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Bachanek S, Wuerzberg P, Biggemann L, Janssen TY, Nietert M, Lotz J, Zeuschner P, Maßmann A, Uhlig A, Uhlig J. Renal tumor segmentation, visualization, and segmentation confidence using ensembles of neural networks in patients undergoing surgical resection. Eur Radiol 2024:10.1007/s00330-024-11026-6. [PMID: 39177855 DOI: 10.1007/s00330-024-11026-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2024] [Revised: 05/29/2024] [Accepted: 08/02/2024] [Indexed: 08/24/2024]
Abstract
OBJECTIVES To develop an automatic segmentation model for solid renal tumors on contrast-enhanced CTs and to visualize segmentation with associated confidence to promote clinical applicability. MATERIALS AND METHODS The training dataset included solid renal tumor patients from two tertiary centers undergoing surgical resection and receiving CT in the corticomedullary or nephrogenic contrast media (CM) phase. Manual tumor segmentation was performed on all axial CT slices serving as reference standard for automatic segmentations. Independent testing was performed on the publicly available KiTS 2019 dataset. Ensembles of neural networks (ENN, DeepLabV3) were used for automatic renal tumor segmentation, and their performance was quantified with DICE score. ENN average foreground entropy measured segmentation confidence (binary: successful segmentation with DICE score > 0.8 versus inadequate segmentation ≤ 0.8). RESULTS N = 639/n = 210 patients were included in the training and independent test dataset. Datasets were comparable regarding age and sex (p > 0.05), while renal tumors in the training dataset were larger and more frequently benign (p < 0.01). In the internal test dataset, the ENN model yielded a median DICE score = 0.84 (IQR: 0.62-0.97, corticomedullary) and 0.86 (IQR: 0.77-0.96, nephrogenic CM phase), and the segmentation confidence an AUC = 0.89 (sensitivity = 0.86; specificity = 0.77). In the independent test dataset, the ENN model achieved a median DICE score = 0.84 (IQR: 0.71-0.97, corticomedullary CM phase); and segmentation confidence an accuracy = 0.84 (sensitivity = 0.86 and specificity = 0.81). ENN segmentations were visualized with color-coded voxelwise tumor probabilities and thresholds superimposed on clinical CT images. CONCLUSIONS ENN-based renal tumor segmentation robustly performs in external test data and might aid in renal tumor classification and treatment planning. CLINICAL RELEVANCE STATEMENT Ensembles of neural networks (ENN) models could automatically segment renal tumors on routine CTs, enabling and standardizing downstream image analyses and treatment planning. Providing confidence measures and segmentation overlays on images can lower the threshold for clinical ENN implementation. KEY POINTS Ensembles of neural networks (ENN) segmentation is visualized by color-coded voxelwise tumor probabilities and thresholds. ENN provided a high segmentation accuracy in internal testing and in an independent external test dataset. ENN models provide measures of segmentation confidence which can robustly discriminate between successful and inadequate segmentations.
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Affiliation(s)
- Sophie Bachanek
- Department of Clinical and Interventional Radiology, University Medical Center Goettingen, Goettingen, Germany
| | - Paul Wuerzberg
- Department of Medical Bioinformatics, University Medical Center Goettingen, Goettingen, Germany
| | - Lorenz Biggemann
- Department of Clinical and Interventional Radiology, University Medical Center Goettingen, Goettingen, Germany
| | - Tanja Yani Janssen
- Department of Clinical and Interventional Radiology, University Medical Center Goettingen, Goettingen, Germany
| | - Manuel Nietert
- Department of Medical Bioinformatics, University Medical Center Goettingen, Goettingen, Germany
| | - Joachim Lotz
- Department of Cardiac Radiology, University Medical Center Goettingen, Goettingen, Germany
| | - Philip Zeuschner
- Department of Urology and Pediatric Urology, Saarland University, Homburg, Germany
| | - Alexander Maßmann
- Department of Radiology & Nuclear Medicine, Robert-Bosch-Krankenhaus, Bosch Health Campus, Stuttgart, Germany
| | - Annemarie Uhlig
- Department of Urology, University Medical Center Goettingen, Goettingen, Germany
| | - Johannes Uhlig
- Department of Clinical and Interventional Radiology, University Medical Center Goettingen, Goettingen, Germany.
- Campus Institute for Data Science (CIDAS), Section of Medical Data Science (MeDaS), University of Goettingen, Goettingen, Germany.
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Wang C, Cui H, Zhang Q, Calle P, Yan Y, Yan F, Fung KM, Patel SG, Yu Z, Duguay S, Vanlandingham W, Jain A, Pan C, Tang Q. Automatic renal carcinoma biopsy guidance using forward-viewing endoscopic optical coherence tomography and deep learning. COMMUNICATIONS ENGINEERING 2024; 3:107. [PMID: 39095532 PMCID: PMC11297278 DOI: 10.1038/s44172-024-00254-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Accepted: 07/22/2024] [Indexed: 08/04/2024]
Abstract
Percutaneous renal biopsy is commonly used for kidney cancer diagnosis. However, the biopsy procedure remains challenging in sampling accuracy. Here we introduce a forward-viewing optical coherence tomography probe for differentiating tumor and normal tissues, aiming at precise biopsy guidance. Totally, ten human kidney samples, nine of which had malignant renal carcinoma and one had benign oncocytoma, were used for system evaluation. Based on their distinct imaging features, carcinoma could be efficiently distinguished from normal renal tissues. Additionally, oncocytoma could be differentiated from carcinoma. We developed convolutional neural networks for tissue recognition. Compared to the conventional attenuation coefficient method, convolutional neural network models provided more accurate carcinoma predictions. These models reached a tissue recognition accuracy of 99.1% on a hold-out set of four kidney samples. Furthermore, they could efficiently distinguish oncocytoma from carcinoma. In conclusion, our convolutional neural network-aided endoscopic imaging platform could enhance carcinoma diagnosis during percutaneous renal biopsy procedures.
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Affiliation(s)
- Chen Wang
- Stephenson School of Biomedical Engineering, University of Oklahoma, Norman, OK, USA
| | - Haoyang Cui
- School of Computer Science, University of Oklahoma, Norman, OK, USA
| | - Qinghao Zhang
- Stephenson School of Biomedical Engineering, University of Oklahoma, Norman, OK, USA
| | - Paul Calle
- School of Computer Science, University of Oklahoma, Norman, OK, USA
| | - Yuyang Yan
- Stephenson School of Biomedical Engineering, University of Oklahoma, Norman, OK, USA
| | - Feng Yan
- Stephenson School of Biomedical Engineering, University of Oklahoma, Norman, OK, USA
| | - Kar-Ming Fung
- Department of Pathology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
- Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Sanjay G Patel
- Deparment of Urology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Zhongxin Yu
- Department of Pathology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
- Children's Hospital, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Sean Duguay
- Department of Radiological Sciences, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - William Vanlandingham
- Department of Radiological Sciences, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Ajay Jain
- Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
- Department of Surgery, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Chongle Pan
- School of Computer Science, University of Oklahoma, Norman, OK, USA.
| | - Qinggong Tang
- Stephenson School of Biomedical Engineering, University of Oklahoma, Norman, OK, USA.
- Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA.
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Bak R, Junker T, Jensen JB, Pelant T, Haase RN, Zachariae R, Nielsen TK. A comparative analysis of fear of cancer recurrence in patients with small renal masses: Active surveillance versus cryoablation. Acta Oncol 2024; 63:573-579. [PMID: 39037075 PMCID: PMC11332454 DOI: 10.2340/1651-226x.2024.40418] [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: 03/25/2024] [Accepted: 06/28/2024] [Indexed: 07/23/2024]
Abstract
BACKGROUND AND PURPOSE The aim of this study was to evaluate and compare the fear of cancer recurrence (FCR) in patients diagnosed with a small renal mass (SRM) and managed with either active surveillance (AS) or minimal invasive renal cryoablation (CA). PATIENTS/MATERIAL AND METHODS A total of 398 patients with SRMs (263 AS and 135 CA patients) were retrospectively identified across three institutions and invited to complete the Fear of Cancer Recurrence-Short Form (FCRI-SF) questionnaire. RESULTS No statistically significant differences in FCRI-SF score were observed between the AS (mean = 10.9, standard deviation [SD] = 6.9) and CA (mean = 10.2, SD = 7.2) (p = 0.559) patients, with the mean scores of both groups being below the suggested clinically significant cut-off of 16. A total of 25% of AS and 28% of CA patients reported sub-clinical or clinical levels of FCR (FCRI-SF score > 16). Within the AS group, a weak negative association between FCR severity and age was observed (r = -0.23, p = 0.006), and a statistically significant difference in FCRI-SF score between patients aged more or less than 73 years (p = 0.009). INTERPRETATION FCR levels were comparable between AS and CA patients, suggesting that treatment decisions should prioritise clinical factors. Up to 28% of AS and CA patients report clinically significant FCR, highlighting the importance of considering the possibility of FCR, especially in younger patients.
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Affiliation(s)
- Rasmine Bak
- Department of Urology, Aarhus University Hospital, Aarhus, Denmark.
| | - Theresa Junker
- Research and Innovation Unit of Radiology - UNIFY, SDU, Odense, Denmark; Radiological Research and Innovation Unit, Aarhus University Hospital, Aarhus, Denmark; Department of Urology, Odense University Hospital, Odense, Denmark
| | - Jørgen B Jensen
- Department of Urology, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Tau Pelant
- Department of Urology, Regional Hospital Gødstrup, Gødstrup, Denmark
| | - Rikke N Haase
- Department of Urology, Aalborg University Hospital, Aalborg, Denmark
| | - Robert Zachariae
- Department of Oncology, Aarhus University Hospital, Aarhus, Denmark; Department of Psychology and Behavioural Sciences, Aarhus University, Aarhus, Denmark
| | - Tommy K Nielsen
- Department of Urology, Aarhus University Hospital, Aarhus, Denmark; Department of Urology, Aalborg University Hospital, Aalborg, Denmark
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Milecki T, Kluzek K, Pstrąg N, Antczak A, Cieślikowski WA, Wichtowski M, Kuncman Ł, Kwias Z, Wesoły J. Preoperative cell-free DNA concentration in plasma as a diagnostic and prognostic biomarker of clear cell renal cell carcinoma. Contemp Oncol (Pozn) 2024; 27:284-291. [PMID: 38405214 PMCID: PMC10883193 DOI: 10.5114/wo.2023.135366] [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: 08/06/2023] [Accepted: 01/02/2024] [Indexed: 02/27/2024] Open
Abstract
Introduction Assessment of renal tumour masses is based on conventional imaging studies (computer tomography or magnetic resonance), which does not allow characterisation of the histopathological type. Moreover, the prediction of prognosis in localised and metastatic renal cell carcinoma requires improvement as well. Analysis of circulating free DNA (cfDNA) in blood is one of the variants of liquid biopsy that may improve diagnostics and prognosis issues of patients with renal tumour masses suspected to be renal cell carcinoma. The aim of the study was to assess the diagnostic and prognostic role of preoperative cfDNA concentration in the plasma samples of clear cell renal cell carcinoma (ccRCC) patients. Material and methods The preoperative plasma cfDNA concentration was assessed in ccRCC patients (n = 46) and healthy individuals (control group) (n = 17). The circulating free DNA concentration was reflected by the 90 bp DNA fragments determined by real-time polymerase chain reaction. Results The median cfDNA concentration was significantly higher in ccRCC patients (n = 46) compared to the control g roup (n = 17) (2588 ±2554 copies/ml vs. 960 ±490 copies/ml, p < 0.01). In multivariate analysis, the preoperative plasma cfDNA concentration was the significant factor increasing the probability of ccRCC detection (OR: 1.003; 95% CI: 1.001-1.005). The median cfDNA concentration depended on the stage of ccRCC; it was higher in metastatic ccRCC patients (n = 11) compared to non-metastatic ccRCC patients (n = 35) (3619 ±4059 copies/ml vs. 2473 ±1378 copies/ml, p < 0.03). Kaplan-Meier survival analysis demon-strated that patients with high cfDNA values (above 2913 copies/ml) had significantly worse cancer-specific survival (HR: 4.5; 95% CI: 1.3-16.9, log-rank Mantel-Cox test p = 0.015). Conclusions Preoperative plasma cfDNA concentration has diagnostic and prognostic potential in ccRCC pa-tients.
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Affiliation(s)
- Tomasz Milecki
- Department of Urology, Poznań University of Medical Sciences, Poznań, Poland
| | - Katarzyna Kluzek
- Human Molecular Genetics Research Unit, Institute of Molecular Biology and Biotechnology, Faculty of Biology, Poznań University of Medical Sciences, Poznań, Poland
| | - Natalia Pstrąg
- High Throughput Technologies Laboratory, Faculty of Biology, Poznań University of Medical Sciences, Poznań, Poland
| | - Andrzej Antczak
- Department of Urology, Poznań University of Medical Sciences, Poznań, Poland
| | | | - Mateusz Wichtowski
- Surgical Oncology Clinic, Poznań University of Medical Sciences, Poznań, Poland
| | - Łukasz Kuncman
- Department of Radiotherapy, Medical University of Łódź, Łódź, Poland
| | - Zbigniew Kwias
- Department of Urology, Poznań University of Medical Sciences, Poznań, Poland
| | - Joanna Wesoły
- High Throughput Technologies Laboratory, Faculty of Biology, Poznań University of Medical Sciences, Poznań, Poland
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Tang Q, Wang C, Cui H, Zhang Q, Calle P, Yan Y, Yan F, Fung KM, Patel S, Yu Z, Duguay S, Vanlandingham W, Pan C. Automatic renal carcinoma biopsy guidance using forward-viewing endoscopic optical coherence tomography and deep learning. RESEARCH SQUARE 2023:rs.3.rs-3592809. [PMID: 38045314 PMCID: PMC10690309 DOI: 10.21203/rs.3.rs-3592809/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/05/2023]
Abstract
Percutaneous renal biopsy (PRB) is commonly used for kidney cancer diagnosis. However, current PRB remains challenging in sampling accuracy. This study introduces a forward-viewing optical coherence tomography (OCT) probe for differentiating tumor and normal tissues, aiming at precise PRB guidance. Five human kidneys and renal carcinoma samples were used to evaluate the performance of our probe. Based on their distinct OCT imaging features, tumor and normal renal tissues can be accurately distinguished. We examined the attenuation coefficient for tissue classification and achieved 98.19% tumor recognition accuracy, but underperformed for distinguishing normal tissues. We further developed convolutional neural networks (CNN) and evaluated two CNN architectures: ResNet50 and InceptionV3, yielding 99.51% and 99.48% accuracies for tumor recognition, and over 98.90% for normal tissues recognition. In conclusion, combining OCT and CNN significantly enhanced the PRB guidance, offering a promising guidance technology for improved kidney cancer diagnosis.
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Liu A, Kremyanskaya M, Mehrazin R, Si Q, Robinson BD, Cushing MM, Hoffman R, Ginzburg YZ. Erythropoietin-secreting metanephric adenoma presenting as erythrocytosis. Am J Hematol 2023; 98:1808-1813. [PMID: 37528578 DOI: 10.1002/ajh.27047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 07/14/2023] [Accepted: 07/16/2023] [Indexed: 08/03/2023]
Affiliation(s)
- Angela Liu
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Marina Kremyanskaya
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Reza Mehrazin
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Qiusheng Si
- Pathology Department, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Brian D Robinson
- Department of Pathology & Laboratory Medicine, Weill Cornell Medicine, New York, New York, USA
| | - Melissa M Cushing
- Department of Pathology & Laboratory Medicine, Weill Cornell Medicine, New York, New York, USA
| | - Ronald Hoffman
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Yelena Z Ginzburg
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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7
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Zhao T, Sun Z, Guo Y, Sun Y, Zhang Y, Wang X. Automatic renal mass segmentation and classification on CT images based on 3D U-Net and ResNet algorithms. Front Oncol 2023; 13:1169922. [PMID: 37274226 PMCID: PMC10233136 DOI: 10.3389/fonc.2023.1169922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 05/09/2023] [Indexed: 06/06/2023] Open
Abstract
Purpose To automatically evaluate renal masses in CT images by using a cascade 3D U-Net- and ResNet-based method to accurately segment and classify focal renal lesions. Material and Methods We used an institutional dataset comprising 610 CT image series from 490 patients from August 2009 to August 2021 to train and evaluate the proposed method. We first determined the boundaries of the kidneys on the CT images utilizing a 3D U-Net-based method to be used as a region of interest to search for renal mass. An ensemble learning model based on 3D U-Net was then used to detect and segment the masses, followed by a ResNet algorithm for classification. Our algorithm was evaluated with an external validation dataset and kidney tumor segmentation (KiTS21) challenge dataset. Results The algorithm achieved a Dice similarity coefficient (DSC) of 0.99 for bilateral kidney boundary segmentation in the test set. The average DSC for renal mass delineation using the 3D U-Net was 0.75 and 0.83. Our method detected renal masses with recalls of 84.54% and 75.90%. The classification accuracy in the test set was 86.05% for masses (<5 mm) and 91.97% for masses (≥5 mm). Conclusion We developed a deep learning-based method for fully automated segmentation and classification of renal masses in CT images. Testing of this algorithm showed that it has the capability of accurately localizing and classifying renal masses.
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Affiliation(s)
- Tongtong Zhao
- Department of Radiology, Peking University First Hospital, Beijing, China
| | - Zhaonan Sun
- Department of Radiology, Peking University First Hospital, Beijing, China
| | - Ying Guo
- Department of Radiology, Peking University First Hospital, Beijing, China
| | - Yumeng Sun
- Department of Development and Research, Beijing Smart Tree Medical Technology Co. Ltd., Beijing, China
| | - Yaofeng Zhang
- Department of Development and Research, Beijing Smart Tree Medical Technology Co. Ltd., Beijing, China
| | - Xiaoying Wang
- Department of Radiology, Peking University First Hospital, Beijing, China
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Chartier S, Arif-Tiwari H. MR Virtual Biopsy of Solid Renal Masses: An Algorithmic Approach. Cancers (Basel) 2023; 15:2799. [PMID: 37345136 DOI: 10.3390/cancers15102799] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 05/12/2023] [Accepted: 05/12/2023] [Indexed: 06/23/2023] Open
Abstract
Between 1983 and 2002, the incidence of solid renal tumors increased from 7.1 to 10.8 cases per 100,000. This is in large part due to the increase in the volume of ultrasound and cross-sectional imaging, although a majority of solid renal tumors are still found incidentally. Ultrasound and computed tomography (CT) have been the mainstay of renal mass screening and diagnosis but recent advances in magnetic resonance (MR) technology have made this the optimal choice when diagnosing and staging renal tumors. Our purpose in writing this review is to survey the modern MR imaging approach to benign and malignant solid renal tumors, consolidate the various imaging findings into an easy-to-read reference, and provide an imaging-based, algorithmic approach to renal mass characterization for clinicians. MR is at the forefront of renal mass characterization, surpassing ultrasound and CT in its ability to describe multiple tissue parameters and predict tumor biology. Cutting-edge MR protocols and the integration of diagnostic algorithms can improve patient outcomes, allowing the imager to narrow the differential and better guide oncologic and surgical management.
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Affiliation(s)
- Stephane Chartier
- Department of Medical Imaging, College of Medicine, The University of Arizona, Tucson, AZ 85724, USA
| | - Hina Arif-Tiwari
- Department of Medical Imaging, College of Medicine, The University of Arizona, Tucson, AZ 85724, USA
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Kalantzakos T, Hooper K, Das S, Sullivan T, Canes D, Moinzadeh A, Rieger-Christ K. MicroRNA-155-5p Targets JADE-1, Promoting Proliferation, Migration, and Invasion in Clear Cell Renal Cell Carcinoma Cells. Int J Mol Sci 2023; 24:ijms24097825. [PMID: 37175531 PMCID: PMC10178234 DOI: 10.3390/ijms24097825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 03/30/2023] [Accepted: 04/20/2023] [Indexed: 05/15/2023] Open
Abstract
Clear cell renal cell carcinoma (ccRCC) incidence has been rising in recent years, with strong association between differential microRNA (miRNA) expression and neoplastic progression. Specifically, overexpression of miR-155-5p has been associated with promoting aggressive cancer in ccRCC and other cancers. In this study, we further investigate the role of this miRNA and one of its protein targets, Jade-1, to better understand the mechanism behind aggressive forms of ccRCC. Jade-1, a tumor suppressor, is stabilized by Von-Hippel Lindau (VHL), which is frequently mutated in ccRCC. Experiments featuring downregulation of miR-155-5p in two ccRCC cell lines (786-O and Caki-1) attenuated their oncogenic potential and led to increased levels of Jade-1. Conversely, knockdown experiments with an anti-Jade-1 shRNA in 786-O and Caki-1 cells showed increased metastatic potential through elevated proliferation, migration, and invasion rates. In a mouse xenograft model, downregulation of miR-155 decreased the rate of tumor implantation and proliferation. Direct interaction between miR-155-5p and Jade-1 was confirmed through a 3'UTR luciferase reporter assay. These findings further elucidate the mechanism of action of miR-155-5p in driving an aggressive phenotype in ccRCC through its role in regulating Jade-1.
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Affiliation(s)
- Thomas Kalantzakos
- Department of Translational Research, Lahey Hospital and Medical Center, Burlington, MA 01805, USA
| | - Kailey Hooper
- Department of Translational Research, Lahey Hospital and Medical Center, Burlington, MA 01805, USA
| | - Sanjna Das
- Department of Translational Research, Lahey Hospital and Medical Center, Burlington, MA 01805, USA
| | - Travis Sullivan
- Department of Translational Research, Lahey Hospital and Medical Center, Burlington, MA 01805, USA
| | - David Canes
- Department of Urology, Lahey Hospital and Medical Center, Burlington, MA 01805, USA
| | - Alireza Moinzadeh
- Department of Urology, Lahey Hospital and Medical Center, Burlington, MA 01805, USA
| | - Kimberly Rieger-Christ
- Department of Translational Research, Lahey Hospital and Medical Center, Burlington, MA 01805, USA
- Department of Urology, Lahey Hospital and Medical Center, Burlington, MA 01805, USA
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10
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Fateri C, Peta A, Limfueco L, Bui TL, Kar N, Glavis-Bloom J, Roth B, Landman J, Houshyar R. Novel Retroperitoneal Neovascularity Scoring System in Renal Cell Carcinoma Tumor Staging. J Endourol 2023; 37:367-373. [PMID: 36367194 DOI: 10.1089/end.2022.0338] [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: 11/13/2022] Open
Abstract
Purpose: Renal cell carcinoma (RCC) is the most common type of kidney cancer worldwide. Although radiologists assess enhancement patterns of renal tumors to predict tumor pathology report, to our knowledge, no formal scoring system has been created and validated to assess the level of neovascularity in RCC, despite its critical role in cancer metastases. In this study, we characterized and analyzed the level of angiogenesis in tumor-burdened kidneys and their benign counterparts. We then created and validated a scoring scale for neovascularity that can help predict tumor staging for RCC. Methods: After Institutional Review Board approval, the charts of patients who had undergone operation for RCC between January 13, 2014 and February 4, 2020 were retrospectively reviewed for inclusion in this study. Inclusion criteria were a diagnosis of RCC, simple/radical nephrectomy, preoperative contrast-enhanced CT scans, and complete pathology reports. Neovascularity was scored on a scale of 0-4 where 0 = no neovascularity detected, 1 = a single vessel <3 mm wide, 2 = a single vessel ≥3 mm wide, 3 = multiple vessels <3 mm wide, and 4 = multiple vessels ≥3 mm wide. Results: A total of 227 patients were included in this study. Most of the tumor pathology reports were clear cell carcinoma, regardless of tumor staging. The average neovascularity score was 1.07 for pT1x tumors, 2.83 for pT2x tumors, and 3.04 for pT3x tumors. There was a significant difference in neovascularity score between pT1x and pT2x tumors (p = 0.0046), pT1x and pT3x tumors (p < 0.0001), and benign kidneys and kidneys with RCC (p < 0.0001). Conclusion: Our novel vascular scoring system for RCC demonstrates significant correlation with RCC pathological tumor staging. This scoring system may be utilized as part of a comprehensive radiological assessment of renal tumors, potentially improving tumor characterization and clinical decision making.
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Affiliation(s)
- Cameron Fateri
- Department of Radiology and School of Medicine, University of California, Irvine, Orange, California, USA
| | - Akhil Peta
- Department of Urology, School of Medicine, University of California, Irvine, Orange, California, USA
| | - Luke Limfueco
- Department of Urology, School of Medicine, University of California, Irvine, Orange, California, USA
| | - Thanh-Lan Bui
- Department of Urology, School of Medicine, University of California, Irvine, Orange, California, USA
| | - Nina Kar
- Department of Urology, School of Medicine, University of California, Irvine, Orange, California, USA
| | - Justin Glavis-Bloom
- Department of Radiology and School of Medicine, University of California, Irvine, Orange, California, USA
| | - Bradley Roth
- Department of Radiology and School of Medicine, University of California, Irvine, Orange, California, USA
| | - Jaime Landman
- Department of Radiology and School of Medicine, University of California, Irvine, Orange, California, USA.,Department of Urology, School of Medicine, University of California, Irvine, Orange, California, USA
| | - Roozbeh Houshyar
- Department of Radiology and School of Medicine, University of California, Irvine, Orange, California, USA
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11
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Kim J, Lee JS, Jo Y, Han WK. Superiority of magnetic resonance imaging in small renal mass diagnosis where image reports mismatches between computed tomography and magnetic resonance imaging. Investig Clin Urol 2023; 64:148-153. [PMID: 36882173 PMCID: PMC9995955 DOI: 10.4111/icu.20220375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 12/26/2022] [Accepted: 01/01/2023] [Indexed: 01/31/2023] Open
Abstract
PURPOSE To analyze malignancy of computed tomography (CT) and magnetic resonance imaging (MRI) results in the same renal mass. MATERIALS AND METHODS We retrospectively reviewed 1,216 patients who underwent partial nephrectomy from January 2017 to December 2021 in our institute. Patients who had both CT and MRI reports prior to surgery were included. We compared the diagnostic accuracy between the CT and the MRI. The patients were divided into two groups according to the consistency of reports: the 'Consistent group' and the 'Inconsistent group'. The Inconsistent group was further divided into two subgroups. Group 1 is the case that showed benign findings on CT but malignancy on MRI. Group 2 is the cases of malignancy on CT but benign on MRI. RESULTS 410 patients were identified. Benign lesion was identified in 68 cases (16.6%). The sensitivity, specificity and diagnostic accuracy of MRI was 91.2%, 36.8%, and 82.2% respectively, whereas that of CT was 84.8%, 41.2%, and 77.6% respectively. Consistent group were 335 cases (81.7%) and inconsistent group were 75 cases (18.3%). The mean mass size was significantly smaller in the inconsistent group compared to the consistent group (consistent group vs. inconsistent group: 2.31±0.84 cm vs.1.84±0.75 cm, p<0.001). Also, the Group 1 had higher odds of malignancy compared to Group 2 in the renal mass size 2-4 cm (odds ratio, 5.62 [1.02-30.90]). CONCLUSIONS Smaller mass size affects the discrepancy of CT and MRI reports. In addition, MRI showed better diagnostic performance in mismatch cases in the small renal masses.
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Affiliation(s)
- Jinu Kim
- Department of Urology, Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Jong Soo Lee
- Department of Urology, Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Youngheun Jo
- Department of Urology, Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Woong Kyu Han
- Department of Urology, Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea.
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12
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Baio R, Molisso G, Caruana C, Di Mauro U, Intilla O, Pane U, D’Angelo C, Campitelli A, Pentimalli F, Sanseverino R. "To Be or Not to Be Benign" at Partial Nephrectomy for Presumed RCC Renal Masses: Single-Center Experience with 195 Consecutive Patients. Diseases 2023; 11:diseases11010027. [PMID: 36810541 PMCID: PMC9945135 DOI: 10.3390/diseases11010027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 01/21/2023] [Accepted: 01/31/2023] [Indexed: 02/11/2023] Open
Abstract
In daily medical practice, an increasing number of kidney masses are being incidentally detected using common imaging techniques, owing to the improved diagnostic accuracy and increasingly frequent use of these techniques. As a consequence, the rate of detection of smaller lesions is increasing considerably. According to certain studies, following surgical treatment, up to 27% of small enhancing renal masses are identified as benign tumors at the final pathological examination. This high rate of benign tumors challenges the appropriateness of surgery for all suspicious lesions, given the morbidity associated with such an intervention. The objective of the present study was, therefore, to determine the incidence of benign tumors at partial nephrectomy (PN) for a solitary renal mass. To meet this end, a total of 195 patients who each underwent one PN for a solitary renal lesion with the intent to cure RCC were included in the final retrospective analysis. A benign neoplasm was identified in 30 of these patients. The age of the patients ranged from 29.9-79 years (average: 60.9 years). The tumor size range was 1.5-7 cm (average: 3 cm). All the operations were successful using the laparoscopic approach. The pathological results were renal oncocytoma in 26 cases, angiomyolipomas in two cases, and cysts in the remaining two cases. In conclusion, we have shown in our present series the incidence rate of benign tumors in patients who have been subjected to laparoscopic PN due to a suspected solitary renal mass. Based on these results, we advise that the patient should be counseled not only about the intra- and post-operative risks of nephron-sparing surgery but also about its dual therapeutic and diagnostic role. Therefore, the patients should be informed of the considerably high probability of a benign histological result.
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Affiliation(s)
- Raffaele Baio
- Department of Medicine and Surgery “Scuola Medica Salernitana”, University of Salerno, 84081 Baronissi, Italy
- Correspondence:
| | - Giovanni Molisso
- Department of Urology, Umberto I, Nocera Inferiore, 84014 Salerno, Italy
| | | | - Umberto Di Mauro
- Department of Urology, Umberto I, Nocera Inferiore, 84014 Salerno, Italy
| | - Olivier Intilla
- Department of Urology, Umberto I, Nocera Inferiore, 84014 Salerno, Italy
| | - Umberto Pane
- Department of Urology, Umberto I, Nocera Inferiore, 84014 Salerno, Italy
| | - Costantino D’Angelo
- Department of Medical Biotechnologies, University of Siena, 53100 Siena, Italy
| | - Antonio Campitelli
- Department of Urology, Umberto I, Nocera Inferiore, 84014 Salerno, Italy
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13
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The Role of CT Imaging in Characterization of Small Renal Masses. Diagnostics (Basel) 2023; 13:diagnostics13030334. [PMID: 36766439 PMCID: PMC9914376 DOI: 10.3390/diagnostics13030334] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 01/02/2023] [Accepted: 01/09/2023] [Indexed: 01/18/2023] Open
Abstract
Small renal masses (SRM) are increasingly detected incidentally during imaging. They vary widely in histology and aggressiveness, and include benign renal tumors and renal cell carcinomas that can be either indolent or aggressive. Imaging plays a key role in the characterization of these small renal masses. While a confident diagnosis can be made in many cases, some renal masses are indeterminate at imaging and can present as diagnostic dilemmas for both the radiologists and the referring clinicians. This review focuses on CT characterization of small renal masses, perhaps helping us understand small renal masses. The following aspects were considered for the review: (a) assessing the presence of fat, (b) assessing the enhancement, (c) differentiating renal tumor subtype, and (d) identifying valuable CT signs.
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14
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CT and MRI Imaging of Theranostic Bimodal Fe 3O 4@Au NanoParticles in Tumor Bearing Mice. Int J Mol Sci 2022; 24:ijms24010070. [PMID: 36613511 PMCID: PMC9820463 DOI: 10.3390/ijms24010070] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Revised: 12/13/2022] [Accepted: 12/16/2022] [Indexed: 12/24/2022] Open
Abstract
Gold-containing nanoparticles are proven to be an effective radiosensitizer in the radiotherapy of tumors. Reliable imaging of nanoparticles in a tumor and surrounding normal tissues is crucial both for diagnostics and for nanoparticle application as radiosensitizers. The Fe3O4 core was introduced into gold nanoparticles to form a core/shell structure suitable for MRI imaging. The aim of this study was to assess the in vivo bimodal CT and MRI enhancement ability of novel core/shell Fe3O4@Au theranostic nanoparticles. Core/shell Fe3O4@Au nanoparticles were synthesized and coated with PEG and glucose. C57Bl/6 mice bearing Ca755 mammary adenocarcinoma tumors received intravenous injections of the nanoparticles. CT and MRI were performed at several timepoints between 5 and 102 min, and on day 17 post-injection. Core/shell Fe3O4@Au nanoparticles provided significant enhancement of the tumor and tumor blood vessels. Nanoparticles also accumulated in the liver and spleen and were retained in these organs for 17 days. Mice did not show any signs of toxicity over the study duration. These results indicate that theranostic bimodal Fe3O4@Au nanoparticles are non-toxic and serve as effective contrast agents both for CT and MRI diagnostics. These nanoparticles have potential for future biomedical applications in cancer diagnostics and beyond.
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15
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Khader A, Braschi-Amirfarzan M, McIntosh LJ, Gosangi B, Wortman JR, Wald C, Thomas R. Importance of tumor subtypes in cancer imaging. Eur J Radiol Open 2022; 9:100433. [PMID: 35909389 PMCID: PMC9335388 DOI: 10.1016/j.ejro.2022.100433] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 07/25/2022] [Indexed: 12/22/2022] Open
Abstract
Cancer therapy has evolved from being broadly directed towards tumor types, to highly specific treatment protocols that target individual molecular subtypes of tumors. With the ever-increasing data on imaging characteristics of tumor subtypes and advancements in imaging techniques, it is now often possible for radiologists to differentiate tumor subtypes on imaging. Armed with this knowledge, radiologists may be able to provide specific information that can obviate the need for invasive methods to identify tumor subtypes. Different tumor subtypes also differ in their patterns of metastatic spread. Awareness of these differences can direct radiologists to relevant anatomical sites to screen for early metastases that may otherwise be difficult to detect during cursory inspection. Likewise, this knowledge will help radiologists to interpret indeterminate findings in a more specific manner. Tumor subtypes can be identified based on their different imaging characteristics. Awareness of tumor subtype can help radiologists chose the appropriate modality for additional imaging workup. Awareness of differences in metastatic pattern between tumor subtypes can be helpful to identify early metastases.
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Affiliation(s)
- Ali Khader
- Department of Radiology, Lahey Hospital and Medical Center, Tufts University School of Medicine, 41 Mall Road, Burlington, MA 01805, the United States of America
| | - Marta Braschi-Amirfarzan
- Department of Radiology, Lahey Hospital and Medical Center, Tufts University School of Medicine, 41 Mall Road, Burlington, MA 01805, the United States of America
| | - Lacey J. McIntosh
- University of Massachusetts Chan Medical School/Memorial Health Care, Division of Oncologic and Molecular Imaging, 55 Lake Avenue North, Worcester, MA 01655, the United States of America
| | - Babina Gosangi
- Department of Radiology, Yale School of Medicine, 333 Cedar Street, New Haven, CT 06510, the United States of America
| | - Jeremy R. Wortman
- Department of Radiology, Lahey Hospital and Medical Center, Tufts University School of Medicine, 41 Mall Road, Burlington, MA 01805, the United States of America
| | - Christoph Wald
- Department of Radiology, Lahey Hospital and Medical Center, Tufts University School of Medicine, 41 Mall Road, Burlington, MA 01805, the United States of America
| | - Richard Thomas
- Department of Radiology, Lahey Hospital and Medical Center, Tufts University School of Medicine, 41 Mall Road, Burlington, MA 01805, the United States of America
- Correspondence to: Department of Radiology, Lahey Hospital and Medical Center, 41 Mall Road, Burlington, MA 01805, the United States of America.
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16
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Liu H, Cao H, Chen L, Fang L, Liu Y, Zhan J, Diao X, Chen Y. The quantitative evaluation of contrast-enhanced ultrasound in the differentiation of small renal cell carcinoma subtypes and angiomyolipoma. Quant Imaging Med Surg 2022; 12:106-118. [PMID: 34993064 DOI: 10.21037/qims-21-248] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Accepted: 06/22/2021] [Indexed: 12/24/2022]
Abstract
Background Contrast-enhanced ultrasound (CEUS) has been widely used for renal lesion diagnosis and differential diagnosis. However, qualitative analysis of CEUS is subject to examinations with low reproducibility. This study aims to investigate the diagnostic value of CEUS quantitative parameters in differentiating small renal cell carcinoma (RCC) subtypes and angiomyolipoma (AML). Methods A retrospective analysis was performed on 97 cases of a small renal mass undergoing a CEUS before a radical or partial nephrectomy procedure. A region of interest (ROI) was placed in the tumor's maximum enhanced region (ROImax) as much as possible, and adjacent renal cortex (ROIrefer) was selected from normal renal tissue around a mass of the same depth. The time-intensity curve (TIC) was used to analyze the ROImax and the ROIrefer of the tumors quantitatively. Then the parameters of the ROImax and the ROIrefer, including the differences between the parameters of the ROImax and the ROIrefer, were analyzed statistically. Results In RCC and clear cell renal cell carcinoma (ccRCC), the peak intensity (PI), slope (SL), area under the curve (AUC), area under the wash-in curve (AWI), area under the wash-out curve (AWO), time to peak intensity (TTP) and the mean transit time (MTT) were statistically significant between ROImax and ROIrefer (all P=0.000). The △PI (△PI = PImax - PIrefer), △SL (△SL = SLmax - SLrefer), △AUC (△AUC = AUCmax - AUCrefer), △AWI (△AWI = AWImax - AWIrefer) and △AWO (△AWO = AWOmax - AWOrefer) of RCC were significantly higher than in AML (P=0.007, 0.000, 0.003, 0.048, 0.009, respectively), while the TTP (△TTP = TTPmax - TTPrefer) and △MTT (△MTT = MTTmax - MTTrefer) of RCC were significantly lower (both P=0.000). In comparison with papillary renal cell carcinoma (pRCC) and chromophobe renal cell carcinoma (chRCC), the △PI, △SL, △AUC and △AWO of ccRCC were all larger (all P<0.05). The sensitivity, specificity, and AUC of the combination of parameter difference for differentiating RCC from AML were 100%, 81.2%, and 0.965, respectively, and for differentiating ccRCC from pRCC and chRCC, 85.71%, 85.92% and 0.911, respectively. Conclusions CEUS quantitative parameters have value in differentiating small RCC from AML and distinguishing ccRCC from pRCC and chRCC.
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Affiliation(s)
- Hui Liu
- Department of Ultrasound, Huadong Hospital, Fudan University, Shanghai, China.,Shanghai Key Laboratory of Clinical Geriatric Medicine, Shanghai, China
| | - Hongli Cao
- Department of Ultrasound, Huadong Hospital, Fudan University, Shanghai, China.,Shanghai Key Laboratory of Clinical Geriatric Medicine, Shanghai, China
| | - Lin Chen
- Department of Ultrasound, Huadong Hospital, Fudan University, Shanghai, China.,Shanghai Key Laboratory of Clinical Geriatric Medicine, Shanghai, China
| | - Liang Fang
- Department of Ultrasound, Huadong Hospital, Fudan University, Shanghai, China.,Shanghai Key Laboratory of Clinical Geriatric Medicine, Shanghai, China
| | - Yingchun Liu
- Department of Ultrasound, Huadong Hospital, Fudan University, Shanghai, China.,Shanghai Key Laboratory of Clinical Geriatric Medicine, Shanghai, China
| | - Jia Zhan
- Department of Ultrasound, Huadong Hospital, Fudan University, Shanghai, China.,Shanghai Key Laboratory of Clinical Geriatric Medicine, Shanghai, China
| | - Xuehong Diao
- Department of Ultrasound, Huadong Hospital, Fudan University, Shanghai, China.,Shanghai Key Laboratory of Clinical Geriatric Medicine, Shanghai, China
| | - Yue Chen
- Department of Ultrasound, Huadong Hospital, Fudan University, Shanghai, China.,Shanghai Key Laboratory of Clinical Geriatric Medicine, Shanghai, China
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17
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Quantitative 3-tesla multiparametric MRI in differentiation between renal cell carcinoma subtypes. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2021. [DOI: 10.1186/s43055-020-00405-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
MRI provides several distinct quantitative parameters that may better differentiate renal cell carcinoma (RCC) subtypes. The purpose of the study is to evaluate the diagnostic accuracy of apparent diffusion coefficient (ADC), chemical shift signal intensity index (SII), and contrast enhancement in differentiation between different subtypes of renal cell carcinoma.
Results
There were 63 RCC as regard surgical histopathological analysis: 43 clear cell (ccRCC), 12 papillary (pRCC), and 8 chromophobe (cbRCC). The mean ADC ratio for ccRCC (0.75 ± 0.13) was significantly higher than that of pRCC (0.46 ± 0.12, P < 0.001) and cbRCC (0.41 ± 0.15, P < 0.001). The mean ADC value for ccRCC (1.56 ± 0.27 × 10−3 mm2/s) was significantly higher than that of pRCC (0.96 ± 0.25 × 10−3 mm2/s, P < 0.001) and cbRCC (0.89 ± 0.29 × 10−3 mm2/s, P < 0.001). The mean SII of pRCC (1.49 ± 0.04) was significantly higher than that of ccRCC (0.93 ± 0.01, P < 0.001) and cbRCC (1.01 ± 0.16, P < 0.001). The ccRCC absolute corticomedullary enhancement (196.7 ± 81.6) was significantly greater than that of cbRCC (177.8 ± 77.7, P < 0.001) and pRCC (164.3 ± 84.6, P < 0.001).
Conclusion
Our study demonstrated that multiparametric MRI is able to afford some quantitative features such as ADC ratio, SII, and absolute corticomedullary enhancement which can be used to accurately distinguish different subtypes of renal cell carcinoma.
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18
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Basta Nikolic M, Spasic A, Hadnadjev Simonji D, Stojanović S, Nikolic O, Nikolic D. Imaging of acute pelvic pain. Br J Radiol 2021; 94:20210281. [PMID: 34491817 DOI: 10.1259/bjr.20210281] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Acute pelvic pain (APP) requires urgent medical evaluation and treatment. Differential diagnosis of APP is broad, including a variety of gynecologic and non-gynecologic/ urinary, gastrointestinal, vascular and other entities. Close anatomical and physiological relations of pelvic structures, together with similar clinical presentation of different disorders and overlapping of symptoms, especially in the emergency background, make the proper diagnosis of APP challenging. Imaging plays a crucial role in the fast and precise diagnosis of APP. Ultrasonography is the first-line imaging modality, often accompanied by CT, while MRI is utilized in specific cases, using short, tailored protocols. Recognizing the cause of APP in females is a challenging task, due to the wide spectrum of possible origin and overlap of their imaging features. Therefore, the radiologist has to be familiar with the possible causes of APP, and, relying on clinical presentation, together with laboratory findings, choose the best imaging strategy in order to establish a fast and accurate diagnosis.
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Affiliation(s)
- Marijana Basta Nikolic
- Centre of Radiology, Clinical Centre of Vojvodina, Faculty of Medicine, University of Novi Sad, Vojvodina, Serbia
| | - Aleksandar Spasic
- Centre of Radiology, Clinical Centre of Vojvodina, Faculty of Medicine, University of Novi Sad, Vojvodina, Serbia
| | - Darka Hadnadjev Simonji
- Centre of Radiology, Clinical Centre of Vojvodina, Faculty of Medicine, University of Novi Sad, Vojvodina, Serbia
| | - Sanja Stojanović
- Centre of Radiology, Clinical Centre of Vojvodina, Faculty of Medicine, University of Novi Sad, Vojvodina, Serbia
| | - Olivera Nikolic
- Centre of Radiology, Clinical Centre of Vojvodina, Faculty of Medicine, University of Novi Sad, Vojvodina, Serbia
| | - Dragan Nikolic
- Clinic for Vascular and Endovascular Surgery, Clinical Centre of Vojvodina, Faculty of Medicine, University of Novi Sad, Vojvodina, Serbia
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19
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Tsili AC, Moulopoulos LA, Varakarakis IΜ, Argyropoulou MI. Cross-sectional imaging assessment of renal masses with emphasis on MRI. Acta Radiol 2021; 63:1570-1587. [PMID: 34709096 DOI: 10.1177/02841851211052999] [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: 11/17/2022]
Abstract
Magnetic resonance imaging (MRI) is a useful complementary imaging tool for the diagnosis and characterization of renal masses, as it provides both morphologic and functional information. A core MRI protocol for renal imaging should include a T1-weighted sequence with in- and opposed-phase images (or, alternatively with DIXON technique), T2-weighted and diffusion-weighted images as well as a dynamic contrast-enhanced sequence with subtraction images, followed by a delayed post-contrast T1-weighted sequence. The main advantages of MRI over computed tomography include increased sensitivity for contrast enhancement, less sensitivity for detection of calcifications, absence of pseudoenhancement, and lack of radiation exposure. MRI may be applied for renal cystic lesion characterization, differentiation of renal cell carcinoma (RCC) from benign solid renal tumors, RCC histologic grading, staging, post-treatment follow-up, and active surveillance of patients with treated or untreated RCC.
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Affiliation(s)
- Athina C Tsili
- Department of Clinical Radiology, School of Medicine, University of Ioannina, Ioannina, Greece
| | - Lia-Angela Moulopoulos
- 1st Department of Radiology, School of Medicine, National and Kapodistrian University of Athens, Areteion Hospital, Athens, Greece
| | - Ioannis Μ Varakarakis
- 2nd Department of Urology, National and Kapodistrian University of Athens, Sismanoglio Hospital, Athens, Greece
| | - Maria I Argyropoulou
- Department of Clinical Radiology, School of Medicine, University of Ioannina, Ioannina, Greece
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20
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Mussi TC, Martins T, Yamauchi FI, Zanini LAP, Baroni RH. Which criteria can be used to predict benignity in solid renal lesions lower-equal to 2 cm? Abdom Radiol (NY) 2021; 46:4873-4880. [PMID: 34097117 DOI: 10.1007/s00261-021-03158-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Revised: 05/19/2021] [Accepted: 05/27/2021] [Indexed: 01/31/2023]
Abstract
PURPOSE To evaluate magnetic resonance imaging (MRI) criteria of solid renal lesions lower-equal to 2 cm to differentiate benign and malignant tumors, using histopathology as gold standard. METHODS Three radiologists independently evaluated objective and subjective MRI criteria of focal renal lesions. A total of 105 nodules of patients who had MRI and histopathological results in our institution were included. Subjective criteria evaluated were signal on T2-weighted imaging, presence of microscopic and macroscopic fat, hemosiderin, hemorrhage, central scar, segmented inversion enhancement and enhancement type; objective criteria were gender, ADC value, heterogeneity on T2-weighted imaging and proportion of enhancement in late post-contrast phases. Finally, the readers classified the lesions in probably benign or malignant. Interobserver agreement was evaluated by the Gwet method, and the quantitative variables by intraclass correlation coefficients. To adjust the predictive model, the logistic regression model was used considering the benignity variable as outcome. RESULTS A total of 26 nodules (24.5%) were benign and 79 (75.2%) were malignant, with size ranging from 7 to 20 mm (median: 14 mm). The most frequent subtype was papillary renal cell carcinoma (RCC) (35.2%), followed by clear-cell RCC (24.8%) and oncocytoma (12.4%). The univariate and multivariate analysis showed, among all categories evaluated, that microscopic fat (p: 0.072), intermediate (p: 0.004) and hyper-enhancement (p: 0.031) and female sex (p: 0.0047) had the best outcome for benignity, within odds ratios of 4.29, 5.75, 4.07 and 2.86, respectively. CONCLUSION In small solid renal lesions lower-equal to 2 cm, microscopic fat, moderate and hyper-enhancement and female sex were associated with benignity.
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Affiliation(s)
- Thais C Mussi
- Radiology and Diagnostic Imaging Department, Hospital Israelita Albert Einstein, Av. Albert Einstein, 627/701 - Jardim Leonor, São Paulo, SP, 05652-900, Brazil.
| | - Tatiana Martins
- Ecoar Medicina Diagnóstica, Av. do Contorno, 6760 - Lourdes, Belo Horizonte, MG, 30110-110, Brazil
| | - Fernando Ide Yamauchi
- Radiology and Diagnostic Imaging Department, Hospital Israelita Albert Einstein, Av. Albert Einstein, 627/701 - Jardim Leonor, São Paulo, SP, 05652-900, Brazil
| | - Lilian A P Zanini
- Radiology and Diagnostic Imaging Department, Hospital Israelita Albert Einstein, Av. Albert Einstein, 627/701 - Jardim Leonor, São Paulo, SP, 05652-900, Brazil
| | - Ronaldo H Baroni
- Radiology and Diagnostic Imaging Department, Hospital Israelita Albert Einstein, Av. Albert Einstein, 627/701 - Jardim Leonor, São Paulo, SP, 05652-900, Brazil
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21
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Yu J, Yu XL, Cheng ZG, Hu B, Han ZY, Liu FY, Hu ZQ, Wang H, Dong J, Pan J, Yang B, Sai X, Guo AT, Liang P. Percutaneous microwave ablation of renal cell carcinoma: practice guidelines of the ultrasound committee of Chinese medical association, interventional oncology committee of Chinese research hospital association. Int J Hyperthermia 2021; 37:827-835. [PMID: 32635839 DOI: 10.1080/02656736.2020.1779356] [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: 12/29/2022] Open
Abstract
Imaging-guided percutaneous microwave ablation (MWA) with high thermal efficiency comprises rapid, successful management of small renal cell carcinomas (RCCs) in selected patients. Ultrasound Committee of Chinese Medical Association, Interventional Oncology Committee of Chinese Research Hospital Association developed evidence-based guidelines for MWA of RCCs after systematically reviewing the 1969-2019 literature. Systematic reviews, meta-analyses, randomized controlled trials, cohort, and case-control studies reporting MWA of RCCs were included and levels of evidence assessed. Altogether, 146 articles were identified, of which 35 reported percutaneous MWA for T1a RCCs and 5 articles for T1b RCCs. Guidelines were established based on indications, techniques, safety, and effectiveness of MWA for RCCs, with the goal of standardizing imaging-guided percutaneous MWA treatment of RCCs. Key points Microwave ablation is recommended for managing small renal cell carcinoma in selected patients. Imaging protocols are tailored based on the procedural plan, guidance, and evaluation. Patient's selection evaluation, updated technique information, clinical efficacy, and complications are recommended to standardize management. A joint task force (multidisciplinary team) summarized the key elements of the standardized report.
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Affiliation(s)
- Jie Yu
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, China.,State Key Laboratory of Kidney Disease, The Chinese PLA General Hospital, Beijing, China.,Ultrasound Committee of Chinese Medical Association, Beijing, China.,Interventional Oncology Committee of Chinese Research Hospital Association, Beijing, China
| | - Xiao-Ling Yu
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, China.,Ultrasound Committee of Chinese Medical Association, Beijing, China.,Interventional Oncology Committee of Chinese Research Hospital Association, Beijing, China
| | - Zhi-Gang Cheng
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, China.,Ultrasound Committee of Chinese Medical Association, Beijing, China.,Interventional Oncology Committee of Chinese Research Hospital Association, Beijing, China
| | - Bing Hu
- Ultrasound Committee of Chinese Medical Association, Beijing, China.,Interventional Oncology Committee of Chinese Research Hospital Association, Beijing, China.,Department of Ultrasound in Med, 6th People's Hospital of Shanghai Jiaotong, University, Shanghai, China
| | - Zhi-Yu Han
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, China.,Ultrasound Committee of Chinese Medical Association, Beijing, China.,Interventional Oncology Committee of Chinese Research Hospital Association, Beijing, China
| | - Fang-Yi Liu
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, China.,Ultrasound Committee of Chinese Medical Association, Beijing, China.,Interventional Oncology Committee of Chinese Research Hospital Association, Beijing, China
| | - Zhi-Quan Hu
- Department of Ultrasound, Medical Imaging Union Hospital of Tongji Medical College of HUST Wuhan, China
| | - Hui Wang
- Ultrasound Committee of Chinese Medical Association, Beijing, China.,Interventional Oncology Committee of Chinese Research Hospital Association, Beijing, China.,Department of Ultrasound, China-Japan Union Hospital of Jilin University, Changchun, Jilin, China
| | - Jun Dong
- Department of Urology, Chinese PLA General Hospital, Beijing, China
| | - Jie Pan
- Interventional Oncology Committee of Chinese Research Hospital Association, Beijing, China.,Department of Radiology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Bo Yang
- Department of Oncology, Chinese PLA General Hospital, Beijing, China
| | - Xiaoyong Sai
- Chinese PLA General Hospital, Beijing, China.,National Clinical Research Center for Geriatric Diseases, Institute of Geriatrics, Beijing, China
| | - Ai-Tao Guo
- Department of Pathology, Chinese PLA General Hospital, Beijing, China
| | - Ping Liang
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, China.,State Key Laboratory of Kidney Disease, The Chinese PLA General Hospital, Beijing, China.,Ultrasound Committee of Chinese Medical Association, Beijing, China.,Interventional Oncology Committee of Chinese Research Hospital Association, Beijing, China
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22
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Chen L, Qi L, Zhang J, Ma Q, Chai X. Neutrophil-lymphocyte ratio as a prognostic factor for minute clear cell renal cell carcinoma diagnosed using multi-slice spiral CT. Medicine (Baltimore) 2021; 100:e26292. [PMID: 34115033 PMCID: PMC8202639 DOI: 10.1097/md.0000000000026292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Accepted: 05/19/2021] [Indexed: 11/22/2022] Open
Abstract
Minute clear cell renal cell carcinoma (MccRCC) has a diameter of <1.5 cm and can be diagnosed using multi-slice spiral CT (MSCT). Recently, the role of the neutrophil-lymphocyte ratio (NLR) in the development of MccRCC has attracted attention. This study aimed to further explore the relationship between the NLR and MccRCC.This was a prospective study of 100 patients who were diagnosed with MccRCC using MSCT at Urumqi Friendship Hospital, China. The study investigated a series of pretreatment factors, including NLR and patients' general clinical data. Statistical methods employed included Pearson's chi-square test, Spearman-rho correlation test, Cox regression analysis, and receiver operator characteristic curve analysis.Based on Pearson's χ2, Spearman-rho test, and univariate/multivariate Cox regression analysis, the overall survival of patients with MccRCC was shown to be significantly related to NLR (P < .001). NLR (hazard ratio = 50.676, 95%CI, 17.543-146.390, P < .001) is a significant independent risk-factor for MccRCC. A receiver operator characteristic curve was plotted to examine specificity and sensitivity between NLR and MccRCC (area under curve = 0.958, P < .001).The level of the NLR plays a crucial role in the survival of patients with MccRCC, as diagnosed with MSCT. The higher the NLR, the worse the prognosis for patients with MccRCC.
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23
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Tsili AC, Andriotis E, Gkeli MG, Krokidis M, Stasinopoulou M, Varkarakis IM, Moulopoulos LA. The role of imaging in the management of renal masses. Eur J Radiol 2021; 141:109777. [PMID: 34020173 DOI: 10.1016/j.ejrad.2021.109777] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 05/09/2021] [Accepted: 05/14/2021] [Indexed: 12/26/2022]
Abstract
The wide availability of cross-sectional imaging is responsible for the increased detection of small, usually asymptomatic renal masses. More than 50 % of renal cell carcinomas (RCCs) represent incidental findings on noninvasive imaging. Multimodality imaging, including conventional US, contrast-enhanced US (CEUS), CT and multiparametric MRI (mpMRI) is pivotal in diagnosing and characterizing a renal mass, but also provides information regarding its prognosis, therapeutic management, and follow-up. In this review, imaging data for renal masses that urologists need for accurate treatment planning will be discussed. The role of US, CEUS, CT and mpMRI in the detection and characterization of renal masses, RCC staging and follow-up of surgically treated or untreated localized RCC will be presented. The role of percutaneous image-guided ablation in the management of RCC will be also reviewed.
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Affiliation(s)
- Athina C Tsili
- Department of Clinical Radiology, School of Health Sciences, Faculty of Medicine, University of Ioannina, 45110, Ioannina, Greece.
| | - Efthimios Andriotis
- Department of Newer Imaging Methods of Tomography, General Anti-Cancer Hospital Agios Savvas, 11522, Athens, Greece.
| | - Myrsini G Gkeli
- 1st Department of Radiology, General Anti-Cancer Hospital Agios Savvas, 11522, Athens, Greece.
| | - Miltiadis Krokidis
- 1st Department of Radiology, School of Medicine, National and Kapodistrian University of Athens, Areteion Hospital, 11528, Athens, Greece; Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital Bern University Hospital, University of Bern, 3010, Bern, Switzerland.
| | - Myrsini Stasinopoulou
- Department of Newer Imaging Methods of Tomography, General Anti-Cancer Hospital Agios Savvas, 11522, Athens, Greece.
| | - Ioannis M Varkarakis
- 2nd Department of Urology, National and Kapodistrian University of Athens, Sismanoglio Hospital, 15126, Athens, Greece.
| | - Lia-Angela Moulopoulos
- 1st Department of Radiology, School of Medicine, National and Kapodistrian University of Athens, Areteion Hospital, 11528, Athens, Greece.
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Spiesecke P, Reinhold T, Wehrenberg Y, Werner S, Maxeiner A, Busch J, Fischer T, Hamm B, Lerchbaumer MH. Cost‐effectiveness analysis of multiple imaging modalities in diagnosis and follow‐up of intermediate complex cystic renal lesions. BJU Int 2021; 128:575-585. [DOI: 10.1111/bju.15353] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Affiliation(s)
| | - Thomas Reinhold
- Institute of Social Medicine, Epidemiology, and Health Economics
| | | | | | - Andreas Maxeiner
- Department of Urology Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt‐Universität zu Berlin, and Berlin Institute of Health Berlin Germany
| | - Jonas Busch
- Department of Urology Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt‐Universität zu Berlin, and Berlin Institute of Health Berlin Germany
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Bo S, Sedaghat F, Pavuluri K, Rowe SP, Cohen A, Kates M, McMahon MT. Dynamic Contrast Enhanced-MR CEST Urography: An Emerging Tool in the Diagnosis and Management of Upper Urinary Tract Obstruction. Tomography 2021; 7:80-94. [PMID: 33801533 PMCID: PMC8103243 DOI: 10.3390/tomography7010008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 02/16/2021] [Indexed: 02/04/2023] Open
Abstract
Upper urinary tract obstructions (UTOs) are blockages that inhibit the flow of urine through its normal course, leading to impaired kidney function. Imaging plays a significant role in the initial diagnosis of UTO, with anatomic imaging (primarily ultrasound (US) and non-contrast computed tomography (CT)) serving as screening tools for the detection of the dilation of the urinary collecting systems (i.e., hydronephrosis). Whether hydronephrosis represents UTO or a non-obstructive process is determined by functional imaging (typically nuclear medicine renal scintigraphy). If these exams reveal evidence of UTO but no discernable source, multiphase contrast enhanced CT urography and/or dynamic contrast enhanced MR urography (DCE-MRU) may be performed to delineate a cause. These are often performed in conjunction with direct ureteroscopic evaluation. While contrast-enhanced CT currently predominates, it can induce renal injury due to contrast induced nephropathy (CIN), subject patients to ionizing radiation and is limited in quantifying renal function (traditionally assessed by renal scintigraphy) and establishing the extent to which hydronephrosis is due to functional obstruction. Traditional MRI is similarly limited in its ability to quantify function. DCE-MRU presents concerns regarding nephrogenic systemic fibrosis (NSF), although decreased with newer gadolinium-based contrast agents, and regarding cumulative gadolinium deposition in the basal ganglia. DCE-MR CEST urography is a promising alternative, employing new MRI contrast agents and imaging schemes and allowing for concurrent assessment of renal anatomy and functional parameters. In this review we highlight clinical challenges in the diagnosis and management of UTO, identify key advances in imaging agents and techniques for DCE-MR CEST urography and provide perspective on how this technique may evolve in clinical importance.
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Affiliation(s)
- Shaowei Bo
- The Russell H. Morgan Department of Radiology and Radiological Science, School of Medicine, The Johns Hopkins University, Baltimore, MD 21205, USA; (S.B.); (F.S.); (K.P.); (S.P.R.)
| | - Farzad Sedaghat
- The Russell H. Morgan Department of Radiology and Radiological Science, School of Medicine, The Johns Hopkins University, Baltimore, MD 21205, USA; (S.B.); (F.S.); (K.P.); (S.P.R.)
| | - KowsalyaDevi Pavuluri
- The Russell H. Morgan Department of Radiology and Radiological Science, School of Medicine, The Johns Hopkins University, Baltimore, MD 21205, USA; (S.B.); (F.S.); (K.P.); (S.P.R.)
| | - Steven P. Rowe
- The Russell H. Morgan Department of Radiology and Radiological Science, School of Medicine, The Johns Hopkins University, Baltimore, MD 21205, USA; (S.B.); (F.S.); (K.P.); (S.P.R.)
- The James Buchanan Brady Urological Institute, Department of Urology, School of Medicine, Johns Hopkins University, Baltimore, MD 21205, USA; (A.C.); (M.K.)
| | - Andrew Cohen
- The James Buchanan Brady Urological Institute, Department of Urology, School of Medicine, Johns Hopkins University, Baltimore, MD 21205, USA; (A.C.); (M.K.)
| | - Max Kates
- The James Buchanan Brady Urological Institute, Department of Urology, School of Medicine, Johns Hopkins University, Baltimore, MD 21205, USA; (A.C.); (M.K.)
| | - Michael T. McMahon
- The Russell H. Morgan Department of Radiology and Radiological Science, School of Medicine, The Johns Hopkins University, Baltimore, MD 21205, USA; (S.B.); (F.S.); (K.P.); (S.P.R.)
- F.M. Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, MD 21205, USA
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Kalarakis G, Brehmer K, Svensson A, Axelsson R, Brismar TB, Tzortzakakis A. Combining contrast-enhanced ultrasound, CT perfusion and 99mTc-Sestamibi SPECT/CT to guide diagnosis in a case of solid renal tumour. BJR Case Rep 2021; 7:20200115. [PMID: 33614118 PMCID: PMC7869121 DOI: 10.1259/bjrcr.20200115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 08/24/2020] [Accepted: 08/25/2020] [Indexed: 11/11/2022] Open
Abstract
Definitive, pre-operative differentiation of solid renal lesions by ultrasound, contrast-enhanced multiphasic CT or MRI examinations is often not possible. An increasing amount of literature indicates the added value of 99mTc-Sestamibi SPECT/CT, CT perfusion and contrast-enhanced ultrasound in the pre-operative characterisation of solid renal tumours. This case report presents the diagnostic approach of a solid renal tumour that turned out to be a hybrid oncocytic chromophobe tumour in a patient with Stage 3 renal failure by combining the three aforementioned modern examination techniques.
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Affiliation(s)
- Georgios Kalarakis
- Department of Radiology, Karolinska University Hospital, Huddinge, Stockholm, Sweden
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Ye Z, Fan H, Tong A, Xiao Y, Zhang Y. The Small Size and Superficial Location Suggest That Laparoscopic Partial Nephrectomy Is the First Choice for the Treatment of Juxtaglomerular Cell Tumors. Front Endocrinol (Lausanne) 2021; 12:646649. [PMID: 33995279 PMCID: PMC8120284 DOI: 10.3389/fendo.2021.646649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2020] [Accepted: 04/09/2021] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Juxtaglomerular cell tumor (JGCT) is a very rare disease, and surgical resection is the only possible way to cure this tumor. Open nephrectomy and partial nephrectomy have been reported to manage JGCTs with excellent results in the previous reviews. Laparoscopic surgery has been popularized in recent years, while critical issues associated with laparoscopic surgical management have been seldom reported. We summarized the JGCTs in our center to discover the optimal surgical management and its anatomic foundation. METHODS In this retrospective study, we enrolled a total of 14 JGCT patients. All patients received surgeries and were followed up for up to 11 years. We mainly summarized the size and location of tumors, imaging features, and surgical strategies. A descriptive statistical analysis was performed. RESULTS The JGCTs in this study had a median size of 1.35 cm and all located superficially, mainly in the cortical or subcortical area of the kidney. All 14 patients had hypertension, ten had hypokalemia, and seven had elevated plasma renin activity. Pathologically, JGCT cells were polygonal or spindle shape, with positive CD34 and vimentin immunostaining. All patients received partial nephrectomy; nine were laparoscopic, and five were open. Laparoscopic partial nephrectomy (LPN) was performed in seven out of eight patients over the last nine years. Postoperative blood pressure, serum potassium, and plasma renin activity were normal in all patients. No recurrence occurred within a median follow-up of 60 months. CONCLUSION The small size and superficial location are the characteristic anatomic features of JGCT; they suggest that LPN is the preferred surgical strategy. Laparoscopic ultrasound is helpful for the intraoperative detection of small JGCTs. Longer follow-up is required to examine the biological behavior of JGCTs and the effect of LPN.
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Affiliation(s)
- Zixing Ye
- Department of Urology, Peking Union Medical College Hospital, Beijing, China
| | - Hua Fan
- Department of Urology, Peking Union Medical College Hospital, Beijing, China
| | - Anli Tong
- Department of Endocrinology, Peking Union Medical College Hospital, Beijing, China
| | - Yu Xiao
- Department of Pathology, Peking Union Medical College Hospital, Beijing, China
| | - Yushi Zhang
- Department of Urology, Peking Union Medical College Hospital, Beijing, China
- *Correspondence: Yushi Zhang,
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Chu JS, Wang ZJ. Protocol Optimization for Renal Mass Detection and Characterization. Radiol Clin North Am 2020; 58:851-873. [PMID: 32792119 DOI: 10.1016/j.rcl.2020.05.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Renal masses increasingly are found incidentally, largely due to the frequent use of medical imaging. Computed tomography (CT) and MR imaging are mainstays for renal mass characterization, presurgical planning of renal tumors, and surveillance after surgery or systemic therapy for advanced renal cell carcinomas. CT protocols should be tailored to different clinical indications, balancing diagnostic accuracy and radiation exposure. MR imaging protocols should take advantage of the improved soft tissue contrast for renal tumor diagnosis and staging. Optimized imaging protocols enable analysis of imaging features that help narrow the differential diagnoses and guide management in patients with renal masses.
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Affiliation(s)
- Jason S Chu
- Department of Radiology and Biomedical Imaging, University of California San Francisco, 505 Parnassus Avenue, Box 0628, San Francisco, CA 94143, USA
| | - Zhen J Wang
- Department of Radiology and Biomedical Imaging, University of California San Francisco, 505 Parnassus Avenue, Box 0628, San Francisco, CA 94143, USA.
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Wu JF, Ge LJ, Ye XB, Sun Y, Wang YL, Wang ZP. Can acoustic radiation force impulse imaging (ARFI) accurately diagnose renal masses?: A protocol of systematic review and meta-analysis. Medicine (Baltimore) 2020; 99:e21500. [PMID: 32756185 PMCID: PMC7402870 DOI: 10.1097/md.0000000000021500] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Renal masses are increasingly being discovered because of the wide accessibility of modern high resolution imaging procedures. Previous clinical studies have reported that acoustic radiation force impulse imaging (ARFI) is used for diagnosis of renal masses. However, no study has investigated this topic systematically. Therefore, this study will evaluate the diagnostic value of ARFI for the diagnosis of renal masses. METHODS A systematic search using the databases of Cochrane Library, EMBASE, Pubmed, WANGFANG, and China National Knowledge Infrastructure will be performed to identify studies in which patients with renal masses are assessed by ARFI. Two investigators will independently screen the literature and extract the data. Any discrepancies will be resolved via discussion with the senior author. Study quality will be assessed by the Quality Assessment of Diagnostic Accuracy Studies 2 tool, and pooled sensitivity and specificity of various ARFI findings for the diagnosis of renal masses will be determined. Summary receiver operating characteristic curve will be used to assess the overall performance of ARFI. RESULTS This study will evaluate the diagnostic value of ARFI for the diagnosis of renal masses through sensitivity, specificity, positive and negative likelihood ratio, and diagnostic odds ratio. CONCLUSION This study will summarize the most recent evidence that focusing on the diagnosis of ARFI for renal masses. STUDY REGISTRATION INPLASY202060105.
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Wu JF, Wu C, Wang YL, Wang ZP. Diagnostic accuracy of contrast-enhanced ultrasound in the detection of small renal masses: A protocol of systematic review and meta-analysis. Medicine (Baltimore) 2020; 99:e21262. [PMID: 32702910 PMCID: PMC7373583 DOI: 10.1097/md.0000000000021262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 06/12/2020] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND The small renal masses (SRMs) were defined that the diameter of renal masses measured by enhanced image was ≤4 cm. The diagnostic accuracy of contrast-enhanced ultrasound (CEUS) for SRMs is apparently variable among previous studies. Hence, this study will evaluate the diagnostic accuracy of CEUS in the identification of benign and malignant SRMs. METHODS A comprehensive search using the databases of Cochrane Library, Embase, PubMed, WANGFANG, and China National Knowledge Infrastructure will be carried out to identify studies in which patients with SRMs are assessed by CEUS. Two investigators will independently screen the literature and extract the data. Any discrepancies will be resolved via discussion with the senior author. Study quality will be assessed by the Quality Assessment of Diagnostic Accuracy Studies 2 tool, and pooled sensitivity and specificity of various CEUS findings for the diagnosis of SRMs will be determined. Summary receiver operating characteristic curve will be used to assess the overall performance of CEUS. RESULTS This study will evaluate the diagnostic accuracy of CEUS for the diagnosis of SRMs through sensitivity, specificity, positive and negative likelihood ratio, and diagnostic odds ratio. CONCLUSION This study will summarize the most recent evidence that focusing on the diagnosis of CEUS for SRMs. STUDY REGISTRATION INPLASY202060040.
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Heller MT, Furlan A, Kawashima A. Multiparametric MR for Solid Renal Mass Characterization. Magn Reson Imaging Clin N Am 2020; 28:457-469. [PMID: 32624162 DOI: 10.1016/j.mric.2020.03.008] [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: 11/26/2022]
Abstract
Multiparametric MR provides a noninvasive means for improved differentiation between benign and malignant solid renal masses. Although most large, heterogeneous renal masses are due to renal cell carcinoma, smaller "indeterminate" renal masses are being identified on cross-sectional imaging. Although definitive diagnosis of a solid renal mass may not always be possible by MR imaging, integrated evaluation of multiple MR imaging parameters can result in concise differential diagnosis. Multiparametric MR should be considered a critical step in the triage of patients with a solid renal mass for whom treatment options are being considered in the context of morbidity, prognosis, and mortality.
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Affiliation(s)
- Matthew T Heller
- Department of Radiology, Mayo Clinic, Mayo Clinic Hospital, 5777 East Mayo Boulevard, PX SS 01 RADLGY, Phoenix, AZ 85054, USA.
| | - Alessandro Furlan
- Department of Radiology, University of Pittsburgh, University of Pittsburgh Medical Center, 200 Lothrop Street, Pittsburgh, PA 15213, USA
| | - Akira Kawashima
- Department of Radiology, Mayo Clinic, Mayo Clinic Hospital, 5777 East Mayo Boulevard, PX SS 01 RADLGY, Phoenix, AZ 85054, USA
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32
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Martínez Rodríguez C, Tardáguila de la Fuente G, Villanueva Campos A. Current management of small renal masses. RADIOLOGIA 2020. [DOI: 10.1016/j.rxeng.2020.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Martínez Rodríguez C, Tardáguila de la Fuente G, Villanueva Campos AM. Current management of small renal masses. RADIOLOGIA 2019; 62:167-179. [PMID: 31882171 DOI: 10.1016/j.rx.2019.11.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Revised: 11/18/2019] [Accepted: 11/22/2019] [Indexed: 12/12/2022]
Abstract
One of the consequences of the growing use of diagnostic imaging techniques is the notable growth in the detection of small renal masses presumably corresponding to localized tumors that are potentially curable with surgical treatment. When faced with the finding of a small renal mass, radiologists must determine whether it is benign or malignant, and if it is malignant, what subtype it belong to, and whether it should be managed with surgical treatment, with ablative techniques, or with watchful waiting with active surveillance. Small renal masses are now a clinical entity that require management different from the approaches used for classical renal cell carcinomas. In this scenario, radiologists are key because they are involved in all aspects of the management of these tumors, including in their diagnosis, treatment, and follow-up.
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