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Sun D, Lu Q, Wei C, Li Y, Zheng Y, Hu B. Differential diagnosis of <3 cm renal tumors by ultrasonography: a rapid, quantitative, elastography self-corrected contrast-enhanced ultrasound imaging mode beyond screening. Br J Radiol 2020; 93:20190974. [PMID: 32479108 DOI: 10.1259/bjr.20190974] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVES To assess the combined diagnostic strategy of contrast-enhanced ultrasound (CEUS) and acoustic radiation force impulse (ARFI) in the precise differential diagnosis of clear cell renal cell carcinoma (CCRCC) and urothelium carcinoma of the renal pelvis (UCRP) with other small renal tumors (SRTs) <3 cm in size. METHODS The elastography self-corrected CEUS (ESC) mode was established to perform the quantitative differential diagnosis of SRTs (<3 cm). The kidney shear wave velocity (SWV) value recorded by ARFI showed substantial variability in patients with CCRCC (high elasticity value) and UCRP (low elasticity value) compared with other renal masses, thus providing critical self-correction information for the ultrasound differential diagnosis of SRTs. RESULTS In this work, the ESC observations and the corresponding ESC criteria show a remarkable 94.6% accuracy in reference to the gold standards, thus allowing the quantitative, early triple distinction of CCRCC with UCRP and other SRTs in patients with suspicious SRTs. CONCLUSIONS This ARFI self-corrected CEUS diagnostic strategy is far beyond a screening method and may have the potential to identify a window of therapeutic opportunity in which emerging therapies might be applied to patients with CCRCC and UCRP, reducing overtreatment and medical costs. ADVANCES IN KNOWLEDGE In our study, a new rapid and non-invasive elastography self-corrected CEUS (ESC) ultrasound imaging mode was developed, which was useful in the triple distinction of CCRCC, UCRP, and other SRTs with 94.6% accuracy. ESC is a promising method in the differential diagnosis of SRTs with accuracy and practicability far beyond a single screening model.
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Affiliation(s)
- Di Sun
- Department of Ultrasound in Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital & Shanghai Institute of Ultrasound in Medicine, Shanghai, 200233, PR China
| | - Qijie Lu
- Department of Ultrasound in Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital & Shanghai Institute of Ultrasound in Medicine, Shanghai, 200233, PR China
| | - Cong Wei
- Department of Ultrasound in Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital & Shanghai Institute of Ultrasound in Medicine, Shanghai, 200233, PR China
| | - Yi Li
- Department of Ultrasound in Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital & Shanghai Institute of Ultrasound in Medicine, Shanghai, 200233, PR China
| | - Yuanyi Zheng
- Department of Ultrasound in Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital & Shanghai Institute of Ultrasound in Medicine, Shanghai, 200233, PR China
| | - Bing Hu
- Department of Ultrasound in Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital & Shanghai Institute of Ultrasound in Medicine, Shanghai, 200233, PR China
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Withey SJ, Gariani J, Reddy K, Prezzi D, Kelly-Morland C, Ilyas S, Adam A, Goh V. Is there a role for perfusion imaging in assessing treatment response following ablative therapy of small renal masses-A systematic review. Eur J Radiol Open 2018; 5:102-107. [PMID: 30094296 PMCID: PMC6077124 DOI: 10.1016/j.ejro.2018.07.002] [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: 02/18/2018] [Accepted: 07/02/2018] [Indexed: 12/01/2022] Open
Abstract
Aims Ablation therapies are an innovative nephron-sparing alternative to radical nephrectomy for early stage renal cancers, although determination of treatment success is challenging. We aimed to undertake a systematic review of the literature to determine whether assessment of tumour perfusion may improve response assessment or alter clinical management when compared to standard imaging. Material and Methods Two radiologists performed independent primary literature searches for perfusion imaging in response assessment following ablative therapies (radiofrequency ablation and cryotherapy) focused on renal tumours. Results 5 of 795 articles were eligible, totaling 110 patients. The study designs were heterogeneous with different imaging techniques, perfusion calculations, reference standard and follow-up periods. All studies found lower perfusion following treatment, with a return of ‘high grade’ perfusion in the 7/110 patients with residual or recurrent tumour. One study found perfusion curves were different between successfully ablated regions and residual tumour. Conclusions Studies were limited by small sample size and heterogeneous methodology. No studies have investigated the impact of perfusion imaging on management. This review highlights the current lack of evidence for perfusion imaging in response assessment following renal ablation, however it suggests that there may be a future role. Further prospective research is required to address this.
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Affiliation(s)
- S J Withey
- Department of Radiology, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom.,Cancer Imaging, Division of Imaging Sciences and Biomedical Engineering, King's College London, United Kingdom
| | - J Gariani
- Cancer Imaging, Division of Imaging Sciences and Biomedical Engineering, King's College London, United Kingdom
| | - K Reddy
- Department of Radiology, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - D Prezzi
- Department of Radiology, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom.,Cancer Imaging, Division of Imaging Sciences and Biomedical Engineering, King's College London, United Kingdom
| | - C Kelly-Morland
- Department of Radiology, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom.,Cancer Imaging, Division of Imaging Sciences and Biomedical Engineering, King's College London, United Kingdom
| | - S Ilyas
- Department of Radiology, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - A Adam
- Department of Radiology, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom.,Cancer Imaging, Division of Imaging Sciences and Biomedical Engineering, King's College London, United Kingdom
| | - V Goh
- Department of Radiology, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom.,Cancer Imaging, Division of Imaging Sciences and Biomedical Engineering, King's College London, United Kingdom
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Lamid-Ochir O, Nakajima T, Miyazaki M, Zhang X, Erdene K, Murakami T, Tsushima Y. Bioluminescence Image as a Quantitative Imaging Biomarker for Preclinical Evaluation of Cryoablation in a Murine Model. J Vasc Interv Radiol 2018; 29:1034-1040. [PMID: 29884506 DOI: 10.1016/j.jvir.2018.03.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Revised: 02/22/2018] [Accepted: 03/07/2018] [Indexed: 01/29/2023] Open
Abstract
PURPOSE To employ bioluminescence imaging (BLI) as a quantitative imaging biomarker to assess preclinical evaluation of cryoablation in a murine model. MATERIALS AND METHODS In vitro, Colon26-Luc (C26-Luc) cells were seeded at 6 different concentrations in 35-mm dishes. These were divided into 6 groups: group 0 (G0), a control group without treatment; and groups 1-5 (G1-G5) according to the number of freeze-thaw cycles, with each cycle consisting of freezing at -80°C for 10 min followed by thawing at room temperature for 5 minutes. BLI and flow-cytometric analysis were performed after cryotherapy. In vivo, 20 tumor-bearing mice with C26-Luc cells were divided into 4 groups: group 0 (G0), a control group; and groups 1-3 (G1-G3) according to the number of freeze-thaw cycles. Each cryoablation procedure was performed for 30 seconds with liquid nitrogen (-170°C) applied with cotton-tipped applicators. BLI was acquired at 6 hours and 1, 3, and 7 days after treatments. RESULTS In vitro, BLI signal showed a negative correlation with the number of freeze-thaw cycles (r = -0.86, P = .02). In vivo, there was no difference in tumor volume at 1 day after cryoablation among all groups, but the BLI signals were significantly different between G0 and G2/G3 (P = .03 and P = .02, respectively) and between G1 and G3 (P = .04). BLI signals reflected tumor growth speed and survival ratio. CONCLUSIONS This study demonstrates the direct validation of BLI as a quantitative tool for the early assessment of therapeutic effects of cryoablation.
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Affiliation(s)
- Oyunbold Lamid-Ochir
- Department of Diagnostic Radiology and Nuclear Medicine, Gunma University Graduate School of Medicine, 3-39-22 Showa, Maebashi, Gunma 371-8511, Japan
| | - Takahito Nakajima
- Department of Diagnostic Radiology and Nuclear Medicine, Gunma University Graduate School of Medicine, 3-39-22 Showa, Maebashi, Gunma 371-8511, Japan.
| | - Masaya Miyazaki
- Department of Diagnostic Radiology and Nuclear Medicine, Gunma University Graduate School of Medicine, 3-39-22 Showa, Maebashi, Gunma 371-8511, Japan
| | - Xieyi Zhang
- Department of Diagnostic Radiology and Nuclear Medicine, Gunma University Graduate School of Medicine, 3-39-22 Showa, Maebashi, Gunma 371-8511, Japan
| | - Khongorzul Erdene
- Department of Diagnostic Radiology and Nuclear Medicine, Gunma University Graduate School of Medicine, 3-39-22 Showa, Maebashi, Gunma 371-8511, Japan
| | - Takashi Murakami
- Department of Microbiology, Faculty of Medicine, Saitama Medical University, Moroyama, Japan
| | - Yoshito Tsushima
- Department of Diagnostic Radiology and Nuclear Medicine, Gunma University Graduate School of Medicine, 3-39-22 Showa, Maebashi, Gunma 371-8511, Japan; Research Program for Diagnostic and Molecular Imaging, Division of Integrated Oncology Research, Gunma University Initiative for Advanced Research, Maebashi, Japan
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Liu D, Liu J, Wen Z, Li Y, Sun Z, Xu Q, Fan Z. 320-row CT renal perfusion imaging in patients with aortic dissection: A preliminary study. PLoS One 2017; 12:e0171235. [PMID: 28182709 PMCID: PMC5300209 DOI: 10.1371/journal.pone.0171235] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Accepted: 01/17/2017] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE To investigate the clinical value of renal perfusion imaging in patients with aortic dissection (AD) using 320-row computed tomography (CT), and to determine the relationship between renal CT perfusion imaging and various factors of aortic dissection. METHODS Forty-three patients with AD who underwent 320-row CT renal perfusion before operation were prospectively enrolled in this study. Diagnosis of AD was confirmed by transthoracic echocardiography. Blood flow (BF) of bilateral renal perfusion was measured and analyzed. CT perfusion imaging signs of AD in relation to the type of AD, number of entry tears and the false lumen thrombus were observed and compared. RESULTS The BF values of patients with type A AD were significantly lower than those of patients with type B AD (P = 0.004). No significant difference was found in the BF between different numbers of intimal tears (P = 0.288), but BF values were significantly higher in cases with a false lumen without thrombus and renal arteries arising from the true lumen than in those with thrombus (P = 0.036). The BF values measured between the true lumen, false lumen and overriding groups were different (P = 0.02), with the true lumen group having the highest. Also, the difference in BF values between true lumen and false lumen groups was statistically significant (P = 0.016), while no statistical significance was found in the other two groups (P > 0.05). The larger the size of intimal entry tears, the greater the BF values (P = 0.044). CONCLUSIONS This study shows a direct correlation between renal CT perfusion changes and AD, with the size, number of intimal tears, different types of AD, different renal artery origins and false lumen thrombosis, significantly affecting the perfusion values.
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Affiliation(s)
- Dongting Liu
- Department of Radiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Jiayi Liu
- Department of Radiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Zhaoying Wen
- Department of Radiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Yu Li
- Department of Radiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Zhonghua Sun
- Department of Medical Radiation Sciences, Curtin University, Perth, Australia
| | - Qin Xu
- School of Public Health, Capital Medical University, Beijing, China
| | - Zhanming Fan
- Department of Radiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
- * E-mail:
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Prezzi D, Khan A, Goh V. Perfusion CT imaging of treatment response in oncology. Eur J Radiol 2015; 84:2380-5. [PMID: 25864440 DOI: 10.1016/j.ejrad.2015.03.022] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2014] [Revised: 03/11/2015] [Accepted: 03/16/2015] [Indexed: 01/15/2023]
Abstract
Perfusion CT was first described in the 1970s but has become accepted as a clinical technique in recent years. In oncological practice Perfusion CT allows the downstream effects of therapies on the tumour vasculature to be monitored. From the dynamic changes in tumour and vascular enhancement following intravenous iodinated contrast agent administration, qualitative and quantitative parameters may be derived that reflect tumour perfusion, blood volume, and microcirculatory changes with treatment. This review outlines the mechanisms of action of available therapies and state-of-the-art imaging practice.
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Affiliation(s)
- Davide Prezzi
- Division of Imaging Sciences & Biomedical Engineering, King's College London, United Kingdom; Department of Radiology, Guy's & St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Aisha Khan
- Department of Radiology, Guy's & St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Vicky Goh
- Division of Imaging Sciences & Biomedical Engineering, King's College London, United Kingdom; Department of Radiology, Guy's & St Thomas' NHS Foundation Trust, London, United Kingdom.
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Technical prerequisites and imaging protocols for CT perfusion imaging in oncology. Eur J Radiol 2015; 84:2359-67. [PMID: 26137905 DOI: 10.1016/j.ejrad.2015.06.010] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2015] [Accepted: 06/11/2015] [Indexed: 12/29/2022]
Abstract
The aim of this review article is to define the technical prerequisites of modern state-of-the-art CT perfusion imaging in oncology at reasonable dose levels. The focus is mainly on abdominal and thoracic tumor imaging, as they pose the largest challenges with respect to attenuation and patient motion. We will show that low kV dynamic scanning in conjunction with detection technology optimized for low photon fluxes has the highest impact on reducing dose independently of other choices made in the protocol selection. We discuss, derived from relatively simple first principles, on what appropriate temporal sampling and total scan duration depend on and why optimized contrast medium injection protocols are also essential in limiting dose. Finally we will examine the possibility of simultaneously extracting standard morphological and functional information from one single 4D examination as a potential enabler for a more widespread use of dynamic contrast enhanced CT in oncology.
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Lang EK, Zhang KK, Nguyen Q, Myers L, Allaf M, Colon I. Efficacy of percutaneous cryoablation of renal cell carcinoma in older patients with medical comorbidities: Outcome study in 70 patients. Can Urol Assoc J 2015; 9:E256-61. [PMID: 26029291 DOI: 10.5489/cuaj.2597] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
INTRODUCTION The aim of this study was to establish the efficacy of cryoablation for incidentally discovered small renal cell carcinomas in older patients with medical comorbidities. METHODS We carried out a retrospective chart analysis of outcomes of 70 patients treated by cryoablation. The inclusion criteria were age >56 years, medical comorbidities (Charlson class I-III), and suitability for cryoablation established by urologists and interventional radiologists. In total, 43 patients were male, 27 female, and the age range was 56 to 89. The lesions measured 1.5 to 4 cm; 29 were high-grade Fuhrman and 41 were low grade. All lesions were treated by 2 10-minute freezing cycles separated by an 8-minute thawing period. One to seven cryoprobes were inserted according to a preoperative, 3D computed tomography (CT)-based plan. RESULTS Results were assessed on follow-up CTs (at 8-9 months). Of the 70 patients, 68 were treated by cryoablations and surgical salvage procedures; these patients were free of disease for 23 to 72 months (mean 39). One patient experienced recurrence and the other was lost to follow-up. One or two cryoablations rendered 66 patients tumour-free and additional surgery rendered another 2 patients tumour-free. The location and configuration of the lesion affected outcomes. Of the 27 posterior lesions, there was 1 failure; of the postero-lateral lesions, there were 4 failures; of the anterior lesions, there were 5 lesions; finally of the 32 central or deep seated lesions, there were 9 failures. Implants with one and two cryoprobes had a high recurrence rate. Three major complications were managed by minor interventions. The mean hospitalization was 1.3 days and the procedure times were variable. CONCLUSION Percutaneous cryoablation is recommended as a minimally invasive nephron-sparing treatment for amenable lesions in older patients with medical comorbidities.
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Affiliation(s)
| | - Kan Karl Zhang
- Department of Surgery, Division of Urology, Duke University Medical Center, Durham, NC
| | | | | | | | - Ivan Colon
- SUNY Downstate Medical Center, Brooklyn, NY
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CT perfusion as an imaging biomarker in monitoring response to neoadjuvant bevacizumab and radiation in soft-tissue sarcomas: comparison with tumor morphology, circulating and tumor biomarkers, and gene expression. AJR Am J Roentgenol 2015; 204:W11-8. [PMID: 25539263 DOI: 10.2214/ajr.13.12412] [Citation(s) in RCA: 21] [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 evaluate the role of CT perfusion in monitoring response to neoadjuvant antiangiogenic and radiation therapy in resectable soft-tissue sarcomas and correlate the findings with tumor size, circulating and tumor biomarkers, and gene expression. SUBJECTS AND METHODS This phase II clinical trial included 20 patients (13 men and 7 women; mean age, 55 years) with soft-tissue sarcomas who were undergoing treatment with the antiangiogenic drug bevacizumab followed by bevacizumab, radiation, and surgical resection. The patients underwent CT perfusion and diagnostic contrast-enhanced CT at baseline, at 2 weeks after bevacizumab therapy, and after completion of bevacizumab and radiation therapy. Multiple CT perfusion parameters (blood flow, blood volume, mean transit time, and permeability) were correlated with tumor size, circulating and tumor biomarkers, and gene expression. RESULTS Two weeks after bevacizumab therapy, there was substantial fall in blood volume (31.9% reduction, p = 0.01) with more pronounced reduction in blood flow, blood volume, and permeability after treatment completion (53-64% reduction in blood flow, blood volume, and permeability; p = 0.001), whereas tumor size showed no significant change (p = 0.34). Tumors with higher baseline blood volume and lower baseline tumor size showed superior response to bevacizumab and radiation (p = 0.05). There was also an increase in median plasma vascular endothelial growth factor and placental-derived growth factor concentration after bevacizumab therapy paralleled by a decrease in tumor perfusion depicted by CT perfusion, although this was not statistically significant (p = 0.4). The baseline tumor microvessel density (MVD) correlated with blood flow (p = 0.04). At least 20 different genes were differentially expressed in tumors with higher and lower baseline perfusion. CONCLUSION CT perfusion is more sensitive than tumor size for monitoring early and late response to bevacizumab and radiation therapy. CT perfusion parameters correlate with MVD, and the gene expression levels of baseline tumors could potentially predict treatment response.
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Reginelli A, Di Grezia G, Izzo A, D'andrea A, Gatta G, Cappabianca S, Squillaci E, Grassi R. Imaging of adrenal incidentaloma: our experience. Int J Surg 2014; 12 Suppl 1:S126-31. [PMID: 24862667 DOI: 10.1016/j.ijsu.2014.05.029] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2014] [Accepted: 05/03/2014] [Indexed: 11/20/2022]
Abstract
PURPOSE To investigate clinical, biochemical and radiological features in 35 patients with adrenal incidentaloma found on CT and/or MRI and to define the management of patients with adrenal masses. MATHERIAL AND METHODS From January 2011 and May 2013, 35 patients (19F, 16M) with an adrenal mass incidentally discovered on CT and/or MRI were enrolled in a retrospective study. Thirthy-two patients underwent MDCT and eight 1.5 MRI. RESULTS Patients consisted in 16 males and 19 females, aged between 25 and 89 yo. Adrenal lesions were most commonly found in the sixth decade; in relation to the side of the mass, 20 were found on left side, 15 on the right. Of all the mass analyzed, 3 were <1 cm diameter, 29 between 1 and 4 cm, 3 > 4 cm. The most common finding on CT was adenoma-like appearance (19 cases in relation to size, 14 in relation to attenuation values). Hormonal analysis showed 32 cases of nonfunctional masses and 3 cases of hormone activity. Adrenalectomy was performed in ten patients having adenoma (5 cases), malignant lesions (2 cases), pheocromocitoma, cyst and myelolipoma (1 case). CONCLUSION Diagnostic approach to adrenal incidentaloma is focused on the definition of malignancy and hormonal activity; the characterization is needs hormonal and radiological (CT and/or MRI) evaluation, even if a fine needle aspiration is needed in selected cases. Benign and/or non-hypersecreting hormone lesion with <4 cm diameter could be sent to follow-up; active adrenal tumors or >4 cm diameter lesions with malignancy suspicious or growth during follow-up could be treated with surgical adrenalectomy.
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Affiliation(s)
- Alfonso Reginelli
- Department of Internal and Experimental Medicine, Magrassi-Lanzara, Institute of Radiology, Second University of Naples, Piazza Miraglia 2, 80138 Napoli, Naples, Italy.
| | - Graziella Di Grezia
- Department of Internal and Experimental Medicine, Magrassi-Lanzara, Institute of Radiology, Second University of Naples, Piazza Miraglia 2, 80138 Napoli, Naples, Italy
| | - Andrea Izzo
- Department of Internal and Experimental Medicine, Magrassi-Lanzara, Institute of Radiology, Second University of Naples, Piazza Miraglia 2, 80138 Napoli, Naples, Italy
| | - Alfredo D'andrea
- Department of Internal and Experimental Medicine, Magrassi-Lanzara, Institute of Radiology, Second University of Naples, Piazza Miraglia 2, 80138 Napoli, Naples, Italy
| | - Gianluca Gatta
- Department of Internal and Experimental Medicine, Magrassi-Lanzara, Institute of Radiology, Second University of Naples, Piazza Miraglia 2, 80138 Napoli, Naples, Italy
| | - Salvatore Cappabianca
- Department of Internal and Experimental Medicine, Magrassi-Lanzara, Institute of Radiology, Second University of Naples, Piazza Miraglia 2, 80138 Napoli, Naples, Italy
| | - Ettore Squillaci
- Department of Diagnostic Imaging, Molecular Imaging, Interventional Radiology and Radiotherapy, University of Rome Tor Vergata, Rome, Italy
| | - Roberto Grassi
- Department of Internal and Experimental Medicine, Magrassi-Lanzara, Institute of Radiology, Second University of Naples, Piazza Miraglia 2, 80138 Napoli, Naples, Italy
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Purohit NB, Theaker J, Breen DJ. Unusual radiological behaviour after cryoablation of renal cell carcinoma. Cardiovasc Intervent Radiol 2014; 37:1631-4. [PMID: 24798132 DOI: 10.1007/s00270-014-0886-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2014] [Accepted: 02/16/2014] [Indexed: 11/25/2022]
Abstract
Cryoablation has evolved into an effective treatment option in patients with renal tumours. The procedure is minimally invasive, and patients are often spared the morbidity and hospital stay that is often associated with open or partial nephrectomy. We present an unusual case of a 62-year-old male patient who underwent cryoablation of a renal cell carcinoma. He subsequently developed apparent exuberant local disease progression, which spontaneously regressed on follow-up CT imaging.
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Affiliation(s)
- Neeraj B Purohit
- Department of Clinical and Interventional Radiology, University Hospital Southampton, Southampton, Hampshire, SO16 6YD, UK,
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Chen C, Liu Q, Hao Q, Xu B, Ma C, Zhang H, Shen Q, Lu J. Study of 320-slice dynamic volume CT perfusion in different pathologic types of kidney tumor: preliminary results. PLoS One 2014; 9:e85522. [PMID: 24465588 PMCID: PMC3897451 DOI: 10.1371/journal.pone.0085522] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2013] [Accepted: 11/27/2013] [Indexed: 12/18/2022] Open
Abstract
Objective To investigate microcirculatory differences between pathologic types of kidney tumor using 320-slice dynamic volume CT perfusion. Methods Perfusion imaging with 320-slice dynamic volume CT was prospectively performed in 85 patients with pathologically proven clear cell renal cell carcinoma (RCC) (n = 66), papillary RCC (n = 7), chromophobe RCC (n = 5), angiomyolipoma (AML) with minimal fat (n = 7), or RCC (n = 78). Equivalent blood volume (Equiv BV), permeability surface-area product (PS; clearance/unit volume = permeability), and blood flow (BF) of tumor and normal renal cortex were measured and analyzed. Effective radiation dose was calculated. Results There was a significant difference in all three parameters between tumor and normal renal cortex (P<0.001). Equiv BV was significantly different between RCC and AML with minimal fat (P = 0.038) and between clear cell RCC and AML with minimal fat (P<0.001). Mean Equiv BV and BF were significantly higher in clear cell RCC than in papillary RCC (P<0.001 for both) and mean Equiv BV was higher in clear cell RCC than in chromophobe RCC (P<0.001). The effective radiation dose of the CT perfusion protocol was 18.5 mSv. Conclusion Perfusion imaging using 320-slice dynamic volume CT can be used to evaluate hemodynamic features of the whole kidney and kidney tumors, which may be useful in the differential diagnosis of these four pathologic types of kidney tumor.
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Affiliation(s)
- Chao Chen
- Department of Radiology, Changhai Hospital of Shang hai, The second Military Medical University, Shanghai, China
| | - Qi Liu
- Department of Radiology, Changhai Hospital of Shang hai, The second Military Medical University, Shanghai, China
| | - Qiang Hao
- Department of Radiology, Changhai Hospital of Shang hai, The second Military Medical University, Shanghai, China
| | - Bing Xu
- Department of Radiology, Changhai Hospital of Shang hai, The second Military Medical University, Shanghai, China
| | - Chao Ma
- Department of Radiology, Changhai Hospital of Shang hai, The second Military Medical University, Shanghai, China
| | - Huojun Zhang
- Department of Radiology, Changhai Hospital of Shang hai, The second Military Medical University, Shanghai, China
| | - Qianjin Shen
- Department of Radiology, Changhai Hospital of Shang hai, The second Military Medical University, Shanghai, China
| | - Jianping Lu
- Department of Radiology, Changhai Hospital of Shang hai, The second Military Medical University, Shanghai, China
- * E-mail:
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Perfusion CT: A biomarker for soft tissue tumors of extremities. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2013. [DOI: 10.1016/j.ejrnm.2013.05.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Chapman SJ, Wah TM, Sourbron SP, Buckley DL. The effects of cryoablation on renal cell carcinoma perfusion and glomerular filtration rate measured using dynamic contrast-enhanced MRI: a feasibility study. Clin Radiol 2013; 68:887-94. [PMID: 23639366 DOI: 10.1016/j.crad.2013.03.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2013] [Accepted: 03/14/2013] [Indexed: 11/25/2022]
Abstract
AIM To assess the effect of cryoablation on renal cell carcinoma (RCC) perfusion and single kidney (SK) glomerular filtration rate (GFR) using dynamic contrast-enhanced (DCE) magnetic resonance imaging (MRI). MATERIALS AND METHODS Eighteen patients undergoing percutaneous cryoablation of a solitary RCC between August 2010 and November 2011 were evaluated with DCE-MRI immediately before and 1 month post-cryoablation. DCE-MRI data were acquired with 2 s temporal resolution in a coronal plane during the first pass of a 0.1 mmol/kg bolus dose of Gd-DOTA. Perfusion of the RCC (in ml/min/100 ml tissue) was estimated using a maximum slope technique. An index of SK GFR (SK-GFRi) was assessed using data acquired every 30 s for the following 3 min in the axial plane and analysed using Rutland-Patlak plots. This was compared to the GFR estimated by creatinine clearance (eGFR). RESULTS Perfusion in the zone of ablation decreased significantly (p<0.001) from a mean of 98.0 ± 37.5 ml/min/100 ml pre-cryoablation to 11.6 ± 4.1 ml/min/100 ml post-cryoablation; a mean decrease of 88.2%. Functional analysis was performed in seventeen patients. eGFR was underestimated by SK-GFRi which decreased significantly in tumour-bearing (-31.7%, p = 0.011), but not in contralateral kidneys (-4.4%, p = 0.14). CONCLUSION It is feasible to measure RCC perfusion pre- and post-cryoablation using DCE-MRI. The significant decrease within the zone of ablation suggests that this technique may be useful for assessment of treatment response. Further work is required to address the underestimation of eGFR by SK-GFRi and to validate the perfusion findings.
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Affiliation(s)
- S J Chapman
- Division of Medical Physics, University of Leeds, Leeds, UK
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Comparison of free breathing versus breath-hold in perfusion imaging using dynamic volume CT. Insights Imaging 2012; 3:323-8. [PMID: 22695948 PMCID: PMC3481081 DOI: 10.1007/s13244-012-0169-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2011] [Revised: 03/04/2012] [Accepted: 03/19/2012] [Indexed: 12/11/2022] Open
Abstract
Objectives To compare two scanning protocols (free breathing versus breath-hold) for perfusion imaging using dynamic volume computed tomography (CT) and to evaluate their effects on image registration. Material and methods Forty patients underwent dynamic volume CT for pancreatic perfusion analysis and were randomly assigned to either a shallow-breathing (I) or breath-hold (II) group. Both dynamic CT protocols consisted of 17 low-dose volumetric scans. Rigid image registration was performed by using the volume with highest aortic attenuation as reference. All other volumes were visually matched with the pancreatic lesion serving as the volumetric region of interest. The overall demand for post-processing per patient was calculated as the median of three-dimensional vector lengths of all volumes in relation to the relative patient origin. The number of volumes not requiring registration was recorded per group. Results Registration mismatch for groups I and II was 2.61 mm (SD, 1.57) and 4.95 mm (SD, 2.71), respectively (P < 0.005). Twenty-eight volumes in group I (8.2%) and 47 volumes in group II (14.1%) did not require manual registration (P = 0.014). Conclusion Shallow breathing during dynamic volume CT scanning reduces the overall demand for motion correction and thus may be beneficial in perfusion imaging of the pancreas Main Messages • Shallow breathing during perfusion CT scanning reduces the overall demand for motion correction. • Shallow breathing may be beneficial in perfusion imaging of the pancreas. • Image registration is crucial for CT perfusion imaging.
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Computed tomography perfusion imaging for therapeutic assessment: has it come of age as a biomarker in oncology? Invest Radiol 2012; 47:2-4. [PMID: 21808202 DOI: 10.1097/rli.0b013e318229ff3e] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
With the emergence of novel targeted therapies, imaging techniques that assess tumor vascular support have gained credence for response assessment alongside standard response criteria. Computed tomography (CT) perfusion techniques that quantify regional tumor blood flow, blood volume, flow-extraction product, and permeability-surface area product through standard kinetic models are attractive, but the level of evidence for CT perfusion to be a truly mature biomarker remains insufficient. Studies to date have not been powered to assess this. Future studies that include good quality prospective validation correlating perfusion CT to outcome end points in the trial setting are needed to take CT perfusion forward as a biomarker in oncology.
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Piper J, Ikeda Y, Fujisawa Y, Ohno Y, Yoshikawa T, O’Neil A, Poole I. Objective evaluation of the correction by non-rigid registration of abdominal organ motion in low-dose 4D dynamic contrast-enhanced CT. Phys Med Biol 2012; 57:1701-15. [DOI: 10.1088/0031-9155/57/6/1701] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Afaq A, Akin O. Imaging assessment of tumor response: past, present and future. Future Oncol 2011; 7:669-77. [PMID: 21568682 DOI: 10.2217/fon.11.38] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Anatomical response assessment criteria have been in use for decades, with the WHO guidelines being replaced by Response Evaluation Criteria in Solid Tumors (RECIST), updated in 2009 to RECIST 1.1. These methods rely on a change in size of a tumor as the main response criteria, but newer cytostatic agents tend to target tumor function at a molecular level before changing the size of a lesion. Recent modifications, such as the Choi criteria, have improved assessment by taking into account density of tumor, but all of these criteria fail to utilize functional imaging parameters, which are becoming increasingly available, including perfusion CT, perfusion MRI, diffusion-weighted imaging, magnetic resonance spectroscopy, dynamic contrast-enhanced ultrasound and combined PET/computed tomography. Developments in these modalities and standardization of imaging acquisition will help to optimize the next set of response criteria, with inclusion of multiparametric, functional modalities, evaluating tumors at the same molecular level at which they are being targeted by therapeutic agents.
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Affiliation(s)
- Asim Afaq
- Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY 10065, USA
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Georgiades CS, Rodriguez R, Littrup PJ, Frangakis CE, Leveille R, Ahrar K, Atwell TD, Cadeddu J, Trimmer C, Durack JC, Hammers HJ, Meng MV, Raman S, Solomon SB, Zagoria RJ, McLennan G, LaBerge JM, Gervais DA, Kee ST. Development of a Research Agenda for Percutaneous Renal Tumor Ablation: Proceedings from a Multidisciplinary Research Consensus Panel. J Vasc Interv Radiol 2010; 21:1807-16. [DOI: 10.1016/j.jvir.2010.10.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2010] [Revised: 09/28/2010] [Accepted: 10/07/2010] [Indexed: 10/18/2022] Open
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Abstract
The present decade can be credited with the improved understanding of renal-cell carcinoma (RCC), its local and systemic management, and various controversies from diagnosis to types of various available interventions. The old paradigms and dogmas are no longer accepted as "the best way" without evidence, and many "old" principles are cautiously questioned. These notions have resulted in new knowledge, questions, arguments, and treatment options. This article will describe the "changing face of RCC" over the past several years and will briefly summarize the major changes and issues in the field of renal oncology. The discussed topics include improved molecular understanding of RCC, management of small renal masses, the safety and accuracy of renal mass biopsy, the emerging role of molecular imaging, the importance of maximal renal preservation, and the evolving role of laparoscopy, robotics, and ablation.
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Affiliation(s)
- Gennady Bratslavsky
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland 20892-1107, USA.
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