doha, Qatar
- Department of Pediatrics, Weill Cornel Medicine University, Doha, Qatar
| | - Noor Al Khori
- Department of Radiology, Division of Body Imaging, Sidra Medicine, Doha, Qatar
| | - Mehdi Djekidel
- Department of Radiology, Division of Nuclear Medicine, Northwell, New York, USA
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Fogarty J, Siriruchatanon M, Makarov D, Langford A, Kang S. An Evaluation of a Web-Based Decision Aid for Treatment Planning of Small Kidney Tumors: Pilot Randomized Controlled Trial. JMIR Res Protoc 2022; 11:e41451. [PMID: 36053558 PMCID: PMC9482069 DOI: 10.2196/41451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Revised: 08/16/2022] [Accepted: 08/19/2022] [Indexed: 11/13/2022] Open
Abstract
Background Surgery is the most common treatment for localized small kidney masses (SKMs) up to 4 cm, despite a lack of evidence for improved overall survival. Nonsurgical management options are gaining recognition, as evidence supports the indolence of most SKMs. Decision aids (DAs) have been shown to improve patient comprehension of the trade-offs of treatment options and overall decision quality, and may improve consideration of all major options according to individual health priorities and preferences. Objective This pilot randomized controlled trial (RCT) primarily aims to evaluate the impact of a new web-based DA on treatment decisions for patients with SKM; that is, selection of surgical versus nonsurgical treatment options. Secondary objectives include an assessment of decision-making outcomes: decisional conflict, decision satisfaction, and an understanding of individual preferences for treatment that incorporate the trade-offs associated with surgical versus nonsurgical interventions. Methods Three phases comprise the construction and evaluation of a new web-based DA on SKM treatment. In phase 1, this DA was developed in print format through a multidisciplinary design committee incorporating patient focus groups. Phase 2 was an observational study on patient knowledge and decision-making measures after randomization to receive the printed DA or institutional educational materials, which identified further educational needs applied to a web-based DA. Phase 3 will preliminarily evaluate the web-based DA: in a pilot RCT, 50 adults diagnosed with SKMs will receive the web-based DA or an existing web-based institutional website at urology clinics at a large academic medical center. The web-based DA applies risk communication and information about diagnosis and treatment options, elicits preferences regarding treatment options, and provides a set of options to consider with their doctor based on a decision-analytic model of benefits/harm analysis that accounts for comorbidity, age group, and tumor features. Questionnaires and treatment decision data will be gathered before and after viewing the educational material. Results This phase will consist of a pilot RCT from August 2022 to January 2023 to establish feasibility and preliminarily evaluate decision outcomes. Previous study phases from 2018 to 2020 supported the feasibility of providing the printed DA in urology clinics before clinical consultation and demonstrated increased patient knowledge about the diagnosis and treatment options and greater likelihood of favoring nonsurgical treatment just before consultation. This study was funded by the National Cancer Institute. Recruitment will begin in August 2022. Conclusions A web-based DA has been designed to address educational needs for patients making treatment decisions for SKM, accounting for comorbidities and treatment-related benefits and risks. Outcomes from the pilot trial will evaluate the potential of a web-based DA in personalizing treatment decisions and in helping patients weigh attributes of surgical versus nonsurgical treatment options for their SKMs. Trial Registration ClinicalTrials.gov NCT05387863; https://clinicaltrials.gov/ct2/show/NCT05387863 International Registered Report Identifier (IRRID) PRR1-10.2196/41451
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Affiliation(s)
- Justin Fogarty
- Department of Radiology, New York University Grossman School of Medicine, New York, NY, United States
| | - Mutita Siriruchatanon
- Department of Radiology, New York University Grossman School of Medicine, New York, NY, United States
| | - Danil Makarov
- Department of Urology, New York University Grossman School of Medicine, New York, NY, United States.,Department of Population Health, New York University Grossman School of Medicine, New York, NY, United States
| | - Aisha Langford
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, United States
| | - Stella Kang
- Department of Radiology, New York University Grossman School of Medicine, New York, NY, United States.,Department of Population Health, New York University Grossman School of Medicine, New York, NY, United States
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Predictive Value of CT-Based Radiomics in Distinguishing Renal Angiomyolipomas with Minimal Fat from Other Renal Tumors. DISEASE MARKERS 2022; 2022:9108129. [PMID: 35669501 PMCID: PMC9167090 DOI: 10.1155/2022/9108129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Accepted: 05/03/2022] [Indexed: 01/05/2023]
Abstract
Objectives This study is aimed at determining whether CT-based radiomics models can help differentiate renal angiomyolipomas with minimal fat (AMLmf) from other solid renal tumors. Methods This retrospective study included 58 patients with a postoperative pathologically confirmed AMLmf (observation group) and 140 patients with other common renal tumors (control group). Non-contrast-enhanced CT and contrast-enhanced CT data were evaluated. Radiomics features were extracted from manually delineated volume of interest (VOIs). The least absolute shrinkage and selection operator (LASSO) regression was used for feature screening. Five classifiers, including logistic regression, multilayer perceptron (MLP), support vector machine (SVM), k-nearest neighbor (KNN), and logistic regression (LR), were used, with leave-out validation (128 training, 60 testing). The diagnostic performance of the classifier was evaluated and compared by receiver operating characteristic curve (ROC) analysis. Results Among the 1029 extracted features, prediction models of AMLmf were composed, by 2, 10, 4, and 9 selected features for precontrast phase (PCP), corticomedullary phase (CMP), nephrographic phase (NP), and excretory phase (EP), respectively. Models of CMP and NP achieved adequate performance after using MLP classifier, with prediction accuracy of 0.767 (AUC 0.85, sensitivity 0.76, and specificity 0.78) and 0.783 (AUC 0.83, sensitivity 0.79, and specificity 0.78), respectively. MLP model of features selected from the combination of the all features had the best diagnostic performance (accuracy 0.8500, sensitivity 0.8095, specificity 0.9444, and AUC 0.9193). Conclusions Radiomics features may help to distinguish benign AMLmf from common malignant kidney masses, which may contribute to the selection of interventions for renal tumors.
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Lyske J, Mathew RP, Hutchinson C, Patel V, Low G. Multimodality imaging review of focal renal lesions. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2021. [DOI: 10.1186/s43055-020-00391-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Focal lesions of the kidney comprise a spectrum of entities that can be broadly classified as malignant tumors, benign tumors, and non-neoplastic lesions. Malignant tumors include renal cell carcinoma subtypes, urothelial carcinoma, lymphoma, post-transplant lymphoproliferative disease, metastases to the kidney, and rare malignant lesions. Benign tumors include angiomyolipoma (fat-rich and fat-poor) and oncocytoma. Non-neoplastic lesions include infective, inflammatory, and vascular entities. Anatomical variants can also mimic focal masses.
Main body of the abstract
A range of imaging modalities are available to facilitate characterization; ultrasound (US), contrast-enhanced ultrasound (CEUS), computed tomography (CT), magnetic resonance (MR) imaging, and positron emission tomography (PET), each with their own strengths and limitations. Renal lesions are being detected with increasing frequency due to escalating imaging volumes. Accurate diagnosis is central to guiding clinical management and determining prognosis. Certain lesions require intervention, whereas others may be managed conservatively or deemed clinically insignificant. Challenging cases often benefit from a multimodality imaging approach combining the morphology, enhancement and metabolic features.
Short conclusion
Knowledge of the relevant clinical details and key imaging features is crucial for accurate characterization and differentiation of renal lesions.
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Tummalapalli SL, Zech JR, Cho HJ, Goetz C. Risk stratification for hydronephrosis in the evaluation of acute kidney injury: a cross-sectional analysis. BMJ Open 2021; 11:e046761. [PMID: 34389565 PMCID: PMC8365791 DOI: 10.1136/bmjopen-2020-046761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To validate an existing clinical decision support tool to risk-stratify patients with acute kidney injury (AKI) for hydronephrosis and compare the risk stratification framework with nephrology consultant recommendations. SETTING Cross-sectional study of hospitalised adults with AKI who had a renal ultrasound (RUS) ordered at a large, tertiary, academic medical centre. PARTICIPANTS Two hundred and eighty-one patients were included in the study cohort. Based on the risk stratification framework, 111 (40%), 76 (27%) and 94 (33%) patients were in the high-risk, medium-risk and low-risk groups for hydronephrosis, respectively. OUTCOMES Outcomes were the presence of unilateral or bilateral hydronephrosis on RUS. RESULTS Thirty-five patients (12%) were found to have hydronephrosis. The high-risk group had 86% sensitivity and 67% specificity for identifying hydronephrosis. A nephrology consult was involved in 168 (60%) patients and RUS was recommended by the nephrology service in 95 (57%) cases. Among patients with a nephrology consultation, 9 (56%) of the 16 total patients with hydronephrosis were recommended to obtain an RUS. CONCLUSIONS We further externally validated a risk stratification framework for hydronephrosis. Clinical decision support systems may be useful to supplement clinical judgement in the evaluation of AKI.
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Affiliation(s)
- Sri Lekha Tummalapalli
- Division of Healthcare Delivery Science and Innovation, Department of Population Health Sciences, Weill Cornell Medicine, New York, New York, USA
| | - John R Zech
- Department of Radiology, New York Presbyterian Hospital-Columbia University Irving Medical Center, New York, New York, USA
| | - Hyung J Cho
- Chief Value Officer, New York City Health and Hospitals, New York, NY, USA
- Senior Fellow, Lown Institute, Brookline, MA, USA
| | - Celine Goetz
- Director of Education, Division of Hospital Medicine, Department of Internal Medicine, Rush University Medical Center, Chicago, IL, USA
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Spiesecke P, Fischer T, Maxeiner A, Hamm B, Lerchbaumer MH. Contrast-enhanced ultrasound (CEUS) reliably rules out neoplasm in developmental renal pseudotumor. Acta Radiol 2021; 62:821-829. [PMID: 32631079 DOI: 10.1177/0284185120939291] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Renal pseudotumors appear as benign cortical hypertrophies and are typically assessed by contrast-enhanced computed tomography or magnetic resonance imaging to rule out malignancy. PURPOSE To investigate whether contrast-enhanced ultrasound (CEUS) can rule out renal neoplasm and thus potentially reduce cross-sectional imaging and further follow-up in these patients. MATERIAL AND METHODS Thirty-two patients with presumption of developmental renal pseudotumor on CEUS between June 2011 and July 2019 were retrospectively analyzed. All patients were examined with a standardized renal US protocol including B-mode, color-coded duplex sonography (CCDS), and CEUS by an experienced radiologist (EFSUMB level 3). Images were retrospectively interpreted in consensus by two highly experienced radiologists. Histopathological reports, cross-sectional imaging findings, and clinical course (treatment response, long-term imaging follow-up) were defined as standard of reference. RESULTS CEUS correctly identified 8/9 neoplastic lesions and missed one oncocytoma within the 32 included patients. Irregular vessel structure (88.9% vs. 13.0%, P = 0.007) and hyperenhancement (66.6% vs. 17.4%, P = 0.031) on CEUS were more common in neoplasm compared to developmental pseudotumors reaching statistical significance. Compared with the standard of reference, CEUS had 89% sensitivity (95% confidence interval [CI] 57-98), 96% specificity (95% CI 80-99), a positive predictive value of 89% (95% CI 57-98), and a negative predictive value of 96% (95% CI 79-99) for ruling out renal malignancy in developmental pseudotumors. CONCLUSION CEUS is a safe and fast method to rule out neoplasm in the diagnostic work-up of renal pseudotumors. In conjunction with B-mode and CCDS, CEUS has the potential to reduce further (invasive) diagnostic procedures.
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Affiliation(s)
- Paul Spiesecke
- Department of Radiology, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Thomas Fischer
- Department of Radiology, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Andreas Maxeiner
- Department of Urology, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Bernd Hamm
- Department of Radiology, Charité – Universitätsmedizin Berlin, Berlin, Germany
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Najafi A, Wildt M, Hainc N, Hohmann J. Evaluation of Cystic and Solid Renal Lesions with Contrast-Enhanced Ultrasound: A Retrospective Study. Ultrasound Int Open 2021; 7:E25-E34. [PMID: 34337312 PMCID: PMC8315990 DOI: 10.1055/a-1522-8969] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Accepted: 04/15/2021] [Indexed: 10/25/2022] Open
Abstract
Purpose Renal lesions are frequent random findings on CT, MRI, and conventional ultrasound. Since they are usually found accidentally, the respective examinations have not been performed optimally to provide a conclusive diagnosis, making additional multiphase contrast-enhanced examinations necessary. The aim of the study is to correlate CEUS findings with the final diagnosis and to determine whether it is a suitable method for the conclusive characterization of undetermined renal lesions. Materials and Methods All CEUS examinations of focal renal lesions performed at our institute between 2007 and 2014 were retrospectively examined. 437 patients with a total of 491 lesions and 543 examinations were included. 54 patients had bilateral lesions. One patient had three lesions in one kidney. Histology was available in 49 cases and follow-ups in 124 cases. The sensitivity, specificity, positive and negative predictive value as well as positive and negative likelihood ratios were calculated. Results There were 54 malignant and 437 benign lesions. The sensitivity and specificity were 0.981/0.954 overall, 1.000/0.956 for cystic lesions, 0.977/0.906 for solid lesions, and 0.971/0.071 for the histologically confirmed lesions. Bosniak classification was consistent in 289 of 301 lesions (96%). Only 12 lesions (3.9%) were falsely assessed as malignant. Conclusion CEUS is an appropriate method for the clarification of undetermined renal lesions. The characterization of cystic lesions according to Bosniak is adequately possible, especially for potentially malignant lesions (types III and IV).
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Affiliation(s)
- Arash Najafi
- Department of Radiology and Nuclear Medicine, Canton Hospital
Winterthur, Winterthur, Switzerland
| | - Michael Wildt
- Department of Radiology and Nuclear Medicine, University Hospital
Basel, Basel, Switzerland
| | - Nicolin Hainc
- Department of Medical Imaging, Division of Neuroradiology, Toronto
Western Hospital, Toronto, Canada
| | - Joachim Hohmann
- Department of Radiology and Nuclear Medicine, Canton Hospital
Winterthur, Winterthur, Switzerland
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Bersang AB, Søndergaard Mosholt KS, Verner Jensen C, Germer U, Holm M, Røder MA. Safety and oncological outcome following radiofrequency ablation of small renal masses in a single center. Scand J Urol 2021; 55:203-208. [PMID: 33739218 DOI: 10.1080/21681805.2021.1900386] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
OBJECTIVE To evaluate the safety and efficacy of percutaneous CT-guided radiofrequency ablation (RFA) for small renal masses (SRMs) at a large single-institution center during a period of 12 years. MATERIALS AND METHODS A total of 118 patients underwent RFA for SRM between July 2006 and July 2018 at our institution. We included demographic information, comorbidity, procedural details, and oncological outcome in the analysis. Survival analysis was performed using competing risk. RESULTS 87 males and 31 females with median age 66 years underwent RFA. Median tumor size was 23 mm. Tumor biopsy was performed in 94% of cases, of which 56% were confirmed renal cell carcinoma (RCCs). Twenty-eight patients had benign tumors or underwent treatment for recurrence of prior RCC. Median follow-up of 5 years. Median Charlson Comorbidity Index was 5. Major complications occurred in 1.7%. No change in kidney function was observed. The initial treatment response was 98%. Among patients treated for newly diagnosed radiological suspected RCC without Von Hippel-Lindau or benign biopsy (90 pts), the cumulative incidence of radiological recurrence after 5 and 10 years was 6.6% (95% CI: 0.8-12%) and 16% (95% CI: 4.2-28%), respectively. Three patients died of RCC during follow-up. The cumulative incidence of kidney cancer death was 4.5% (95% CI: 4.3-13%) after 10 years. The incidence of other-cause mortality was 50% (95% CI: 34-67%). CONCLUSION CT-guided RFA is a safe and effective treatment option for patients unsuitable for surgery. RFA is a good alternative to partial or radical nephrectomy for SRMs, although randomized trials comparing surgery to minimally invasive thermal ablation techniques are missing.
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Affiliation(s)
- Ann Buhl Bersang
- Urological Research Unit, Department of Urology, Centre for Cancer and Organ Diseases, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Karina Sif Søndergaard Mosholt
- Urological Research Unit, Department of Urology, Centre for Cancer and Organ Diseases, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Claus Verner Jensen
- Department of Radiology, Centre of Diagnostic Investigations, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Ulla Germer
- Department of Radiology, Centre of Diagnostic Investigations, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Mette Holm
- Urological Research Unit, Department of Urology, Centre for Cancer and Organ Diseases, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Martin Andreas Røder
- Urological Research Unit, Department of Urology, Centre for Cancer and Organ Diseases, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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Abdominal Stiffness Evaluation in Massage for Constipation. SENSORS 2021; 21:s21041192. [PMID: 33567621 PMCID: PMC7915621 DOI: 10.3390/s21041192] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Revised: 02/04/2021] [Accepted: 02/04/2021] [Indexed: 12/13/2022]
Abstract
According to the experience of nurses and physiotherapists, the abdomen of constipated people becomes softer after abdominal massage. However, the relationship between the decrease in abdominal stiffness and the benefits of abdominal massage has not been examined quantitatively and is unclear. Furthermore, devices for measuring stiffness have been designed to measure relatively hard areas such as the shoulders and do not take into account the lateral outflow of the target tissue, which can be a problem when measuring the stiffness of soft areas such as the abdomen. To address these issues, this study presents a stiffness sensor suitable for measuring abdominal stiffness and investigates the relationship between the reduction in abdominal stiffness and the benefits of abdominal massage. The solution to prevent the lateral outflow of the target is the realization of a stopper, including a contact detection device, which enables a wide-area contact around the targeted area. The sensor consists of a stopper, probe, spring, and time-of-flight (ToF) sensors. The probe and spring provide appropriate pressure and deformation to the abdomen, whereas the stopper prevents the probe from being pushed into the abdomen more than necessary. The ToF sensor measures the deformation length when the deformation is stopped by the stopper. The abdominal stiffness can be derived from the deformation length. The investigation results indicate that the reduction in abdominal stiffness corresponds to the improvement of the stool condition or the maintenance of a healthy stool condition, whereas the maintenance of abdominal stiffness indicates the maintenance or deterioration of the stool condition.
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Prevalence and Clinical Significance of Incidental Vertebral Marrow Signal Abnormality in Thoracolumbar Spine MRI. Spine (Phila Pa 1976) 2020; 45:390-396. [PMID: 31593057 DOI: 10.1097/brs.0000000000003278] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A cross-sectional study. OBJECTIVE This study investigates the prevalence of incidental vertebral marrow signal abnormality (VMSA) in thoracolumbar spine magnetic resonance imaging (MRI) ordered for the evaluation of back and/or leg pain and assess the clinical work-up for VMSAs. SUMMARY OF BACKGROUND DATA Patients presenting with back pain are often referred for spine MRI for diagnostic evaluation. VMSA is most frequently found in the lumbar spine and is of clinical concern because it can represent malignancy. Standardized procedures for reporting and managing VMSAs do not exist. METHODS The radiology database at the Oregon Health & Science University health system was queried to identify patients with thoracolumbar spine MRI scans performed between January 2014 and June 2016. Patients 16 years or older with MRIs ordered by providers at a multidisciplinary spine specialty clinic for the diagnostic evaluation of back and/or leg pain were included. Radiology reports were searched for keywords pertaining to VMSAs, such as "malignancy." Medical records of these patients were further reviewed for the clinical work-up and final diagnoses pertaining to the VMSA. RESULTS The study sample included 1503 individual patients, of whom 65 (4%) had MRI radiology reports that described a VMSA. Thirty-one (48%) of the 65 patients with VMSAs had further evaluation recommended by radiology. Ten (32%) of these 31 patients were followed clinically without further diagnostic testing for the VMSA. Of the 65 patients with VMSAs, only one was diagnosed with malignancy (multiple myeloma). CONCLUSION While VMSAs are not frequently found on thoracolumbar MRIs ordered to evaluate back and/or leg pain, there is a large amount of heterogeneity in how these abnormalities are documented and managed. This may indicate the need for clinical guidelines for the reporting and management of VMSAs detected on spine MRI and for improvement in communication between radiologists and ordering providers. LEVEL OF EVIDENCE 3.
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Prince JT. Comparison of Diagnostic Medical Sonography, Computed Tomography, Magnetic Resonance Imaging, and Contrast-Enhanced Ultrasound in the Investigation of Renal Lesions. JOURNAL OF DIAGNOSTIC MEDICAL SONOGRAPHY 2020. [DOI: 10.1177/8756479319882015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This review explores the classification and evaluation of suspicious renal lesions across several radiologic imaging modalities. Diagnostic medical sonography (DMS), computed tomography (CT), magnetic resonance imaging (MRI), and contrast-enhanced ultrasound (CEUS) are the primary modalities used to investigate questionable lesions found within the kidneys. Renal masses may range from completely benign to malignant. They are classified based on many different features and characteristics. These lesions may be simple cystic, complex cystic, or solid in nature. Masses may also exhibit varying degrees of vascularity, septations, and calcifications. The discussed imaging modalities have varying strengths, limitations, and implications for use. Imaging techniques may be used independently or in conjunction to best diagnose and treat a patient with a suspicious renal mass. The aim of this review was to describe the diagnostic value of the imaging modalities (DMS, CT, MRI, and CEUS) and their role in the evaluation of suspicious renal lesions.
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Cicero G, Blandino A, Italiano F, Micalizzi MF, Mazziotti S. Spontaneous reduction of a minimally complex cyst mimicking a renal cancer. Clin Case Rep 2019; 7:2600-2602. [PMID: 31893115 PMCID: PMC6935623 DOI: 10.1002/ccr3.2541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Revised: 09/05/2019] [Accepted: 10/15/2019] [Indexed: 11/18/2022] Open
Abstract
Renal cyst shrinkage is a rare finding. Since the collapsed cystic walls may mimic soft tissue components, this scenario has to be taken into account in the differential diagnosis of benign and malignant renal cysts.
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Affiliation(s)
- Giuseppe Cicero
- Section of Radiological SciencesDepartment of Biomedical Sciences and Morphological and Functional ImagingUniversity of MessinaMessinaItaly
| | - Alfredo Blandino
- Section of Radiological SciencesDepartment of Biomedical Sciences and Morphological and Functional ImagingUniversity of MessinaMessinaItaly
| | - Fabio Italiano
- Section of Radiological SciencesDepartment of Biomedical Sciences and Morphological and Functional ImagingUniversity of MessinaMessinaItaly
| | - Martina Francesca Micalizzi
- Section of Radiological SciencesDepartment of Biomedical Sciences and Morphological and Functional ImagingUniversity of MessinaMessinaItaly
| | - Silvio Mazziotti
- Section of Radiological SciencesDepartment of Biomedical Sciences and Morphological and Functional ImagingUniversity of MessinaMessinaItaly
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Rembeyo G, Correas JM, Jantzen R, Audenet F, Dariane C, Delavaud C, Mejean A, Timsit MO. Percutaneous Ablation Versus Robotic Partial Nephrectomy in the Treatment of cT1b Renal Tumors: Oncologic and Functional Outcomes of a Propensity Score-weighted Analysis. Clin Genitourin Cancer 2019; 18:138-147. [PMID: 31982346 DOI: 10.1016/j.clgc.2019.10.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2019] [Revised: 09/25/2019] [Accepted: 10/06/2019] [Indexed: 01/20/2023]
Abstract
INTRODUCTION The purpose of this study was to assess oncologic and functional outcomes of both percutaneous ablation (cryoablation and radiofrequency ablation) and robot-assisted partial nephrectomy (RAPN) in the treatment of renal tumors larger than 4 cm. MATERIALS AND METHODS We retrospectively analyzed prospectively collected data from 102 consecutive patients, who underwent minimally invasive treatment for cT1b renal tumors at our institution. Primary renal function outcome was assessed by estimated glomerular filtration rate preservation at baseline and 1 year postoperatively. Perioperative data and functional and oncologic outcome were collected. Multivariate regression models were used to compare functional outcomes between groups. Cancer-specific survival and recurrence-free survival were estimated at 2 years using the Kaplan-Meier method and compared with Cox proportional hazards regression model to calculate hazard ratios (HRs). To control for selection bias between the different treatments, we adjusted our models with an inverse probability of treatment weighting propensity score. RESULTS There was no significant difference in renal preservation between the groups (P = .664). Multivariate analysis did not show a statistically significant difference in terms of renal function outcomes between the RAPN and percutaneous thermal ablation groups. The adjusted HR regarding the local recurrence-free survival was significantly shorter for the cryoablation group (HR, 4.3; 95% confidence interval, 1.78-10.37; P = .001). CONCLUSIONS Our study demonstrated the equivalence between RAPN and percutaneous ablative techniques for the preservation of renal function in the treatment of T1b tumors. RAPN offers a better local control than percutaneous ablation, in terms of primary success rate.
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Affiliation(s)
- Gregory Rembeyo
- Department of Urology, HEGP, Paris, France; Université Paris Descartes, Faculté de Médecine, Paris, France.
| | - Jean-Michel Correas
- Université Paris Descartes, Faculté de Médecine, Paris, France; Department of Adult Radiology, Hôpital NECKER - Enfant Malades, Paris, France
| | - Rodolphe Jantzen
- Université Paris Descartes, Faculté de Médecine, Paris, France; Medical Informatics, Biostatistics and Public Health Department, HEGP, Paris, France
| | - François Audenet
- Department of Urology, HEGP, Paris, France; Université Paris Descartes, Faculté de Médecine, Paris, France
| | - Charles Dariane
- Department of Urology, HEGP, Paris, France; Université Paris Descartes, Faculté de Médecine, Paris, France
| | - Christophe Delavaud
- Université Paris Descartes, Faculté de Médecine, Paris, France; Department of Adult Radiology, Hôpital NECKER - Enfant Malades, Paris, France
| | - Arnaud Mejean
- Department of Urology, HEGP, Paris, France; Université Paris Descartes, Faculté de Médecine, Paris, France
| | - Marc-Olivier Timsit
- Department of Urology, HEGP, Paris, France; Université Paris Descartes, Faculté de Médecine, Paris, France
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Sun J, Zhang XY, Li XT, Li YL, Wang ZL. Use of Iodine Concentration in the Lipid-Poor Portion of the Renal Mass for Differentiation of Angiomyolipoma from Renal Cell Carcinoma. Cancer Biother Radiopharm 2019; 34:224-230. [PMID: 31070481 DOI: 10.1089/cbr.2018.2696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Purpose: This study is aimed to evaluate the iodine concentration in the lipid-poor portion of the renal mass as a potential tool for the differentiation between angiomyolipoma (AML) and renal cell carcinoma (RCC). Materials and Methods: There were eight cases of AML and eight cases of RCC. All patients received corticomedullary, nephrographic and excretory phase enhanced scanning. The regions of interest (ROI) were manually placed in the lipid-poor portion of the renal mass and in the abdominal aorta. Average iodine concentrations were obtained for the ROIs and abdominal aorta. Data were compared using repeated measures analysis with the Bonferroni correction for multiple comparisons. Results: At the unenhanced phase, the iodine concentration in the lipid-poor portion of the renal mass of RCC was not significantly different from that of AML (p = 0.298). At the three enhanced phases, the iodine concentrations in the renal mass of RCC were substantially elevated compared with those of AML. In addition, the CT values of the renal mass of RCC were significantly higher than those of AML at all the enhanced phases. Of note, there was a significant correlation between iodine concentrations and CT values (r = 0.919; p < 0.001) in the lipid-poor portion of the renal mass of RCC. Conclusions: Between RCC and AML there was significant difference in iodine concentrations in the lipid-poor portion of the renal masses. Iodine concentration holds promise as a diagnostic alternative to macroscopic fat for differentiation of AML from RCC.
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Affiliation(s)
- Jia Sun
- 1 Department of Radiology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Xiao-Yan Zhang
- 2 Department of Radiology, Peking University Cancer Hospital & Institute, Beijing, China
| | - Xiao-Ting Li
- 2 Department of Radiology, Peking University Cancer Hospital & Institute, Beijing, China
| | - Yan-Ling Li
- 2 Department of Radiology, Peking University Cancer Hospital & Institute, Beijing, China
| | - Zhi-Long Wang
- 2 Department of Radiology, Peking University Cancer Hospital & Institute, Beijing, China
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Brennan O, Oh S, Necas M. The value of surveying the kidneys during pelvic ultrasound examinations. Australas J Ultrasound Med 2019; 22:118-128. [PMID: 34760548 PMCID: PMC8411717 DOI: 10.1002/ajum.12122] [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: 11/10/2022] Open
Abstract
INTRODUCTION Pelvic ultrasounds are commonly performed for various clinical indications in female patients presenting to the hospital. A survey of the kidneys is routinely included as part of the examination, but there is limited justification for their inclusion in the assessment of every female presenting for a pelvic ultrasound. METHOD We examined the utility of surveying the kidney ultrasound during pelvic ultrasonography by reviewing the records of 1009 pelvic ultrasound examinations in 1000 women. RESULTS In total, 46 incidental findings were identified, but 91% of these were clinically inconsequential. Only four patients had incidental findings of high clinical priority requiring specialist treatment. Of these, two patients were symptomatic and had urinary tract obstruction due to stones. The other two patients harboured asymptomatic renal cell carcinomas. The overall incidence of renal incidental findings of high clinical priority in asymptomatic patients was two in 1009 examinations (1999 kidneys). CONCLUSION Indiscriminate uncritical screening of the kidneys in women presenting for pelvic ultrasound is not evidence-based and represents a low-yield examination with extremely low rate of incidental findings of clinical significance.
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Affiliation(s)
| | - Sheila Oh
- Department of UltrasoundWaikato HospitalHamiltonNew Zealand
| | - Martin Necas
- Department of UltrasoundWaikato HospitalHamiltonNew Zealand
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D'Angelo T, Cicero G, Mazziotti S, Ascenti G, Albrecht MH, Martin SS, Othman AE, Vogl TJ, Wichmann JL. Dual energy computed tomography virtual monoenergetic imaging: technique and clinical applications. Br J Radiol 2019; 92:20180546. [PMID: 30919651 DOI: 10.1259/bjr.20180546] [Citation(s) in RCA: 67] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Dual energy CT (DECT) has evolved into a commonly applied imaging technique in clinical routine due to its unique post-processing opportunities for improved evaluation of all body areas. Reconstruction of virtual monoenergetic imaging (VMI) series has shown beneficial effects for both non-contrast and contrast-enhanced DECT due to the flexibility to calculate low-keV VMI reconstructions to increase contrast and iodine attenuation, or to compute high-keV VMI reconstructions to reduce beam-hardening artefacts. The goal of this review article is to explain the technical background of VMI and noise-optimized VMI+ algorithms and to give an overview of useful clinical applications of the VMI technique in DECT of various body regions.
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Affiliation(s)
- Tommaso D'Angelo
- 1 Department of Biomedical Sciences and Morphological and Functional Imaging, Policlinico G. Martino - University Hospital Messina , Messina , Italy.,2 Department of Diagnostic and Interventional Radiology, Division of Experimental Imaging, University Hospital Frankfurt , Frankfurt , Germany
| | - Giuseppe Cicero
- 1 Department of Biomedical Sciences and Morphological and Functional Imaging, Policlinico G. Martino - University Hospital Messina , Messina , Italy
| | - Silvio Mazziotti
- 1 Department of Biomedical Sciences and Morphological and Functional Imaging, Policlinico G. Martino - University Hospital Messina , Messina , Italy
| | - Giorgio Ascenti
- 1 Department of Biomedical Sciences and Morphological and Functional Imaging, Policlinico G. Martino - University Hospital Messina , Messina , Italy
| | - Moritz H Albrecht
- 2 Department of Diagnostic and Interventional Radiology, Division of Experimental Imaging, University Hospital Frankfurt , Frankfurt , Germany
| | - Simon S Martin
- 2 Department of Diagnostic and Interventional Radiology, Division of Experimental Imaging, University Hospital Frankfurt , Frankfurt , Germany
| | - Ahmed E Othman
- 3 Department of Diagnostic and Interventional Radiology, Eberhard Karls University Tübingen , Tübingen , Germany
| | - Thomas J Vogl
- 2 Department of Diagnostic and Interventional Radiology, Division of Experimental Imaging, University Hospital Frankfurt , Frankfurt , Germany
| | - Julian L Wichmann
- 2 Department of Diagnostic and Interventional Radiology, Division of Experimental Imaging, University Hospital Frankfurt , Frankfurt , Germany
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Differentiation of Predominantly Solid Enhancing Lipid-Poor Renal Cell Masses by Use of Contrast-Enhanced CT: Evaluating the Role of Texture in Tumor Subtyping. AJR Am J Roentgenol 2018; 211:W288-W296. [PMID: 30240299 DOI: 10.2214/ajr.18.19551] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVE The purpose of this study was to assess the accuracy of a panel of texture features extracted from clinical CT in differentiating benign from malignant solid enhancing lipid-poor renal masses. MATERIALS AND METHODS In a retrospective case-control study of 174 patients with predominantly solid nonmacroscopic fat-containing enhancing renal masses, 129 cases of malignant renal cell carcinoma were found, including clear cell, papillary, and chromophobe subtypes. Benign renal masses-oncocytoma and lipid-poor angiomyolipoma-were found in 45 patients. Whole-lesion ROIs were manually segmented and coregistered from the standard-of-care multiphase contrast-enhanced CT (CECT) scans of these patients. Pathologic diagnosis of all tumors was obtained after surgical resection. CECT images of the renal masses were used as inputs to a CECT texture analysis panel comprising 31 texture metrics derived with six texture methods. Stepwise logistic regression analysis was used to select the best predictor among all candidate predictors from each of the texture methods, and their performance was quantified by AUC. RESULTS Among the texture predictors aiding renal mass subtyping were entropy, entropy of fast-Fourier transform magnitude, mean, uniformity, information measure of correlation 2, and sum of averages. These metrics had AUC values ranging from good (0.80) to excellent (0.98) across the various subtype comparisons. The overall CECT-based tumor texture model had an AUC of 0.87 (p < 0.05) for differentiating benign from malignant renal masses. CONCLUSION The CT texture statistical model studied was accurate for differentiating benign from malignant solid enhancing lipid-poor renal masses.
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