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Bodard S, Delavaud C, Dariane C, Boudhabhay I, Bensenouci NEI, Timsit MO, Correas JM, Verkarre V, Hélénon O. Low-grade oncocytic tumor of the kidney: imaging features of a novel tumor entity. Abdom Radiol (NY) 2024:10.1007/s00261-024-04487-2. [PMID: 39068611 DOI: 10.1007/s00261-024-04487-2] [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: 05/04/2024] [Revised: 06/30/2024] [Accepted: 06/30/2024] [Indexed: 07/30/2024]
Abstract
PURPOSES Low-grade oncocytic tumor (LOT) is a rare renal tumor that has emerged from the spectrum of eosinophilic/oncocytic renal tumors and poses a diagnostic challenge due to its similarity to chromophobe renal cell carcinoma (CHRCC) and renal oncocytoma (RO). The imaging features of this novel tumor entity have not yet been clearly described. The purpose of this study was to describe the imaging features of LOT with radiologic-pathologic correlation. METHODS We conducted a retrospective observational study involving two expert centers. We identified 12 pathologically proven LOT with preoperative imaging available, including at least computed tomography (CT) or magnetic resonance imaging (MRI), from the past 12 years. Three experienced radiologists performed the imaging analysis independently. RESULTS All tumors presented well-defined borders. Nine of the 12 LOT exhibited an early peripheral enhancement with complete or almost complete centripetal fill-in on nephrographic or delayed phases without any particular shape. Three showed a homogeneous contrast enhancement. Macroscopic fat and calcifications were not observed in any of the tumors. CONCLUSION Early peripheral enhancement with complete or almost complete centripetal fill-in on nephrographic or delayed phases without any particular shape suggests a LOT diagnosis. Further analyses involving larger studies are needed to fully confirm these imaging characteristics. To date, a percutaneous biopsy should be performed before considering management.
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Affiliation(s)
- Sylvain Bodard
- Adult Department of Radiology, Service d'Imagerie Adulte, AP-HP-Centre, Hôpital Necker Enfants Malades, Université de Paris Cité, 149 Rue de Sèvres, 75015, Paris, France.
- Laboratoire d'Imagerie Biomédicale, Sorbonne Université, CNRS, INSERM, Paris, France.
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA.
| | - Christophe Delavaud
- Adult Department of Radiology, Service d'Imagerie Adulte, AP-HP-Centre, Hôpital Necker Enfants Malades, Université de Paris Cité, 149 Rue de Sèvres, 75015, Paris, France
| | - Charles Dariane
- Service d'Urologie, AP-HP-Centre, Hôpital Européen Georges Pompidou, Université de Paris Cité, 75015, Paris, France
| | - Idris Boudhabhay
- Service de Transplantation Rénale, AP-HP-Centre, Hôpital Necker Enfants Malades, Université de Paris Cité, 75015, Paris, France
| | - Nour El Imane Bensenouci
- Service d'Anatomie Pathologie, AP-HP-Centre, Hôpital Européen Georges Pompidou, Université de Paris Cité, 75015, Paris, France
| | - Marc-Olivier Timsit
- Service d'Urologie, AP-HP-Centre, Hôpital Européen Georges Pompidou, Université de Paris Cité, 75015, Paris, France
| | - Jean-Michel Correas
- Adult Department of Radiology, Service d'Imagerie Adulte, AP-HP-Centre, Hôpital Necker Enfants Malades, Université de Paris Cité, 149 Rue de Sèvres, 75015, Paris, France
- Laboratoire d'Imagerie Biomédicale, Sorbonne Université, CNRS, INSERM, Paris, France
| | - Virginie Verkarre
- Service d'Anatomie Pathologie, AP-HP-Centre, Hôpital Européen Georges Pompidou, Université de Paris Cité, 75015, Paris, France
- Equipe INSERM UMR 970 "Genetic and Metabolism of Rare Tumors" Equipe Labélisée Ligue Contre Le Cancer, PARCC, SIRIC CARPEM, Université de Paris-Cité, Paris, France
| | - Olivier Hélénon
- Adult Department of Radiology, Service d'Imagerie Adulte, AP-HP-Centre, Hôpital Necker Enfants Malades, Université de Paris Cité, 149 Rue de Sèvres, 75015, Paris, France
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Blachura T, Matusik PS, Kowal A, Radzikowska J, Jarczewski JD, Skiba Ł, Popiela TJ, Chrzan R. Diagnostic accuracy of the Clear Cell Likelihood Score and selected MRI parameters in the characterization of indeterminate renal masses - a single-institution study. Abdom Radiol (NY) 2024:10.1007/s00261-024-04484-5. [PMID: 38980404 DOI: 10.1007/s00261-024-04484-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2024] [Revised: 06/25/2024] [Accepted: 06/30/2024] [Indexed: 07/10/2024]
Abstract
PURPOSE We aimed to assess the diagnostic accuracy of the clear cell likelihood score (ccLS) and value of other selected magnetic resonance imaging (MRI) features in the characterization of indeterminate small renal masses (SRMs). METHODS Fifty patients with indeterminate SRMs discovered on MRI between 2012 and 2023 were included. The ccLS for the characterization of clear cell renal cell carcinoma (ccRCC) was calculated and compared to the final diagnosis (ccRCC vs. 'all other' masses). RESULTS The ccLS = 5 had a satisfactory accuracy of 64.0% and a very high specificity of 96.3%; however, its sensitivity of 26.1% was relatively low. Receiver operating curve (ROC) analysis revealed that from the selected MRI features, only T1 ratio and arterial to delayed enhancement (ADER) were good discriminators between ccRCC and other types of renal masses (area under curve, AUC = 0.707, p = 0.01; AUC = 0.673, p = 0.03; respectively). The cut-off points determined in ROC analysis using the Youden index were 0.73 (p = 0.01) for T1 ratio and 0.99 for ADER (p = 0.03). The logistic regression model demonstrated that ccLS = 5 and T1 ratio (OR = 15.5 [1.1-218.72], p = 0.04; OR = 0.002 [0.00-0.81], p = 0.04) were significant predictors of ccRCC. CONCLUSIONS The ccLS algorithm offers an encouraging method for the standardization of imaging protocols to aid in the diagnosis and management of SRMs in daily clinical practice by enhancing detectability of ccRCC and reducing the number of unnecessary invasive procedures for benign or indolent lesions. However, its diagnostic performance needs multi-center large cohort studies to validate it before it can be incorporated as a diagnostic algorithm and will guide future iterations of clinical guidelines. The retrospective nature of our study and small patient population confined to a single clinical center may impact the generalizability of the results; thus, future studies are required to define whether employment of the T1 ratio or ADER parameter may strengthen the diagnostic accuracy of ccRCC diagnosis.
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Affiliation(s)
- Tomasz Blachura
- Department of Diagnostic Imaging, University Hospital, Kraków, 30-688, Poland
| | - Patrycja S Matusik
- Department of Diagnostic Imaging, University Hospital, Kraków, 30-688, Poland.
- Chair of Radiology, Jagiellonian University Medical College, Kraków, 30-688, Poland.
| | - Aleksander Kowal
- Department of Neurosurgery, Comprehensive Cancer Centre and Traumatology, Copernicus Memorial Hospital in Lodz, Lodz, Poland
| | - Julia Radzikowska
- Student's Scientific Group, Jagiellonian University Medical College, Kraków, 30-688, Poland
| | | | - Łukasz Skiba
- Student's Scientific Group, Jagiellonian University Medical College, Kraków, 30-688, Poland
| | - Tadeusz J Popiela
- Department of Diagnostic Imaging, University Hospital, Kraków, 30-688, Poland
- Chair of Radiology, Jagiellonian University Medical College, Kraków, 30-688, Poland
| | - Robert Chrzan
- Department of Diagnostic Imaging, University Hospital, Kraków, 30-688, Poland
- Chair of Radiology, Jagiellonian University Medical College, Kraków, 30-688, Poland
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3
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Iwatani K, Kimura S, Urabe F, Matsukawa A, Aikawa K, Yanagisawa T, Shimizu K, Miki K, Kimura T, Miki J. Preoperative Tyrosine Kinase Inhibitors Before Percutaneous Cryoablation for Clinical T1b Renal Tumors. Cureus 2024; 16:e60345. [PMID: 38883051 PMCID: PMC11177236 DOI: 10.7759/cureus.60345] [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: 04/30/2024] [Accepted: 05/15/2024] [Indexed: 06/18/2024] Open
Abstract
Purpose To treat renal cell carcinoma, local ablative therapy is a viable alternative treatment option. Traditionally, cryoablation has been used for the treatment of T1a renal tumors. However, recent technological developments have expanded its application to encompass select T1b renal tumors. Here, we present a retrospective study of the utilization of preoperative tyrosine kinase inhibitors (TKIs) to induce tumor shrinkage and achieve favorable outcomes in percutaneous cryoablation (PCA). Methods We retrospectively evaluated the data from nine patients with clinical T1b renal tumors who underwent PCA. Six patients with TKI pretreatment at our institution between 2016 and 2018 were included in the study. We evaluated the safety and efficacy of preoperative TKIs prior to PCA. Results All patients received axitinib with a median treatment duration of 80.5 days (IQR: 49-85). All patients experienced tumor shrinkage (median: 13.5 mm; IQR: 7-16); five experienced downstaging to T1a following tumor shrinkage. There were no severe adverse events (common terminology criteria for adverse events (CTCAE) grade ≥ 3) in TKIs. After the discontinuation of TKIs for two weeks, all PCA procedures were performed successfully without any severe complications. During a median follow-up of 46 months, no local recurrence was observed in any of these cases. Conclusion In cases with large renal tumors, TKI pretreatment prior to PCA had potential benefits in terms of tumor shrinkage and long-term local control rate. Further well-designed studies in larger populations are needed to validate our findings.
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Affiliation(s)
- Kosuke Iwatani
- Department of Urology, The Jikei University School of Medicine, Kashiwa Hospital, Chiba, JPN
| | - Shoji Kimura
- Department of Urology, The Jikei University School of Medicine, Kashiwa Hospital, Chiba, JPN
| | - Fumihiko Urabe
- Department of Urology, The Jikei University School of Medicine, Tokyo, JPN
| | - Akihiro Matsukawa
- Department of Urology, The Jikei University School of Medicine, Tokyo, JPN
| | - Koichi Aikawa
- Department of Urology, The Jikei University School of Medicine, Tokyo, JPN
| | | | - Kanichiro Shimizu
- Department of Radiology, The Jikei University School of Medicine, Kashiwa Hospital, Chiba, JPN
| | - Kenta Miki
- Department of Urology, The Jikei University School of Medicine, Tokyo, JPN
| | - Takahiro Kimura
- Department of Urology, The Jikei University School of Medicine, Tokyo, JPN
| | - Jun Miki
- Department of Urology, The Jikei University School of Medicine, Kashiwa Hospital, Chiba, JPN
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Ratnaparkhi C, Dhok A, Kumar N, Pande S, Jeswani S. Bilateral Renal Cell Carcinoma in the Horseshoe Kidney With Metastasis in Gallbladder, Pancreas and Duodenum: A Report of a Rare Case and Literature Review. Cureus 2024; 16:e58363. [PMID: 38756314 PMCID: PMC11096990 DOI: 10.7759/cureus.58363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/16/2024] [Indexed: 05/18/2024] Open
Abstract
Horseshoe kidney is the most common renal fusion anomaly and is associated with various complications, ranging from infections to neoplasms. While renal cell carcinoma (RCC) is the most frequent renal neoplasm in adults, its occurrence in a horseshoe kidney is rare, and bilateral involvement is rarer. Furthermore, RCC metastasizing to organs is known and rare sites of metastasis are also documented. The report presents a unique case of bilateral RCC in a horseshoe kidney with synchronous metastasis to the gallbladder, pancreas, and duodenum. This presentation, involving metastasis to these specific organs, is exceedingly uncommon, making it a rarest of rare possibilities. The current case report underscores the importance of vigilant monitoring and comprehensive evaluation in patients with horseshoe kidneys, as they may be predisposed to unusual complications like RCC and rare site metastasis.
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Affiliation(s)
- Chetana Ratnaparkhi
- Radiodiagnosis, All India Institute of Medical Sciences, Nagpur, Nagpur, IND
| | - Avinash Dhok
- Radiodiagnosis and Interventional Radiology, All India Institute of Medical Sciences, Nagpur, Nagpur, IND
| | - Neeraj Kumar
- Radiodiagnosis, Shree Mangala Hospital, Bilaspur, IND
| | - Shantanu Pande
- Nuclear Medicine, All India Institute of Medical Sciences, Nagpur, Nagpur, IND
| | - Sakshi Jeswani
- Radiodiagnosis, All India Institute of Medical Sciences, Nagpur, Nagpur, IND
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Elek A, Kwon JW, Ertugrul S, Oren NC. Radiologic and pathologic correlation of a renal venous hemangioma. Int Cancer Conf J 2023; 12:227-232. [PMID: 37577340 PMCID: PMC10421804 DOI: 10.1007/s13691-023-00626-6] [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: 05/22/2023] [Accepted: 07/26/2023] [Indexed: 08/15/2023] Open
Abstract
Renal hemangiomas, including the rare subtype of venous hemangioma, are typically non-cancerous, often asymptomatic, and usually discovered incidentally during imaging studies. Here, we report a unique case of a 59-year-old African-American female with a renal venous hemangioma that initially mimicked papillary-type renal cell carcinoma (RCC-pt) on imaging studies. The patient's presentation included a long history of rectal bleeding and an incidental discovery of a hypoattenuating mass in the left kidney during a contrast-enhanced CT scan. Renal MRI revealed a 3.5 cm left renal lower pole mass, presenting as heterogeneously hyperintense on T1-weighted images and hypointense on T2-weighted images, with gradual mild enhancement post-contrast. Subsequent total nephrectomy confirmed the histopathological diagnosis of a venous hemangioma. This case underlines the need for recognizing unique imaging features of renal venous hemangiomas, contributing to the differential diagnosis of T2 dark hypoenhancing renal masses. Correct interpretation may prevent unnecessary invasive procedures and operations, thereby improving patient management and outcomes.
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Affiliation(s)
- Alperen Elek
- Faculty of Medicine, Ege University, Erzene Ave, 35040 Bornova, Izmir Turkey
| | - Jung Woo Kwon
- Faculty of Medicine, Department of Pathology, University of Chicago, 5801 S. Ellis Ave, Chicago, IL 60637 USA
| | - Sena Ertugrul
- Gulhane Faculty of Medicine, University of Health Sciences, Emrah Ave, Etlik, Kecioren, 06018 Ankara, Turkey
| | - Nisa Cem Oren
- Faculty of Medicine, Department of Radiology, University of Chicago, 5801 S. Ellis Ave, Chicago, IL 60637 USA
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6
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Wu G, Zhang J, Jiang L, Liu J, Zhang L, Yang W. Indolent mucinous tubular and spindle cell carcinoma of the kidney: A case report and review of the literature. Oncol Lett 2023; 26:406. [PMID: 37609375 PMCID: PMC10440723 DOI: 10.3892/ol.2023.13992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 07/10/2023] [Indexed: 08/24/2023] Open
Abstract
Mucinous tubular and spindle cell carcinoma of the kidney (MTSCC) is a rare subtype of renal cancer. It consists of tubules separated by mucus stroma and a spindle cell. Few cases have been reported; thus, the imaging features of MTSCC are not well characterized. An MTSCC in the left kidney of a 65-year-old woman was incidentally discovered during a medical checkup. A review of the patient's medical history revealed that this kidney lump had an indolent growth process. The current study presented this case and reviewed the pathological features, imaging findings and treatment options of MTSCC to strengthen the recognition of this rare renal neoplasm by radiologists.
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Affiliation(s)
- Guangrong Wu
- Department of Radiology, The First People's Hospital of Zunyi, The Third Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou 563000, P.R. China
| | - Jiaren Zhang
- Department of Radiology, The First People's Hospital of Zunyi, The Third Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou 563000, P.R. China
| | - Lin Jiang
- Department of Radiology, The First People's Hospital of Zunyi, The Third Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou 563000, P.R. China
| | - Jiaji Liu
- Department of Radiology, The First People's Hospital of Zunyi, The Third Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou 563000, P.R. China
| | - Lunyou Zhang
- Department of Radiology, The First People's Hospital of Zunyi, The Third Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou 563000, P.R. China
| | - Wei Yang
- Department of Radiology, The First People's Hospital of Zunyi, The Third Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou 563000, P.R. China
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7
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Saifi A, Jungels C, Veron Sanchez A. Discovery of Gastric Metastases From Primary Renal Cell Carcinoma Through MRI: A Case Report. Cureus 2023; 15:e43637. [PMID: 37719552 PMCID: PMC10504865 DOI: 10.7759/cureus.43637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/16/2023] [Indexed: 09/19/2023] Open
Abstract
Gastric metastases from primary renal cell carcinoma (RCC) are rare and poorly documented in the existing literature. This case report presents the clinical course of a 65-year-old male with multi-metastatic clear cell RCC (ccRCC) who was incidentally found to have stomach metastases during follow-up magnetic resonance imaging (MRI). Gastric metastases from ccRCC are typically associated with other metastatic sites. They often emerge at an advanced stage of the disease, indicating a poor prognosis. It is therefore important to consider gastric metastases as a potential site of involvement in RCC patients. MRI revealed three gastric mucosal lesions exhibiting hypervascularity, a characteristic feature of ccRCC. Histological analysis confirmed the presence of malignant cells compatible with RCC.
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Shetty AS, Fraum TJ, Ballard DH, Hoegger MJ, Itani M, Rajput MZ, Lanier MH, Cusworth BM, Mehrsheikh AL, Cabrera-Lebron JA, Chu J, Cunningham CR, Hirschi RS, Mokkarala M, Unteriner JG, Kim EH, Siegel CL, Ludwig DR. Renal Mass Imaging with MRI Clear Cell Likelihood Score: A User's Guide. Radiographics 2023; 43:e220209. [PMID: 37319026 DOI: 10.1148/rg.220209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
Small solid renal masses (SRMs) are frequently detected at imaging. Nearly 20% are benign, making careful evaluation with MRI an important consideration before deciding on management. Clear cell renal cell carcinoma (ccRCC) is the most common renal cell carcinoma subtype with potentially aggressive behavior. Thus, confident identification of ccRCC imaging features is a critical task for the radiologist. Imaging features distinguishing ccRCC from other benign and malignant renal masses are based on major features (T2 signal intensity, corticomedullary phase enhancement, and the presence of microscopic fat) and ancillary features (segmental enhancement inversion, arterial-to-delayed enhancement ratio, and diffusion restriction). The clear cell likelihood score (ccLS) system was recently devised to provide a standardized framework for categorizing SRMs, offering a Likert score of the likelihood of ccRCC ranging from 1 (very unlikely) to 5 (very likely). Alternative diagnoses based on imaging appearance are also suggested by the algorithm. Furthermore, the ccLS system aims to stratify which patients may or may not benefit from biopsy. The authors use case examples to guide the reader through the evaluation of major and ancillary MRI features of the ccLS algorithm for assigning a likelihood score to an SRM. The authors also discuss patient selection, imaging parameters, pitfalls, and areas for future development. The goal is for radiologists to be better equipped to guide management and improve shared decision making between the patient and treating physician. © RSNA, 2023 Quiz questions for this article are available in the supplemental material. See the invited commentary by Pedrosa in this issue.
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Affiliation(s)
- Anup S Shetty
- From the Mallinckrodt Institute of Radiology (A.S.S., T.J.F., D.H.B., M.J.H., M.I., M.Z.R., M.H.L., B.M.C., A.L.M., J.A.C.L., J.C., C.R.C., R.S.H., M.M., J.G.U., C.L.S., D.R.L.) and Division of Urologic Surgery (E.H.K.), Washington University School of Medicine, 510 S Kingshighway Blvd, Campus Box 8131, St Louis, MO 63110
| | - Tyler J Fraum
- From the Mallinckrodt Institute of Radiology (A.S.S., T.J.F., D.H.B., M.J.H., M.I., M.Z.R., M.H.L., B.M.C., A.L.M., J.A.C.L., J.C., C.R.C., R.S.H., M.M., J.G.U., C.L.S., D.R.L.) and Division of Urologic Surgery (E.H.K.), Washington University School of Medicine, 510 S Kingshighway Blvd, Campus Box 8131, St Louis, MO 63110
| | - David H Ballard
- From the Mallinckrodt Institute of Radiology (A.S.S., T.J.F., D.H.B., M.J.H., M.I., M.Z.R., M.H.L., B.M.C., A.L.M., J.A.C.L., J.C., C.R.C., R.S.H., M.M., J.G.U., C.L.S., D.R.L.) and Division of Urologic Surgery (E.H.K.), Washington University School of Medicine, 510 S Kingshighway Blvd, Campus Box 8131, St Louis, MO 63110
| | - Mark J Hoegger
- From the Mallinckrodt Institute of Radiology (A.S.S., T.J.F., D.H.B., M.J.H., M.I., M.Z.R., M.H.L., B.M.C., A.L.M., J.A.C.L., J.C., C.R.C., R.S.H., M.M., J.G.U., C.L.S., D.R.L.) and Division of Urologic Surgery (E.H.K.), Washington University School of Medicine, 510 S Kingshighway Blvd, Campus Box 8131, St Louis, MO 63110
| | - Malak Itani
- From the Mallinckrodt Institute of Radiology (A.S.S., T.J.F., D.H.B., M.J.H., M.I., M.Z.R., M.H.L., B.M.C., A.L.M., J.A.C.L., J.C., C.R.C., R.S.H., M.M., J.G.U., C.L.S., D.R.L.) and Division of Urologic Surgery (E.H.K.), Washington University School of Medicine, 510 S Kingshighway Blvd, Campus Box 8131, St Louis, MO 63110
| | - Mohamed Z Rajput
- From the Mallinckrodt Institute of Radiology (A.S.S., T.J.F., D.H.B., M.J.H., M.I., M.Z.R., M.H.L., B.M.C., A.L.M., J.A.C.L., J.C., C.R.C., R.S.H., M.M., J.G.U., C.L.S., D.R.L.) and Division of Urologic Surgery (E.H.K.), Washington University School of Medicine, 510 S Kingshighway Blvd, Campus Box 8131, St Louis, MO 63110
| | - Michael H Lanier
- From the Mallinckrodt Institute of Radiology (A.S.S., T.J.F., D.H.B., M.J.H., M.I., M.Z.R., M.H.L., B.M.C., A.L.M., J.A.C.L., J.C., C.R.C., R.S.H., M.M., J.G.U., C.L.S., D.R.L.) and Division of Urologic Surgery (E.H.K.), Washington University School of Medicine, 510 S Kingshighway Blvd, Campus Box 8131, St Louis, MO 63110
| | - Brian M Cusworth
- From the Mallinckrodt Institute of Radiology (A.S.S., T.J.F., D.H.B., M.J.H., M.I., M.Z.R., M.H.L., B.M.C., A.L.M., J.A.C.L., J.C., C.R.C., R.S.H., M.M., J.G.U., C.L.S., D.R.L.) and Division of Urologic Surgery (E.H.K.), Washington University School of Medicine, 510 S Kingshighway Blvd, Campus Box 8131, St Louis, MO 63110
| | - Amanda L Mehrsheikh
- From the Mallinckrodt Institute of Radiology (A.S.S., T.J.F., D.H.B., M.J.H., M.I., M.Z.R., M.H.L., B.M.C., A.L.M., J.A.C.L., J.C., C.R.C., R.S.H., M.M., J.G.U., C.L.S., D.R.L.) and Division of Urologic Surgery (E.H.K.), Washington University School of Medicine, 510 S Kingshighway Blvd, Campus Box 8131, St Louis, MO 63110
| | - Jorge A Cabrera-Lebron
- From the Mallinckrodt Institute of Radiology (A.S.S., T.J.F., D.H.B., M.J.H., M.I., M.Z.R., M.H.L., B.M.C., A.L.M., J.A.C.L., J.C., C.R.C., R.S.H., M.M., J.G.U., C.L.S., D.R.L.) and Division of Urologic Surgery (E.H.K.), Washington University School of Medicine, 510 S Kingshighway Blvd, Campus Box 8131, St Louis, MO 63110
| | - Jia Chu
- From the Mallinckrodt Institute of Radiology (A.S.S., T.J.F., D.H.B., M.J.H., M.I., M.Z.R., M.H.L., B.M.C., A.L.M., J.A.C.L., J.C., C.R.C., R.S.H., M.M., J.G.U., C.L.S., D.R.L.) and Division of Urologic Surgery (E.H.K.), Washington University School of Medicine, 510 S Kingshighway Blvd, Campus Box 8131, St Louis, MO 63110
| | - Christopher R Cunningham
- From the Mallinckrodt Institute of Radiology (A.S.S., T.J.F., D.H.B., M.J.H., M.I., M.Z.R., M.H.L., B.M.C., A.L.M., J.A.C.L., J.C., C.R.C., R.S.H., M.M., J.G.U., C.L.S., D.R.L.) and Division of Urologic Surgery (E.H.K.), Washington University School of Medicine, 510 S Kingshighway Blvd, Campus Box 8131, St Louis, MO 63110
| | - Ryan S Hirschi
- From the Mallinckrodt Institute of Radiology (A.S.S., T.J.F., D.H.B., M.J.H., M.I., M.Z.R., M.H.L., B.M.C., A.L.M., J.A.C.L., J.C., C.R.C., R.S.H., M.M., J.G.U., C.L.S., D.R.L.) and Division of Urologic Surgery (E.H.K.), Washington University School of Medicine, 510 S Kingshighway Blvd, Campus Box 8131, St Louis, MO 63110
| | - Mahati Mokkarala
- From the Mallinckrodt Institute of Radiology (A.S.S., T.J.F., D.H.B., M.J.H., M.I., M.Z.R., M.H.L., B.M.C., A.L.M., J.A.C.L., J.C., C.R.C., R.S.H., M.M., J.G.U., C.L.S., D.R.L.) and Division of Urologic Surgery (E.H.K.), Washington University School of Medicine, 510 S Kingshighway Blvd, Campus Box 8131, St Louis, MO 63110
| | - Jackson G Unteriner
- From the Mallinckrodt Institute of Radiology (A.S.S., T.J.F., D.H.B., M.J.H., M.I., M.Z.R., M.H.L., B.M.C., A.L.M., J.A.C.L., J.C., C.R.C., R.S.H., M.M., J.G.U., C.L.S., D.R.L.) and Division of Urologic Surgery (E.H.K.), Washington University School of Medicine, 510 S Kingshighway Blvd, Campus Box 8131, St Louis, MO 63110
| | - Eric H Kim
- From the Mallinckrodt Institute of Radiology (A.S.S., T.J.F., D.H.B., M.J.H., M.I., M.Z.R., M.H.L., B.M.C., A.L.M., J.A.C.L., J.C., C.R.C., R.S.H., M.M., J.G.U., C.L.S., D.R.L.) and Division of Urologic Surgery (E.H.K.), Washington University School of Medicine, 510 S Kingshighway Blvd, Campus Box 8131, St Louis, MO 63110
| | - Cary L Siegel
- From the Mallinckrodt Institute of Radiology (A.S.S., T.J.F., D.H.B., M.J.H., M.I., M.Z.R., M.H.L., B.M.C., A.L.M., J.A.C.L., J.C., C.R.C., R.S.H., M.M., J.G.U., C.L.S., D.R.L.) and Division of Urologic Surgery (E.H.K.), Washington University School of Medicine, 510 S Kingshighway Blvd, Campus Box 8131, St Louis, MO 63110
| | - Daniel R Ludwig
- From the Mallinckrodt Institute of Radiology (A.S.S., T.J.F., D.H.B., M.J.H., M.I., M.Z.R., M.H.L., B.M.C., A.L.M., J.A.C.L., J.C., C.R.C., R.S.H., M.M., J.G.U., C.L.S., D.R.L.) and Division of Urologic Surgery (E.H.K.), Washington University School of Medicine, 510 S Kingshighway Blvd, Campus Box 8131, St Louis, MO 63110
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9
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Ali SN, Tano Z, Landman J. The Changing Role of Renal Mass Biopsy. Urol Clin North Am 2023; 50:217-225. [PMID: 36948668 DOI: 10.1016/j.ucl.2023.01.002] [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: 02/22/2023]
Abstract
The incidence and prevalence of small renal masses (SRMs) continues to rise and with increased detection comes increases in surgical management, although the probability of an SRM being benign is upward of 30%. An extirpative treatment first diagnose-later strategy persists and clinical tools for risk stratification such as renal mass biopsy remain severely underutilized. The overtreatment of SRMs has multiple detrimental effects including surgical complications, psychosocial stress, financial loss, and reduced renal function leading to downstream effects such as the need for dialysis and cardiovascular disease.
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Affiliation(s)
| | - Zachary Tano
- Department of Urology, University of California, Irvine, CA, USA
| | - Jaime Landman
- Department of Urology, University of California, Irvine, CA, USA.
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10
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MRI Characteristics of Pediatric and Young-Adult Renal Cell Carcinoma: A Single-Center Retrospective Study and Literature Review. Cancers (Basel) 2023; 15:cancers15051401. [PMID: 36900194 PMCID: PMC10000563 DOI: 10.3390/cancers15051401] [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: 01/11/2023] [Revised: 02/09/2023] [Accepted: 02/17/2023] [Indexed: 02/25/2023] Open
Abstract
Pediatric renal cell carcinoma (RCC) is a rare malignancy. Magnetic resonance imaging (MRI) is the preferred imaging modality for assessment of these tumors. The previous literature has suggested that cross-sectional-imaging findings differ between RCC and other pediatric renal tumors and between RCC subtypes. However, studies focusing on MRI characteristics are limited. Therefore, this study aims to identify MRI characteristics of pediatric and young-adult RCC, through a single-center case series and literature review. Six identified diagnostic MRI scans were retrospectively assessed, and an extensive literature review was conducted. The included patients had a median age of 12 years (63-193 months). Among other subtypes, 2/6 (33%) were translocation-type RCC (MiT-RCC) and 2/6 (33%) were clear-cell RCC. Median tumor volume was 393 cm3 (29-2191 cm3). Five tumors had a hypo-intense appearance on T2-weighted imaging, whereas 4/6 were iso-intense on T1-weighted imaging. Four/six tumors showed well-defined margins. The median apparent diffusion coefficient (ADC) values ranged from 0.70 to 1.20 × 10-3 mm2/s. In thirteen identified articles focusing on MRI characteristics of MiT-RCC, the majority of the patients also showed T2-weighted hypo-intensity. T1-weighted hyper-intensity, irregular growth pattern and limited diffusion-restriction were also often described. Discrimination of RCC subtypes and differentiation from other pediatric renal tumors based on MRI remains difficult. Nevertheless, T2-weighted hypo-intensity of the tumor seems a potential distinctive characteristic.
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11
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Comparative diagnostic performance of contrast-enhanced ultrasound and dynamic contrast-enhanced magnetic resonance imaging for differentiating clear cell and non-clear cell renal cell carcinoma. Eur Radiol 2023; 33:3766-3774. [PMID: 36725722 DOI: 10.1007/s00330-023-09391-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 12/09/2022] [Accepted: 12/23/2022] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To compare the diagnostic efficiency of contrast-enhanced ultrasound (CEUS) with that of dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) for the differential diagnosis of clear and non-clear cell renal cell carcinoma, as confirmed by subsequent pathology. METHODS A total of 181 patients with 184 renal lesions diagnosed by both CEUS and DCE-MRI were enrolled in the study, including 136 clear cell renal cell carcinoma (ccRCC) and 48 non-clear cell renal cell carcinoma (non-ccRCC) tumors. All lesions were confirmed by histopathologic diagnosis after surgical resection. Interobserver agreement was estimated using a weighted kappa statistic. Diagnostic efficiency in evaluating ccRCC and non-ccRCC was compared between CEUS and DCE-MRI. RESULTS The weighted kappa value for interobserver agreement was 0.746 to 0.884 for CEUS diagnosis and 0.764 to 0.895 for DCE-MRI diagnosis. Good diagnostic performance in differential diagnosis of ccRCC and non-ccRCC was displayed by both CEUS and DCE-MRI: sensitivity was 89.7% and 91.9%, respectively; specificity was 77.1% and 68.8%, respectively; and area under the receiver operating curve was 0.834 and 0.803, respectively. No statistically significant differences were present between the two methods (p = 0.54). CONCLUSIONS Both CEUS and DCE-MRI imaging are effective for the differential diagnosis of ccRCC and non-ccRCC. Thus, CEUS could be an alternative to DCE-MRI as a first test for patients at risk of renal cancer, particularly where DCE-MRI cannot be carried out. KEY POINTS • CEUS and DCE-MRI features can help differentiate ccRCC and non-ccRCC. • The differential diagnosis of ccRCC and non-ccRCC by CEUS is comparable to that of DCE-MRI. • Interobserver agreement is generally high using CEUS and DCE-MRI.
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12
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Agudelo JP, Upadhyay D, Zhang D, Zhao H, Nolley R, Sun J, Agarwal S, Bok RA, Vigneron DB, Brooks JD, Kurhanewicz J, Peehl DM, Sriram R. Multiparametric Magnetic Resonance Imaging and Metabolic Characterization of Patient-Derived Xenograft Models of Clear Cell Renal Cell Carcinoma. Metabolites 2022; 12:1117. [PMID: 36422257 PMCID: PMC9692472 DOI: 10.3390/metabo12111117] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 10/31/2022] [Accepted: 11/08/2022] [Indexed: 08/26/2023] Open
Abstract
Patient-derived xenografts (PDX) are high-fidelity cancer models typically credentialled by genomics, transcriptomics and proteomics. Characterization of metabolic reprogramming, a hallmark of cancer, is less frequent. Dysregulated metabolism is a key feature of clear cell renal cell carcinoma (ccRCC) and authentic preclinical models are needed to evaluate novel imaging and therapeutic approaches targeting metabolism. We characterized 5 PDX from high-grade or metastatic ccRCC by multiparametric magnetic resonance imaging (MRI) and steady state metabolic profiling and flux analysis. Similar to MRI of clinical ccRCC, T2-weighted images of orthotopic tumors of most PDX were homogeneous. The increased hyperintense (cystic) areas observed in one PDX mimicked the cystic phenotype typical of some RCC. The negligible hypointense (necrotic) areas of PDX grown under the highly vascularized renal capsule are beneficial for preclinical studies. Mean apparent diffusion coefficient (ADC) values were equivalent to those of ccRCC in human patients. Hyperpolarized (HP) [1-13C]pyruvate MRI of PDX showed high glycolytic activity typical of high-grade primary and metastatic ccRCC with considerable intra- and inter-tumoral variability, as has been observed in clinical HP MRI of ccRCC. Comparison of steady state metabolite concentrations and metabolic flux in [U-13C]glucose-labeled tumors highlighted the distinctive phenotypes of two PDX with elevated levels of numerous metabolites and increased fractional enrichment of lactate and/or glutamate, capturing the metabolic heterogeneity of glycolysis and the TCA cycle in clinical ccRCC. Culturing PDX cells and reimplanting to generate xenografts (XEN), or passaging PDX in vivo, altered some imaging and metabolic characteristics while transcription remained like that of the original PDX. These findings show that PDX are realistic models of ccRCC for imaging and metabolic studies but that the plasticity of metabolism must be considered when manipulating PDX for preclinical studies.
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Affiliation(s)
- Joao Piraquive Agudelo
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA 94143, USA
| | - Deepti Upadhyay
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA 94143, USA
| | - Dalin Zhang
- Department of Urology, Stanford University, Stanford, CA 94305, USA
| | - Hongjuan Zhao
- Department of Urology, Stanford University, Stanford, CA 94305, USA
| | - Rosalie Nolley
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA 94143, USA
| | - Jinny Sun
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA 94143, USA
| | - Shubhangi Agarwal
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA 94143, USA
| | - Robert A. Bok
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA 94143, USA
| | - Daniel B. Vigneron
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA 94143, USA
| | - James D. Brooks
- Department of Urology, Stanford University, Stanford, CA 94305, USA
| | - John Kurhanewicz
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA 94143, USA
| | - Donna M. Peehl
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA 94143, USA
| | - Renuka Sriram
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA 94143, USA
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13
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van der Beek JN, Artunduaga M, Schenk JP, Eklund MJ, Smith EA, Lederman HM, Warwick AB, Littooij AS, Khanna G. Similarities and controversies in imaging of pediatric renal tumors: A SIOP-RTSG and COG collaboration. Pediatr Blood Cancer 2022; 70 Suppl 2:e30080. [PMID: 36349564 DOI: 10.1002/pbc.30080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 10/03/2022] [Accepted: 10/11/2022] [Indexed: 11/11/2022]
Abstract
Malignant renal tumors are rare in children, and Wilms tumors (WTs) are the most common subtype. Imaging plays an essential role in the diagnosis, staging, and follow-up of these patients. Initial workup for staging is mainly performed by cross-sectional imaging modalities such as computed tomography (CT) and magnetic resonance imaging (MRI). Imaging approach within the two core international groups, the Children's Oncology Group (COG, North America) and the International Society of Pediatric Oncology - Renal Tumor Study Group (SIOP-RTSG, Europe), differs. Whereas abdominal ultrasound (US) is used for the initial diagnosis of a suspected pediatric renal tumor globally, COG protocols support the use of CT or MRI for locoregional staging, contrary to the preference for MRI over CT for abdominopelvic evaluation within the SIOP-RTSG. The purpose of this manuscript is to summarize current imaging approaches, highlighting differences and similarities within these core international groups, while focusing on future innovative efforts and collaboration within the HARMONICA initiative.
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Affiliation(s)
- Justine N van der Beek
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht/Wilhelmina Children's Hospital, Utrecht University, Utrecht, The Netherlands.,Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Maddy Artunduaga
- Pediatric Radiology Division, Department of Radiology, University of Texas Southwestern Medical Center, Children's Health Medical Center, Dallas, Texas, USA
| | - Jens-Peter Schenk
- Clinic of Diagnostic and Interventional Radiology, Division of Pediatric Radiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Meryle J Eklund
- Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Ethan A Smith
- Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA.,Department of Radiology, Cincinnati Children's Hospital, Cincinnati, Ohio, USA
| | - Henrique M Lederman
- Department of Diagnostic Imaging, Escola Paulista de Medicina, UNIFESP, São Paulo, Brazil
| | - Anne B Warwick
- Department of Pediatrics, F. Edward Hébert School of Medicine, Uniformed Services University, Bethesda, Maryland, USA
| | - Annemieke S Littooij
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht/Wilhelmina Children's Hospital, Utrecht University, Utrecht, The Netherlands.,Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Geetika Khanna
- Department of Radiology & Imaging Sciences, Emory University, Children's Healthcare of Atlanta, Atlanta, Georgia, USA
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14
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Oh H, Park SB, Lee TJ, Chi BH, Park HJ, Lee ES. Renomedullary Interstitial Cell Tumor Mimicking Renal Cell Carcinoma: A Case Report. JOURNAL OF THE KOREAN SOCIETY OF RADIOLOGY 2022; 83:1412-1417. [PMID: 36545409 PMCID: PMC9748446 DOI: 10.3348/jksr.2022.0042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 06/04/2022] [Accepted: 07/08/2022] [Indexed: 11/18/2022]
Abstract
Renomedullary interstitial cell tumors are often incidentally identified either upon autopsy or kidney resection for other reasons. However, rare renomedullary interstitial cell tumor cases resulting in a clinical symptomatic mass have been reported. We present a case of renomedullary interstitial cell tumor that was manifested as an incidentally detected renal mass and mimicked renal cell carcinoma on the imaging features.
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15
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de Silva S, Lockhart KR, Aslan P, Nash P, Hutton A, Malouf D, Lee D, Cozzi P, MacLean F, Thompson J. Differentiation of renal masses with multi-parametric MRI: the de Silva St George classification scheme. BMC Urol 2022; 22:141. [PMID: 36057604 PMCID: PMC9441035 DOI: 10.1186/s12894-022-01082-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Accepted: 06/06/2022] [Indexed: 11/13/2022] Open
Abstract
Purpose To develop a system for multi-parametric MRI to differentiate benign from malignant solid renal masses and assess its accuracy compared to the gold standard of histopathological diagnosis. Methods This is a retrospective analysis of patients who underwent 3 Tesla mpMRI for further assessment of small renal tumours with specific scanning and reporting protocol incorporating T2 HASTE signal intensity, contrast enhancement ratios, apparent diffusion coefficient and presence of microscopic/macroscopic fat. All MRIs were reported prior to comparison with histopathologic diagnosis and a reporting scheme was developed. 2 × 2 contingency table analysis (sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV)), Fisher Exact test were used to assess the association between suspicion of malignancy on mpMRI and histopathology, and descriptive statistics were performed. Results 67 patients were included over a 5-year period with a total of 75 renal masses. 70 masses were confirmed on histopathology (five had pathognomonic findings for angiomyolipomas; biopsy was therefore considered unethical, so these were included without histopathology). Three patients were excluded due to a non-diagnostic result, non-standardised imaging and one found to be an organising haematoma rather than a mass. Therefore 72 cases were included in analysis (in 64 patients, with seven patients having multiple tumours). Unless otherwise specified, all further statistics refer to individual tumours rather than patients. 52 (72.2%) were deemed ‘suspicious or malignant’ and 20 (27.8%) were deemed ‘benign’ on mpMRI. 51 cases (70.8%) had renal cell carcinoma confirmed. The sensitivity, NPV, specificity and PPV for MRI for detecting malignancy were 96.1%, 90%, 85.7% and 94.2% respectively, Fisher’s exact test demonstrated p < 0.0001 for the association between suspicion of malignancy on MRI and histopathology. Conclusion The de Silva St George classification scheme performed well in differentiating benign from malignant solid renal masses, and may be useful in predicting the likelihood of malignancy to determine the need for biopsy/excision. Further validation is required before this reporting system can be recommended for clinical use. Supplementary Information The online version contains supplementary material available at 10.1186/s12894-022-01082-9.
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Affiliation(s)
- Suresh de Silva
- Faculty of Medicine, University of NSW, Kensington, NSW, Australia. .,Department of Radiology, I-MED Radiology Network, Ground Floor, 527-533 Kingsway, Miranda, 2228, Australia.
| | | | - Peter Aslan
- Department of Urology, St George Hospital, Kogarah, NSW, Australia
| | - Peter Nash
- Department of Urology, St George Hospital, Kogarah, NSW, Australia
| | - Anthony Hutton
- Faculty of Medicine, University of NSW, Kensington, NSW, Australia.,Department of Urology, St George Hospital, Kogarah, NSW, Australia
| | - David Malouf
- Department of Urology, St George Hospital, Kogarah, NSW, Australia
| | - Dominic Lee
- Department of Urology, St George Hospital, Kogarah, NSW, Australia
| | - Paul Cozzi
- Department of Urology, Hurstville Private Hospital, Hurstville, NSW, Australia
| | - Fiona MacLean
- Department of Anatomical Pathology, Sonic Healthcare, Ryde, NSW, Australia
| | - James Thompson
- Faculty of Medicine, University of NSW, Kensington, NSW, Australia.,Department of Urology, St George Hospital, Kogarah, NSW, Australia
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16
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Greene CJ, Attwood K, Sharma NJ, Balderman B, Deng R, Muhitch JB, Smith GJ, Gross KW, Xu B, Kauffman EC. Iron accumulation typifies renal cell carcinoma tumorigenesis but abates with pathological progression, sarcomatoid dedifferentiation, and metastasis. Front Oncol 2022; 12:923043. [PMID: 35992801 PMCID: PMC9389085 DOI: 10.3389/fonc.2022.923043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Accepted: 06/29/2022] [Indexed: 11/13/2022] Open
Abstract
Iron is a potent catalyst of oxidative stress and cellular proliferation implicated in renal cell carcinoma (RCC) tumorigenesis, yet it also drives ferroptosis that suppresses cancer progression and represents a novel therapeutic target for advanced RCC. The von Hippel Lindau (VHL)/hypoxia-inducible factor-α (HIF-α) axis is a major regulator of cellular iron, and its inactivation underlying most clear cell (cc) RCC tumors introduces both iron dependency and ferroptosis susceptibility. Despite the central role for iron in VHL/HIF-α signaling and ferroptosis, RCC iron levels and their dynamics during RCC initiation/progression are poorly defined. Here, we conducted a large-scale investigation into the incidence and prognostic significance of total tissue iron in ccRCC and non-ccRCC patient primary tumor cancer cells, tumor microenvironment (TME), metastases and non-neoplastic kidneys. Prussian Blue staining was performed to detect non-heme iron accumulation in over 1600 needle-core sections across multiple tissue microarrays. We found that RCC had significantly higher iron staining scores compared with other solid cancers and, on average, >40 times higher than adjacent renal epithelium. RCC cell iron levels correlated positively with TME iron levels and inversely with RCC levels of the main iron uptake protein, transferrin receptor 1 (TfR1/TFRC/CD71). Intriguingly, RCC iron levels, including in the TME, decreased significantly with pathologic (size/stage/grade) progression, sarcomatoid dedifferentiation, and metastasis, particularly among patients with ccRCC, despite increasing TfR1 levels, consistent with an increasingly iron-deficient tumor state. Opposite to tumor iron changes, adjacent renal epithelial iron increased significantly with RCC/ccRCC progression, sarcomatoid dedifferentiation, and metastasis. Lower tumor iron and higher renal epithelial iron each predicted significantly shorter ccRCC patient metastasis-free survival. In conclusion, iron accumulation typifies RCC tumors but declines toward a relative iron-deficient tumor state during progression to metastasis, despite precisely opposite dynamics in adjacent renal epithelium. These findings raise questions regarding the historically presumed selective advantage for high iron during all phases of cancer evolution, suggesting instead distinct tissue-specific roles during RCC carcinogenesis and early tumorigenesis versus later progression. Future study is warranted to determine how the relative iron deficiency of advanced RCC contributes to ferroptosis resistance and/or introduces a heightened susceptibility to iron deprivation that might be therapeutically exploitable.
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Affiliation(s)
- Christopher J. Greene
- Department of Urology, Roswell Park Comprehensive Cancer Center, Buffalo, NY, United States
- Department of Biological Sciences, University at Buffalo, Buffalo, NY, United States
| | - Kristopher Attwood
- Department of Biostatistics and Bioinformatics, Roswell Park Comprehensive Cancer Center, Buffalo, NY, United States
| | - Nitika J. Sharma
- Department of Urology, Roswell Park Comprehensive Cancer Center, Buffalo, NY, United States
| | - Benjamin Balderman
- Department of Urology, Roswell Park Comprehensive Cancer Center, Buffalo, NY, United States
| | - Rongia Deng
- Department of Urology, Roswell Park Comprehensive Cancer Center, Buffalo, NY, United States
| | - Jason B. Muhitch
- Department of Immunology, Roswell Park Comprehensive Cancer Center, Buffalo, NY, United States
| | - Gary J. Smith
- Department of Urology, Roswell Park Comprehensive Cancer Center, Buffalo, NY, United States
| | - Kenneth W. Gross
- Department of Molecular and Cellular Biology, Roswell Park Comprehensive Cancer Center, Buffalo, NY, United States
| | - Bo Xu
- Department of Pathology, Roswell Park Comprehensive Cancer Center, Buffalo, NY, United States
| | - Eric C. Kauffman
- Department of Urology, Roswell Park Comprehensive Cancer Center, Buffalo, NY, United States
- Department of Cancer Genetics, Roswell Park Comprehensive Cancer Center, Buffalo, NY, United States
- *Correspondence: Eric C. Kauffman,
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17
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Acquired cystic disease subtype renal cell carcinoma (ACD-RCC): prevalence and imaging features at a single institution. ABDOMINAL RADIOLOGY (NEW YORK) 2022; 47:2858-2866. [PMID: 35674787 DOI: 10.1007/s00261-022-03566-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Revised: 05/18/2022] [Accepted: 05/19/2022] [Indexed: 01/18/2023]
Abstract
PURPOSE Acquired cystic kidney disease (ACKD) is commonly seen in patients with end-stage renal disease (ESRD), and patients with ACKD have an increased risk of renal cell carcinoma (RCC). Acquired cystic disease-associated RCC (ACD-RCC) was incorporated into the 2016 World Health Organization Classification. This study aims to describe the imaging features of ACD-RCC, which are not well reported previously. METHODS Retrospective review of patients with ACKD who underwent total nephrectomy for concern of a renal mass between 2016 and 2021 yielded 122 nephrectomies in 107 patients. Pathology reports were searched for type and subtype of mass. In ACD-RCC subtypes, imaging studies were evaluated for modality and contrast enhancement (CE). Imaging findings assessed included cystic/solid nature, unenhanced CT (NECT) attenuation, enhancement characteristics [non-enhancing (< 10 HU difference), equivocal (10-20 HU), enhancing (> 20 HU)], subjective MRI enhancement, T1 and T2 signal intensity, restricted diffusion, ultrasound (US) echogenicity, and subjective CEUS enhancement. RESULTS 148 masses were identified, 122 (82%) of which were malignant and 26 (18%) benign. The three most common tumors were clear cell RCC (n = 47), papillary RCC (n = 35), and ACD-RCC (n = 21). Of the 21 cases of ACD-RCC, 16 had preoperative imaging: CT (15: 6 NECT only, 2 CECT only, 7 combined NECT and CECT), MRI (4), CEUS (5). Ten of these tumors were solid/mostly solid and 6 mixed cystic/solid. On NECT, the average attenuation was 35 HU (range 13-52). Of those with multiphasic CTs, 1 was non-enhancing, 3 were equivocal, and 3 enhanced. All 3 masses imaged with CE-MRI showed enhancement. All 4 tumors evaluated by MRI demonstrated T2 hypointensity and restricted diffusion. All five masses enhanced on CEUS. CONCLUSION ACD-RCC subtype was the third most common renal neoplasm in ACKD patients. Our findings found that no single imaging feature is pathognomonic for ACD-RCC. However, ACD-RCCs are typically solid masses with most demonstrating equivocal or mild enhancement on CT. T2 hypointensity and restricted diffusion were the most common MRI features.
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18
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Agarwal S, Decavel-Bueff E, Wang YH, Qin H, Santos RD, Evans MJ, Sriram R. Defining the Magnetic Resonance Features of Renal Lesions and Their Response to Everolimus in a Transgenic Mouse Model of Tuberous Sclerosis Complex. Front Oncol 2022; 12:851192. [PMID: 35814396 PMCID: PMC9260108 DOI: 10.3389/fonc.2022.851192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Accepted: 05/24/2022] [Indexed: 11/13/2022] Open
Abstract
Tuberous sclerosis complex (TSC) is an inherited genetic disorder characterized by mutations in TSC1 or TSC2 class of tumor suppressers which impact several organs including the kidney. The renal manifestations are usually in the form of angiomyolipoma (AML, in 80% of the cases) and cystadenomas. mTOR inhibitors such as rapamycin and everolimus have shown efficacy in reducing the renal tumor burden. Early treatment prevents the progression of AML; however, the tumors regrow upon cessation of therapy implying a lifelong need for monitoring and management of this morbid disease. There is a critical need for development of imaging strategies to monitor response to therapy and progression of disease which will also facilitate development of newer targeted therapy. In this study we evaluated the potential of multiparametric 1H magnetic resonance imaging (mpMRI) to monitor tumor response to therapy in a preclinical model of TSC, the transgenic mouse A/J Tsc2+/-. We found 2-dimensional T2-weighted sequence with 0.5 mm slice thickness to be optimal for detecting renal lesions as small as 0.016 mm3. Baseline characterization of lesions with MRI to assess physiological parameters such as cellularity and perfusion is critical for distinguishing between cystic and solid lesions. Everolimus treatment for three weeks maintained tumor growth at 36% from baseline, while control tumors displayed steady growth and were 70% larger than baseline at the end of therapy. Apparent diffusion coefficient, T1 values and normalized T2 intensity changes were also indictive of response to treatment. Our results indicate that standardization and implementation of improved MR imaging protocols will significantly enhance the utility of mpMRI in determining the severity and composition of renal lesions for better treatment planning.
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Affiliation(s)
- Shubhangi Agarwal
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA, United States
| | - Emilie Decavel-Bueff
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA, United States
| | - Yung-Hua Wang
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA, United States
| | - Hecong Qin
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA, United States
| | - Romelyn Delos Santos
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA, United States
| | - Michael J. Evans
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA, United States
- Department of Pharmaceutical Chemistry, University of California, San Francisco, San Francisco, CA, United States
- Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, San Francisco, CA, United States
| | - Renuka Sriram
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA, United States
- *Correspondence: Renuka Sriram,
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Trevisani F, Floris M, Minnei R, Cinque A. Renal Oncocytoma: The Diagnostic Challenge to Unmask the Double of Renal Cancer. Int J Mol Sci 2022; 23:ijms23052603. [PMID: 35269747 PMCID: PMC8910282 DOI: 10.3390/ijms23052603] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 02/23/2022] [Accepted: 02/24/2022] [Indexed: 11/16/2022] Open
Abstract
Renal oncocytoma represents the most common type of benign neoplasm that is an increasing concern for urologists, oncologists, and nephrologists due to its difficult differential diagnosis and frequent overtreatment. It displays a variable neoplastic parenchymal and stromal architecture, and the defining cellular element is a large polygonal, granular, eosinophilic, mitochondria-rich cell known as an oncocyte. The real challenge in the oncocytoma treatment algorithm is related to the misdiagnosis due to its resemblance, at an initial radiological assessment, to malignant renal cancers with a completely different prognosis and medical treatment. Unfortunately, percutaneous renal biopsy is not frequently performed due to the possible side effects related to the procedure. Therefore, the majority of oncocytoma are diagnosed after the surgical operation via partial or radical nephrectomy. For this reason, new reliable strategies to solve this issue are needed. In our review, we will discuss the clinical implications of renal oncocytoma in daily clinical practice with a particular focus on the medical diagnosis and treatment and on the potential of novel promising molecular biomarkers such as circulating microRNAs to distinguish between a benign and a malignant lesion.
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Affiliation(s)
- Francesco Trevisani
- Urological Research Institute, San Raffaele Scientific Institute, 20132 Milan, Italy;
- Unit of Urology, San Raffaele Scientific Institute, 20132 Milan, Italy
- Biorek S.r.l., San Raffaele Scientific Institute, 20132 Milan, Italy
| | - Matteo Floris
- Nephrology, Dialysis and Transplantation, G. Brotzu Hospital, Università degli Studi di Cagliari, 09134 Cagliari, Italy; (M.F.); (R.M.)
| | - Roberto Minnei
- Nephrology, Dialysis and Transplantation, G. Brotzu Hospital, Università degli Studi di Cagliari, 09134 Cagliari, Italy; (M.F.); (R.M.)
| | - Alessandra Cinque
- Biorek S.r.l., San Raffaele Scientific Institute, 20132 Milan, Italy
- Correspondence:
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20
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Liu MC, Liu YJ, Lin YT, Hung SW, Chai JW, Chan SW, Chiu KY, Chang CH, Tsou YL. Common Subtype of Small Renal Mass MR Imaging Characterisation: A Medical Center Experience in Taiwan. J Med Biol Eng 2022. [DOI: 10.1007/s40846-022-00684-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Abstract
Purpose
Many studies have shown that multiparametric magnetic resonance imaging (MRI) may be helpful for differentiating malignant renal cell carcinomas (RCCs) from benign lesions. However, the key imaging characteristics that differ between malignant and benign tumors still require further discussion.
Methods
We analyzed 60 adult patients diagnosed with 72 small renal masses (SRMs) who received preoperative MRI from 2014 to 2019 at a hospital in Taiwan. The MRI features included conventional MRI parameters, diffusion-weighted imaging (DWI) data, and dynamic contrast-enhanced (DCE) patterns, which were documented and compared among the four common subtypes: clear cell RCC (ccRCC), papillary RCC (pRCC), angiomyolipoma (AML) and other types of RCC. The apparent diffusion coefficient (ADC) values of high- and low-grade RCCs were also analyzed.
Results
The results show that ccRCC had higher T2-weighted signal intensity than the other three subgroups, a higher arterial wash-in index (AWI) and ADC value than AML and pRCC, and manifested a plateau (n = 9, 25%) or washout (n = 27, 75%) enhancement pattern. AMLs exhibited more intravoxel fat than the other three subtype groups, and half of the AMLs (6 in 12) contained bulk fat. pRCC demonstrated a more progressive (n = 3, 60%) enhancement pattern than the other three subgroups. The ADC value of high-grade RCCs was significantly lower than that of low-grade RCCs.
Conclusion
These findings may indicate that multiparametric MRI is useful in differentiating among four common pathological types of SRMs, and the ADC value may be helpful in evaluating the histological grade of malignancy.
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21
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YANG Z, LI M, GUO A, LIANG Y, FANG P. Imaging features and clinic value of mri and ct in diagnosis of clear cell renal cell carcinoma. FOOD SCIENCE AND TECHNOLOGY 2022. [DOI: 10.1590/fst.40520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
| | - Ming LI
- Henan Province Hospital of TCM, China
| | - Aiju GUO
- Henan Province Hospital of TCM, China
| | | | - Peng FANG
- Henan Province Hospital of TCM, China
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22
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Comparison of cortico-medullary phase contrast-enhanced MDCT and T2-weighted MR imaging in the histological subtype differentiation of renal cell carcinoma: radiology-pathology correlation. Pol J Radiol 2021; 86:e583-e593. [PMID: 34876939 PMCID: PMC8634423 DOI: 10.5114/pjr.2021.111013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 12/22/2020] [Indexed: 11/17/2022] Open
Abstract
Purpose Renal cell carcinoma (RCC) subtype differentiation is of crucial importance in the management and prognosis of these patients. In this study, we investigated the usefulness of unenhanced and cortico-medullary phase contrast-enhanced multidetector-row computed tomography (MDCT) and T2-weighted fast spin-echo (FSE) magnetic resonance imaging (MRI) modalities in the discrimination of the 3 main subtype RCC patients in correlation with their histopathological findings. Material and methods A total of 80 pathologically proven RCC patients who had undergone either partial or total nephrectomy were retrospectively investigated in this study. Their histological subtypes were 54 clear cell renal cell carcinoma (ccRCC), 15 papillary renal cell carcinoma (pRCC), and 11 chromophobe renal cell carcinoma (cRCC), based on pathological evaluation. There were 62 male (77.5%) and 18 female (22.5%) patients. Among the 54 ccRCC patients, 29 patients had both non-contrast and cortico-medullary phase CT, 1 had only non-contrast CT, 5 only had cortico-medullary phase CT, and 38 had MRI examination. In the pRCC group, 10 patients had both non-contrast and cortico-medullary phase CT, 1 had only non-contrast CT, 1 had only cortico-medullary phase CT, and 12 had MRI. Finally, in the remaining 11 cRCC patients, 9 had both non-contrast and cortico-medullary phase CT, and only 5 had MRI. We calculated both tumour attenuation values as HU (Hounsfield units) on unenhanced and cortico-medullary phase MDCT images and also tumour mean signal intensity values on FSE T2-weighted MRI images by using the region of interest (ROI) including normal renal cortex measurements. Besides quantitative evaluation, we also performed qualitative visual assessment of tumours on contrast-enhanced MDCT and FSE T2-weighted MRI. Results There was no statistically significant difference among the attenuation values of the 3 tumour subtypes on pre-contrast CT images. ccRCC demonstrated a prominent degree of contrast enhancement compared to the chromophobe and papillary ones on cortico-medullary phase MDCT. We found no statistically significant difference between chromophobe and papillary subtypes, although chromophobe tumours showed slightly higher attenuation values compared to papillary ones. ccRCCs usually demonstrated a heterogenous contrast enhancement on cortico-medullary phase CT images, while the papillary subtype usually had a homogenous appearance on visual assessment. On FSE T2-weighted MR images, the signal intensity values of ccRCC patients were found to be significantly higher than both chromophobe and papillary subtypes. Although cRCC patients had a prominently lower T2 signal intensity than clear cell subtype, there was no statistically significant signal intensity difference between chromophobe and papillary subtypes. Regarding visual assessment, papillary subtype tumours showed a mostly homogenous appearance on T2-weighted images and a statistically significant difference was present. On the other hand, there was no significant difference of visual assessment of the clear cell and chromophobe subtypes. Conclusions The measurement of the attenuation values on cortico-medullary phase MDCT and the mean signal intensity values on FSE T2-weighted MRI can provide useful information in the differentiation of RCC main subtypes. Also, visual assessment of tumours on both modalities can contribute to this issue by providing additional imaging properties.
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23
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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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24
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Arita Y, Yoshida S, Kwee TC, Akita H, Okuda S, Iwaita Y, Mukai K, Matsumoto S, Ueda R, Ishii R, Mizuno R, Fujii Y, Oya M, Jinzaki M. Diagnostic value of texture analysis of apparent diffusion coefficient maps for differentiating fat-poor angiomyolipoma from non-clear-cell renal cell carcinoma. Eur J Radiol 2021; 143:109895. [PMID: 34388418 DOI: 10.1016/j.ejrad.2021.109895] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Revised: 07/15/2021] [Accepted: 08/02/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE To investigate the feasibility of texture analysis of apparent diffusion coefficient (ADC) maps for differentiating fat-poor angiomyolipomas (fpAMLs) from non-clear-cell renal cell carcinomas (non-ccRCCs). METHODS In this bi-institutional study, we included two consecutive cohorts from different institutions with pathologically confirmed solid renal masses: 67 patients (fpAML = 46; non-ccRCC = 21) for model development and 39 (fpAML = 24; non-ccRCC = 15) for validation. Patients underwent preoperative magnetic resonance imaging (MRI), including diffusion-weighted imaging. We extracted 45 texture features using a software with volumes of interest on ADC maps. Receiver operating characteristic curve analysis was performed to compare the diagnostic performance between the random forest (RF) model (derived from extracted texture features) and conventional subjective evaluation using computed tomography and MRI by radiologists. RESULTS RF analysis revealed that grey-level zone length matrix long-zone high grey-level emphasis was the dominant texture feature for diagnosing fpAML. The area under the curve (AUC) of the RF model to distinguish fpAMLs from non-ccRCCs was not significantly different between the validation and development cohorts (p = .19). In the validation cohort, the AUC of the RF model was similar to that of board-certified radiologists (p = .46) and significantly higher than that of radiology residents (p = .03). CONCLUSIONS Texture analysis of ADC maps demonstrated similar diagnostic performance to that of board-certified radiologists for discriminating between fpAMLs and non-ccRCCs. Diagnostic performances in the development and validation cohorts were comparable despite using data from different imaging device manufacturers and institutions.
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Affiliation(s)
- Yuki Arita
- Department of Radiology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan.
| | - Soichiro Yoshida
- Department of Urology, Tokyo Medical and Dental University Graduate School, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8519, Japan.
| | - Thomas C Kwee
- Department of Radiology, Nuclear Medicine, and Molecular Imaging, University Medical Center Groningen, Hanzeplein 1, PO Box 30.001, 9700 RB Groningen, the Netherlands
| | - Hirotaka Akita
- Department of Radiology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan.
| | - Shigeo Okuda
- Department of Radiology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan.
| | - Yuki Iwaita
- Department of Radiology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan.
| | - Kiyoko Mukai
- Department of Radiology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan.
| | - Shunya Matsumoto
- Department of Urology, Tokyo Medical and Dental University Graduate School, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8519, Japan
| | - Ryo Ueda
- Office of Radiation Technology, Keio University Hospital, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan
| | - Ryota Ishii
- Biostatistics Unit, Clinical and Translational Research Center, Keio University Hospital, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan.
| | - Ryuichi Mizuno
- Department of Urology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan.
| | - Yasuhisa Fujii
- Department of Urology, Tokyo Medical and Dental University Graduate School, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8519, Japan.
| | - Mototsugu Oya
- Department of Urology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan.
| | - Masahiro Jinzaki
- Department of Radiology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan.
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25
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Abrishami A, Ziaeefar P, Ebrahimi S, Khalili N, Nouralizadeh A, Farjad R. Rosai-Dorfman disease: A case report of asymptomatic isolated renal involvement. Clin Case Rep 2021; 9:e04132. [PMID: 34267895 PMCID: PMC8271259 DOI: 10.1002/ccr3.4132] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 03/21/2021] [Accepted: 03/22/2021] [Indexed: 11/13/2022] Open
Abstract
A possible diagnosis of RDD should be kept in mind when encountering a patient with raised plasma creatinine levels and renal mass. Timely diagnosis and management of RDD will help prevent future kidney loss.
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Affiliation(s)
- Alireza Abrishami
- Department of RadiologyShahid Labbafinejad hospitalShahid Beheshti University of Medical SciencesTehranIran
| | - Pardis Ziaeefar
- School of MedicineShahid Beheshti University of Medical SciencesTehranIran
| | - Sara Ebrahimi
- School of MedicineShahid Beheshti University of Medical SciencesTehranIran
| | - Nastaran Khalili
- Cancer Immunology Project (CIP)Universal Scientific Education and Research Network (USERN)TehranIran
- School of MedicineTehran University of Medical SciencesTehranIran
| | - Akbar Nouralizadeh
- Urology and Nephrology Research CenterShahid Labbafinejad hospitalShahid Beheshti University of Medical SciencesTehranIran
| | - Reza Farjad
- Department of RadiologyShahid Labbafinejad hospitalShahid Beheshti University of Medical SciencesTehranIran
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26
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Hines JJ, Eacobacci K, Goyal R. The Incidental Renal Mass- Update on Characterization and Management. Radiol Clin North Am 2021; 59:631-646. [PMID: 34053610 DOI: 10.1016/j.rcl.2021.03.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Renal masses are commonly encountered on cross-sectional imaging examinations performed for nonrenal indications. Although most can be dismissed as benign cysts, a subset will be either indeterminate or suspicious; in many cases, imaging cannot be used to reliably differentiate between benign and malignant masses. On-going research in defining characteristics of common renal masses on advanced imaging shows promise in offering solutions to this issue. A recent update of the Bosniak classification (used to categorize cystic renal masses) was proposed with the goals of decreasing imaging follow-up in likely benign cystic masses, and therefore avoiding unnecessary surgical resection of such masses.
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Affiliation(s)
- John J Hines
- Department of Radiology, Huntington Hospital, Northwell Health, 270 Park Avenue, Huntington, NY 11743, USA.
| | - Katherine Eacobacci
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, 500 Hofstra Boulevard, Hempstead, NY 11549, USA
| | - Riya Goyal
- Department of Radiology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, 500 Hofstra Boulevard, Hempstead, NY 11549, USA
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27
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Edney E, Davenport MS, Curci N, Schieda N, Krishna S, Hindman N, Silverman SG, Pedrosa I. Bosniak classification of cystic renal masses, version 2019: interpretation pitfalls and recommendations to avoid misclassification. Abdom Radiol (NY) 2021; 46:2699-2711. [PMID: 33484283 DOI: 10.1007/s00261-020-02906-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 12/01/2020] [Accepted: 12/06/2020] [Indexed: 12/22/2022]
Abstract
The purpose of this review is to describe the potential sources of variability or discrepancy in interpretation of cystic renal masses under the Bosniak v2019 classification system. Strategies to avoid these pitfalls and clinical examples of diagnostic approaches are also presented. Potential pitfalls in the application of Bosniak v2019 are divided into three categories: interpretative, technical, and mass related. An organized, comprehensive review of possible discrepancies in interpreting Bosniak v2019 cystic masses is presented with pictorial examples of difficult clinical cases and proposed solutions. The scheme provided can guide readers to consistent, precise application of the classification system. Radiologists should be aware of the possible sources of misinterpretation of cystic renal masses when applying Bosniak v2019. Knowing which features and types of cystic masses are prone to interpretive errors, in addition to the inherent trade-offs between the CT and MR techniques used to characterize them, can help radiologists avoid these pitfalls.
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Affiliation(s)
- Elizabeth Edney
- Department of Radiology, University of Nebraska Medical Center, Omaha, NE, USA.
| | - Matthew S Davenport
- Departments of Radiology and Urology, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Nicole Curci
- Department of Radiology, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Nicola Schieda
- Department of Medical Imaging, The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada
| | - Satheesh Krishna
- Joint Department of Medical Imaging, University Health Network, Mount Sinai Hospital and Women's College Hospital, University of Toronto, Toronto, ON, Canada
| | - Nicole Hindman
- Department of Radiology, New York University Langone Medical Center, New York, USA
| | - Stuart G Silverman
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Ivan Pedrosa
- Department of Radiology, University of Texas Southwestern Medical Center, Dallas, TX, USA
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28
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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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29
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Dhulaimi MA, Aldarmasi MA. RENAL, PELVIC AND MESENTERIC TUMORS WITH LOW SIGNAL INTENSITY ON T2-WEIGHTED MR IMAGE: A REVIEW. SANAMED 2020. [DOI: 10.24125/sanamed.v15i3.460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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30
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Xu HS, Balcacer P, Zhang Z, Zhang L, Yee EU, Sun MR, Tsai LL. Characterizing T2 iso- and hypo-intense renal masses on MRI: Can templated algorithms improve accuracy? Clin Imaging 2020; 72:47-54. [PMID: 33217669 DOI: 10.1016/j.clinimag.2020.10.051] [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] [Received: 08/26/2020] [Revised: 10/03/2020] [Accepted: 10/29/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE To assess if a templated algorithm can improve the diagnostic performance of MRI for characterization of T2 isointense and hypointense renal masses. METHODS In this retrospective study, 60 renal masses with histopathologic diagnoses that were also confirmed as T2 iso- or hypointense on MRI were identified (mean ± standard deviation, range: 3.9 ± 2.5, 1.0-13.7 cm). Two semi-quantitative diagnostic algorithms were created based on MRI features of renal masses reported in the literature. Three body-MRI trained radiologists provided clinical diagnoses based on their experience and separately provided semiquantitative data for each components of the two algorithms. The algorithms were applied separately by a radiology trainee without additional interpretive input. Logistic regression was used to compare the accuracy of the three methods in distinguishing malignant versus benign lesions and in diagnosing the exact histopathology. Inter-reader agreement for each method was calculated using Fleiss' kappa statistics. RESULTS The accuracy of the two algorithms and clinical experience were similar (70%, 69%, and 64%, respectively, p = 0.22-0.32), with fair to moderate inter-reader agreement (Fleiss's kappa: r = 0.375, r = 0.308, r = 0.375, respectively, all p < 0.0001). The accuracy of the two algorithms and clinical experience in diagnosing specific histopathology were also no different from each other (34%, 29%, and 32%, respectively, p = 0.49-0.74), with fair to moderate inter-reader agreement (Fleiss's kappa: r = 0.20, r = 0.28, r = 0.375, respectively, all p < 0.0001). CONCLUSION Semi-quantitative templated algorithms based on MRI features of renal masses did not improve the ability to diagnose T2 iso- and hypointense renal masses when compared to unassisted interpretation by body MR trained subspecialists.
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Affiliation(s)
- Helen S Xu
- Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA 02215, United States of America; New York Presbyterian Weill Cornell Medical Center, 525 East 68th Street, New York, NY 10065, United States of America.
| | - Patricia Balcacer
- Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA 02215, United States of America
| | - Zheng Zhang
- Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA 02215, United States of America
| | - Liang Zhang
- Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA 02215, United States of America
| | - Eric U Yee
- University of Arkansas for Medical Sciences, 4301 W. Markham St., #517, Little Rock, AR 72205, United States of America
| | - Maryellen R Sun
- Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA 02215, United States of America
| | - Leo L Tsai
- Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA 02215, United States of America
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31
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Wilson MP, Patel D, Murad MH, McInnes MDF, Katlariwala P, Low G. Diagnostic Performance of MRI in the Detection of Renal Lipid-Poor Angiomyolipomas: A Systematic Review and Meta-Analysis. Radiology 2020; 296:511-520. [DOI: 10.1148/radiol.2020192070] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Mitchell P. Wilson
- From the Department of Radiology and Diagnostic Imaging, University of Alberta, 2B2.41 WMC, 8440-112 St NW, Edmonton, AB, Canada T6G 2B7 (M.P.W., D.P., P.K., G.L.); Evidence-based Practice Center, Mayo Clinic, Rochester, Minn (M.H.M.); and Departments of Radiology and Epidemiology, University of Ottawa/The Ottawa Hospital Research Institute, Ottawa, Canada (M.D.F.M.)
| | - Deelan Patel
- From the Department of Radiology and Diagnostic Imaging, University of Alberta, 2B2.41 WMC, 8440-112 St NW, Edmonton, AB, Canada T6G 2B7 (M.P.W., D.P., P.K., G.L.); Evidence-based Practice Center, Mayo Clinic, Rochester, Minn (M.H.M.); and Departments of Radiology and Epidemiology, University of Ottawa/The Ottawa Hospital Research Institute, Ottawa, Canada (M.D.F.M.)
| | - Mohammad H. Murad
- From the Department of Radiology and Diagnostic Imaging, University of Alberta, 2B2.41 WMC, 8440-112 St NW, Edmonton, AB, Canada T6G 2B7 (M.P.W., D.P., P.K., G.L.); Evidence-based Practice Center, Mayo Clinic, Rochester, Minn (M.H.M.); and Departments of Radiology and Epidemiology, University of Ottawa/The Ottawa Hospital Research Institute, Ottawa, Canada (M.D.F.M.)
| | - Matthew D. F. McInnes
- From the Department of Radiology and Diagnostic Imaging, University of Alberta, 2B2.41 WMC, 8440-112 St NW, Edmonton, AB, Canada T6G 2B7 (M.P.W., D.P., P.K., G.L.); Evidence-based Practice Center, Mayo Clinic, Rochester, Minn (M.H.M.); and Departments of Radiology and Epidemiology, University of Ottawa/The Ottawa Hospital Research Institute, Ottawa, Canada (M.D.F.M.)
| | - Prayash Katlariwala
- From the Department of Radiology and Diagnostic Imaging, University of Alberta, 2B2.41 WMC, 8440-112 St NW, Edmonton, AB, Canada T6G 2B7 (M.P.W., D.P., P.K., G.L.); Evidence-based Practice Center, Mayo Clinic, Rochester, Minn (M.H.M.); and Departments of Radiology and Epidemiology, University of Ottawa/The Ottawa Hospital Research Institute, Ottawa, Canada (M.D.F.M.)
| | - Gavin Low
- From the Department of Radiology and Diagnostic Imaging, University of Alberta, 2B2.41 WMC, 8440-112 St NW, Edmonton, AB, Canada T6G 2B7 (M.P.W., D.P., P.K., G.L.); Evidence-based Practice Center, Mayo Clinic, Rochester, Minn (M.H.M.); and Departments of Radiology and Epidemiology, University of Ottawa/The Ottawa Hospital Research Institute, Ottawa, Canada (M.D.F.M.)
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Lopes Vendrami C, McCarthy RJ, Villavicencio CP, Miller FH. Predicting common solid renal tumors using machine learning models of classification of radiologist-assessed magnetic resonance characteristics. Abdom Radiol (NY) 2020; 45:2797-2809. [PMID: 32666233 DOI: 10.1007/s00261-020-02637-w] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 06/23/2020] [Accepted: 07/04/2020] [Indexed: 02/06/2023]
Abstract
PURPOSE Solid renal masses (SRM) are difficult to differentiate based on standard MR features. The purpose of this study was to assess MR imaging features of SRM to evaluate performance of ensemble methods of classifying SRM subtypes. MATERIALS AND METHODS MR images of SRM (n = 330) were retrospectively evaluated for standard and multiparametric (mp) features. Models of MR features for predicting malignant and benign lesions as well as subtyping SRM were developed using a training dataset and performance was evaluated in a test data-set using recursive partitioning (RP), gradient booting machine (GBM), and random forest (RF) methods. RESULTS In the test dataset, GBM and RF models demonstrated an accuracy of 86% (95% CI 75% to 93%) for predicting benign versus malignant SRM compared to 83% (95% CI 71% to 91%) for the RP model. RF had the greatest accuracy in predicting SRM subtypes, 81.2% (95% CI 69.5% to 89.9%) compared with GBM 73.4% (95% CI 60.9% to 83.7%) or RP 70.3% (95% CI 57.6% to 81.1%). Marginal homogeneity was reduced by the RF model compared with the RP model (P < 0.001), but not the GBM model (P = 0.135). All models had high sensitivity and specificity for clear cell and papillary renal cell carcinomas (RCC), but performed less well in differentiating chromophobe RCC, oncocytomas, and fat-poor angiomyolipomas. CONCLUSION Ensemble methods for prediction of SRM from radiologist-assessed image characteristics have high accuracy for distinguishing benign and malignant lesions. SRM subtype classification is limited by the ability to categorize chromophobe RCCs, oncocytomas, and fat-poor angiomyolipomas.
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Affiliation(s)
- Camila Lopes Vendrami
- Department of Radiology, Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, 676 N. St. Clair St. Suite 800, Chicago, IL, 60611, USA
| | - Robert J McCarthy
- Department of Anesthesiology, Rush University, Chicago, IL, 60612, USA
| | - Carolina Parada Villavicencio
- Department of Radiology, Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, 676 N. St. Clair St. Suite 800, Chicago, IL, 60611, USA
| | - Frank H Miller
- Department of Radiology, Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, 676 N. St. Clair St. Suite 800, Chicago, IL, 60611, USA.
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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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de Silva S, Lockhart K, Aslan P, Nash P, Hutton A, Malouf D, Lee D, Cozzi P, Maclean F, Thompson J. Chemical shift imaging in the identification of those renal tumours that contain microscopic fat and the utility of multiparametric MRI in their differentiation. J Med Imaging Radiat Oncol 2020; 64:762-768. [PMID: 32743914 DOI: 10.1111/1754-9485.13082] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Accepted: 06/18/2020] [Indexed: 11/27/2022]
Abstract
INTRODUCTION The aim of this study was to assess the qualitative and MRI findings of renal tumours, to determine which lesions contain microscopic fat, one of the potential differentiating factors between tumour types. METHODS 73 patients who underwent 3 Tesla MRI including chemical shift imaging, with subsequent biopsy or excision for histopathological diagnosis, were included in the study. The images were reviewed for a decrease in signal intensity (SI) on the opposed phase compared with the in-phase gradient echo T1 images, indicating the presence of microscopic fat. The chemical shift index was then calculated as a percentage of SI change and compared with the pathological diagnosis. RESULTS In total, 38 (52%) of lesions demonstrated a decrease in SI, consistent with microscopic fat. Microscopic fat was found in 28 (80%) clear cell renal cell carcinomas (RCCs), 6 (66.7%) angiomyolipomas, 2 (20%) papillary RCCs, 1 (20%) chromophobe RCC and 1 (9.1%) oncocytoma. Pairwise comparison of means indicated that the amount of microscopic fat was significantly larger only for angiomyolipomas compared with clear cell RCCs (P < 0.001) and other renal lesions (P < 0.001). CONCLUSIONS A decrease in SI on opposed phase compared with in-phase chemical shift imaging favours the diagnosis of either clear cell RCC or an angiomyolipoma. When combined with other parameters in mpMRI, this may aid differentiation of benign from malignant tumours and differentiation of aggressive from indolent RCC subtypes. This may be of value where biopsy is non-diagnostic, not feasible due to location or in high-risk patients.
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Affiliation(s)
- Suresh de Silva
- Faculty of Medicine, University of NSW, Sydney, New South Wales, Australia.,Department of Radiology, I-MED Radiology Network, Sydney, New South Wales, Australia
| | - Kathleen Lockhart
- Department of Urology, St George Hospital, Sydney, New South Wales, Australia
| | - Peter Aslan
- Department of Urology, St George Hospital, Sydney, New South Wales, Australia
| | - Peter Nash
- Department of Urology, St George Hospital, Sydney, New South Wales, Australia
| | - Anthony Hutton
- Faculty of Medicine, University of NSW, Sydney, New South Wales, Australia.,Department of Urology, St George Hospital, Sydney, New South Wales, Australia
| | - David Malouf
- Department of Urology, St George Hospital, Sydney, New South Wales, Australia
| | - Dominic Lee
- Department of Urology, St George Hospital, Sydney, New South Wales, Australia
| | - Paul Cozzi
- Faculty of Medicine, University of Notre Dame, Sydney, New South Wales, Australia
| | - Fiona Maclean
- Department of Anatomical Pathology, Sonic Healthcare, Sydney, New South Wales, Australia
| | - James Thompson
- Faculty of Medicine, University of NSW, Sydney, New South Wales, Australia.,Department of Urology, St George Hospital, Sydney, New South Wales, Australia
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Lima FVA, Elias J, Chahud F, Reis RB, Muglia VF. Diagnostic accuracy of signal loss in in-phase gradient-echo images for differentiation between small renal cell carcinoma and lipid-poor angiomyolipomas. Br J Radiol 2020; 93:20190975. [PMID: 31971819 DOI: 10.1259/bjr.20190975] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES To assess the diagnostic accuracy of signal loss on in-phase (IP) gradient-echo (GRE) images for differentiation between renal cell carcinomas (RCCs) and lipid-poor angiomyolipomas (lpAMLs). METHODS We retrospectively searched our institutional database for histologically proven small RCCs (<5.0 cm) and AMLs without visible macroscopic fat (lpAMLs). Two experienced radiologists assessed MRIs qualitatively, to depict signal loss foci on IP GRE images. A third radiologist drew regions of interest (ROIs) on the same lesions, on IP and out-of-phase (OP) images to calculate the ratio of signal loss. Diagnostic accuracy parameters were calculated for both techniques and the inter-reader agreement for the qualitative analysis was evaluated using the κ test. RESULTS 15 (38.4%) RCCs lost their signal on IP images, with a sensitivity of 38.5% (95% CI = 23.4-55.4), a specificity of 100% (71.1-100), a positive predictive value (PPV) of 100% (73.4-100), a negative predictive value (NPV) of 31.4% (26.3-37.0), and an overall accuracy of 52% (37.4-66.3%). In terms of the quantitative analysis, the signal intensity index (SII= [(SIIP - SIOP) / SIOP] x 100) for RCCs was -0.132 ± 0.05, while for AMLs it was -0.031 ± 0.02, p = 0.26. The AUC was 0.414 ± -0.09 (0.237-0.592). Using 19% of signal loss as the threshold, sensitivity was 16% and specificity was 100%. The κappa value for subjective analysis was 0.63. CONCLUSION Signal loss in "IP" images, assessed subjectively, was highly specific for distinction between RCCs and lpAMLs, although with low sensitivity. The findings can be used to improve the preoperative diagnostic accuracy of MRI for renal masses. ADVANCES IN KNOWLEDGE Signal loss on "IP" GRE images is a reliable sign for differentiation between RCC and lpAMLs.
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Affiliation(s)
- Francisco V A Lima
- Radiologist, Post-graduation Scholar, Department of Imaging, Radiation Oncology and Oncohematology, Ribeirao Preto School of Medicine, University of Sao Paulo, Sao Paulo, Brazil
| | - Jorge Elias
- Department of Imaging, Radiation Oncology and Oncohematology, Ribeirao Preto School of Medicine, University of Sao Paulo, Sao Paulo, Brazil
| | - Fernando Chahud
- Department of Pathology, Ribeirao Preto School of Medicine, University of Sao Paulo, Sao Paulo, Brazil
| | - Rodolfo B Reis
- Department of Surgery and Anatomy, Urology Division, Ribeirao Preto School of Medicine, University of Sao Paulo, Sao Paulo, Brazil
| | - Valdair F Muglia
- Department of Imaging, Radiation Oncology and Oncohematology, Ribeirao Preto School of Medicine, University of Sao Paulo, Sao Paulo, Brazil
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Diagnostic Imaging in Renal Tumors. KIDNEY CANCER 2020. [DOI: 10.1007/978-3-030-28333-9_17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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37
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Wang X, Li R, Chen R, Huang G, Zhou X, Liu J. Prognostic Values of TIGAR Expression and 18F-FDG PET/CT in Clear Cell Renal Cell Carcinoma. J Cancer 2020; 11:1-8. [PMID: 31892967 PMCID: PMC6930409 DOI: 10.7150/jca.33442] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Accepted: 08/18/2019] [Indexed: 12/15/2022] Open
Abstract
Aim: Evaluation of 18F-FDG accumulation using PET/CT is an potential imaging biomarker to reflect tumor metabolic burdens and to help predict prognosis in renal cell carcinoma (RCC). p53-induced glycolysis and apoptosis regulator (TIGAR) is a protein regulates glycolytic activity and glucose metabolism. The deregulated TIGAR expression has been associated with tumorigenesis and poor disease prognosis in several cancers. The purpose of this study is to evaluate the impact of the TIGAR expression and the maximum standardized uptake value (SUVmax) of 18F-FDG PET/CT on survival for patients with clear cell RCC. Methods: A total of 62 patients with confirmed clear cell RCC were included in this retrospective study. The TIGAR expression of tumors were determined through immunohistochemistry staining. The SUVmax of clear cell RCC lesions were assessed using 18F-FDG PET/CT. The impact of TIGAR expression and SUVmax on overall survival was evaluated by the Cox proportional hazards model and the Kaplan-Meier survival analysis. Results: Increased TIGAR staining was associated in clear cell RCC patients with older age, venous tumor thrombus, or increased SUVmax. A positive correlation was found between TIGAR expression and SUVmax in patients (r=0.396, P=0.001). Patients with positive TIGAR expression had a decreased overall survival time than those with negative TIGAR expression. The overall survival time was significantly shorter in patients with high SUVmax (>5.25) compared with those with low SUVmax (≤5.25). SUVmax and Fuhrman grade were identified as independent prognostic factors in clear cell RCC. Patients with high SUVmax (>5.25) and positive TIGAR expression were associated with a worse disease prognosis. Conclusion: The expression of TIGAR is significantly correlated with SUVmax in clear cell RCC. The combined use of TIGAR expression and 18F-FDG PET/CT can provide additional information for tumor glucose metabolic status and disease prognosis in patients with clear cell RCC.
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Affiliation(s)
- Xiaoyan Wang
- Department of Ultrasound, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Rui Li
- Department of Nuclear Medicine, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Ruohua Chen
- Department of Nuclear Medicine, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Gang Huang
- Department of Nuclear Medicine, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.,Shanghai Key Laboratory for Molecular Imaging, Shanghai University of Medicine and Health Sciences, Shanghai, China
| | - Xiang Zhou
- Department of Nuclear Medicine, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Jianjun Liu
- Department of Nuclear Medicine, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
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Are Hemorrhagic Cysts Hyperintense Enough on T1-Weighted MRI to Be Distinguished From Renal Cell Carcinomas? A Retrospective Analysis of 204 Patients. AJR Am J Roentgenol 2019; 213:1267-1273. [DOI: 10.2214/ajr.19.21257] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Kim JH, Li S, Khandwala Y, Chung KJ, Park HK, Chung BI. Association of Prevalence of Benign Pathologic Findings After Partial Nephrectomy With Preoperative Imaging Patterns in the United States From 2007 to 2014. JAMA Surg 2019; 154:225-231. [PMID: 30516801 DOI: 10.1001/jamasurg.2018.4602] [Citation(s) in RCA: 68] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Importance Although the intent of nephron-sparing surgery is to eradicate malignant tumors found on preoperative imaging, benign masses often cannot be differentiated from malignant tumors. However, in the past there have been discrepancies in the reported percentages of benign masses removed by partial nephrectomy (PNx). Objective To investigate the annual trend of prevalence of benign pathologic findings after PNx and to investigate what potential factors are associated with this prevalence. Design, Setting, and Participants A total of 18 060 patients who underwent PNx between 2007 and 2014 were selected from Truven Health MarketScan Research Databases. We selected those patients who underwent PNx as an inpatient from 2007 and set the surgery date as the index date. Overall, a total of 21 445 patients with International Classification of Diseases, Ninth Revision, Clinical Modification code of 55.4 were identified from 2007 to 2015. Main Outcomes and Measures The annual trend of benign pathologic findings was described as an actual number and as a proportion. Univariate and multiple analyses were performed to investigate factors predictive of a benign final pathologic diagnosis, including type of preoperative imaging modality or performance of a renal mass biopsy. Results Among the 18 060 patients, mean (SD) age was 57 (12) years, and there were 10637 (58.9%) men and 7423 (41.1%) women. The overall prevalence of benign pathologic findings was 30.9% and the annual trends demonstrated a prevalence of over 30% for nearly every year of the study period. On univariate analysis, the performance of magnetic resonance imaging (MRI) and renal mass biopsy was associated with benign pathologic findings (P = .02 and P < .001, respectively). On multivariable analysis, female sex (odds ratio [OR], 0.62; 95% CI, 0.58-0.66; P < .001), older age (>65 years) (OR, 0.99; 95% CI, 0.99-0.99; P < .001), and computed tomography (CT) only preoperative imaging (OR, 1.16; 95% CI, 1.05-1.28; P = .004) were associated with benign pathologic findings after PNx. Conclusions and Relevance We found that the overall prevalence of benign pathologic findings after PNx was higher than the literature suggests, with consistent year-over-year rates exceeding 30%. Female sex, older age (>65 years), and CT only preoperative imaging were predictive of a benign tumor. Further elucidation concerning covariates associated with a benign diagnosis should be the focus of future investigations to identify a cohort of patients who could potentially avoid unnecessary surgical intervention.
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Affiliation(s)
- Jae Heon Kim
- Department of Urology, Stanford University Medical Center, Stanford, California.,Department of Urology, Soonchunhyang University Hospital, Soonchuhyang University Medical College, Seoul, Korea
| | - Shufeng Li
- Department of Urology and Dermatology, Stanford University Medical Center, Stanford, California
| | - Yash Khandwala
- Department of Urology, Stanford University Medical Center, Stanford, California.,San Diego School of Medicine, University of California, San Diego
| | - Kyung Jin Chung
- Department of Urology, Stanford University Medical Center, Stanford, California
| | - Hyung Keun Park
- Department of Urology, Stanford University Medical Center, Stanford, California
| | - Benjamin I Chung
- Department of Urology, Stanford University Medical Center, Stanford, California
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Bertelli E, Mercatelli L, Savi E, Pili A, Verna S, Palombella A, Caramella D, Minervini A, Serni S, Agostini S, Miele V. Surgical margin follow-up after nephron-sparing surgery: the possible role of CEUS. J Ultrasound 2019; 23:515-520. [PMID: 31741304 DOI: 10.1007/s40477-019-00413-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Accepted: 10/25/2019] [Indexed: 02/06/2023] Open
Abstract
PURPOSE To evaluate the possible role of CEUS in the management of patients who underwent nephron-sparing surgery (NSS) and presented questionable findings on the surgical margins at the CECT follow-up exam. METHODS In our retro-prospective study, we included 952 patients with small renal masses (SRMs) treated with NSS between 2012 and 2015 and followed with CECT for at least 3 years at Careggi University Hospital. Twenty-two of them presented solid masses on the site of surgery with questionable enhancement at CECT and were further studied with CEUS. This examination was followed by a quantitative analysis of the enhancement pattern. RESULTS Out of the 22 masses, 18 were considered possible granulomas, presenting slow wash-in and low enhancement peaks compared to the surrounding parenchyma and persistent delayed wash-out at CEUS. Four lesions presented a suspicious malignant enhancement pattern, with rapid wash-in, high peak and rapid wash-out. In accordance with instructions from the urologist, the first group of 18 patients was strictly monitored, revealing that the mass dimensions and enhancement pattern were stable for at least 3 years of follow-up, while the other 4 patients underwent a second intervention and their masses were confirmed as tumor recurrence at the histopathological evaluation. CONCLUSIONS CEUS can play a key role in the surgical margin follow-up after NSS when a suspicious enhancing mass is detected by CECT, giving an accurate depiction of the enhancement pattern and thus helping the clinician in the management of the patient.
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Affiliation(s)
- Elena Bertelli
- Department of Radiology, Careggi University Hospital, Florence, Italy. .,Clinical and Translational Sciences, University of Pisa, Florence, Italy.
| | - Laura Mercatelli
- Department of Radiology, Careggi University Hospital, Florence, Italy
| | - Elena Savi
- Department of Radiology, Careggi University Hospital, Florence, Italy
| | - Alessandro Pili
- Department of Urologic Robotic Surgery and Renal Transplantation, Careggi Hospital, University of Florence, Florence, Italy
| | - Silvia Verna
- Department of Radiology, Careggi University Hospital, Florence, Italy
| | | | - Davide Caramella
- Diagnostic and Interventional Radiology, University of Pisa, Florence, Italy
| | - Andrea Minervini
- Department of Urologic Robotic Surgery and Renal Transplantation, Careggi Hospital, University of Florence, Florence, Italy
| | - Sergio Serni
- Department of Urologic Robotic Surgery and Renal Transplantation, Careggi Hospital, University of Florence, Florence, Italy
| | - Simone Agostini
- Department of Radiology, Careggi University Hospital, Florence, Italy
| | - Vittorio Miele
- Department of Radiology, Careggi University Hospital, Florence, Italy
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Stanzione A, Santangelo M, De Rosa F, Ponsiglione A, Peluso G, Insabato L, Imbriaco M. Giant leiomyoma of the renal capsule: CT and MR imaging features with pathologic correlations. MEMO - MAGAZINE OF EUROPEAN MEDICAL ONCOLOGY 2019. [DOI: 10.1007/s12254-019-0505-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Uncommon malignant renal tumors and atypical presentation of common ones: a guide for radiologists. Abdom Radiol (NY) 2019; 44:1430-1452. [PMID: 30311049 DOI: 10.1007/s00261-018-1789-4] [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: 10/28/2022]
Abstract
OBJECTIVE While the typical imaging features of the more common RCC subtypes have previously been described, they can at times have unusual, but distinguishing features. Rarer renal tumors span a broad range of imaging features, but they may also have characteristic presentations. We review the key imaging features of atypical presentations of malignant renal tumors and uncommon malignant renal tumors. CONCLUSION Renal tumors have many different presentation patterns, but knowledge of the distinguishing MR and CT features can help identify both atypical presentation of common malignancies and uncommon renal tumors.
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43
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Kim JH, Li S, Khandwala Y, Del Giudice F, Chung KJ, Park HK, Chung BI. National trends of preoperative imaging modalities before partial nephrectomy for renal masses in the U.S. from 2007-2015. Can Urol Assoc J 2019; 13:E89-E94. [PMID: 30169151 DOI: 10.5489/cuaj.5414] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Although the performance of partial nephrectomies (PN) for renal masses has increased rapidly over the years, only a few studies have investigated the frequency and patterns of preoperative imaging modalities. The aim of this study was to investigate the frequency and patterns in preoperative imaging modalities before PN. METHODS A total of 21 445 patients who underwent PN between 2007 and 2015 were selected from a national representative population in the MarketScan database and included in this study. The annual incidence and proportion of PN, as well as the use of each preoperative imaging modality were analyzed. RESULTS Both annual crude number and frequency rate of PN decreased or became static since 2012. Computed tomography (CT) shows the greatest proportion of the crude number and percentage; despite a slight decrease in percentage, it is still >80%. Among the combinations, CT alone and CT combined with ultrasonography showed the highest performance rate during the complete observational period. The proportion of all other combinations, which include other complex combinations except CT alone, CT plus ultrasonography, CT plus magnetic resonance imaging (MRI), and CT plus MRI plus ultrasonography, was 13.95% in 2007, but increased to 19.04% in 2014. CONCLUSIONS CT still plays a major role in preoperative imaging for renal masses, whereby CT alone and CT combined with ultrasonography account for a major proportion of the preoperative imaging patterns. The use of other imaging combinations, as well as renal biopsies, shows an increasing trend. Additional studies are needed to investigate whether this trend in preoperative imaging is related to the frequency rate of PN.
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Affiliation(s)
- Jae Heon Kim
- Department of Urology, Stanford University Medical Center, Stanford, CA, United States.,Department of Urology, Soonchunhyang University Hospital, Soonchuhyang University Medical College, Seoul, Korea
| | - Shufeng Li
- Department of Urology and Dermatology, Stanford University Medical Center, CA, United States
| | - Yash Khandwala
- Department of Urology, Stanford University Medical Center, Stanford, CA, United States.,University of California, San Diego School of Medicine, San Diego, CA, United States
| | | | - Kyung Jin Chung
- Department of Urology, Stanford University Medical Center, Stanford, CA, United States
| | - Hyung Keun Park
- Department of Urology, Stanford University Medical Center, Stanford, CA, United States
| | - Benjamin I Chung
- Department of Urology, Stanford University Medical Center, Stanford, CA, United States
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Hu EM, Zhang A, Silverman SG, Pedrosa I, Wang ZJ, Smith AD, Chandarana H, Doshi A, Shinagare AB, Remer EM, Kaffenberger SD, Miller DC, Davenport MS. Multi-institutional analysis of CT and MRI reports evaluating indeterminate renal masses: comparison to a national survey investigating desired report elements. Abdom Radiol (NY) 2018; 43:3493-3502. [PMID: 29666953 DOI: 10.1007/s00261-018-1609-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
PURPOSE To determine the need for a standardized renal mass reporting template by analyzing reports of indeterminate renal masses and comparing their contents to stated preferences of radiologists and urologists. METHODS The host IRB waived regulatory oversight for this multi-institutional HIPAA-compliant quality improvement effort. CT and MRI reports created to characterize an indeterminate renal mass were analyzed from 6 community (median: 17 reports/site) and 6 academic (median: 23 reports/site) United States practices. Report contents were compared to a published national survey of stated preferences by academic radiologists and urologists from 9 institutions. Descriptive statistics and Chi-square tests were calculated. RESULTS Of 319 reports, 85% (271; 192 CT, 79 MRI) reported a possibly malignant mass (236 solid, 35 cystic). Some essential elements were commonly described: size (99% [269/271]), mass type (solid vs. cystic; 99% [268/271]), enhancement (presence vs. absence; 92% [248/271]). Other essential elements had incomplete penetrance: the presence or absence of fat in solid masses (14% [34/236]), size comparisons when available (79% [111/140]), Bosniak classification for cystic masses (54% [19/35]). Preferred but non-essential elements generally were described in less than half of reports. Nephrometry scores usually were not included for local therapy candidates (12% [30/257]). Academic practices were significantly more likely than community practices to include mass characterization details, probability of malignancy, and staging. Community practices were significantly more likely to include management recommendations. CONCLUSIONS Renal mass reporting elements considered essential or preferred often are omitted in radiology reports. Variation exists across radiologists and practice settings. A standardized template may mitigate these inconsistencies.
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Affiliation(s)
- Eric M Hu
- Michigan Medicine, Ann Arbor, MI, USA.,Michigan Radiology Quality Collaborative, Ann Arbor, MI, USA
| | - Andrew Zhang
- Michigan Medicine, Ann Arbor, MI, USA.,Michigan Radiology Quality Collaborative, Ann Arbor, MI, USA
| | - Stuart G Silverman
- Brigham and Women's, Boston, MA, USA.,Society of Abdominal Radiology Disease-Focused Panel on Renal Cell Carcinoma, Ann Arbor, MI, USA
| | - Ivan Pedrosa
- UT Southwestern, Dallas, TX, USA.,Society of Abdominal Radiology Disease-Focused Panel on Renal Cell Carcinoma, Ann Arbor, MI, USA
| | - Zhen J Wang
- UCSF, San Francisco, CA, USA.,Society of Abdominal Radiology Disease-Focused Panel on Renal Cell Carcinoma, Ann Arbor, MI, USA
| | - Andrew D Smith
- UAB, Birmingham, AL, USA.,Society of Abdominal Radiology Disease-Focused Panel on Renal Cell Carcinoma, Ann Arbor, MI, USA
| | - Hersh Chandarana
- NYU, New York, NY, USA.,Society of Abdominal Radiology Disease-Focused Panel on Renal Cell Carcinoma, Ann Arbor, MI, USA
| | - Ankur Doshi
- NYU, New York, NY, USA.,Society of Abdominal Radiology Disease-Focused Panel on Renal Cell Carcinoma, Ann Arbor, MI, USA
| | - Atul B Shinagare
- Brigham and Women's, Boston, MA, USA.,Society of Abdominal Radiology Disease-Focused Panel on Renal Cell Carcinoma, Ann Arbor, MI, USA
| | - Erick M Remer
- Cleveland Clinic, Cleveland, OH, USA.,Society of Abdominal Radiology Disease-Focused Panel on Renal Cell Carcinoma, Ann Arbor, MI, USA
| | - Samuel D Kaffenberger
- Michigan Medicine, Ann Arbor, MI, USA.,Michigan Urological Surgery Improvement Collaborative, Ann Arbor, MI, USA
| | - David C Miller
- Michigan Medicine, Ann Arbor, MI, USA.,Michigan Urological Surgery Improvement Collaborative, Ann Arbor, MI, USA
| | - Matthew S Davenport
- Michigan Medicine, Ann Arbor, MI, USA. .,Michigan Radiology Quality Collaborative, Ann Arbor, MI, USA. .,Society of Abdominal Radiology Disease-Focused Panel on Renal Cell Carcinoma, Ann Arbor, MI, USA. .,Michigan Urological Surgery Improvement Collaborative, Ann Arbor, MI, USA. .,Department of Radiology, 1500 E. Medical Center Dr. B2-A209P, Ann Arbor, MI, 48108, USA.
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45
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Ward RD, Tanaka H, Campbell SC, Remer EM. 2017 AUA Renal Mass and Localized Renal Cancer Guidelines: Imaging Implications. Radiographics 2018; 38:2021-2033. [DOI: 10.1148/rg.2018180127] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- Ryan D. Ward
- From the Imaging Institute (R.D.W., E.M.R.) and Glickman Urological and Kidney Institute (H.T., S.C.C., E.M.R.), Cleveland Clinic, 9500 Euclid Ave, A21, Cleveland, OH 44195; and Department of Urology, Tokyo Medical and Dental University, Tokyo, Japan (H.T.)
| | - Hajime Tanaka
- From the Imaging Institute (R.D.W., E.M.R.) and Glickman Urological and Kidney Institute (H.T., S.C.C., E.M.R.), Cleveland Clinic, 9500 Euclid Ave, A21, Cleveland, OH 44195; and Department of Urology, Tokyo Medical and Dental University, Tokyo, Japan (H.T.)
| | - Steven C. Campbell
- From the Imaging Institute (R.D.W., E.M.R.) and Glickman Urological and Kidney Institute (H.T., S.C.C., E.M.R.), Cleveland Clinic, 9500 Euclid Ave, A21, Cleveland, OH 44195; and Department of Urology, Tokyo Medical and Dental University, Tokyo, Japan (H.T.)
| | - Erick M. Remer
- From the Imaging Institute (R.D.W., E.M.R.) and Glickman Urological and Kidney Institute (H.T., S.C.C., E.M.R.), Cleveland Clinic, 9500 Euclid Ave, A21, Cleveland, OH 44195; and Department of Urology, Tokyo Medical and Dental University, Tokyo, Japan (H.T.)
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46
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Kania L, Guglielmo F, Mitchell D. Interpreting body MRI cases: classic findings in abdominal MRI. Abdom Radiol (NY) 2018; 43:2790-2808. [PMID: 29594465 DOI: 10.1007/s00261-018-1551-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Few things in radiology are "pathognomonic" in their appearance or presentation. However, having an awareness of those findings which are specific to a certain entity is important when interpreting imaging studies. These classic findings can be identified with many imaging modalities, but no modality provides as many recognizable observations as an MRI. This results from the large variety of pulse sequences that provide high contrast resolution, prior to and following contrast administration. In this article, the most classically recognized abdominal findings are presented including the following: Liver: Cyst, hemangioma, focal nodular hyperplasia, hepatic adenoma, hemosiderosis, hepatocellular carcinoma. Spleen: Cyst, hemangioma, lymphangioma, hemosiderosis, Gandy-Gamna bodies. Biliary system: Biliary stones and choledocholithiasis, pneumobilia, choledochal cyst. Gallbladder: Adenomyomatosis, sludge, surgical clips in the gallbladder fossa. Pancreas: Pancreatic divisum, intraductal papillary mucinous neoplasm, pseudocyst, autoimmune pancreatitis, chronic pancreatitis, adenocarcinoma. Kidneys: Simple cyst, hemorrhagic cyst, renal sinus cyst, angiomyolipoma, solid mass.
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47
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Chiarello MA, Mali RD, Kang SK. Diagnostic Accuracy of MRI for Detection of Papillary Renal Cell Carcinoma: A Systematic Review and Meta-Analysis. AJR Am J Roentgenol 2018; 211:812-821. [PMID: 30063398 PMCID: PMC6440798 DOI: 10.2214/ajr.17.19462] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVE The objective of our study was to perform a systematic review and meta-analysis of the diagnostic performance of MRI in differentiation of papillary renal cell carcinoma (RCC) from other renal masses. MATERIALS AND METHODS We performed searches of three electronic databases for studies that used MRI techniques to differentiate papillary RCC from other renal lesions. Methodologic quality was assessed, and diagnostic test accuracy was summarized using bivariate random-effects modeling or with construction of a summary ROC (SROC) curve. RESULTS Thirteen studies involving 275 papillary RCC lesions and 758 other renal masses met the inclusion criteria. Resulting summary estimates for the performance of MRI to differentiate papillary RCC from other renal lesions were a sensitivity of 79.6% (95% CI, 62.3-90.2%) and specificity of 88.1% (95% CI, 80.1-93.1%). In subgroup analysis, quantitative pooling of seven studies using enhancement in the corticomedullary phase resulted in a sensitivity of 85.6% (95% CI, 67.8-94.4%), specificity of 91.7% (95% CI, 76.0-97.5%), and area under the SROC curve of 0.894. Four studies used tumor appearance on T2-weighted imaging to detect papillary RCC, and results showed a pooled sensitivity of 89.9% (95% CI, 73.0-96.7%) and specificity of 84.9% (95% CI, 69.0-93.4%). Three studies used signal loss on T1-weighted in-phase imaging to detect papillary RCC but marked heterogeneity precluded pooling. CONCLUSION Meta-analysis supports moderate sensitivity and excellent specificity of quantitative enhancement in the corticomedullary phase for differentiating papillary RCC from other tumors. The accuracy of combining enhancement and T2 signal-intensity characteristics merits further evaluation as a potential aid for management decisions.
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Affiliation(s)
- Matthew A Chiarello
- 1 Department of Radiology, NYU School of Medicine, 550 First Ave, New York, NY 10016
| | - Rahul D Mali
- 1 Department of Radiology, NYU School of Medicine, 550 First Ave, New York, NY 10016
| | - Stella K Kang
- 1 Department of Radiology, NYU School of Medicine, 550 First Ave, New York, NY 10016
- 2 Department of Population Health, NYU School of Medicine, New York, NY
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48
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van Oostenbrugge TJ, Fütterer JJ, Mulders PFA. Diagnostic Imaging for Solid Renal Tumors: A Pictorial Review. KIDNEY CANCER 2018; 2:79-93. [PMID: 30740580 PMCID: PMC6364093 DOI: 10.3233/kca-180028] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
The prognosis of renal tumors depends on histologic subtype. The increased use of abdominal imaging has resulted in an increase in the number of small renal incidentaloma in recent decades. Of these incidentally discovered tumors, 20% are benign lesions warranting conservative management, but most are renal cell carcinomas that warrant a more aggressive therapeutic approach due to their malignant potential. Dedicated diagnostic renal imaging is important for characterization of renal tumors to facilitate treatment planning. This review discusses the ability to detect and differentiate renal cell carcinoma subtypes, angiomyolipoma and oncocytoma based on ultrasound imaging, computed tomography, multiparametric magnetic resonance, and nuclear imaging.
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Affiliation(s)
| | - Jurgen J Fütterer
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Peter F A Mulders
- Department of Urology, Radboud University Medical Center, Nijmegen, The Netherlands
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49
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Li SR, Pui MH, Guo Y, Wang HJ, Guan J, Zhang XL, Pan WB. Efficacy of 3D VIBE Dixon fat quantification for differentiating clear-cell from non-clear-cell renal cell carcinoma. Clin Radiol 2018; 73:975-980. [PMID: 30055765 DOI: 10.1016/j.crad.2018.06.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2017] [Accepted: 06/27/2018] [Indexed: 12/27/2022]
Abstract
AIM To assess the efficacy of three-dimensional (3D) volumetric interpolated breath-hold examination (VIBE) magnetic resonance imaging (MRI) with Dixon quantification for differentiating clear-cell from non-clear-cell types of renal cell carcinoma (RCC). MATERIALS AND METHODS The 3D VIBE Dixon renal MRI examinations of 44 patients with 45 histologically confirmed RCCs was analysed. The fat fractions and signal intensity indexes (SIindex) of the solid portions of clear-cell and non-clear-cell RCCs were measured and compared using Student's t-test and receiver operating characteristic (ROC) curves. The agreement of measurements among observers was evaluated by the intraclass correlation coefficient (ICC), and Bland-Altman plots. RESULTS The mean values of fat fraction (13.16±7.16%) and SIindex (22.64±15.7%) in clear-cell RCCs were significantly higher than that in non-clear-cell RCCs (7.7±2% and 7.9±4.8%; p<0.001, respectively). With the area under the ROC curve (AUC) of the fat fraction at 0.811, 75% (95% CI: 55.1-89.43%) sensitivity and 76.5% (95% CI: 50.1-93.2%) specificity for diagnosing clear-cell RCC were obtained at a cut-off fat fraction value of 8.9%. With a cut-off value of 8.89%, the diagnostic sensitivity and specificity were 85.7% (95% CI: 67.3-96%) and 70.6% (95% CI: 44-89.7%), respectively. The AUC of the SIindex was 0.870 (0.766-0.973). ICC and Bland-Altman plots show excellent agreement of the tumour fat fraction and SIindex measurement between the two observers. CONCLUSION Intracellular lipid content analysis using the 3D Dixon technique can help to differentiate clear-cell from non-clear-cell RCCs.
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Affiliation(s)
- S-R Li
- Department of Radiology, The First Affiliated Hospital of Sun Yat-sen University, 58 Zhongshan Road 2, Guangzhou, Guangdong, People's Republic of China
| | - M H Pui
- Department of Radiology, Timmins District Hospital, 700 Ross Avenue E, Timmins, Ontario P4N 8P2, Canada
| | - Y Guo
- Department of Radiology, The First Affiliated Hospital of Sun Yat-sen University, 58 Zhongshan Road 2, Guangzhou, Guangdong, People's Republic of China.
| | - H-J Wang
- Department of Radiology, The First Affiliated Hospital of Sun Yat-sen University, 58 Zhongshan Road 2, Guangzhou, Guangdong, People's Republic of China
| | - J Guan
- Department of Radiology, The First Affiliated Hospital of Sun Yat-sen University, 58 Zhongshan Road 2, Guangzhou, Guangdong, People's Republic of China
| | - X-L Zhang
- Department of Radiology, The First Affiliated Hospital of Sun Yat-sen University, 58 Zhongshan Road 2, Guangzhou, Guangdong, People's Republic of China
| | - W-B Pan
- Department of Radiology, The First Affiliated Hospital of Sun Yat-sen University, 58 Zhongshan Road 2, Guangzhou, Guangdong, People's Republic of China
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50
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Bindayi A, Mcdonald ML, Beksac AT, Rivera-Sanfeliz G, Shabaik A, Hughes F, Aganovic L, Hansel DE, Derweesh IH. Can multiphase CT scan distinguish between papillary renal cell carcinoma type 1 and type 2? Turk J Urol 2018; 44:316-322. [PMID: 29932401 DOI: 10.5152/tud.2018.28938] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Accepted: 03/07/2018] [Indexed: 01/06/2023]
Abstract
OBJECTIVE To investigate the utility of multiphase computed tomography (CT) and percutaneous renal mass biopsy (PRMB) in differentiating between papillary renal cell carcinoma (pRCC)-Type 1 and -Type 2, as emerging data have suggested differential enhancement patterns in different renal tumor histologies. MATERIAL AND METHODS Retrospective analysis of 51 patients (23 pRCC-Type 1/28 pRCC-Type 2) who underwent multiphase CT followed by surgery from July 2011 to April 2016 was performed. Data were analyzed between subgroups based on histology. Multiphase CT was analyzed for tumor size, and attenuation [Hounsfield Units (HU)]. Change in HU (ΔHU) was calculated between noncontrast (NC), corticomedullary (CM), nephrographic (N), and delayed (D) phases. Subset analysis was carried out on patients who underwent PRMB prior to surgery. RESULTS There was no difference in median tumor size (pRCC-Type 1 2.8 vs. pRCC-Type 2 2.6 cm, p=0.832). In addition to tumor size being similar between groups, distribution of tumor stages between groups was also similar (p=0.651). Greater proportion of high-grade tumors (III/IV) was noted in pRCC-Type 2 (42.9% vs. 8.7%) (p=0.011). There was no difference in HU values for NC (p=0.961), CM (p=0.118), N (p=0.277), and D (p=0.256) phases, and in ΔHU between CM-NC (p=0.278), N-NC (p=0.316), and D-NC (p=0.103). Thirteen patients underwent percutaneous biopsy, 11 of whom had diagnostic samples. Examination of 10/11 (90.9%) samples accurately predicted correct histology, and of 6/11 (54.5%) samples correctly identified high-vs. low-grade histology. CONCLUSION Our findings suggest substantial overlap of CT findings, despite pRCC-Type 2 having greater proportion of high-grade tumors. Utility of CT is limited in the differentiation between pRCC subtypes. Patients with suggested pRCC on CT imaging being considered for a non-extirpative strategy should undergo PRMB for risk stratification.
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Affiliation(s)
- Ahmet Bindayi
- Department of Urology, UC San Diego Health System, La Jolla, California, USA
| | - Michelle L Mcdonald
- Department of Urology, UC San Diego Health System, La Jolla, California, USA
| | - Alp T Beksac
- Department of Urology, UC San Diego Health System, La Jolla, California, USA
| | | | - Ahmed Shabaik
- Department of Pathology, UC San Diego Health System, La Jolla, California, USA
| | - Fiona Hughes
- Department of Radiology, UC San Diego Health System, La Jolla, California, USA
| | - Lejla Aganovic
- Department of Radiology, UC San Diego Health System, La Jolla, California, USA
| | - Donna E Hansel
- Department of Pathology, UC San Diego Health System, La Jolla, California, USA
| | - Ithaar H Derweesh
- Department of Urology, UC San Diego Health System, La Jolla, California, USA
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