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Trovato P, Simonetti I, Morrone A, Fusco R, Setola SV, Giacobbe G, Brunese MC, Pecchi A, Triggiani S, Pellegrino G, Petralia G, Sica G, Petrillo A, Granata V. Scientific Status Quo of Small Renal Lesions: Diagnostic Assessment and Radiomics. J Clin Med 2024; 13:547. [PMID: 38256682 PMCID: PMC10816509 DOI: 10.3390/jcm13020547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Revised: 01/05/2024] [Accepted: 01/16/2024] [Indexed: 01/24/2024] Open
Abstract
Background: Small renal masses (SRMs) are defined as contrast-enhanced renal lesions less than or equal to 4 cm in maximal diameter, which can be compatible with stage T1a renal cell carcinomas (RCCs). Currently, 50-61% of all renal tumors are found incidentally. Methods: The characteristics of the lesion influence the choice of the type of management, which include several methods SRM of management, including nephrectomy, partial nephrectomy, ablation, observation, and also stereotactic body radiotherapy. Typical imaging methods available for differentiating benign from malignant renal lesions include ultrasound (US), contrast-enhanced ultrasound (CEUS), computed tomography (CT), and magnetic resonance imaging (MRI). Results: Although ultrasound is the first imaging technique used to detect small renal lesions, it has several limitations. CT is the main and most widely used imaging technique for SRM characterization. The main advantages of MRI compared to CT are the better contrast resolution and tissue characterization, the use of functional imaging sequences, the possibility of performing the examination in patients allergic to iodine-containing contrast medium, and the absence of exposure to ionizing radiation. For a correct evaluation during imaging follow-up, it is necessary to use a reliable method for the assessment of renal lesions, represented by the Bosniak classification system. This classification was initially developed based on contrast-enhanced CT imaging findings, and the 2019 revision proposed the inclusion of MRI features; however, the latest classification has not yet received widespread validation. Conclusions: The use of radiomics in the evaluation of renal masses is an emerging and increasingly central field with several applications such as characterizing renal masses, distinguishing RCC subtypes, monitoring response to targeted therapeutic agents, and prognosis in a metastatic context.
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Affiliation(s)
- Piero Trovato
- Radiology Division, Istituto Nazionale Tumori-IRCCS-Fondazione G. Pascale, 80131 Naples, Italy; (P.T.); (I.S.); (S.V.S.); (A.P.); (V.G.)
| | - Igino Simonetti
- Radiology Division, Istituto Nazionale Tumori-IRCCS-Fondazione G. Pascale, 80131 Naples, Italy; (P.T.); (I.S.); (S.V.S.); (A.P.); (V.G.)
| | - Alessio Morrone
- Division of Radiology, Università degli Studi della Campania Luigi Vanvitelli, 80138 Naples, Italy;
| | - Roberta Fusco
- Medical Oncology Division, Igea SpA, 80013 Naples, Italy
- Italian Society of Medical and Interventional Radiology (SIRM), SIRM Foundation, Via della Signora 2, 20122 Milan, Italy
| | - Sergio Venanzio Setola
- Radiology Division, Istituto Nazionale Tumori-IRCCS-Fondazione G. Pascale, 80131 Naples, Italy; (P.T.); (I.S.); (S.V.S.); (A.P.); (V.G.)
| | - Giuliana Giacobbe
- General and Emergency Radiology Department, “Antonio Cardarelli” Hospital, 80131 Naples, Italy;
| | - Maria Chiara Brunese
- Diagnostic Imaging Section, Department of Medical and Surgical Sciences & Neurosciences, University of Molise, 86100 Campobasso, Italy;
| | - Annarita Pecchi
- Department of Radiology, University of Modena and Reggio Emilia, 41121 Modena, Italy;
| | - Sonia Triggiani
- Postgraduate School of Radiodiagnostics, University of Milan, 20122 Milan, Italy; (S.T.); (G.P.)
| | - Giuseppe Pellegrino
- Postgraduate School of Radiodiagnostics, University of Milan, 20122 Milan, Italy; (S.T.); (G.P.)
| | - Giuseppe Petralia
- Department of Medical Imaging and Radiation Sciences, IEO European Institute of Oncology IRCCS, Via Ripamonti 435, 20141 Milan, Italy;
| | - Giacomo Sica
- Radiology Unit, Monaldi Hospital, Azienda Ospedaliera dei Colli, 80131 Naples, Italy;
| | - Antonella Petrillo
- Radiology Division, Istituto Nazionale Tumori-IRCCS-Fondazione G. Pascale, 80131 Naples, Italy; (P.T.); (I.S.); (S.V.S.); (A.P.); (V.G.)
| | - Vincenza Granata
- Radiology Division, Istituto Nazionale Tumori-IRCCS-Fondazione G. Pascale, 80131 Naples, Italy; (P.T.); (I.S.); (S.V.S.); (A.P.); (V.G.)
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Luo HC, Cheng WQ, Ding H, He L. Diagnostic performance of diffusion-weighted imaging and intravoxel incoherent motion for renal lesions: a meta-analysis. Clin Radiol 2023; 78:935-946. [PMID: 37652795 DOI: 10.1016/j.crad.2023.07.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 07/06/2023] [Accepted: 07/30/2023] [Indexed: 09/02/2023]
Abstract
AIM To compare the diagnostic performance of diffusion-weighted imaging (DWI) and intravoxel incoherent motion (IVIM) parameters, specifically true diffusion coefficient (D), pseudo diffusion coefficient (D∗), and perfusion fraction (f) for quantitatively differentiating benign and malignant renal lesions. MATERIALS AND METHODS A comprehensive search was conducted in the EMBASE and PubMed databases before September 2022 to identify studies in English investigating the diagnostic accuracy of DWI and IVIM in renal lesions. The quality of the included studies was assessed using the QUADAS-2 tool. Pooled sensitivity, specificity, and area under the curve (AUC) values were estimated for each parameter. RESULTS A total of 19 studies involving 1,860 renal lesions (1,160 malignant and 700 benign), met the inclusion criteria. Among these studies, 15 assessed the apparent diffusion coefficient (ADC), four assessed IVIM, and three evaluated both ADC and IVIM. The pooled sensitivity, specificity, and AUC for ADC were 0.84 (95% confidence interval [Cl], 0.79-0.88), 0.82 (95% Cl, 0.72-0.89), and 0.89 (95% Cl, 0.86-0.92), respectively. The IVIM parameter with the highest diagnostic accuracy was D, with a pooled sensitivity, specificity, and AUC of 0.89 (95% Cl, 0.74-0.96), 0.96 (95% Cl, 0.85-0.99), and 0.98 (95% Cl, 0.96-0.99), respectively. The pooled sensitivity, specificity and AUC for f were 0.67 (95% Cl, 0.55-0.77), 0.81 (95% Cl, 0.30-0.98), and 0.73 (95% Cl, 0.69-0.77), respectively. The pooled sensitivity, specificity, and AUC for D∗ were 0.87 (95% Cl, 0.81-0.91), 0.59 (95% Cl, 0.48-0.70), and 0.82 (95% Cl, 0.78-0.85), respectively. CONCLUSION This meta-analysis indicated that both IVIM and DWI had moderate to high diagnostic accuracy for differentiating benign and malignant renal lesions. Among the IVIM parameter, D exhibited the highest diagnostic accuracy, demonstrating higher sensitivity and specificity than ADC, D∗, and f.
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Affiliation(s)
- H C Luo
- Department of Radiology, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - W Q Cheng
- Department of Radiology, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - H Ding
- Department of Radiology, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - L He
- Department of Radiology, Children's Hospital of Chongqing Medical University, Chongqing, China.
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Sighinolfi MC, Menezes AD, Patel V, Moschovas M, Assumma S, Calcagnile T, Panio E, Sangalli M, Turri F, Sarchi L, Micali S, Varca V, Annino F, Leonardo C, Bozzini G, Cacciamani G, Gregori A, Morini E, Terzoni S, Eissa A, Rocco B. Three-Dimensional Customized Imaging Reconstruction for Urological Surgery: Diffusion and Role in Real-Life Practice from an International Survey. J Pers Med 2023; 13:1435. [PMID: 37888045 PMCID: PMC10607910 DOI: 10.3390/jpm13101435] [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: 08/29/2023] [Revised: 09/21/2023] [Accepted: 09/22/2023] [Indexed: 10/28/2023] Open
Abstract
Despite the arising interest in three-dimensional (3D) reconstruction models from 2D imaging, their diffusion and perception among urologists have been scarcely explored. The aim of the study is to report the results of an international survey investigating the use of such tools among urologists of different backgrounds and origins. Beyond demographics, the survey explored the degree to which 3D models are perceived to improve surgical outcomes, the procedures mostly making use of them, the settings in which those tools are mostly applied, the surgical steps benefiting from 3D reconstructions and future perspectives of improvement. One hundred responders fully completed the survey. All levels of expertise were allowed; more than half (53%) were first surgeons, and 59% had already completed their training. Their main application was partial nephrectomy (85%), followed by radical nephrectomy and radical prostatectomy. Three-dimensional models are mostly used for preoperative planning (75%), intraoperative consultation and tailoring. More than half recognized that 3D models may highly improve surgical outcomes. Despite their recognized usefulness, 77% of responders use 3D models in less than 25% of their major operations due to costs or the extra time taken to perform the reconstruction. Technical improvements and a higher availability of the 3D models will further increase their role in surgical and clinical daily practice.
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Affiliation(s)
| | | | - Vipul Patel
- Global Robotic Institute, AdventHealth, Orlando, FL 34747, USA
| | | | - Simone Assumma
- Urologic Unit, ASST Santi Paolo e Carlo, La Statale University, 20122 Milan, Italy
| | - Tommaso Calcagnile
- Urologic Unit, ASST Santi Paolo e Carlo, La Statale University, 20122 Milan, Italy
| | - Enrico Panio
- Urologic Unit, ASST Santi Paolo e Carlo, La Statale University, 20122 Milan, Italy
| | - Mattia Sangalli
- Urologic Unit, ASST Santi Paolo e Carlo, La Statale University, 20122 Milan, Italy
| | - Filippo Turri
- Urologic Unit, ASST Santi Paolo e Carlo, La Statale University, 20122 Milan, Italy
| | - Luca Sarchi
- Urologic Unit, ASST Santi Paolo e Carlo, La Statale University, 20122 Milan, Italy
| | - Salvatore Micali
- Urologic Unit, Azienda Ospedaliera Universitaria di Modena, 41124 Modena, Italy
| | - Virginia Varca
- Urologic Unit, ASST Rhodense—Presidio di Garbagnate Milanese, 20024 Milan, Italy
| | | | | | | | - Giovanni Cacciamani
- USC Institute of Urology, University of Southern California, Los Angeles, CA 90089, USA
| | - Andrea Gregori
- Urologic Unit, Fatebenefratelli-Sacco Hospital, 20157 Milan, Italy
| | | | - Stefano Terzoni
- Urologic Unit, ASST Santi Paolo e Carlo, La Statale University, 20122 Milan, Italy
| | - Ahmed Eissa
- Urologic Department, Faculty of Medicine, Tanta University, Tanta 31527, Egypt
| | - Bernardo Rocco
- Urologic Unit, ASST Santi Paolo e Carlo, La Statale University, 20122 Milan, Italy
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Akıncı Ö, Türkoglu F, Nalbant MO, Öner Ö, İnci E. The Effectiveness of Volumetric MRI Histogram Analysis in Renal Cell Carcinoma. Acad Radiol 2023; 30 Suppl 1:S278-S285. [PMID: 37105802 DOI: 10.1016/j.acra.2023.03.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 03/19/2023] [Accepted: 03/20/2023] [Indexed: 04/29/2023]
Abstract
RATIONALE AND OBJECTIVES This study investigated the utility of histogram parameters derived from diffusion-weighted imaging (DWI) for evaluating renal cell carcinoma (RCC) grading prior to surgery. MATERIALS AND METHODS This retrospective study included 88 patients who were histopathologically diagnosed with RCC and underwent magnetic resonance imaging (MRI) examinations. The patients were divided into two groups as well-differentiated (Group 1) and poorly differentiated (Group 2). Demographic data, preoperative MRI findings, MRI apparent diffusion coefficient (ADC) histogram analyzes, operation types, postoperative histopathological data and cancer stages of the patients were recorded. The histogram parameters of ADC values, comprising the mean, minimum, maximum, 5th, 10th, 25th, 50th, 75th, 90th, and 95th percentiles, as well as skewness, kurtosis, and variance, were calculated. RESULTS The study included 59 males and 29 women with an average age of 56.21 ± 1.33 years. There were 52 patients in Group 1 and 36 patients in Group 2. The ADCmin, ADCmean, ADCmax, 5th, 10th, 25th, 50th, 75th, 90th, and 95th percentiles of ADC values of the poorly differentiated group were all lower than those of the well-differentiated group. ADCmin and the 5th percentile of ADC values, as well as ADCmean and the 10th, 25th, 50th, and 75th percentiles of ADC values, showed a statistically significant difference (p < 0.05). The AUC, sensitivity, and specificity of the ADCmin value were 0.703, 56.3%, and 75.7%, respectively. CONCLUSION The present study indicated that histogram parameters generated from DWI were capable of differentiating between high-grade and low-grade RCC.
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Affiliation(s)
- Özlem Akıncı
- Bakırköy Dr Sadi Konuk Training and Research Hospital, Department of Radiology, Istanbul, Turkey.
| | - Furkan Türkoglu
- Bakırköy Dr Sadi Konuk Training and Research Hospital, Department of Radiology, Istanbul, Turkey
| | - Mustafa Orhan Nalbant
- Bakırköy Dr Sadi Konuk Training and Research Hospital, Department of Radiology, Istanbul, Turkey
| | - Özkan Öner
- Bakırköy Dr Sadi Konuk Training and Research Hospital, Department of Radiology, Istanbul, Turkey
| | - Ercan İnci
- Bakırköy Dr Sadi Konuk Training and Research Hospital, Department of Radiology, Istanbul, Turkey
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5
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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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Ren Q, Chen Y, Shao X, Guo L, Xu X. Lymph nodes primary staging of colorectal cancer in 18F-FDG PET/MRI: a systematic review and meta-analysis. Eur J Med Res 2023; 28:162. [PMID: 37143144 PMCID: PMC10157899 DOI: 10.1186/s40001-023-01124-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Accepted: 04/23/2023] [Indexed: 05/06/2023] Open
Abstract
OBJECTIVE To assess the diagnostic efficacy of 18F-FDG PET/MRI for lymph node (LN) metastasis primary staging in patients with colorectal cancer (CRC). METHODS This study was conducted and reported in accordance with the PRISMA-DTA statement. Electronic databases (PubMed, Embase, Cochrane Library) were searched for studies on 18F-FDG PET/MRI for diagnosing LN metastasis. The pooled sensitivity (SEN), specificity (SPE), and area under the curve (AUC) were applied to assess the diagnostic performance. Heterogeneity was identified and processed using meta-regression and sensitivity analysis. All data analyses were performed via STATA 15 and Meta-Disc 1.4 software. RESULTS There were finally 7 studies included, involving a total of 184 patients. The Spearman rank correlation coefficient was 0.108 (P = 0.818), with no threshold-effect observed. The pooled SEN was 0.81 (95%CI 0.66-0.90) and the SPE was 0.89 (95% CI 0.73-0.96). In sub-groups, prospective groups demonstrated to have the highest SEN of 0.92 (95%CI 0.79-1.00). The studies conducted by Catalano et al. and Kang et al. were considered to be potential sources of heterogeneity. CONCLUSION 18F-FDG PET/MRI has shown remarkable diagnostic performance in identification of LN metastases in newly diagnosed CRC patients. It would be of great application value for the primary staging of CRC lymph node metastases.
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Affiliation(s)
- Qingwei Ren
- Department of Gastroenterology, Dongyang Hospital of Traditional Chinese Medicine, Dongyang, China
| | - Yanyan Chen
- Department of Medical Oncology, Dongyang Women & Children Hospital, No. 40, Wuning East Road, Dongyang, 322100, China.
| | - Xuejun Shao
- Department of Gastroenterology, Dongyang Hospital of Traditional Chinese Medicine, Dongyang, China
| | - Lanzhong Guo
- Department of Medical Oncology, Dongyang Women & Children Hospital, No. 40, Wuning East Road, Dongyang, 322100, China
| | - Xinxin Xu
- Department of Gastroenterology, Dongyang Hospital of Traditional Chinese Medicine, Dongyang, China
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7
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Nolazco JI, Soerensen SJC, Chung BI. Biomarkers for the Detection and Surveillance of Renal Cancer. Urol Clin North Am 2023; 50:191-204. [PMID: 36948666 DOI: 10.1016/j.ucl.2023.01.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
Abstract
Renal cell carcinoma (RCC) is a heterogeneous disease characterized by a broad spectrum of disorders in terms of genetics, molecular and clinical characteristics. There is an urgent need for noninvasive tools to stratify and select patients for treatment accurately. In this review, we analyze serum, urinary, and imaging biomarkers that have the potential to detect malignant tumors in patients with RCC. We discuss the characteristics of these numerous biomarkers and their ability to be used routinely in clinical practice. The development of biomarkers continues to evolve with promising prospects.
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Affiliation(s)
- José Ignacio Nolazco
- Division of Urological Surgery, Brigham and Women's Hospital, Harvard Medical School, 45 Francis Street, Boston, MA 02115, USA; Servicio de Urología, Hospital Universitario Austral, Universidad Austral, Av Juan Domingo Perón 1500, B1629AHJ Pilar, Argentina.
| | - Simon John Christoph Soerensen
- Department of Urology, Stanford University School of Medicine, Stanford, CA, USA; Department of Epidemiology and Population Health, Stanford University School of Medicine, Stanford, USA
| | - Benjamin I Chung
- Department of Urology, Stanford University School of Medicine, Stanford, CA, USA
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8
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Frank RA, Dawit H, Bossuyt PMM, Leeflang M, Flood TA, Breau RH, McInnes MDF, Schieda N. Diagnostic Accuracy of MRI for Solid Renal Masses: A Systematic Review and Meta-analysis. J Magn Reson Imaging 2023; 57:1172-1184. [PMID: 36054467 DOI: 10.1002/jmri.28397] [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: 06/13/2022] [Revised: 07/29/2022] [Accepted: 08/03/2022] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Biparametric (bp)-MRI and multiparametric (mp)-MRI may improve the diagnostic accuracy of renal mass histology. PURPOSE To evaluate the available evidence on the diagnostic accuracy of bp-MRI and mp-MRI for solid renal masses in differentiating malignant from benign, aggressive from indolent, and clear cell renal cell carcinoma (ccRCC) from other histology. STUDY TYPE Systematic review. POPULATION MEDLINE, EMBASE, and CENTRAL up to January 11, 2022 were searched. FIELD STRENGTH/SEQUENCE 1.5 or 3 Tesla. ASSESSMENT Eligible studies evaluated the accuracy of MRI (with at least two sequences: T2, T1, dynamic contrast and diffusion-weighted imaging) for diagnosis of solid renal masses in adult patients, using histology as reference standard. Risk of bias and applicability were assessed using QUADAS-2. STATISTICAL TESTS Meta-analysis using a bivariate logitnormal random effects model. RESULTS We included 10 studies (1239 masses from approximately 1200 patients). The risk of bias was high in three studies, unclear in five studies and low in two studies. The diagnostic accuracy of malignant (vs. benign) masses was assessed in five studies (64% [179/281] malignant). The summary estimate of sensitivity was 95% (95% confidence interval [CI]: 77%-99%), and specificity was 63% (95% CI: 46%-77%). No study assessed aggressive (vs. indolent) masses. The diagnostic accuracy of ccRCC (vs. other subtypes) was evaluated in six studies (47% [455/971] ccRCC): the summary estimate of sensitivity was 85% (95% CI: 77%-90%) and specificity was 77% (95% CI: 73%-81%). DATA CONCLUSION Our study reveals deficits in the available evidence on MRI for diagnosis of renal mass histology. The number of studies was limited, at unclear/high risk of bias, with heterogeneous definitions of solid masses, imaging techniques, diagnostic criteria, and outcome measures. EVIDENCE LEVEL 3 TECHNICAL EFFICACY: Stage 2.
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Affiliation(s)
- Robert A Frank
- Department of Radiology, University of Ottawa, Ottawa, Canada
| | - Haben Dawit
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada.,School of Epidemiology, Public Health and Preventative Medicine, Faculty of Medicine, University of Ottawa, Ottawa, Canada
| | - Patrick M M Bossuyt
- Amsterdam University Medical Centers, University of Amsterdam, Epidemiology and Data Science, Amsterdam, the Netherlands
| | - Mariska Leeflang
- Amsterdam University Medical Centers, University of Amsterdam, Epidemiology and Data Science, Amsterdam, the Netherlands
| | - Trevor A Flood
- Department of Anatomical Pathology, University of Ottawa, Ottawa, Canada
| | - Rodney H Breau
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada.,Department of Surgery, University of Ottawa, Ottawa, Canada
| | - Matthew D F McInnes
- Department of Radiology, University of Ottawa, Ottawa, Canada.,Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
| | - Nicola Schieda
- Department of Radiology, University of Ottawa, Ottawa, Canada.,Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
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9
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Kumar S, Virarkar M, Vulasala SSR, Daoud T, Ozdemir S, Wieseler C, Vincety-Latorre F, Gopireddy DR, Bhosale P, Lall C. Magnetic Resonance Imaging Virtual Biopsy of Common Solid Renal Masses-A Pictorial Review. J Comput Assist Tomogr 2023; 47:186-198. [PMID: 36790908 DOI: 10.1097/rct.0000000000001424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
ABSTRACT The expanded application of radiologic imaging resulted in an increased incidence of renal masses in the recent decade. Clinically, it is difficult to determine the malignant potential of the renal masses, thus resulting in complex management. Image-guided biopsies are the ongoing standard of care to identify molecular variance but are limited by tumor accessibility and heterogeneity. With the evolving importance of individualized cancer therapies, radiomics has displayed promising results in the identification of tumoral mutation status on routine imaging. This article discusses how magnetic resonance imaging features can guide a radiologist toward identifying renal mass characteristics.
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Affiliation(s)
- Sindhu Kumar
- From the Department of Radiology, University of Florida College of Medicine, Jacksonville, FL
| | - Mayur Virarkar
- From the Department of Radiology, University of Florida College of Medicine, Jacksonville, FL
| | - Sai Swarupa R Vulasala
- From the Department of Radiology, University of Florida College of Medicine, Jacksonville, FL
| | - Taher Daoud
- Division of Diagnostic Imaging, Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Savas Ozdemir
- From the Department of Radiology, University of Florida College of Medicine, Jacksonville, FL
| | - Carissa Wieseler
- From the Department of Radiology, University of Florida College of Medicine, Jacksonville, FL
| | | | - Dheeraj R Gopireddy
- From the Department of Radiology, University of Florida College of Medicine, Jacksonville, FL
| | - Priya Bhosale
- Division of Diagnostic Imaging, Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Chandana Lall
- From the Department of Radiology, University of Florida College of Medicine, Jacksonville, FL
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10
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Posada Calderon L, Eismann L, Reese SW, Reznik E, Hakimi AA. Advances in Imaging-Based Biomarkers in Renal Cell Carcinoma: A Critical Analysis of the Current Literature. Cancers (Basel) 2023; 15:cancers15020354. [PMID: 36672304 PMCID: PMC9856305 DOI: 10.3390/cancers15020354] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 12/31/2022] [Accepted: 01/03/2023] [Indexed: 01/06/2023] Open
Abstract
Cross-sectional imaging is the standard diagnostic tool to determine underlying biology in renal masses, which is crucial for subsequent treatment. Currently, standard CT imaging is limited in its ability to differentiate benign from malignant disease. Therefore, various modalities have been investigated to identify imaging-based parameters to improve the noninvasive diagnosis of renal masses and renal cell carcinoma (RCC) subtypes. MRI was reported to predict grading of RCC and to identify RCC subtypes, and has been shown in a small cohort to predict the response to targeted therapy. Dynamic imaging is promising for the staging and diagnosis of RCC. PET/CT radiotracers, such as 18F-fluorodeoxyglucose (FDG), 124I-cG250, radiolabeled prostate-specific membrane antigen (PSMA), and 11C-acetate, have been reported to improve the identification of histology, grading, detection of metastasis, and assessment of response to systemic therapy, and to predict oncological outcomes. Moreover, 99Tc-sestamibi and SPECT scans have shown promising results in distinguishing low-grade RCC from benign lesions. Radiomics has been used to further characterize renal masses based on semantic and textural analyses. In preliminary studies, integrated machine learning algorithms using radiomics proved to be more accurate in distinguishing benign from malignant renal masses compared to radiologists' interpretations. Radiomics and radiogenomics are used to complement risk classification models to predict oncological outcomes. Imaging-based biomarkers hold strong potential in RCC, but require standardization and external validation before integration into clinical routines.
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Affiliation(s)
- Lina Posada Calderon
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Lennert Eismann
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Stephen W. Reese
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Ed Reznik
- Computational Oncology, Department of Epidemiology & Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Abraham Ari Hakimi
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
- Correspondence:
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11
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Dagestad MH, Vetti N, Kristoffersen PM, Zwart JA, Storheim K, Bakland G, Brox JI, Grøvle L, Marchand GH, Andersen E, Assmus J, Espeland A. Apparent diffusion coefficient values in Modic changes – interobserver reproducibility and relation to Modic type. BMC Musculoskelet Disord 2022; 23:695. [PMID: 35869480 PMCID: PMC9306145 DOI: 10.1186/s12891-022-05610-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 06/29/2022] [Indexed: 11/21/2022] Open
Abstract
Background Modic Changes (MCs) in the vertebral bone marrow were related to back pain in some studies but have uncertain clinical relevance. Diffusion weighted MRI with apparent diffusion coefficient (ADC)-measurements can add information on bone marrow lesions. However, few have studied ADC measurements in MCs. Further studies require reproducible and valid measurements. We expect valid ADC values to be higher in MC type 1 (oedema type) vs type 3 (sclerotic type) vs type 2 (fatty type). Accordingly, the purpose of this study was to evaluate ADC values in MCs for interobserver reproducibility and relation to MC type. Methods We used ADC maps (b 50, 400, 800 s/mm2) from 1.5 T lumbar spine MRI of 90 chronic low back pain patients with MCs in the AIM (Antibiotics In Modic changes)-study. Two radiologists independently measured ADC in fixed-sized regions of interests. Variables were MC-ADC (ADC in MC), MC-ADC% (0% = vertebral body, 100% = cerebrospinal fluid) and MC-ADC-ratio (MC-ADC divided by vertebral body ADC). We calculated mean difference between observers ± limits of agreement (LoA) at separate endplates. The relation between ADC variables and MC type was assessed using linear mixed-effects models and by calculating the area under the receiver operating characteristic curve (AUC). Results The 90 patients (mean age 44 years; 54 women) had 224 MCs Th12-S1 comprising type 1 (n = 111), type 2 (n = 91) and type 3 MC groups (n = 22). All ADC variables had higher predicted mean for type 1 vs 3 vs 2 (p < 0.001 to 0.02): MC-ADC (10− 6 mm2/s) 1201/796/576, MC-ADC% 36/21/14, and MC-ADC-ratio 5.9/4.2/3.1. MC-ADC and MC-ADC% had moderate to high ability to discriminate between the MC type groups (AUC 0.73–0.91). MC-ADC-ratio had low to moderate ability (AUC 0.67–0.85). At L4-S1, widest/narrowest LoA were for MC-ADC 20 ± 407/12 ± 254, MC-ADC% 1.6 ± 18.8/1.4 ± 10.4, and MC-ADC-ratio 0.3 ± 4.3/0.2 ± 3.9. Difference between observers > 50% of their mean value was less frequent for MC-ADC (9% of MCs) vs MC-ADC% and MC-ADC-ratio (17–20%). Conclusions The MC-ADC variable (highest mean ADC in the MC) had best interobserver reproducibility, discriminated between MC type groups, and may be used in further research. ADC values differed between MC types as expected from previously reported MC histology. Supplementary Information The online version contains supplementary material available at 10.1186/s12891-022-05610-4.
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12
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Gulati M, Goyal A, Sharma R. Pseudotumors in chronic kidney disease: a distinct entity. Acta Radiol 2022; 63:984-985. [PMID: 34812059 DOI: 10.1177/02841851211062075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Malvika Gulati
- Department of Radiodiagnosis and Interventional Radiology, All India Institute of Medical Sciences, New Delhi, India
| | - Ankur Goyal
- Department of Radiodiagnosis and Interventional Radiology, All India Institute of Medical Sciences, New Delhi, India
| | - Raju Sharma
- Department of Radiodiagnosis and Interventional Radiology, All India Institute of Medical Sciences, New Delhi, India
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13
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Diagnosis and Treatment of Small Renal Masses: Where Do We Stand? Curr Urol Rep 2022; 23:99-111. [PMID: 35507213 DOI: 10.1007/s11934-022-01093-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/03/2022] [Indexed: 01/20/2023]
Abstract
PURPOSE OF REVIEW To present an overview of the current evidence-based studies covering diagnostic and management of SRM. RECENT FINDINGS Renal cell carcinoma (RCC) represents 3% of the cancers. Nowadays, partial nephrectomy (PN) represents gold standard treatment. New nephron-sparing approaches such as active surveillance and ablative therapies have been increasingly used as an alternative to surgical intervention. Due to novel comprehension of RCC and widespread use of imaging techniques, diagnosis at early stage in elderly patients has increased. Treatment decision-making should be based on patient and tumour characteristics. With expanding treatment options, the management of SRMs has become a debate and should be adjusted to patient and tumour characteristics. In a shared decision manner, both active surveillance with possible delayed intervention and focal therapy should be discussed with the patient as an alternative to partial nephrectomy.
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14
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Roussel E, Capitanio U, Kutikov A, Oosterwijk E, Pedrosa I, Rowe SP, Gorin MA. Novel Imaging Methods for Renal Mass Characterization: A Collaborative Review. Eur Urol 2022; 81:476-488. [PMID: 35216855 PMCID: PMC9844544 DOI: 10.1016/j.eururo.2022.01.040] [Citation(s) in RCA: 40] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 01/08/2022] [Accepted: 01/21/2022] [Indexed: 01/19/2023]
Abstract
CONTEXT The incidental detection of localized renal masses has been rising steadily, but a significant proportion of these tumors are benign or indolent and, in most cases, do not require treatment. At the present time, a majority of patients with an incidentally detected renal tumor undergo treatment for the presumption of cancer, leading to a significant number of unnecessary surgical interventions that can result in complications including loss of renal function. Thus, there exists a clinical need for improved tools to aid in the pretreatment characterization of renal tumors to inform patient management. OBJECTIVE To systematically review the evidence on noninvasive, imaging-based tools for solid renal mass characterization. EVIDENCE ACQUISITION The MEDLINE database was systematically searched for relevant studies on novel imaging techniques and interpretative tools for the characterization of solid renal masses, published in the past 10 yr. EVIDENCE SYNTHESIS Over the past decade, several novel imaging tools have offered promise for the improved characterization of indeterminate renal masses. Technologies of particular note include multiparametric magnetic resonance imaging of the kidney, molecular imaging with targeted radiopharmaceutical agents, and use of radiomics as well as artificial intelligence to enhance the interpretation of imaging studies. Among these, 99mTc-sestamibi single photon emission computed tomography/computed tomography (CT) for the identification of benign renal oncocytomas and hybrid oncocytic chromophobe tumors, and positron emission tomography/CT imaging with radiolabeled girentuximab for the identification of clear cell renal cell carcinoma, are likely to be closest to implementation in clinical practice. CONCLUSIONS A number of novel imaging tools stand poised to aid in the noninvasive characterization of indeterminate renal masses. In the future, these tools may aid in patient management by providing a comprehensive virtual biopsy, complete with information on tumor histology, underlying molecular abnormalities, and ultimately disease prognosis. PATIENT SUMMARY Not all renal tumors require treatment, as a significant proportion are either benign or have limited metastatic potential. Several innovative imaging tools have shown promise for their ability to improve the characterization of renal tumors and provide guidance in terms of patient management.
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Affiliation(s)
- Eduard Roussel
- Department of Urology, University Hospitals Leuven, Leuven, Belgium
| | - Umberto Capitanio
- Department of Urology, University Vita-Salute, San Raffaele Scientific Institute, Milan, Italy; Division of Experimental Oncology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Alexander Kutikov
- Division of Urology, Department of Surgery, Fox Chase Cancer Center, Temple University Health System, Philadelphia, PA, USA
| | - Egbert Oosterwijk
- Department of Urology, Radboud University Medical Center, Radboud Institute for Molecular Life Sciences (RIMLS), Nijmegen, The Netherlands
| | - Ivan Pedrosa
- Department of Radiology, University of Texas Southwestern Medical Center, Dallas, TX, USA; Advanced Imaging Research Center. University of Texas Southwestern Medical Center, Dallas, TX, USA; Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Steven P Rowe
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA; The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Michael A Gorin
- Urology Associates and UPMC Western Maryland, Cumberland, MD, USA; Department of Urology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
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15
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LiKidMiRs: A ddPCR-Based Panel of 4 Circulating miRNAs for Detection of Renal Cell Carcinoma. Cancers (Basel) 2022; 14:cancers14040858. [PMID: 35205607 PMCID: PMC8869982 DOI: 10.3390/cancers14040858] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 02/06/2022] [Accepted: 02/07/2022] [Indexed: 01/26/2023] Open
Abstract
Simple Summary Early detection of renal cell carcinoma (RCC) significantly increases the likelihood of curative treatment, avoiding the need of adjuvant therapies, associated side effects and comorbidities. Thus, we aimed to discover circulating microRNAs that might aid in early, minimally invasive, RCC detection/diagnosis. Abstract Background: Decreased renal cell cancer-related mortality is an important societal goal, embodied by efforts to develop effective biomarkers enabling early detection and increasing the likelihood of curative treatment. Herein, we sought to develop a new biomarker for early and minimally invasive detection of renal cell carcinoma (RCC) based on a microRNA panel assessed by ddPCR. Methods: Plasma samples from patients with RCC (n = 124) or oncocytomas (n = 15), and 64 healthy donors, were selected. Hsa-miR-21-5p, hsa-miR-126-3p, hsa-miR-155-5p and hsa-miR-200b-3p levels were evaluated using a ddPCR protocol. Results: RCC patients disclosed significantly higher circulating levels of hsa-miR-155-5p compared to healthy donors, whereas the opposite was observed for hsa-miR-21-5p levels. Furthermore, hsa-miR-21-5p and hsa-miR-155-5p panels detected RCC with high sensitivity (82.66%) and accuracy (71.89%). The hsa-miR-126-3p/hsa-miR-200b-3p panel identified the most common RCC subtype (clear cell, ccRCC) with 74.78% sensitivity. Conclusion: Variable combinations of plasma miR levels assessed by ddPCR enable accurate detection of RCC in general, and of ccRCC. These findings, if confirmed in larger studies, provide evidence for a novel ancillary tool which might aid in early detection of RCC.
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16
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Goyal A, Gulati M, Sharma R, Gamanagatti S, Seith Bhalla A, Seth A. Multimodality imaging evaluation of pseudotumors in chronic renal dysfunction: exposing the masquerade! Acta Radiol 2021; 64:387-394. [PMID: 34913396 DOI: 10.1177/02841851211061441] [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
Focal renal lesions in the background of chronic kidney disease (CKD) present a diagnostic challenge. Contrast administration is usually avoided in such a setting, undermining the usefulness of computed tomography and magnetic resonance imaging. Focal regenerating nodules may occur in the background of CKD and closely mimic renal neoplasms. The aim of the present article was to highlight the salient manifestations of such CKD pseudotumors on different imaging modalities and also to depict the differentiating features from malignancy. Radiologists must be aware of the imaging appearance of this uncommonly talked about entity so as to avoid inadvertent surgery or cause undue anxiety to the patient.
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Affiliation(s)
- Ankur Goyal
- Department of Radiodiagnosis and Interventional Radiology, All India Institute of Medical Sciences, New Delhi, India
| | - Malvika Gulati
- Department of Radiodiagnosis and Interventional Radiology, All India Institute of Medical Sciences, New Delhi, India
| | - Raju Sharma
- Department of Radiodiagnosis and Interventional Radiology, All India Institute of Medical Sciences, New Delhi, India
| | - Shivanand Gamanagatti
- Department of Radiodiagnosis and Interventional Radiology, All India Institute of Medical Sciences, New Delhi, India
| | - Ashu Seith Bhalla
- Department of Radiodiagnosis and Interventional Radiology, All India Institute of Medical Sciences, New Delhi, India
| | - Amlesh Seth
- Department of Urology, All India Institute of Medical Sciences, New Delhi, India
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17
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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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18
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Lee SK, Lee J, Jang S, Lee E, Jeon CY, Lim KS, Jin YB, Choi J. Renal Diffusion-Weighted Imaging in Healthy Dogs: Reproducibility, Test-Retest Repeatability, and Selection of the Optimal b-value Combination. Front Vet Sci 2021; 8:641971. [PMID: 34277748 PMCID: PMC8282824 DOI: 10.3389/fvets.2021.641971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 06/08/2021] [Indexed: 11/13/2022] Open
Abstract
Diffusion-weighted imaging (DWI) magnetic resonance imaging can evaluate alterations in the microstructure of the kidney. The purpose of this study was to assess the apparent diffusion coefficient (ADC) and the intravoxel incoherent motion model (IVIM) parameters of a normal kidney in healthy dogs, to evaluate the effect of b-value combinations on the ADC value, and the reproducibility and test-retest repeatability in monoexponential and IVIM analysis. In this experimental study, the ADC, pure diffusion coefficient (D), pseudodiffusion coefficient (D*), and perfusion fraction (f p) were measured from both kidneys in nine healthy beagles using nine b-values (b = 0, 50, 70, 100, 150, 200, 500, 800, and 1,000 s/mm2) twice with a 1-week interval between measurements. Interobserver and intraobserver reproducibility, and test-retest repeatability of the measurements were calculated. ADC values were measured using 10 different b-value combinations consisting of three b-values each, and were compared to the ADC obtained from nine b-values. All the ADC, D, D*, and f p values measured from the renal cortex, medulla, and the entire kidney had excellent interobserver and intraobserver reproducibility, and test-retest repeatability. The ADC obtained from a b-value combination of 0, 100, and 800 s/mm2 had the highest intraclass correlation coefficient with the ADC from nine b-values. The results of this study indicated that DWI MRI using multiple b-values is feasible for the measurement of ADC and IVIM parameters with high reproducibility and repeatability in the kidneys of healthy dogs. A combination of b = 0, 100, and 800 s/mm2 can be used for ADC measurements when multiple b-values are not available in dogs.
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Affiliation(s)
- Sang-Kwon Lee
- College of Veterinary Medicine and BK21 Plus Project Team, Chonnam National University, Gwangju, South Korea
| | - Juryeoung Lee
- College of Veterinary Medicine and BK21 Plus Project Team, Chonnam National University, Gwangju, South Korea
| | - Seolyn Jang
- College of Veterinary Medicine and BK21 Plus Project Team, Chonnam National University, Gwangju, South Korea
| | - Eunji Lee
- College of Veterinary Medicine and BK21 Plus Project Team, Chonnam National University, Gwangju, South Korea
| | - Chang-Yeop Jeon
- National Primate Research Center, Korea Research Institute of Bioscience and Biotechnology, Cheongju, South Korea
| | - Kyung-Seoub Lim
- Futuristic Animal Resource and Research Center, Korea Research Institute of Bioscience and Biotechnology, Cheongju, South Korea
| | - Yeung Bae Jin
- College of Veterinary Medicine, Gyeongsang National University, Jinju, South Korea
| | - Jihye Choi
- College of Veterinary Medicine and BK21 Plus Project Team, Chonnam National University, Gwangju, South Korea
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Zhu J, Luo X, Gao J, Li S, Li C, Chen M. Application of diffusion kurtosis tensor MR imaging in characterization of renal cell carcinomas with different pathological types and grades. Cancer Imaging 2021; 21:30. [PMID: 33726862 PMCID: PMC7962255 DOI: 10.1186/s40644-021-00394-7] [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: 08/03/2020] [Accepted: 02/19/2021] [Indexed: 12/13/2022] Open
Abstract
Background To probe the feasibility and reproducibility of diffusion kurtosis tensor imaging (DKTI) in renal cell carcinoma (RCC) and to apply DKTI in distinguishing the subtypes of RCC and the grades of clear cell RCC (CCRCC). Methods Thirty-eight patients with pathologically confirmed RCCs [CCRCC for 30 tumors, papillary RCC (PRCC) for 5 tumors and chromophobic RCC (CRCC) for 3 tumors] were involved in the study. Diffusion kurtosis tensor MR imaging were performed with 3 b-values (0, 500, 1000s/mm2) and 30 diffusion directions. The mean kurtosis (MK), axial kurtosis (Ka), radial kurtosis (Kr) values and mean diffusity (MD) for RCC and contralateral normal parenchyma were acquired. The inter-observer agreements of all DKTI metrics of contralateral renal cortex and medulla were evaluated using Bland-Altman plots. Statistical comparisons with DKTI metrics of 3 RCC subtypes and between low-grade (Furman grade I ~ II, 22 cases) and high-grade (Furman grade III ~ IV, 8 cases) CCRCC were performed with ANOVA test and Student t test separately. Receiver operating characteristic (ROC) curve analyses were used to compare the diagnostic efficacy of DKTI metrics for predicting nuclear grades of CCRCC. Correlations between DKTI metrics and nuclear grades were also evaluated with Spearman correlation analysis. Results Inter-observer measurements for each metric showed great reproducibility with excellent ICCs ranging from 0.81 to 0.87. There were significant differences between the DKTI metrics of RCCs and contralateral renal parenchyma, also among the subtypes of RCC. MK and Ka values of CRCC were significantly higher than those of CCRCC and PRCC. Statistical difference of the MK, Ka, Kr and MD values were also obtained between CCRCC with high- and low-grades. MK values were more effective for distinguishing between low- and high- grade CCRCC (area under the ROC curve: 0.949). A threshold value of 0.851 permitted distinction with high sensitivity (90.9%) and specificity (87.5%). Conclusion Our preliminary results suggest a possible role of DKTI in differentiating CRCC from CCRCC and PRCC. MK, the principle DKTI metric might be a surrogate biomarker to predict nuclear grades of CCRCC. Trial registration ChiCTC, ChiCTR-DOD-17010833, Registered 10 March, 2017, retrospectively registered, http://www.chictr.org.cn/showproj.aspx?proj=17559.
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Affiliation(s)
- Jie Zhu
- Department of Radiology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, P. R. China
| | - Xiaojie Luo
- Department of Radiology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, P. R. China
| | - Jiayin Gao
- Department of Radiology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, P. R. China
| | - Saying Li
- Department of Radiology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, P. R. China
| | - Chunmei Li
- Department of Radiology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, P. R. China
| | - Min Chen
- Department of Radiology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, P. R. China.
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Moharamzad Y, Davarpanah AH, Yaghobi Joybari A, Shahbazi F, Esmaeilian Toosi L, Kooshkiforooshani M, Ansari A, Sanei Taheri M. Diagnostic performance of apparent diffusion coefficient (ADC) for differentiating endometrial carcinoma from benign lesions: a systematic review and meta-analysis. Abdom Radiol (NY) 2021; 46:1115-1128. [PMID: 32935258 DOI: 10.1007/s00261-020-02734-w] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Revised: 08/20/2020] [Accepted: 08/30/2020] [Indexed: 01/07/2023]
Abstract
To determine the diagnostic performance of mean ADC values in the characterization of endometrial carcinoma (EC) from benign lesions by systematic review of the literature and performing meta-analysis. A systematic search of major electronic bibliographic databases was performed to find studies that used ADC values for differentiating EC from benign lesions. Two reviewers independently screened the titles and abstracts of the search results and then by reading the full texts selected the pertinent studies for final analyses. A bivariate random-effects model with pooled sensitivity and specificity values with 95% CI (confidence interval) was used. Summary receiver operating characteristic (SROC) curve and area under curve (AUC) were created. Between-study heterogeneity was measured using I squared (I2) index. Eleven studies including 269 ECs and 208 benign lesions were analyzed. Pooled average (95% CI) ADC in EC and benign lesions groups were, respectively, 0.82 (0.77-0.87) × 10-3 mm2/s and 1.41 (1.29-1.52) × 10-3 mm2/s. The combined (95% CI) sensitivity and specificity of mean ADC values for differentiating EC from benign lesions were 93% (87-96%; I2 = 41.19%) and 94% (88-97%; I2 = 46.91%), respectively. The AUC (95% CI) of the SROC curve was 98% (96-99%). ADC values had good diagnostic accuracy for differentiating EC from benign lesions. In order to recommend ADC measurement for detecting endometrial lesions in routine clinical practice, more primary studies, especially trials and comparative studies including hysteroscopically-guided biopsy method, with larger sample sizes are still required.
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Affiliation(s)
- Yashar Moharamzad
- School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Amir H Davarpanah
- Department of Radiology and Imaging Sciences, Emory University Hospital, Emory University School of Medicine, Atlanta, GA, 30322, USA
| | - Ali Yaghobi Joybari
- School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Fatemeh Shahbazi
- School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | | | - Ali Ansari
- Department of Mathematics, K. N. Toosi University of Technology, Tehran, Iran
| | - Morteza Sanei Taheri
- School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
- Department of Radiology, Shohada Hospital, Tajrish Sq., 1445613131, Tehran, Iran.
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Dwivedi DK, Xi Y, Kapur P, Madhuranthakam AJ, Lewis MA, Udayakumar D, Rasmussen R, Yuan Q, Bagrodia A, Margulis V, Fulkerson M, Brugarolas J, Cadeddu JA, Pedrosa I. Magnetic Resonance Imaging Radiomics Analyses for Prediction of High-Grade Histology and Necrosis in Clear Cell Renal Cell Carcinoma: Preliminary Experience. Clin Genitourin Cancer 2021; 19:12-21.e1. [PMID: 32669212 PMCID: PMC7680717 DOI: 10.1016/j.clgc.2020.05.011] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Revised: 05/16/2020] [Accepted: 05/16/2020] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Percutaneous renal mass biopsy results can accurately diagnose clear cell renal cell carcinoma (ccRCC); however, their reliability to determine nuclear grade in larger, heterogeneous tumors is limited. We assessed the ability of radiomics analyses of magnetic resonance imaging (MRI) to predict high-grade (HG) histology in ccRCC. PATIENTS AND METHODS Seventy patients with a renal mass underwent 3 T MRI before surgery between August 2012 and August 2017. Tumor length, first-order statistics, and Haralick texture features were calculated on T2-weighted and dynamic contrast-enhanced (DCE) MRI after manual tumor segmentation. After a variable clustering algorithm was applied, tumor length, washout, and all cluster features were evaluated univariably by receiver operating characteristic curves. Three logistic regression models were constructed to assess the predictability of HG ccRCC and then cross-validated. RESULTS At univariate analysis, area under the curve values of length, and DCE texture cluster 1 and cluster 3 for diagnosis of HG ccRCC were 0.7 (95% confidence interval [CI], 0.58-0.82, false discovery rate P = .008), 0.72 (95% CI, 0.59-0.84, false discovery rate P = .004), and 0.75 (95% CI, 0.63-0.87, false discovery rate P = .0009), respectively. At multivariable analysis, area under the curve for model 1 (tumor length only), model 2 (length + DCE clusters 3 and 4), and model 3 (DCE cluster 1 and 3) for diagnosis of HG ccRCC were 0.67 (95% CI, 0.54-0.79), 0.82 (95% CI, 0.71-0.92), and 0.81 (95% CI, 0.70-0.91), respectively. CONCLUSION Radiomics analysis of MRI images was superior to tumor size for the prediction of HG histology in ccRCC in our cohort.
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Affiliation(s)
| | - Yin Xi
- Department of Radiology, UT Southwestern Medical Center, Dallas, TX; Department of Clinical Science, UT Southwestern Medical Center, Dallas, TX
| | - Payal Kapur
- Department of Pathology, UT Southwestern Medical Center, Dallas, TX; Department of Urology, UT Southwestern Medical Center, Dallas, TX; Kidney Cancer Program, UT Southwestern Medical Center, Dallas, TX
| | - Ananth J Madhuranthakam
- Department of Radiology, UT Southwestern Medical Center, Dallas, TX; Kidney Cancer Program, UT Southwestern Medical Center, Dallas, TX; Advanced Imaging Research Center, UT Southwestern Medical Center, Dallas, TX
| | - Matthew A Lewis
- Department of Radiology, UT Southwestern Medical Center, Dallas, TX
| | - Durga Udayakumar
- Department of Radiology, UT Southwestern Medical Center, Dallas, TX; Kidney Cancer Program, UT Southwestern Medical Center, Dallas, TX; Advanced Imaging Research Center, UT Southwestern Medical Center, Dallas, TX
| | - Robert Rasmussen
- Department of Radiology, UT Southwestern Medical Center, Dallas, TX
| | - Qing Yuan
- Department of Radiology, UT Southwestern Medical Center, Dallas, TX
| | - Aditya Bagrodia
- Department of Urology, UT Southwestern Medical Center, Dallas, TX; Kidney Cancer Program, UT Southwestern Medical Center, Dallas, TX
| | - Vitaly Margulis
- Department of Urology, UT Southwestern Medical Center, Dallas, TX; Kidney Cancer Program, UT Southwestern Medical Center, Dallas, TX
| | | | - James Brugarolas
- Kidney Cancer Program, UT Southwestern Medical Center, Dallas, TX; Department of Internal Medicine, UT Southwestern Medical Center, Dallas, TX
| | - Jeffrey A Cadeddu
- Department of Urology, UT Southwestern Medical Center, Dallas, TX; Kidney Cancer Program, UT Southwestern Medical Center, Dallas, TX
| | - Ivan Pedrosa
- Department of Radiology, UT Southwestern Medical Center, Dallas, TX; Department of Urology, UT Southwestern Medical Center, Dallas, TX; Kidney Cancer Program, UT Southwestern Medical Center, Dallas, TX; Advanced Imaging Research Center, UT Southwestern Medical Center, Dallas, TX.
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Chen J, Liu S, Tang Y, Zhang X, Cao M, Xiao Z, Ren M, Chen X. Performance of diffusion-weighted imaging for the diagnosis of parotid gland malignancies: A meta-analysis. Eur J Radiol 2020; 134:109444. [PMID: 33310422 DOI: 10.1016/j.ejrad.2020.109444] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 11/10/2020] [Accepted: 11/24/2020] [Indexed: 02/06/2023]
Abstract
PURPOSE This study aimed to assess the diagnostic performance of diffusion-weighted imaging (DWI) for parotid gland malignancies. METHODS Four databases (PubMed, the Cochrane Library, Embase, and Web of Science) were searched systematically and retrospectively by two researchers until May 18, 2020. The methodological quality of the studies was assessed using the Quality Assessment of Diagnostic Accuracy Studies-2 tool. A bivariate random effects model was used to pool the sensitivity and specificity data for the apparent diffusion coefficient (ADC). Summary receiver operating characteristic curve was constructed, and the area under the curve (AUC) was calculated. The positive (LR+) and negative likelihood ratios (LR-) were also calculated. Subgroup and meta-regression analyses were performed to evaluate heterogeneity within studies. RESULTS Sixteen studies involving 1004 patients were included. The pooled sensitivity, specificity, and AUC for the ADC to distinguish malignant from begin parotid lesions were 89 %, 76 %, and 0.91, respectively. The LR + was 3.7 and LR- was 0.15, respectively. Subgroup analyses revealed that the applied cut-off b values and study size were sources of heterogeneity for the ADC. There were publication bias concerns. CONCLUSIONS Our meta-analysis suggests that the ADC value provides excellent sensitivity and moderate specificity for the diagnosis of malignant lesions in the parotid gland. However, substantial heterogeneity was found. Therefore, additional larger, prospective studies in combination with standard techniques focusing on parotid tumors should be conducted to determine the true performance of DWI for the differential diagnosis of parotid lesions.
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Affiliation(s)
- Jing Chen
- Department of Radiology, Zhongshan Affiliated Hospital, Guangzhou University of Traditional Chinese Medicine, Zhongshan, 528400, PR China.
| | - Shuxue Liu
- Department of Radiology, Zhongshan Affiliated Hospital, Guangzhou University of Traditional Chinese Medicine, Zhongshan, 528400, PR China
| | - Yude Tang
- Department of Radiology, Zhongshan Affiliated Hospital, Guangzhou University of Traditional Chinese Medicine, Zhongshan, 528400, PR China
| | - Xiongbiao Zhang
- Department of Radiology, Zhongshan Affiliated Hospital, Guangzhou University of Traditional Chinese Medicine, Zhongshan, 528400, PR China
| | - Mingming Cao
- Department of Radiology, Zhongshan Affiliated Hospital, Guangzhou University of Traditional Chinese Medicine, Zhongshan, 528400, PR China
| | - Zheng Xiao
- Department of Radiology, Zhongshan Affiliated Hospital, Guangzhou University of Traditional Chinese Medicine, Zhongshan, 528400, PR China
| | - Mingda Ren
- Department of Radiology, Zhongshan Affiliated Hospital, Guangzhou University of Traditional Chinese Medicine, Zhongshan, 528400, PR China
| | - Xianteng Chen
- Department of Radiology, Zhongshan Affiliated Hospital, Guangzhou University of Traditional Chinese Medicine, Zhongshan, 528400, PR China
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Golan S, Aviv T, Groshar D, Yakimov M, Zohar Y, Prokocimer Y, Nadu A, Baniel J, Domachevsky L, Bernstine H. Dynamic 68Ga-PSMA-11 PET/CT for the Primary Evaluation of Localized Renal Mass: A Prospective Study. J Nucl Med 2020; 62:773-778. [PMID: 33097628 DOI: 10.2967/jnumed.120.251272] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 09/23/2020] [Indexed: 01/29/2023] Open
Abstract
The potential role of prostate-specific membrane antigen (PSMA) PET/CT in non-prostate cancer tumors has shown promising results. We examined the performance of dynamic 68Ga-PSMA-11 PET/CT (DPSMA) for the evaluation of localized renal mass. Methods: A prospective case series of patients with a newly diagnosed renal mass who were referred for surgery was examined. DPSMA was performed in a standardized manner before surgery. The final surgical histology served as the standard of reference. PSMA expression in the tumor vasculature was assessed and staining intensity was scored. Tracer uptake and PSMA expression were compared between benign and malignant tissue. Results: Of 29 enhancing renal masses evaluated in 27 patients, 24 (83%) were malignant lesions. The median SUVmean of benign and malignant lesions was 2.3 (interquartile range [IQR], 2.2-2.7) and 6.8 (IQR, 4.2-10.1), respectively (P = 0.009). Median SUVmax of benign and malignant lesions was 3.8 (IQR, 3.3-4.5) and 9.4 (IQR, 5.4-15.8), respectively (P = 0.015). The median washout coefficient (K 2) was significantly lower in malignant lesions than in benign lesions (0.17 vs. 0.70, P = 0.02). Positive PSMA staining was found in 20 of 24 malignant lesions and in 2 of 5 benign lesions (P = 0.04). Conclusion: This pilot study demonstrated DPSMA uptake and kinetics in localized renal masses. Increased 68Ga-PSMA-11 tracer uptake and intratumoral retention correlate with PSMA expression in malignant renal tumors compared with benign renal masses, supporting further assessment of DPSMA as a potential tool for evaluating localized renal masses.
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Affiliation(s)
- Shay Golan
- Department of Urology, Rabin Medical Center, Petach Tikva, Israel .,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Tzach Aviv
- Department of Urology, Rabin Medical Center, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - David Groshar
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Nuclear Medicine Rabin Medical Center, Petach Tikva, Israel
| | - Maxim Yakimov
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Pathology, Rabin Medical Center, Petach Tikva, Israel
| | - Yaniv Zohar
- Department of Pathology, Rambam Health Care Campus, Haifa, Israel; and
| | - Yoad Prokocimer
- Department of Urology, Rabin Medical Center, Petach Tikva, Israel
| | - Andrei Nadu
- Department of Urology, Rabin Medical Center, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Jack Baniel
- Department of Urology, Rabin Medical Center, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Liran Domachevsky
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Nuclear Medicine, The Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - Hanna Bernstine
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Nuclear Medicine Rabin Medical Center, Petach Tikva, Israel
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The role of Tc-99m MIBI scintigraphy in clinical T1 renal mass assessment: Does it have a real benefit? Urol Oncol 2020; 38:937.e11-937.e17. [PMID: 32859460 DOI: 10.1016/j.urolonc.2020.07.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Revised: 06/19/2020] [Accepted: 07/13/2020] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Despite the increasing accuracy of imaging modalities, the rate of benign renal tumors misclassified as malignant before surgery still non-negligible. Tc-99m sestamibi was demonstrated to be a possible reliable agent in discriminating oncocytoma from renal cell carcinoma (RCC). We aimed to study the efficacy of Tc-99m MIBI tumor scintigraphy in evaluating clinical T1 renal masses. METHODS AND MATERIALS Between July 2017 and March 2019, patients with clinical T1 renal mass underwent preoperative Tc-99m sestamibi tumor scintigraphy. Tc-99m sestamibi tumor scintigraphy findings were correlated with the postoperative pathology results. RESULTS A total of 90 renal masses were included in the study. Male to female ratio was 67/23. The mean age and tumor size were 55.5 ± 11.4 years and 4 ± 1.4 cm, respectively. In pathological evaluation, 20% (18/90) of masses were reported as benign (10 oncocytomas, 4 angiomyolipomas (AML), 2 chronic sclerosis, 1 fibroma and 1 hydatid cyst). While Tc-99m sestamibi uptake was positive in all oncocytomas; 6 patients with chronic sclerosis, fibroma, hydatid cyst and angiomyolipoma pathologies had no uptake. Except for 5 chromophobe cell RCC and 3 oncocytic papillary RCC masses, malignant lesions had no uptake. In predicting benign pathology, Tc-99m sestamibi tumor scintigraphy had positive and negative predictive value of 60% and 91.3%, respectively. The mean Tc-99m 2-methoxy isobutyl isonitrile lesion/normal renal parenchyma ratio of benign and malignant lesions was 0.6 and 0.37, respectively. A relative uptake of 0.49 was an acceptable cutoff point to discriminate oncocytomas from all other pathologies. CONCLUSION Tc-99m sestamibi tumor scintigraphy has a beneficial role in the assessment of clinical T1 renal mass. Masses with negative uptake harbor high probability of being malignant. While evaluating masses with positive uptake, it should be kept in mind that some malignant pathologies may demonstrate similar results.
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Musaddaq B, Musaddaq T, Gupta A, Ilyas S, von Stempel C. Renal Cell Carcinoma: The Evolving Role of Imaging in the 21st Century. Semin Ultrasound CT MR 2020; 41:344-350. [DOI: 10.1053/j.sult.2020.05.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Is 18F-FDG PET/CT an Accurate Way to Detect Lymph Node Metastasis in Colorectal Cancer: A Systematic Review and Meta-Analysis. CONTRAST MEDIA & MOLECULAR IMAGING 2020; 2020:5439378. [PMID: 32733174 PMCID: PMC7383332 DOI: 10.1155/2020/5439378] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/11/2020] [Accepted: 06/15/2020] [Indexed: 12/20/2022]
Abstract
Aims The purpose of this study was to assess the diagnostic value of 18F-fluorodeoxy-glucose positron emission tomography/computed tomography (FDG PET/CT) for detection of lymph node (LN) metastasis of colorectal cancer. Material and Methods. A computerized search was performed to determine the relevant articles, published before October 2019. Stata Statistical Software, version 15.0, and Meta-Disc (version 1.4) were used for the meta-analysis. Results the sensitivity, specificity, positive likelihood ratio, and negative likelihood ratio were 0.65, 0.75, 4.57, and 0.37 respectively. Studies that used SUVmax cut-off value (≤2.5) demonstrated the best accuracy. Conclusion 18F-FDG PET/CT shows a low sensitivity and high specificity for detecting the metastasis of LNs in patients with newly diagnosed colorectal cancer.
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Diffusion-Weighted Imaging in Oncology: An Update. Cancers (Basel) 2020; 12:cancers12061493. [PMID: 32521645 PMCID: PMC7352852 DOI: 10.3390/cancers12061493] [Citation(s) in RCA: 73] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 05/28/2020] [Accepted: 06/01/2020] [Indexed: 02/06/2023] Open
Abstract
To date, diffusion weighted imaging (DWI) is included in routine magnetic resonance imaging (MRI) protocols for several cancers. The real additive role of DWI lies in the "functional" information obtained by probing the free diffusivity of water molecules into intra and inter-cellular spaces that in tumors mainly depend on cellularity. Although DWI has not gained much space in some oncologic scenarios, this non-invasive tool is routinely used in clinical practice and still remains a hot research topic: it has been tested in almost all cancers to differentiate malignant from benign lesions, to distinguish different malignant histotypes or tumor grades, to predict and/or assess treatment responses, and to identify residual or recurrent tumors in follow-up examinations. In this review, we provide an up-to-date overview on the application of DWI in oncology.
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Goh V, Prezzi D. Predicting Growth Kinetics in Hereditary Renal Cancer with Diffusion-weighted MRI. Radiology 2020; 295:591-592. [PMID: 32267214 DOI: 10.1148/radiol.2020200700] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Vicky Goh
- From the Department of Cancer Imaging, School of Biomedical Engineering and Imaging Sciences, King's College London, King's Health Partners, London, England; and Department of Radiology, Guy's and St Thomas' NHS Foundation Trust, Level 1, Lambeth Wing, St Thomas' Hospital, Westminster Bridge Road, London SE1 7EH, England
| | - Davide Prezzi
- From the Department of Cancer Imaging, School of Biomedical Engineering and Imaging Sciences, King's College London, King's Health Partners, London, England; and Department of Radiology, Guy's and St Thomas' NHS Foundation Trust, Level 1, Lambeth Wing, St Thomas' Hospital, Westminster Bridge Road, London SE1 7EH, England
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Krishna S, Leckie A, Kielar A, Hartman R, Khandelwal A. Imaging of Renal Cancer. Semin Ultrasound CT MR 2020; 41:152-169. [DOI: 10.1053/j.sult.2019.12.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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Diagnostic test accuracy of ADC values for identification of clear cell renal cell carcinoma: systematic review and meta-analysis. Eur Radiol 2020; 30:4023-4038. [PMID: 32144458 DOI: 10.1007/s00330-020-06740-w] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 01/14/2020] [Accepted: 02/11/2020] [Indexed: 12/11/2022]
Abstract
OBJECTIVES To perform a systematic review on apparent diffusion coefficient (ADC) values of renal tumor subtypes and meta-analysis on the diagnostic performance of ADC for differentiation of localized clear cell renal cell carcinoma (ccRCC) from other renal tumor types. METHODS Medline, Embase, and the Cochrane Library databases were searched for studies published until May 1, 2019, that reported ADC values of renal tumors. Methodological quality was evaluated. For the meta-analysis on diagnostic test accuracy of ADC for differentiation of ccRCC from other renal lesions, we applied a bivariate random-effects model and compared two subgroups of ADC measurement with vs. without cystic and necrotic areas. RESULTS We included 48 studies (2588 lesions) in the systematic review and 13 studies (1126 lesions) in the meta-analysis. There was no significant difference in ADC of renal parenchyma using b values of 0-800 vs. 0-1000 (p = 0.08). ADC measured on selected portions (sADC) excluding cystic and necrotic areas differed significantly from whole-lesion ADC (wADC) (p = 0.002). Compared to ccRCC, minimal-fat angiomyolipoma, papillary RCC, and chromophobe RCC showed significantly lower sADC while oncocytoma exhibited higher sADC. Summary estimates of sensitivity and specificity to differentiate ccRCC from other tumors were 80% (95% CI, 0.76-0.88) and 78% (95% CI, 0.64-0.89), respectively, for sADC and 77% (95% CI, 0.59-0.90) and 77% (95% CI, 0.69-0.86) for wADC. sADC offered a higher area under the receiver operating characteristic curve than wADC (0.852 vs. 0.785, p = 0.02). CONCLUSIONS ADC values of kidney tumors that exclude cystic or necrotic areas more accurately differentiate ccRCC from other renal tumor types than whole-lesion ADC values. KEY POINTS • Selective ADC of renal tumors, excluding cystic and necrotic areas, provides better discriminatory ability than whole-lesion ADC to differentiate clear cell RCC from other renal lesions, with area under the receiver operating characteristic curve (AUC) of 0.852 vs. 0.785, respectively (p = 0.02). • Selective ADC of renal masses provides moderate sensitivity and specificity of 80% and 78%, respectively, for differentiation of clear cell renal cell carcinoma (RCC) from papillary RCC, chromophobe RCC, oncocytoma, and minimal-fat angiomyolipoma. • Selective ADC excluding cystic and necrotic areas are preferable to whole-lesion ADC as an additional tool to multiphasic MRI to differentiate clear cell RCC from other renal lesions whether the highest b value is 800 or 1000.
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Diffusion-weighted Renal MRI at 9.4 Tesla Using RARE to Improve Anatomical Integrity. Sci Rep 2019; 9:19723. [PMID: 31873155 PMCID: PMC6928203 DOI: 10.1038/s41598-019-56184-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Accepted: 10/23/2019] [Indexed: 12/29/2022] Open
Abstract
Diffusion-weighted magnetic resonance imaging (DWI) is a non-invasive imaging technique sensitive to tissue water movement. By enabling a discrimination between tissue properties without the need of contrast agent administration, DWI is invaluable for probing tissue microstructure in kidney diseases. DWI studies commonly make use of single-shot Echo-Planar Imaging (ss-EPI) techniques that are prone to suffering from geometric distortion. The goal of the present study was to develop a robust DWI technique tailored for preclinical magnetic resonance imaging (MRI) studies that is free of distortion and sensitive to detect microstructural changes. Since fast spin-echo imaging techniques are less susceptible to B0 inhomogeneity related image distortions, we introduced a diffusion sensitization to a split-echo Rapid Acquisition with Relaxation Enhancement (RARE) technique for high field preclinical DWI at 9.4 T. Validation studies in standard liquids provided diffusion coefficients consistent with reported values from the literature. Split-echo RARE outperformed conventional ss-EPI, with ss-EPI showing a 3.5-times larger border displacement (2.60 vs. 0.75) and a 60% higher intra-subject variability (cortex = 74%, outer medulla = 62% and inner medulla = 44%). The anatomical integrity provided by the split-echo RARE DWI technique is an essential component of parametric imaging on the way towards robust renal tissue characterization, especially during kidney disease.
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Apparent Diffusion Coefficient Distinguishes Malignancy in T1-Hyperintense Small Renal Masses. AJR Am J Roentgenol 2019; 214:114-121. [PMID: 31573857 DOI: 10.2214/ajr.19.21907] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
OBJECTIVE. Small renal masses (< 4 cm) can be difficult to accurately classify as benign or malignant, particularly when they appear T1 hyperintense on MRI. This intrinsic signal, potentially related to intralesional hemorrhage, may limit evaluation of signal intensity on DWI. The purpose of this study was to test whether apparent diffusion coefficient (ADC) measurements may distinguish malignancy. MATERIALS AND METHODS. This single-center retrospective study identified patients with a T1-hyperintense renal mass less than 4 cm on MRI. Malignant lesions were pathologically proven; a benign mass was established by a predefined hierarchy of pathologic proof, follow-up ultrasound, or follow-up imaging showing more than 5 years of stability. T1 hyperintensity, defined as a signal intensity equivalent to or greater than the adjacent renal cortex, was confirmed by a senior abdominal radiologist. Two additional abdominal radiologists independently measured ADC of the lesion, which was normalized to the ADC of the background ipsilateral kidney and represented as ADCratio. RESULTS. The final cohort included 58 benign and 37 malignant renal lesions in 95 patients. Interrater agreement for ADC measurements was almost perfect (κ = 0.836-0.934). ADCratio was significantly lower in malignant compared with benign lesions (0.65 ± 0.29 vs 1.03 ± 0.32; p < 0.001). Malignant lesions were significantly larger than benign lesions (2.66 ± 0.86 cm vs 1.50 ± 0.65 cm; p < 0.001); however, after controlling for lesion size, ADCratio remained a significant predictor of malignancy (p < 0.001). CONCLUSION. ADCratio was highly reproducible for T1-hyperintense small renal masses and was significantly lower in malignant compared with benign renal masses.
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Zhou S, Wang Y, Ai T, Huang L, Zhu T, Zhu W, Xia L. Diagnosis of solitary pulmonary lesions with intravoxel incoherent motion diffusion-weighted MRI and semi-quantitative dynamic contrast-enhanced MRI. Clin Radiol 2019; 74:409.e7-409.e16. [DOI: 10.1016/j.crad.2018.12.022] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Accepted: 12/06/2018] [Indexed: 01/02/2023]
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Abstract
OBJECTIVE. Renal masses comprise a heterogeneous group of pathologic conditions, including benign and indolent diseases and aggressive malignancies, complicating management. In this article, we explore the emerging role of imaging to provide a comprehensive noninvasive characterization of a renal mass-so-called "virtual biopsy"-and its potential use in the management of patients with renal tumors. CONCLUSION. Percutaneous renal mass biopsy (RMB) remains a valuable method to provide a presurgical histopathologic diagnosis of renal masses, but it is an invasive procedure and is not always feasible. Accumulating data support the use of imaging features to predict histopathology of renal masses. Imaging may help address some of the inherent limitations of RMB, and in certain settings, a multimodal clinical approach may allow decreasing the need for RMB.
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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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Assessment of the extracellular volume fraction for the grading of clear cell renal cell carcinoma: first results and histopathological findings. Eur Radiol 2019; 29:5832-5843. [PMID: 30887194 DOI: 10.1007/s00330-019-06087-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Revised: 01/23/2019] [Accepted: 02/08/2019] [Indexed: 12/28/2022]
Abstract
OBJECTIVES To assess the potential of T1 mapping-based extracellular volume fraction (ECV) for the identification of higher grade clear cell renal cell carcinoma (cRCC), based on histopathology as the reference standard. METHODS For this single-center, institutional review board-approved prospective study, 27 patients (17 men, median age 62 ± 12.4 years) with pathologic diagnosis of cRCC (nucleolar International Society of Urological Pathology (ISUP) grading) received abdominal MRI scans at 1.5 T using a modified Look-Locker inversion recovery (MOLLI) sequence between January 2017 and June 2018. Quantitative T1 values were measured at different time points (pre- and postcontrast agent administration) and quantification of the ECV was performed on MRI and histological sections (H&E staining). RESULTS Reduction in T1 value after contrast agent administration and MR-derived ECV were reliable predictors for differentiating higher from lower grade cRCC. Postcontrast T1diff values (T1diff = T1 difference between the native and nephrogenic phase) and MR-derived ECV were significantly higher for higher grade cRCC (ISUP grades 3-4) compared with lower grade cRCC (ISUP grades 1-2) (p < 0.001). A cutoff value of 700 ms could distinguish higher grade from lower grade tumors with 100% (95% CI 0.69-1.00) sensitivity and 82% (95% CI 0.57-0.96) specificity. There was a positive and strong correlation between MR-derived ECV and histological ECV (p < 0.01, r = 0.88). Interobserver agreement for quantitative longitudinal relaxation times in the T1 maps was excellent. CONCLUSIONS T1 mapping with ECV measurement could represent a novel in vivo biomarker for the classification of cRCC regarding their nucleolar grade, providing incremental diagnostic value as a quantitative MR marker. KEY POINTS • Reduction in MRI T1 relaxation times after contrast agent administration and MR-derived extracellular volume fraction are useful parameters for grading of clear cell renal cell carcinoma (cRCC). • T1 differences between the native and the nephrogenic phase are higher for higher grade cRCC compared with lower grade cRCC and MRI-derived extracellular volume fraction (ECV) and histological ECV show a strong correlation. • T1 mapping with ECV measurement may be helpful for the noninvasive assessment of cRCC pathology, being a safe and feasible method, and it has potential to optimize individualized treatment options, e.g., in the decision of active surveillance.
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Diagnostic Performance of Apparent Diffusion Coefficient for Prediction of Grading of Pancreatic Neuroendocrine Tumors: A Systematic Review and Meta-analysis. Pancreas 2019; 48:151-160. [PMID: 30640226 DOI: 10.1097/mpa.0000000000001212] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
OBJECTIVES The aim of this study was to evaluate the diagnostic value of apparent diffusion coefficient (ADC) for the World Health Organization grade of pancreatic neuroendocrine tumors (pNETs). METHODS The MEDLINE, Google Scholar, PubMed, and Embase databases were searched to identify relevant original articles investigating the ADC value in predicting the grade of pNETs. The pooled sensitivity (SE), specificity (SP), positive likelihood ratio (PLR), and negative likelihood ratio (NLR) were calculated by using random effects models. Subgroup analysis was performed to discover heterogeneity effects. RESULTS Nine studies with 386 patients met our inclusion criteria. For identifying G1 from G2/3, the pooled SE, SP, PLR, NLR, and area under the curve of the summary receiver operating characteristic curve were 0.84 (95% confidence interval [95% CI], 0.73-0.91), 0.87 (95% CI, 0.72-0.94), 6.3 (95% CI, 2.7-14.6), 0.19 (95% CI, 0.10-0.34), and 0.91 (95% CI, 0.89-0.94), respectively. The summary estimates for ADC in distinguishing G3 from G1/2 were as follows: SE, 0.93 (95% CI, 0.66-0.99); SP, 0.92 (95% CI, 0.86-0.95); PLR, 11.1 (95% CI, 6.6-18.6); NLR, 0.08 (95% CI, 0.01-0.45); and area under the curve, 0.92 (95% CI, 0.85-0.96). CONCLUSIONS Diffusion-weighted imaging is a reliable tool for predicting the grade of pNETs, especially for G3. Moreover, the combination of 3.0-T device and higher b value can slightly help improve SE and SP.
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Zhang H, Pan J, Shen Y, Bai X, Wang Y, Wang H, Ye H. High signal renal tumors on DWI: the diagnostic value of morphological characteristics. Abdom Radiol (NY) 2019; 44:239-246. [PMID: 30141057 DOI: 10.1007/s00261-018-1728-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
PURPOSE To assess the usefulness of morphological characteristics of diffusion-weighted imaging (DWI) for differentiating malignant renal tumors from benign renal tumors, and clear cell renal cell carcinoma (RCC) from non-clear cell RCC at 3.0 T. METHODS The study included 249 patients with 251 histopathologically confirmed renal tumors that showed high signal on DWI. For each tumor, two radiologists independently evaluated apparent diffusion coefficient (ADC) values and morphological characteristics of DWI. The differences in the quantitative and qualitative magnetic resonance imaging (MRI) features determined by the readers were assessed. The ADC values between malignant and benign renal tumors and between clear cell and non-clear cell RCC were compared using Mann-Whitney tests. The proportional differences of morphological characteristics of DWI between malignant and benign renal tumors and between clear cell and non-clear cell RCC were compared using Chi-square tests. RESULTS There were no significant differences in the quantitative and qualitative MRI features determined by the readers. The ADC values for malignant renal tumors were statistically significantly higher than those for benign renal tumors (p < 0.05), and the ADC values for clear cell RCC were statistically significantly higher than those for non-clear cell RCC (p < 0.05). The proportion of morphological characteristics of DWI between malignant and benign renal tumors was statistically significantly different at ring, nodular, flaky high signal. The proportion of morphological characteristics of DWI between clear cell and non-clear cell RCC was statistically significantly different at uniform high signal. CONCLUSIONS The morphological characteristics of DWI are useful in differentiating renal tumors.
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Affiliation(s)
- Hongtao Zhang
- Department of Radiology, Chinese PLA General Hospital, Fuxing Road 28, Beijing, 100853, China
- Department of Radiology, 307 Hospital, PLA, Beijing, China
| | - Jingjing Pan
- Department of Radiology, Chinese PLA General Hospital, Fuxing Road 28, Beijing, 100853, China
- Department of Radiology, General Hospital of the PLA Rocket Force, Beijing, China
| | - Yanguang Shen
- Department of Radiology, Chinese PLA General Hospital, Fuxing Road 28, Beijing, 100853, China
| | - Xu Bai
- Department of Radiology, Chinese PLA General Hospital, Fuxing Road 28, Beijing, 100853, China
| | - Yingwei Wang
- Department of Radiology, Chinese PLA General Hospital, Fuxing Road 28, Beijing, 100853, China
| | - Haiyi Wang
- Department of Radiology, Chinese PLA General Hospital, Fuxing Road 28, Beijing, 100853, China.
| | - Huiyi Ye
- Department of Radiology, Chinese PLA General Hospital, Fuxing Road 28, Beijing, 100853, China.
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Li Y, Wang Y, Qin J, Wu J, Dai X, Xu J. Meta-analysis of diffusion-weighted imaging in the differential diagnosis of renal lesions. Clin Imaging 2018; 52:264-272. [PMID: 30172176 DOI: 10.1016/j.clinimag.2018.08.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2018] [Revised: 07/15/2018] [Accepted: 08/13/2018] [Indexed: 01/30/2023]
Abstract
PURPOSE To assess the diagnostic value of diffusion-weighted imaging (DWI) in distinguishing between renal malignant and benign lesions. MATERIALS AND METHODS Electronic databases were systematically searched to identify original studies evaluating DWI findings on renal lesions from January 2000 through January 2018. Pooled weighted estimates of sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), and diagnostic odds ratio (DOR) were calculated. A summary receiver operator characteristic (sROC) curve was constructed to calculate the area under the sROC curve (AUC). Publication bias was assessed by using Deeks' asymmetry test. RESULTS A total of 15 studies including 1386 renal lesions were eligible in the meta-analysis. The pooled sensitivity and specificity with a corresponding 95% confidence interval (CI) were 0.83 (95% CI: 0.80-0.86) and 0.74 (95% CI: 0.71-0.78), respectively. The PLR, NLR, and DOR were 3.21 (95% CI: 2.39-4.32), 0.24 (95% CI: 0.18-0.30), and 15.95 (95% CI: 11.19-22.71), respectively. The AUC was 0.87 (95% CI: 0.84-0.90). Significant heterogeneity was observed between the included studies. Reference standard, country, and gradient factor were identified as the most important variable sources. No evidence of notable publication bias was reported. CONCLUSIONS DWI is an informative MRI modality in discriminating benign and malignant lesions and exhibits moderately high diagnostic accuracy. However, it remains inconclusive and limited in the absence of an optimal b value and ADC cutoff value. High-quality prospective studies regarding DWI have yet to be conducted to explore optimal imaging parameters and diagnostic thresholds.
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Affiliation(s)
- Yang Li
- Department of General Surgery, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200080, China
| | - Ye Wang
- Department of General Surgery, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200080, China
| | - Jun Qin
- Department of General Surgery, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200080, China
| | - Junyi Wu
- Department of General Surgery, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200080, China
| | - Xueming Dai
- Department of General Surgery, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200080, China
| | - Junming Xu
- Department of General Surgery, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200080, China.
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Abstract
The increase in serendipitous detection of solid renal masses on imaging has not resulted in a reduction in mortality from renal cell carcinoma. Consequently, efforts for improved lesion characterization have been pursued and incorporated into management algorithms for distinguishing clinically significant tumors from those with favorable histology or benign conditions. Although diagnostic imaging strategies have evolved for optimized lesion detection, distinction between benign tumors and both indolent and aggressive malignant neoplasms remain an important diagnostic challenge. Recent advances in cross-sectional imaging have expanded the role of these tests in the noninvasive characterization of solid renal tumors.
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Affiliation(s)
- Fernando U Kay
- Department of Radiology; UT Southwestern Medical Center, 2201 Inwood Road, Suite 210, Dallas, TX 75390, USA
| | - Ivan Pedrosa
- Department of Radiology; UT Southwestern Medical Center, 2201 Inwood Road, Suite 210, Dallas, TX 75390, USA.
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Prezzi D, Neji R, Kelly-Morland C, Verma H, OʼBrien T, Challacombe B, Fernando A, Chandra A, Sinkus R, Goh V. Characterization of Small Renal Tumors With Magnetic Resonance Elastography: A Feasibility Study. Invest Radiol 2018; 53:344-351. [PMID: 29462024 DOI: 10.1097/rli.0000000000000449] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVES The aim of this study was to explore the feasibility of magnetic resonance elastography (MRE) for characterizing indeterminate small renal tumors (SRTs) as part of a multiparametric magnetic resonance (MR) imaging protocol. MATERIALS AND METHODS After institutional review board approval and informed consent were obtained, 21 prospective adults (15 men; median age, 55 years; age range, 25-72 years) with SRT were enrolled. Tumors (2-5 cm Ø) were imaged using 3-directional, gradient echo MRE. Viscoelastic parametric maps (shear wave velocity [c] and attenuation [α]) were analyzed by 2 independent radiologists. Interobserver agreement (Bland-Altman statistics and intraclass correlation coefficients) was assessed. Anatomical T2-weighted, dynamic contrast-enhanced (DCE) and diffusion sequences completed the acquisition protocol. Imaging parameters were compared between groups (Mann-Whitney U test). RESULTS Quality of MRE was good in 18 cases (mean nonlinearity <50%), including 1 papillary renal cell carcinoma and 1 metanephric adenoma. A cohort of 5 oncocytomas and 11 clear-cell renal cell carcinomas (ccRCCs) was analyzed for statistical differences. The MRE viscoelastic parameters were the strongest imaging discriminators: oncocytomas displayed significantly lower shear velocity c (median, 0.77 m/s; interquartile range [IQR], 0.76-0.79) (P = 0.007) and higher shear attenuation α (median, 0.087 mm; IQR, 0.082-0.087) (P = 0.008) than ccRCC (medians, 0.92 m/s and 0.066 mm; IQR, 0.84-0.97 and 0.054-0.074, respectively). T2 signal intensity ratio (tumor/renal cortex) was lower in oncocytomas (P = 0.02). The DCE and diffusion MR parameters overlapped substantially (P ≥ 0.1). Oncocytomas displayed a consistent MRE viscoelastic profile, corresponding to data point clustering in a bidimensional scatter plot. Values for MRE intraclass correlation coefficient were 0.982 for c and 0.984 for α, indicating excellent interobserver agreement. CONCLUSIONS Magnetic resonance elastography is feasible for SRT characterization; MRE viscoelastic parameters were stronger discriminators between oncocytoma and ccRCC than anatomical, DCE and diffusion MR imaging parameters.
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Abstract
PURPOSE OF REVIEW Renal cell carcinoma is a heterogeneous disease with a spectrum of subtypes and clinical behavior. Quantitative and qualitative imaging biomarkers are sought to correlate with genetic and histologic features and complement pathologic analysis. RECENT FINDINGS Texture analysis, radiogenomics, and modality-specific advancements have yielded an array of renal cell carcinoma imaging biomarkers in the research domain. Although many techniques are promising, standardization and validation of these procedures are needed prior to implementation into clinical practice. SUMMARY We introduce novel imaging techniques and analytic methods which have been shown to contribute to characterization of renal cell carcinoma and its subtypes, aggressiveness, and responsiveness to therapy, including associated advantages and limitations.
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Kay FU, Canvasser NE, Xi Y, Pinho DF, Costa DN, Diaz de Leon A, Khatri G, Leyendecker JR, Yokoo T, Lay AH, Kavoussi N, Koseoglu E, Cadeddu JA, Pedrosa I. Diagnostic Performance and Interreader Agreement of a Standardized MR Imaging Approach in the Prediction of Small Renal Mass Histology. Radiology 2018; 287:543-553. [PMID: 29390196 DOI: 10.1148/radiol.2018171557] [Citation(s) in RCA: 64] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Purpose To assess the diagnostic performance and interreader agreement of a standardized diagnostic algorithm in determining the histologic type of small (≤4 cm) renal masses (SRMs) with multiparametric magnetic resonance (MR) imaging. Materials and Methods This single-center retrospective HIPAA-compliant institutional review board-approved study included 103 patients with 109 SRMs resected between December 2011 and July 2015. The requirement for informed consent was waived. Presurgical renal MR images were reviewed by seven radiologists with diverse experience. Eleven MR imaging features were assessed, and a standardized diagnostic algorithm was used to determine the most likely histologic diagnosis, which was compared with histopathology results after surgery. Interreader variability was tested with the Cohen κ statistic. Regression models using MR imaging features were used to predict the histopathologic diagnosis with 5% significance level. Results Clear cell renal cell carcinoma (RCC) and papillary RCC were diagnosed, with sensitivities of 85% (47 of 55) and 80% (20 of 25), respectively, and specificities of 76% (41 of 54) and 94% (79 of 84), respectively. Interreader agreement was moderate to substantial (clear cell RCC, κ = 0.58; papillary RCC, κ = 0.73). Signal intensity (SI) of the lesion on T2-weighted MR images and degree of contrast enhancement (CE) during the corticomedullary phase were independent predictors of clear cell RCC (SI odds ratio [OR]: 3.19; 95% confidence interval [CI]: 1.4, 7.1; P = .003; CE OR, 4.45; 95% CI: 1.8, 10.8; P < .001) and papillary RCC (CE OR, 0.053; 95% CI: 0.02, 0.2; P < .001), and both had substantial interreader agreement (SI, κ = 0.69; CE, κ = 0.71). Poorer performance was observed for chromophobe histology, oncocytomas, and minimal fat angiomyolipomas, (sensitivity range, 14%-67%; specificity range, 97%-99%), with fair to moderate interreader agreement (κ range = 0.23-0.43). Segmental enhancement inversion was an independent predictor of oncocytomas (OR, 16.21; 95% CI: 1.0, 275.4; P = .049), with moderate interreader agreement (κ = 0.49). Conclusion The proposed standardized MR imaging-based diagnostic algorithm had diagnostic accuracy of 81% (88 of 109) and 91% (99 of 109) in the diagnosis of clear cell RCC and papillary RCC, respectively, while achieving moderate to substantial interreader agreement among seven radiologists. © RSNA, 2018 Online supplemental material is available for this article.
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Affiliation(s)
- Fernando U Kay
- From the Department of Radiology (F.U.K., Y.X., D.F.P., D.N.C., A.D.d.L., G.K., J.R.L., T.Y., J.A.C., I.P.), Department of Urology (N.E.C., A.H.L., N.K., E.K., J.A.C., I.P.), and Advanced Imaging Research Center (D.C., T.Y., I.P.), University of Texas Southwestern Medical Center, 2201 Inwood Rd, Suite NE2.210, Dallas, TX 75390-9085
| | - Noah E Canvasser
- From the Department of Radiology (F.U.K., Y.X., D.F.P., D.N.C., A.D.d.L., G.K., J.R.L., T.Y., J.A.C., I.P.), Department of Urology (N.E.C., A.H.L., N.K., E.K., J.A.C., I.P.), and Advanced Imaging Research Center (D.C., T.Y., I.P.), University of Texas Southwestern Medical Center, 2201 Inwood Rd, Suite NE2.210, Dallas, TX 75390-9085
| | - Yin Xi
- From the Department of Radiology (F.U.K., Y.X., D.F.P., D.N.C., A.D.d.L., G.K., J.R.L., T.Y., J.A.C., I.P.), Department of Urology (N.E.C., A.H.L., N.K., E.K., J.A.C., I.P.), and Advanced Imaging Research Center (D.C., T.Y., I.P.), University of Texas Southwestern Medical Center, 2201 Inwood Rd, Suite NE2.210, Dallas, TX 75390-9085
| | - Daniella F Pinho
- From the Department of Radiology (F.U.K., Y.X., D.F.P., D.N.C., A.D.d.L., G.K., J.R.L., T.Y., J.A.C., I.P.), Department of Urology (N.E.C., A.H.L., N.K., E.K., J.A.C., I.P.), and Advanced Imaging Research Center (D.C., T.Y., I.P.), University of Texas Southwestern Medical Center, 2201 Inwood Rd, Suite NE2.210, Dallas, TX 75390-9085
| | - Daniel N Costa
- From the Department of Radiology (F.U.K., Y.X., D.F.P., D.N.C., A.D.d.L., G.K., J.R.L., T.Y., J.A.C., I.P.), Department of Urology (N.E.C., A.H.L., N.K., E.K., J.A.C., I.P.), and Advanced Imaging Research Center (D.C., T.Y., I.P.), University of Texas Southwestern Medical Center, 2201 Inwood Rd, Suite NE2.210, Dallas, TX 75390-9085
| | - Alberto Diaz de Leon
- From the Department of Radiology (F.U.K., Y.X., D.F.P., D.N.C., A.D.d.L., G.K., J.R.L., T.Y., J.A.C., I.P.), Department of Urology (N.E.C., A.H.L., N.K., E.K., J.A.C., I.P.), and Advanced Imaging Research Center (D.C., T.Y., I.P.), University of Texas Southwestern Medical Center, 2201 Inwood Rd, Suite NE2.210, Dallas, TX 75390-9085
| | - Gaurav Khatri
- From the Department of Radiology (F.U.K., Y.X., D.F.P., D.N.C., A.D.d.L., G.K., J.R.L., T.Y., J.A.C., I.P.), Department of Urology (N.E.C., A.H.L., N.K., E.K., J.A.C., I.P.), and Advanced Imaging Research Center (D.C., T.Y., I.P.), University of Texas Southwestern Medical Center, 2201 Inwood Rd, Suite NE2.210, Dallas, TX 75390-9085
| | - John R Leyendecker
- From the Department of Radiology (F.U.K., Y.X., D.F.P., D.N.C., A.D.d.L., G.K., J.R.L., T.Y., J.A.C., I.P.), Department of Urology (N.E.C., A.H.L., N.K., E.K., J.A.C., I.P.), and Advanced Imaging Research Center (D.C., T.Y., I.P.), University of Texas Southwestern Medical Center, 2201 Inwood Rd, Suite NE2.210, Dallas, TX 75390-9085
| | - Takeshi Yokoo
- From the Department of Radiology (F.U.K., Y.X., D.F.P., D.N.C., A.D.d.L., G.K., J.R.L., T.Y., J.A.C., I.P.), Department of Urology (N.E.C., A.H.L., N.K., E.K., J.A.C., I.P.), and Advanced Imaging Research Center (D.C., T.Y., I.P.), University of Texas Southwestern Medical Center, 2201 Inwood Rd, Suite NE2.210, Dallas, TX 75390-9085
| | - Aaron H Lay
- From the Department of Radiology (F.U.K., Y.X., D.F.P., D.N.C., A.D.d.L., G.K., J.R.L., T.Y., J.A.C., I.P.), Department of Urology (N.E.C., A.H.L., N.K., E.K., J.A.C., I.P.), and Advanced Imaging Research Center (D.C., T.Y., I.P.), University of Texas Southwestern Medical Center, 2201 Inwood Rd, Suite NE2.210, Dallas, TX 75390-9085
| | - Nicholas Kavoussi
- From the Department of Radiology (F.U.K., Y.X., D.F.P., D.N.C., A.D.d.L., G.K., J.R.L., T.Y., J.A.C., I.P.), Department of Urology (N.E.C., A.H.L., N.K., E.K., J.A.C., I.P.), and Advanced Imaging Research Center (D.C., T.Y., I.P.), University of Texas Southwestern Medical Center, 2201 Inwood Rd, Suite NE2.210, Dallas, TX 75390-9085
| | - Ersin Koseoglu
- From the Department of Radiology (F.U.K., Y.X., D.F.P., D.N.C., A.D.d.L., G.K., J.R.L., T.Y., J.A.C., I.P.), Department of Urology (N.E.C., A.H.L., N.K., E.K., J.A.C., I.P.), and Advanced Imaging Research Center (D.C., T.Y., I.P.), University of Texas Southwestern Medical Center, 2201 Inwood Rd, Suite NE2.210, Dallas, TX 75390-9085
| | - Jeffrey A Cadeddu
- From the Department of Radiology (F.U.K., Y.X., D.F.P., D.N.C., A.D.d.L., G.K., J.R.L., T.Y., J.A.C., I.P.), Department of Urology (N.E.C., A.H.L., N.K., E.K., J.A.C., I.P.), and Advanced Imaging Research Center (D.C., T.Y., I.P.), University of Texas Southwestern Medical Center, 2201 Inwood Rd, Suite NE2.210, Dallas, TX 75390-9085
| | - Ivan Pedrosa
- From the Department of Radiology (F.U.K., Y.X., D.F.P., D.N.C., A.D.d.L., G.K., J.R.L., T.Y., J.A.C., I.P.), Department of Urology (N.E.C., A.H.L., N.K., E.K., J.A.C., I.P.), and Advanced Imaging Research Center (D.C., T.Y., I.P.), University of Texas Southwestern Medical Center, 2201 Inwood Rd, Suite NE2.210, Dallas, TX 75390-9085
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Sasaguri K, Takahashi N. CT and MR imaging for solid renal mass characterization. Eur J Radiol 2017; 99:40-54. [PMID: 29362150 DOI: 10.1016/j.ejrad.2017.12.008] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Revised: 12/04/2017] [Accepted: 12/09/2017] [Indexed: 12/15/2022]
Abstract
As our understanding has expanded that relatively large fraction of incidentally discovered renal masses, especially in small size, are benign or indolent even if malignant, there is growing acceptance of more conservative management including active surveillance for small renal masses. As for advanced renal cell carcinomas (RCCs), nonsurgical and subtype specific treatment options such as immunotherapy and targeted therapy is developing. On these backgrounds, renal mass characterization including differentiation of benign from malignant tumors, RCC subtyping and prediction of RCC aggressiveness is receiving much attention and a variety of imaging techniques and analytic methods are being investigated. In addition to conventional imaging techniques, integration of texture analysis, functional imaging (i.e. diffusion weighted and perfusion imaging) and multivariate diagnostic methods including machine learning have provided promising results for these purposes in research fields, although standardization and external, multi-institutional validations are needed.
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Affiliation(s)
- Kohei Sasaguri
- Department of Radiology, Faculty of Medicine, Saga University, 5-1-1 Nabeshima, Saga, 849-8501, Japan.
| | - Naoki Takahashi
- Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, United States.
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Abstract
Renal cell carcinoma (RCC) exhibits a diverse and heterogeneous disease spectrum, but insight into its molecular biology has provided an improved understanding of potential risk factors, oncologic behavior, and imaging features. Computed tomography (CT) and MR imaging may allow the identification and preoperative subtyping of RCC and assessment of a response to various therapies. Active surveillance is a viable management option in some patients and has provided further insight into the natural history of RCC, including the favorable prognosis of cystic neoplasms. This article reviews CT and MR imaging in RCC and the role of screening in selected high-risk populations.
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Affiliation(s)
- Alberto Diaz de Leon
- Department of Radiology, University of Texas Southwestern Medical Center, 2201 Inwood Road, 2nd Floor, Suite 202, Dallas, TX 75390-9085, USA
| | - Ivan Pedrosa
- Department of Radiology, University of Texas Southwestern Medical Center, 2201 Inwood Road, 2nd Floor, Suite 202, Dallas, TX 75390-9085, USA.
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Diagnostic Performance of DWI for Differentiating High- From Low-Grade Clear Cell Renal Cell Carcinoma: A Systematic Review and Meta-Analysis. AJR Am J Roentgenol 2017; 209:W374-W381. [PMID: 29023154 DOI: 10.2214/ajr.17.18283] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVE The purpose of our study was to review the diagnostic performance of DWI for differentiating high- from low-grade clear cell renal cell carcinoma (RCC). MATERIALS AND METHODS MEDLINE, EMBASE, and Cochrane library databases were searched up to March 15, 2017. We included diagnostic accuracy studies that used DWI for differentiating high- from low-grade clear cell RCC compared with histopathologic results of Fuhrman grade based on nephrectomy or biopsy specimens in original research articles. Two independent reviewers assessed methodologic quality using the Quality Assessment of Diagnostic Accuracy Studies 2 tool. Sensitivity and specificity of the included studies were pooled and graphically presented using a hierarchic summary ROC plot. For heterogeneity exploration, we assessed the presence of a threshold effect and performed meta-regression analyses. RESULTS Eight retrospective studies (394 patients with 397 clear cell RCCs) were included. Pooled sensitivity was 0.78 (95% CI, 0.68-0.85) with a specificity of 0.86 (95% CI, 0.70-0.94). A considerable threshold effect was observed with a correlation coefficient of 0.811 (95% CI, 0.248-0.964) between the sensitivity and false-positive rate. At meta-regression analysis, apparent diffusion coefficient (× 10 mm2/s) cutoff value (< 1.57 vs ≥ 1.57; p = 0.03) and location of ROI (solid portion vs whole tumor; p = 0.04) were significant factors affecting heterogeneity. Other factors with regard to patients and tumors, study, and MRI characteristics were not significant (p = 0.17-0.91). CONCLUSION DWI shows moderate diagnostic performance for differentiating high-from low-grade clear cell RCC. Substantial heterogeneity was observed because of a threshold effect. Further prospective studies may be needed; all included studies were retrospective.
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Farber NJ, Kim CJ, Modi PK, Hon JD, Sadimin ET, Singer EA. Renal cell carcinoma: the search for a reliable biomarker. Transl Cancer Res 2017; 6:620-632. [PMID: 28775935 PMCID: PMC5538266 DOI: 10.21037/tcr.2017.05.19] [Citation(s) in RCA: 60] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
One particular challenge in the treatment of kidney tumors is the range of histologies and tumor phenotypes a renal mass can represent. A kidney tumor can range from benign (e.g., oncocytoma) to a clinically indolent malignancy (e.g., papillary type I, chromophobe) to aggressive disease [e.g., papillary type II or high-grade clear cell renal cell carcinoma (ccRCC)]. Even among various subtypes, kidney cancers are genetically diverse with variable prognoses and treatment response rates. Therefore, the key to proper treatment is the differentiation of these subtypes. Currently, a wide array of diagnostic, prognostic, and predictive biomarkers exist that may help guide the individualized care of kidney cancer patients. This review will discuss the various serum, urine, imaging, and immunohistological biomarkers available in practice.
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Affiliation(s)
- Nicholas J. Farber
- Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey and Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Christopher J. Kim
- Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey and Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Parth K. Modi
- Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey and Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Jane D. Hon
- Section of Urologic Pathology, Rutgers Cancer Institute of New Jersey and Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Evita T. Sadimin
- Section of Urologic Pathology, Rutgers Cancer Institute of New Jersey and Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Eric A. Singer
- Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey and Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
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Mazziotti S, Cicero G, D'Angelo T, Marino MA, Visalli C, Salamone I, Ascenti G, Blandino A. Imaging and Management of Incidental Renal Lesions. BIOMED RESEARCH INTERNATIONAL 2017; 2017:1854027. [PMID: 28642870 PMCID: PMC5470004 DOI: 10.1155/2017/1854027] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Accepted: 05/04/2017] [Indexed: 02/07/2023]
Abstract
The increased use of imaging modalities in the last years has led to a greater incidence in depicting abdominal incidental lesions. In particular, "incidentalomas" of the kidney are discovered in asymptomatic patients or patients who suffer from diseases not directly related to the kidneys. The aim of this paper is to provide the radiologist with a useful guide to recognize and classify the main incidental renal findings with the purpose of establishing the correct management. First we describe the so-called "pseudotumors" which are important to recognize in order to avoid a misdiagnosis. Afterwards we categorize true renal lesions into cystic and solid types, reporting radiological signs helpful in differentiating between benign and malignant nature.
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Affiliation(s)
- Silvio Mazziotti
- Department of Biomedical Sciences and Morphological and Functional Imaging, University of Messina, Policlinico “G. Martino”, Via Consolare Valeria 1, 98100 Messina, Italy
| | - Giuseppe Cicero
- Department of Biomedical Sciences and Morphological and Functional Imaging, University of Messina, Policlinico “G. Martino”, Via Consolare Valeria 1, 98100 Messina, Italy
| | - Tommaso D'Angelo
- Department of Biomedical Sciences and Morphological and Functional Imaging, University of Messina, Policlinico “G. Martino”, Via Consolare Valeria 1, 98100 Messina, Italy
| | - Maria Adele Marino
- Department of Biomedical Sciences and Morphological and Functional Imaging, University of Messina, Policlinico “G. Martino”, Via Consolare Valeria 1, 98100 Messina, Italy
| | - Carmela Visalli
- Department of Biomedical Sciences and Morphological and Functional Imaging, University of Messina, Policlinico “G. Martino”, Via Consolare Valeria 1, 98100 Messina, Italy
| | - Ignazio Salamone
- Department of Biomedical Sciences and Morphological and Functional Imaging, University of Messina, Policlinico “G. Martino”, Via Consolare Valeria 1, 98100 Messina, Italy
| | - Giorgio Ascenti
- Department of Biomedical Sciences and Morphological and Functional Imaging, University of Messina, Policlinico “G. Martino”, Via Consolare Valeria 1, 98100 Messina, Italy
| | - Alfredo Blandino
- Department of Biomedical Sciences and Morphological and Functional Imaging, University of Messina, Policlinico “G. Martino”, Via Consolare Valeria 1, 98100 Messina, Italy
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Canvasser NE, Kay FU, Xi Y, Pinho DF, Costa D, de Leon AD, Khatri G, Leyendecker JR, Yokoo T, Lay A, Kavoussi N, Koseoglu E, Cadeddu JA, Pedrosa I. Diagnostic Accuracy of Multiparametric Magnetic Resonance Imaging to Identify Clear Cell Renal Cell Carcinoma in cT1a Renal Masses. J Urol 2017; 198:780-786. [PMID: 28457802 DOI: 10.1016/j.juro.2017.04.089] [Citation(s) in RCA: 77] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/18/2017] [Indexed: 01/13/2023]
Abstract
PURPOSE The detection of small renal masses is increasing with the use of cross-sectional imaging, although many incidental lesions have negligible metastatic potential. Among malignant masses clear cell renal cell carcinoma is the most prevalent and aggressive subtype. A method to identify such histology would aid in risk stratification. Our goal was to evaluate a likelihood scale for multiparametric magnetic resonance imaging in the diagnosis of clear cell histology. MATERIALS AND METHODS We retrospectively reviewed the records of patients with cT1a masses who underwent magnetic resonance imaging and partial or radical nephrectomy from December 2011 to July 2015. Seven radiologists with different levels of experience who were blinded to final pathology findings independently reviewed studies based on a predefined algorithm. They applied a clear cell likelihood score, including 1-definitely not, 2-probably not, 3-equivocal, 4-probably and 5-definitely. Binary classification was used to determine the accuracy of clear cell vs all other histologies. Interobserver agreement was calculated with the weighted κ statistic. RESULTS A total of 110 patients with 121 masses were identified. Mean tumor size was 2.4 cm and 50% of the lesions were clear cell. Defining clear cell as scores of 4 or greater demonstrated 78% sensitivity and 80% specificity while scores of 3 or greater showed 95% sensitivity and 58% specificity. Interobserver agreement was moderate to good with a mean κ of 0.53. CONCLUSIONS A clear cell likelihood score used with magnetic resonance imaging can reasonably identify clear cell histology in small renal masses and may decrease the number of diagnostic renal mass biopsies. Standardization of imaging protocols and reporting criteria is needed to improve interobserver reliability.
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Affiliation(s)
- Noah E Canvasser
- Department of Urology, University of Texas Southwestern, Dallas, Texas
| | - Fernando U Kay
- Department of Radiology, University of Texas Southwestern, Dallas, Texas
| | - Yin Xi
- Department of Radiology, University of Texas Southwestern, Dallas, Texas
| | - Daniella F Pinho
- Department of Radiology, University of Texas Southwestern, Dallas, Texas
| | - Daniel Costa
- Department of Radiology, University of Texas Southwestern, Dallas, Texas
| | | | - Gaurav Khatri
- Department of Radiology, University of Texas Southwestern, Dallas, Texas
| | - John R Leyendecker
- Department of Radiology, University of Texas Southwestern, Dallas, Texas
| | - Takeshi Yokoo
- Department of Radiology, University of Texas Southwestern, Dallas, Texas
| | - Aaron Lay
- Department of Urology, University of Texas Southwestern, Dallas, Texas
| | - Nicholas Kavoussi
- Department of Urology, University of Texas Southwestern, Dallas, Texas
| | - Ersin Koseoglu
- Department of Urology, University of Texas Southwestern, Dallas, Texas
| | - Jeffrey A Cadeddu
- Department of Urology, University of Texas Southwestern, Dallas, Texas; Department of Radiology, University of Texas Southwestern, Dallas, Texas.
| | - Ivan Pedrosa
- Department of Radiology, University of Texas Southwestern, Dallas, Texas; Imaging Research Center, University of Texas Southwestern, Dallas, Texas
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50
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Systematic Review Classification. AJR Am J Roentgenol 2017; 208:W195. [PMID: 28436698 DOI: 10.2214/ajr.16.17644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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