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Barr RG. The Urgent Need for FDA to Approve a Whole-Body Application of Ultrasound Contrast Agents. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2023; 42:761-764. [PMID: 36029297 DOI: 10.1002/jum.16092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 08/17/2022] [Indexed: 06/15/2023]
Affiliation(s)
- Richard G Barr
- Department of Radiology, Northeastern Ohio Medical University, Rootstown, Ohio, USA
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Recommendations for the Management of the Incidental Renal Mass in Adults: Endorsement and Adaptation of the 2017 ACR Incidental Findings Committee White Paper by the Canadian Association of Radiologists Incidental Findings Working Group. Can Assoc Radiol J 2019; 70:125-133. [DOI: 10.1016/j.carj.2019.03.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Revised: 02/26/2019] [Accepted: 03/02/2019] [Indexed: 12/14/2022] Open
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Contrast-enhanced ultrasound of the kidney: a single-institution experience. Ir J Med Sci 2017; 187:795-802. [PMID: 29218489 DOI: 10.1007/s11845-017-1725-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2017] [Accepted: 11/29/2017] [Indexed: 12/17/2022]
Abstract
BACKGROUND Focal renal masses are typically evaluated by means of triphasic contrast-enhanced CT or MRI scan but use of iodinated contrast or gadolinium is unsuitable for some patients. Contrast-enhanced ultrasound (CEUS) is an imaging alternative in this scenario but has limited availability in Ireland. AIM The aim of the study was to retrospectively evaluate experience with selective use of CEUS for non-invasive characterization of focal renal masses in a tertiary referral institution in Ireland, with a particular focus on cystic renal lesions and the influence of CEUS on final Bosniak classification and treatment outcomes. METHODS All cases of renal CEUS between 2009 and 2017 were identified. Imaging history, patient records, histopathology reports, urology conference notes, clinical follow-up details, details of lesion progression or stability on surveillance, biopsy and/or resection details and pre- and post-CEUS Bosniak scores were recorded. RESULTS Thirty-one patients underwent renal CEUS (7 solid renal lesions, 21 cystic renal lesions and 3 'indeterminate' renal lesions). After CEUS, the CEUS-modified Bosniak score was upgraded in nine patients and downgraded in two patients. All three lesions upgraded from Bosniak III to IV were renal cell carcinomas. One of two lesions downgraded from Bosniak IV to III was resected (cystic nephroma) and the other showed no progression after 19 months of surveillance. CONCLUSION CEUS is a valuable alternative to CT in assessing complex cystic or solid renal lesions where iodinated CT contrast or gadolinium is inappropriate. CEUS can also refine the Bosniak category of atypical cystic renal lesions and help facilitate treatment decisions.
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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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Sugisawa K, Ichikawa K, Minamishima K, Hasegawa M, Yamada Y, Jinzaki M. Evaluation of the CT Parameters to Suppress Renal Cysts Pseudoenhancement Effect: Influence of the Virtual Monochromatic Spectral Images, the Model-based Iterative Reconstruction Algorithm and the Aperture Size in Phantom Model. Nihon Hoshasen Gijutsu Gakkai Zasshi 2017; 73:636-645. [PMID: 28824087 DOI: 10.6009/jjrt.2017_jsrt_73.8.636] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE The purpose of this study was to evaluate the effect of the virtual monochromatic spectral images (VMSI) and the model-based iterative reconstruction (MBIR) images, to evaluate the influence of the aperture size (40- and 20-mm beam) on renal pseudoenhancement (PE) compared with the filtered back projection (FBP) images. METHODS The renal compartment-CT phantom was filled with iodinated contrast material diluted to the attenuation of 180 Hounsfield units (HU) at 120 kV. The water-filled spherical structures, which simulate cyst, were inserted into the renal compartment. Those diameters were 7, 15 and 25 mm. These were scanned by conventional mode (helical scan, 120 kV-FBP) and dual energy mode. 70 keV-VMSI were reconstructed from the dual energy mode, and MBIR images were reconstructed from conventional mode at 40- and 20-mm aperture. Additionally, the phantom was scanned using non-helical mode with 20-mm aperture, and FBP images were reconstructed. The CT value of the PE for cyst areas was measured for these images. RESULTS The CT values of the cysts were 20.0-14.3 HU on the FBP images, 12.8-12.7 HU on the 70 keV-VMSI (PE-inhibition ratio was 36.0-11.2%) and 16.2-14.0 HU on the MBIR images (19.0-2.1%), respectively, at 40-mm aperture. The PE-inhibition ratio scanned by 20-mm aperture was improved by 28.0% with FBP, 32.8% with 70 keV-VMSI and 29.6% with MBIR compared with 40-mm aperture. One of the FBP images with non-helical mode was 11.6 HU. CONCLUSIONS The best CT technique to minimize PE was the combination of 70 keV-VMSI and 20-mm aperture.
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Affiliation(s)
- Koichi Sugisawa
- Graduate School of Medical Science, Kanazawa University.,Department of Radiological Technology, Keio University Hospital
| | - Katsuhiro Ichikawa
- Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University
| | | | | | - Yoshitake Yamada
- Department of Diagnostic Radiology, Keio University School of Medicine
| | - Masahiro Jinzaki
- Department of Diagnostic Radiology, Keio University School of Medicine
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Early-stage clear cell tubulopapillary renal cell carcinoma: imaging features and distinction from clear cell and papillary subtypes. Abdom Radiol (NY) 2016; 41:2187-2195. [PMID: 27383741 DOI: 10.1007/s00261-016-0830-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
PURPOSE Clear cell tubulopapillary renal cell carcinoma (CCTPRCC) is a recently described, low-grade subtype of renal cancer. We determined if imaging features could be used to distinguish early-stage CCTPRCC from stage-matched clear cell RCC (ccRCC) and papillary RCC (pRCC). METHODS This IRB-approved retrospective study included 54 stage T1a patients with pathologically confirmed CCTPRCC (n = 18), ccRCC (n = 18), and pRCC (n = 18). CT (n = 48) and MRI (n = 27) exams were reviewed and imaging features compared. Continuous variables were evaluated using ANOVA and Tukey's multiple comparison tests. Categorical variables were compared using Chi-square test or Fisher's exact test. RESULTS Compared to pRCC, CCTPRCC had a lower mean attenuation value on unenhanced CT (p < 0.017), was more often hyperintense on T2-weighted images (p < 0.0001), showed an ill-defined margin (p = 0.003), and demonstrated nonenhancing areas (p = 0.0003). The presence of all three of these statistically significant features [hypoattenuation (unenhanced attenuation ≤25 HU), ill-defined margin, nonenhancing areas] yielded an area under the receiver operator curve (ROC) of 0.92 (95% CI 0.83-0.99) for differentiating CCTPRCC from pRCC. There were no significant differences in the imaging features of CCTPRCC and ccRCC. CONCLUSIONS Early-stage clear cell tubulopapillary renal cell carcinoma can be distinguished from papillary RCC based on low attenuation on unenhanced CT, high intensity on T2-weighted images, an ill-defined margin, and presence of nonenhancing areas, but cannot be distinguished from clear cell RCC.
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Xue LY, Lu Q, Huang BJ, Li Z, Li CX, Wen JX, Wang WP. Papillary renal cell carcinoma and clear cell renal cell carcinoma: Differentiation of distinct histological types with contrast - enhanced ultrasonography. Eur J Radiol 2015; 84:1849-56. [PMID: 26149528 DOI: 10.1016/j.ejrad.2015.06.017] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2015] [Revised: 06/10/2015] [Accepted: 06/16/2015] [Indexed: 11/16/2022]
Abstract
PURPOSE Papillary renal cell carcinoma (pRCC) and clear cell renal cell carcinoma (ccRCC) have different biological behaviours and imaging features. The role of contrast-enhanced ultrasound (CEUS) in differentiating these two carcinoma subtypes has not been comprehensively studied. MATERIALS AND METHODS Forty-eight patients with 49 pRCC lesions and 153 patients with 156 ccRCC lesions underwent preoperative conventional ultrasound (US) and CEUS. Among them, 91 patients (25 pRCCs and 66 ccRCCs) also underwent preoperative contrast-enhanced computed tomography (CECT) in our hospital. The characteristics of CEUS and CECT images for each patient imaged were analysed by each of two blinded observers. RESULTS Images for five (5/25, 20%) pRCC patients demonstrated equivocal or no enhancement using CECT, while all lesions were enhanced using CEUS. From CEUS, images of pRCCs, when compared with ccRCC images, demonstrated significantly higher frequencies of slow wash-in (59.2% vs. 5.8%), fast wash-out (87.7% vs. 46.1%), and hypo-enhancement (57.1% vs. 7.1%) patterns, p<0.001, as well as the presence of pseudocapsule (42.9% vs. 23.1%), p=0.007. For lesions with large diameters (> 3 cm), a higher percentage of pRCC images demonstrated homogeneous enhancement compared with ccRCC images. Using the combination of slow wash-in, fast wash-out, and hypoenhancement patterns at peak as criteria to differentiate pRCC from ccRCC, positive and negative predictive value, and sensitivity and specificity were found to be 86.7%, 86.9%, 53.1%, and 97.4%, respectively. CONCLUSIONS CEUS imaging features of slow-in, fast-out, and hypo-enhancement patterns may be useful for differentiating pRCC and ccRCC. In addition, CEUS may be helpful for diagnosing hypovascular renal lesions that demonstrate equivocal or no enhancement by CECT and, thus, for improving diagnostic confidence.
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Affiliation(s)
- Li-Yun Xue
- Department of Ultrasound Zhongshan Hospital, Fudan University, Shanghai institute of medical imaging, Bldg. 1#, 180 Fenglin Rd., Xuhui District, Shanghai 200032, China
| | - Qing Lu
- Department of Ultrasound Zhongshan Hospital, Fudan University, Shanghai institute of medical imaging, Bldg. 1#, 180 Fenglin Rd., Xuhui District, Shanghai 200032, China
| | - Bei-Jian Huang
- Department of Ultrasound Zhongshan Hospital, Fudan University, Shanghai institute of medical imaging, Bldg. 1#, 180 Fenglin Rd., Xuhui District, Shanghai 200032, China.
| | - Zheng Li
- Department of Echocardiography, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Cui-Xian Li
- Department of Ultrasound Zhongshan Hospital, Fudan University, Shanghai institute of medical imaging, Bldg. 1#, 180 Fenglin Rd., Xuhui District, Shanghai 200032, China
| | - Jie-Xian Wen
- Department of Ultrasound Zhongshan Hospital, Fudan University, Shanghai institute of medical imaging, Bldg. 1#, 180 Fenglin Rd., Xuhui District, Shanghai 200032, China
| | - Wen-Ping Wang
- Department of Ultrasound Zhongshan Hospital, Fudan University, Shanghai institute of medical imaging, Bldg. 1#, 180 Fenglin Rd., Xuhui District, Shanghai 200032, China
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Yamada Y, Yamada M, Sugisawa K, Akita H, Shiomi E, Abe T, Okuda S, Jinzaki M. Renal cyst pseudoenhancement: intraindividual comparison between virtual monochromatic spectral images and conventional polychromatic 120-kVp images obtained during the same CT examination and comparisons among images reconstructed using filtered back projection, adaptive statistical iterative reconstruction, and model-based iterative reconstruction. Medicine (Baltimore) 2015; 94:e754. [PMID: 25881852 PMCID: PMC4602515 DOI: 10.1097/md.0000000000000754] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
The purpose of this study was to compare renal cyst pseudoenhancement between virtual monochromatic spectral (VMS) and conventional polychromatic 120-kVp images obtained during the same abdominal computed tomography (CT) examination and among images reconstructed using filtered back projection (FBP), adaptive statistical iterative reconstruction (ASIR), and model-based iterative reconstruction (MBIR). Our institutional review board approved this prospective study; each participant provided written informed consent. Thirty-one patients (19 men, 12 women; age range, 59-85 years; mean age, 73.2 ± 5.5 years) with renal cysts underwent unenhanced 120-kVp CT followed by sequential fast kVp-switching dual-energy (80/140 kVp) and 120-kVp abdominal enhanced CT in the nephrographic phase over a 10-cm scan length with a random acquisition order and 4.5-second intervals. Fifty-one renal cysts (maximal diameter, 18.0 ± 14.7 mm [range, 4-61 mm]) were identified. The CT attenuation values of the cysts as well as of the kidneys were measured on the unenhanced images, enhanced VMS images (at 70 keV) reconstructed using FBP and ASIR from dual-energy data, and enhanced 120-kVp images reconstructed using FBP, ASIR, and MBIR. The results were analyzed using the mixed-effects model and paired t test with Bonferroni correction. The attenuation increases (pseudoenhancement) of the renal cysts on the VMS images reconstructed using FBP/ASIR (least square mean, 5.0/6.0 Hounsfield units [HU]; 95% confidence interval, 2.6-7.4/3.6-8.4 HU) were significantly lower than those on the conventional 120-kVp images reconstructed using FBP/ASIR/MBIR (least square mean, 12.1/12.8/11.8 HU; 95% confidence interval, 9.8-14.5/10.4-15.1/9.4-14.2 HU) (all P < .001); on the other hand, the CT attenuation values of the kidneys on the VMS images were comparable to those on the 120-kVp images. Regardless of the reconstruction algorithm, 70-keV VMS images showed a lower degree of pseudoenhancement of renal cysts than 120-kVp images, while maintaining kidney contrast enhancement comparable to that on 120-kVp images.
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Affiliation(s)
- Yoshitake Yamada
- From the Department of Diagnostic Radiology (YY, KS, HA, ES, SO, MJ), Keio University School of Medicine; Multi-dimension Biomedical Imaging & Information Laboratory in Research Park (MY), Keio University School of Medicine; and Department of Preventive Medicine and Public Health, Center for Clinical Research, Keio University School of Medicine (TA), Shinjuku-ku, Tokyo, Japan
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Different presentations of renal cell cancer on ultrasound and computerized tomography. Urologia 2014; 81:228-32. [PMID: 25198941 DOI: 10.5301/uro.5000085] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/11/2014] [Indexed: 12/12/2022]
Abstract
Renal cell carcinoma (RCC) is the most common malignant tumor of the kidney. The major goal of imaging techniques is to correctly differentiate between benign and malignant renal lesions. We present the cases of six patients with renal masses that were interpreted completely differently based on ultrasound (US) and computerized tomography (CT) findings.From January 1st, 2008 to March 1st, 2014, 307 patients from our center underwent nephrectomy for RCC. In all patients US and CT were performed before the operation.In six patients, the US indicated a focal, solid renal lesion that was interpreted by CT as a cystic lesion (Bosniak II-III). Because discrepancies were evident, renal biopsies were performed. The biopsies revealed RCC in the six patients, all of whom underwent subsequent nephrectomy. All of the patients were confirmed to have macroscopically solid RCC without any cystic components.In most cases, CT is the most accurate diagnostic technique for the clinical diagnostic classification of renal masses. In cases where US characterizes a renal lesion as solid, despite CT findings of a cystic lesion, kidney biopsies are recommended. The 6 cases reported here support our belief that, in diagnostic processes of RCC, these techniques should be complementary used.
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de Miranda CMNR, Maranhão CPDM, dos Santos CJJ, Padilha IG, de Farias LDPG, da Rocha MS. Bosniak classification of renal cystic lesions according to multidetector computed tomography findings. Radiol Bras 2014; 47:115-21. [PMID: 25741060 PMCID: PMC4337166 DOI: 10.1590/s0100-39842014000200015] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2013] [Accepted: 08/12/2013] [Indexed: 12/22/2022] Open
Abstract
Renal cystic lesions are usually diagnosed in the radiologists' practice and therefore their characterization is crucial to determine the clinical approach to be adopted and prognosis. The Bosniak classification based on computed tomography findings has allowed for standardization and categorization of lesions in increasing order of malignancy (I, II, IIF, III and IV) in a simple and accurate way. The present iconographic essay developed with multidetector computed tomography images of selected cases from the archives of the authors' institution, is aimed at describing imaging findings that can help in the diagnosis of renal cysts.
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Affiliation(s)
- Christiana Maia Nobre Rocha de Miranda
- PhD, MD, Titular Member of Colégio Brasileiro de Radiologia e
Diagnóstico por Imagem (CBR), Coordinator for the Units of Computed Tomography
and Magnetic Resonance Imaging, and Radiologist at the PET-CT Unit of Clínica de
Medicina Nuclear e Radiologia de Maceió (MedRadiUS), Teacher of Radiology and
Imaging Diagnosis at Universidade Federal de Alagoas (UFAL), Maceió, AL,
Brazil
| | - Carol Pontes de Miranda Maranhão
- Titular Member of Colégio Brasileiro de Radiologia e
Diagnóstico por Imagem (CBR), MD, Radiologist at the Units of Computed Tomography
and Magnetic Resonance Imaging of Clínica de Medicina Nuclear e Radiologia de
Maceió (MedRadiUS), Maceió, AL, Brazil
| | - Carla Jotta Justo dos Santos
- MD, Radiologist at the Units of Computed Tomography, Magnetic Resonance
Imaging and PET-CT of Clínica de Medicina Nuclear e Radiologia de Maceió
(Med-RadiUS), Maceió, AL, Brazil
| | - Igor Gomes Padilha
- Graduate Students (6th year), School of Medicine - Universidade Federal
de Alagoas (UFAL), Maceió, AL, Brazil
| | | | - Milzi Sarmento da Rocha
- Graduate Students (6th year), School of Medicine - Universidade Federal
de Alagoas (UFAL), Maceió, AL, Brazil
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Barr RG, Peterson C, Hindi A. Evaluation of indeterminate renal masses with contrast-enhanced US: a diagnostic performance study. Radiology 2013; 271:133-42. [PMID: 24475802 DOI: 10.1148/radiol.13130161] [Citation(s) in RCA: 127] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
PURPOSE To determine the utility of contrast material-enhanced ultrasonography (US) in the characterization of indeterminate renal masses. MATERIALS AND METHODS This retrospective performance study was approved by the institutional review board and was HIPAA compliant, with waiver of informed consent. Patients included 721 individuals referred for contrast-enhanced US with 1018 indeterminate renal masses from 1999 to 2010, identified initially with an imaging study. Three hundred twenty patients (44.4%) were female, and 401 (55.6%) were male. Patient ages ranged from 17 to 95 years (mean ± standard deviation, 70 years ± 15). Lesion size varied from 2 to 161 mm (mean, 26.6 mm ± 19.5). Contrast-enhanced US enhancement patterns were used to characterize masses as benign or malignant. For lesions with a definitive diagnosis, 306 of 1018 (30.0%) were correlated with contrast-enhanced US findings: 167 (54.6%) were benign, and 139 (45.4%) were malignant. For lesions without a pathologic diagnosis, 712 (70.0%) were followed for as long as 10 years. Diagnostic accuracy measures were calculated by using pathologic diagnosis as the reference standard, as well as lesion stability at 3 and 5 years. RESULTS Contrast-enhanced US had a sensitivity of 100% (126 of 126; 95% confidence interval [CI]: 97.1%, 100%), specificity of 95.0% (132 of 139; 95% CI: 89.9%, 98.0%), positive predictive value (PPV) of 94.7% (126 of 133), and negative predictive value (NPV) of 100% (132 of 132). The five false-positive masses included three oncocytomas and two Bosniak category 3 cystic lesions. Of the 290 lesions that had follow-up of at least 36 months, none of the lesions demonstrated changes that necessitated lesion reclassification. If these lesions were included, assuming lesions classified as malignant were malignant, then of the 596 lesions, sensitivity was 100% (161 of 161), specificity was 96.6% (420 of 435), PPV was 91.5% (161 of 176), and NPV was 100% (420 of 420). CONCLUSION Contrast-enhanced US evaluation is a highly sensitive and specific method for characterization of indeterminate renal masses. Online supplemental material is available for this article.
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Affiliation(s)
- Richard G Barr
- From Radiology Consultants, 250 DeBartolo Place, Bldg B, Youngstown, OH 44512 (R.G.B., C.P.); Kent State University-Salem Campus, Salem, Ohio (C.P.); and Department of Diagnostic Radiology, University Hospitals of Cleveland, Cleveland, Ohio (A.H.)
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Abstract
OBJECTIVE The objective of our study was to determine the frequency of atypical papillary renal cell carcinomas (RCCs) and identify imaging differences between type 1 and type 2 papillary RCCs once atypical papillary RCC tumors have been excluded. MATERIALS AND METHODS Eighty-two papillary RCC tumors were classified at pathology as type 1, type 2, or atypical. The CT and MRI examinations of these tumors were reviewed. Imaging features such as tumor size, margins, heterogeneity, and enhancement were assessed and the findings in type 1 and type 2 tumors were compared. RESULTS There were 43 type 1 and 13 type 2 tumors. Atypical histologic features (i.e., tumors containing both type 1 and type 2 components, clear cells, or components with atypically high nuclear grade [in type 1 tumors] or low nuclear grade [in type 2 tumors]) were seen in 26 tumors. On CT, type 2 tumors more commonly had infiltrative margins (p = 0.05) and were more likely to have calcifications (p = 0.04) than type 1 tumors, although these features were seen in all tumor types. Type 2 tumors were also more heterogeneous than type 1 tumors (p = 0.04). On CT, 11 papillary RCCs showed enhancement of less than 20 HU, seven of which showed enhancement of less than 10 HU. On MRI, all tumors showed enhancement on subtraction images. CONCLUSION Nearly one third of papillary RCCs in our patient population had atypical features at histology. On CT and MRI, there are some significant differences in imaging features between type 1 and type 2 tumors; however, substantial overlap precludes categorization on a per-patient basis. On CT, many papillary RCCs do not enhance, indicating that assessment of enhancement alone is insufficient for differentiating papillary RCCs from hyperdense cysts.
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Costa DMC, Salvadori PS, Monjardim RDF, Bretas EAS, Torres LR, Caldana RP, Shigueoka DC, Medeiros RB, D'ippolito G. When the non-contrast-enhanced phase is unnecessary in abdominal computed tomography scans? A retrospective analysis of 244 cases. Radiol Bras 2013. [DOI: 10.1590/s0100-39842013000400004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
Objective: To evaluate the necessity of the non contrast-enhanced phase in abdominal computed tomography scans. Materials and Methods: A retrospective, cross-sectional, observational study was developed, evaluating 244 consecutive abdominal computed tomography scans both with and without contrast injection. Initially, the contrast-enhanced images were analyzed (first analysis). Subsequently, the observers had access to the non-contrast-enhanced images for a second analysis. The primary and secondary diagnoses were established as a function of the clinical indications for each study (such as tumor staging, acute abdomen, investigation for abdominal collection and hepatocellular carcinoma, among others). Finally, the changes in the diagnoses resulting from the addition of the non-contrast-enhanced phase were evaluated. Results: Only one (0.4%; p > 0.999; non-statistically significant) out of the 244 reviewed cases had the diagnosis changed after the reading of non-contrast-enhanced images. As the secondary diagnoses are considered, 35 (14%) cases presented changes after the second analysis, as follows: nephrolithiasis (10%), steatosis (3%), adrenal nodule (0.7%) and cholelithiasis (0.3%). Conclusion: For the clinical indications of tumor staging, acute abdomen, investigation of abdominal collections and hepatocellular carcinoma, the non-contrast-enhanced phase can be excluded from abdominal computed tomography studies with no significant impact on the diagnosis.
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Sai V, Rakow-Penner R, Yeh BM, Coakley FV, Westphalen AC, Webb EM, Wang ZJ. Renal cyst pseudoenhancement at 16- and 64-dector row MDCT. Clin Imaging 2013; 37:520-5. [DOI: 10.1016/j.clinimag.2012.09.016] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2012] [Revised: 08/26/2012] [Accepted: 09/20/2012] [Indexed: 11/17/2022]
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Liu X, Zhou J, Zeng M, Ma Z, Ding Y. Homogeneous high attenuation renal cysts and solid masses - differentiation with single phase dual energy computed tomography. Clin Radiol 2013; 68:e198-205. [DOI: 10.1016/j.crad.2012.11.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2012] [Revised: 10/31/2012] [Accepted: 11/12/2012] [Indexed: 12/25/2022]
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Jarraya H, Mirabel X, Taieb S, Dewas S, Tresch E, Bonodeau F, Adenis A, Kramar A, Lartigau E, Ceugnart L. Image-based response assessment of liver metastases following stereotactic body radiotherapy with respiratory tracking. Radiat Oncol 2013; 8:24. [PMID: 23363610 PMCID: PMC3627622 DOI: 10.1186/1748-717x-8-24] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2012] [Accepted: 01/22/2013] [Indexed: 02/06/2023] Open
Abstract
Objective To describe post-CyberKnife® imaging characteristics of liver metastases as an aid in assessing response to treatment, and a novel set of combined criteria (CC) as an alternative to response according to change in size (RECIST). Subjects and Methods Imaging data and medical records of 28 patients with 40 liver metastases treated with stereotactic body radiotherapy (SBRT) were reviewed. Tumor size, CT attenuation coefficient, and contrast enhancement of lesions were evaluated up to 2 years post SBRT. Rates of local control, progression-free survival, time to progression, and overall survival according to RECIST and CC were estimated. Results Complete response (CR) was 3.6% (95% CI: 0.1–18%) and 18% (95% CI: 6–37%) according to RECIST and combined criteria, respectively. Two progressive diseases and two partial responses according to RECIST were classified as CR by the combined criteria and one stable response according to RECIST was classified as progressive by CC (Stuart-Maxwell test, p = 0.012). The disease control rate was 60.7% (95% CI: 41–78%) by RECIST and 64% (95% CI: 44%–81%) by CC. Conclusion Use of response criteria based on change in size alone in the interpretation of liver response to SBRT may be inadequate. We propose a simple algorithm with a combination of criteria to better assess tumor response. Further studies are needed to confirm their validity.
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Affiliation(s)
- Hajer Jarraya
- Department of Radiology, CLCC Oscar Lambret, 3 rue Frédéric Combemale, BP 307, Lille cedex, 59020, France.
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Pseudoenhancement of Renal Cysts: Influence of Lesion Size, Lesion Location, Slice Thickness, and Number of MDCT Detectors. AJR Am J Roentgenol 2012; 198:133-7. [DOI: 10.2214/ajr.10.6057] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Iodine Quantification With Dual-Energy CT: Phantom Study and Preliminary Experience With Renal Masses. AJR Am J Roentgenol 2011; 196:W693-700. [DOI: 10.2214/ajr.10.5541] [Citation(s) in RCA: 177] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Vikram R, Ng CS, Tamboli P, Tannir NM, Jonasch E, Matin SF, Wood CG, Sandler CM. Papillary renal cell carcinoma: radiologic-pathologic correlation and spectrum of disease. Radiographics 2009; 29:741-54; discussion 755-7. [PMID: 19448113 DOI: 10.1148/rg.293085190] [Citation(s) in RCA: 105] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Papillary renal cell carcinoma (pRCC) is the second most common type of renal cell carcinoma (RCC). pRCC has unique imaging and clinical features that may allow differentiation from clear cell RCC (cRCC). There have been significant advances in our knowledge of the natural history and treatment of pRCC, with data suggesting that it may be best to manage pRCC differently from the other subtypes of RCC. At contrast material-enhanced computed tomography, pRCC enhances less than does cRCC in all phases of contrast-enhanced imaging. The difference in the degree of enhancement between pRCC and cRCC is due to differences in their intratumoral vascularity. In general, if a heterogeneous mass enhances to a degree similar to that manifested by the renal cortex, it is likely to be a cRCC. A mass that enhances to a lesser degree is likely to be a non-clear cell RCC. It is common for metastatic lesions from pRCC to show enhancement characteristics similar to those of the primary tumor and be hypovascular.
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Affiliation(s)
- Raghunandan Vikram
- Department of Diagnostic Radiology, University of Texas M. D. Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030, USA.
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Dual-energy CT iodine overlay technique for characterization of renal masses as cyst or solid: a phantom feasibility study. Eur Radiol 2009; 19:1289-95. [DOI: 10.1007/s00330-008-1273-6] [Citation(s) in RCA: 83] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2008] [Revised: 09/23/2008] [Accepted: 11/18/2008] [Indexed: 10/21/2022]
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Kim SH, Kim SH. Effect of thin overlapping reconstruction on the attenuation of small (< or = 3 cm) renal cysts in the nephrographic phase of MDCT: a phantom study. Korean J Radiol 2007; 7:275-80. [PMID: 17143031 PMCID: PMC2667614 DOI: 10.3348/kjr.2006.7.4.275] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Objective To evaluate the effect of thin overlapping reconstruction on the attenuation of small (≤ 3 cm) renal cysts in the nephrographic phase of multidetector CT (MDCT). Materials and Methods We scanned a phantom kidney containing spheres of various sizes (10, 20, and 30 mm) using both 4- and 16-channel MDCT scanners, and reconstructed images with various slice thickness (T, mm) and intervals (I, mm). The attenuation increase (AI) was measured for each sphere in 240-HU diluted solution of contrast material and compared with the attenuation in 35-HU solution. Results On the 4-channel MDCT, thin overlapping reconstruction (T/I = 3/1, compared with 5/5) lowered the AI as much as 17 HU in the 10 mm-sphere and 6 HU in the 20 mm-sphere (p < 0.05). Thin slicing alone was also effective; however overlapping alone was not. On the 16-channel MDCT, AI in the 10 mm-sphere was significantly lower than on the 4-channel MDCT with T/I = 5/5 (p < 0.05), however thinner slicing or overlapping did not affect the attenuation significantly in all of the spheres. Conclusion The effect of thin overlapping reconstruction on minimizing falsely elevated attenuation in the nephrographic phase was significant only in cysts ≤ 20 mm on the 4-channel MDCT.
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Affiliation(s)
- Sun Ho Kim
- Department of Radiology, Seoul National University College of Medicine, Institute of Radiation Medicine, Seoul National University Medical Center, Clinical Research Institute, Seoul National University Hospital, Seoul 110-744, Korea
- Department of Radiology, Dongguk University College of Medicine, Goyang 410-733, Korea
| | - Seung Hyup Kim
- Department of Radiology, Seoul National University College of Medicine, Institute of Radiation Medicine, Seoul National University Medical Center, Clinical Research Institute, Seoul National University Hospital, Seoul 110-744, Korea
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Abstract
With modern computed tomography (CT) and magnetic resonance (MR) imaging equipment, the diagnosis of most renal masses is usually straightforward and accurate. The major question to be answered is whether the mass represents a surgical or nonsurgical lesion or, in some cases, if follow-up studies are necessary. This evaluation usually can be accomplished if a high-quality examination is performed, if the clinical history of the patient is kept in mind, if conditions that mimic a renal neoplasm are considered and excluded, and if there is an awareness of the potential pitfalls and limitations of CT and MR imaging. In this article, the authors present their technique in the performance of CT and MR imaging examinations, summarize their approach to the diagnosis of renal masses, review the imaging findings in these lesions, and stress the limitations in renal mass diagnosis.
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Affiliation(s)
- Gary M Israel
- Department of Radiology, New York University Medical Center, New York, NY, USA.
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Abstract
The pathologic and imaging features of the renal cyst have been well described. A fluid-filled lesion is considered a cystic mass (ie, not a simple cyst) when it has any of the following features: calcification, high attenuation (>20 HU) at computed tomography, signal intensity not typical of water at magnetic resonance imaging, septations, multiple locules, enhancement, wall thickening, or nodularity. There are two important causes of a cystic renal mass: a complicated simple cyst (eg, one with hemorrhage, infection, or ischemia) and cystic renal cell carcinoma. At radiologic evaluation of such masses, it is imperative that optimal imaging techniques be used. Masses with calcification, high attenuation or high signal intensity, or septations can be categorized as benign (no further evaluation required), as requiring follow-up (probably benign), or as requiring surgery. Lesions requiring surgery can be benign or malignant at microscopic examination. Lesions that are multiloculated or demonstrate enhancement, wall thickening, or nodularity usually require surgery. When multiple features are present (eg, calcification and enhancement), the mass should be managed according to its most aggressive feature. Likewise, when there are conflicting findings at evaluation with different imaging modalities, the mass should be managed according to the most aggressive finding.
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Affiliation(s)
- David S Hartman
- Department of Radiology, Milton S. Hershey Medical Center, Penn State University School of Medicine, HO66, 500 University Dr, Hershey, PA 17033, USA.
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