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Effect of Ultra-High Resolution CT on Pseudoenhancement in Renal Cysts: A Phantom Experiment and Clinical Study. AJR Am J Roentgenol 2022; 219:624-633. [PMID: 35583427 DOI: 10.2214/ajr.22.27354] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Background: Ultra-high resolution CT (U-HRCT) allows acquisition using a small detector element size, in turn allowing very high spatial resolutions. The high resolution may reduce partial-volume averaging and thereby renal cyst pseudoenhancement. Objective: To assess the impact of U-HRCT on renal cyst pseudoenhancement. Methods: A phantom was constructed that contained 7-, 15-, and 25-mm simulated cysts within compartments simulating unenhanced and nephrographic-phase renal parenchyma. The phantom underwent two U-HRCT acquisitions using 0.25- and 0.5-mm detector elements, with reconstruction at varying matrices and slice thicknesses. A retrospective study was performed of 36 patients (24 men, 12 women; mean age, 75.7±9.4 years) with 118 renal cysts who underwent renal-mass protocol CT using U-HRCT and the 0.25-mm detector element, with reconstruction at varying matrices and slice thicknesses; detector element size could not be retrospectively adjusted. ROIs were placed to measure cysts' attenuation increase from unenhanced to nephrographic phases (to reflect pseudoenhancement), and SD of unenhanced-phase attenuation (to reflect image noise). Results: In the phantom, attenuation increase was lower for the 0.25 mm than 0.5 mm detector element for the 15-mm cyst (4.6±2.7 HU vs 6.8±2.9 HU, p=.03) and 25-mm cyst (2.3±1.4 HU vs 3.8±1.2 HU, p=.02), but not the 7-mm cyst (p=.72). Attenuation increase was not different between 512×512 and 1024×1024 matrices for any cyst size in the phantom or patients (p>.05). Attenuation increase was not associated with slice thickness for any cyst size in the phantom or for ≥5-to-<10 mm and ≥10 mm cysts in patients (p>.05). For cysts <5 mm in patients, attenuation increase showed decreases with thinner slices (3 mm: 23.7±22.5, 2 mm: 20.2±22.7 HU, 0.5 mm: 11.6±17.5 HU, 0.25 mm: 12.6±19.7 HU; p<.001). Smaller detector element size, increased matrix size, and thinner slices all increased image noise for cysts of all sizes in the phantom and patients (p<.05). Conclusion: U-HRCT may reduce renal cyst pseudoenhancement through a smaller detector element size and, for <5 mm cysts, very thin slices; however, these adjustments result in increased noise. Clinical Impact: Although requiring further clinical evaluation, U-HRCT may facilitate characterization of small cystic renal lesions, thereby reducing equivocal interpretations and follow-up recommendations.
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Toia GV, Kim S, Dighe MK, Mileto A. Dual-Energy Computed Tomography in Body Imaging. Semin Roentgenol 2018; 53:132-146. [PMID: 29861005 DOI: 10.1053/j.ro.2018.02.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Affiliation(s)
- Giuseppe V Toia
- Body Imaging Section, Department of Radiology, University of Washington School of Medicine, Seattle, WA 98195
| | - Sooah Kim
- Body Imaging Section, Department of Radiology, University of Washington School of Medicine, Seattle, WA 98195
| | - Manjiri K Dighe
- Body Imaging Section, Department of Radiology, University of Washington School of Medicine, Seattle, WA 98195
| | - Achille Mileto
- Body Imaging Section, Department of Radiology, University of Washington School of Medicine, Seattle, WA 98195.
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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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Mileto A, Sofue K, Marin D. Imaging the renal lesion with dual-energy multidetector CT and multi-energy applications in clinical practice: what can it truly do for you? Eur Radiol 2016; 26:3677-90. [DOI: 10.1007/s00330-015-4180-7] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2015] [Revised: 12/16/2015] [Accepted: 12/18/2015] [Indexed: 01/30/2023]
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Jinzaki M, Kikuchi E, Akita H, Sugiura H, Shinmoto H, Oya M. Role of computed tomography urography in the clinical evaluation of upper tract urothelial carcinoma. Int J Urol 2016; 23:284-98. [DOI: 10.1111/iju.13032] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2015] [Accepted: 11/15/2015] [Indexed: 12/24/2022]
Affiliation(s)
- Masahiro Jinzaki
- Department of Diagnostic Radiology; Keio University School of Medicine; Tokyo Japan
| | - Eiji Kikuchi
- Department of Urology; Keio University School of Medicine; Tokyo Japan
| | - Hirotaka Akita
- Department of Diagnostic Radiology; Keio University School of Medicine; Tokyo Japan
| | - Hiroaki Sugiura
- Department of Diagnostic Radiology; Keio University School of Medicine; Tokyo Japan
| | - Hiroshi Shinmoto
- Department of Radiology; National Defense Medical College; Tokorozawa Saitama Japan
| | - Mototsugu Oya
- Department of Urology; Keio University School of Medicine; Tokyo Japan
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Heilbrun ME, Remer EM, Casalino DD, Beland MD, Bishoff JT, Blaufox MD, Coursey CA, Goldfarb S, Harvin HJ, Nikolaidis P, Preminger GM, Raman SS, Sahni A, Vikram R, Weinfeld RM. ACR Appropriateness Criteria indeterminate renal mass. J Am Coll Radiol 2015; 12:333-41. [PMID: 25842014 DOI: 10.1016/j.jacr.2014.12.012] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2014] [Accepted: 12/30/2014] [Indexed: 11/29/2022]
Abstract
Renal masses are increasingly detected in asymptomatic individuals as incidental findings. An indeterminate renal mass is one that cannot be diagnosed confidently as benign or malignant at the time it is discovered. CT, ultrasonography, and MRI of renal masses with fast-scan techniques and intravenous (IV) contrast are the mainstays of evaluation. Dual-energy CT, contrast-enhanced ultrasonography, PET/CT, and percutaneous biopsy are all technologies that are gaining traction in the characterization of the indeterminate renal mass. In cases in which IV contrast cannot be used, whether because of IV contrast allergy or renal insufficiency, renal mass classification with CT is markedly limited. In the absence of IV contrast, ultrasonography, MRI, and biopsy have some advantages. Owing to the low malignant and metastatic potential of small renal cell carcinomas (≤4 cm in diameter), active surveillance is additionally emerging as a diagnostic strategy for patients who have high surgical risk or limited life expectancy. The ACR Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed every 3 years by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of current medical literature from peer-reviewed journals and application by the panel of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures. In those instances in which evidence is lacking or not definitive, expert opinion may be used to recommend imaging or treatment.
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Affiliation(s)
| | | | | | | | | | | | | | - Stanley Goldfarb
- University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
| | | | | | | | - Steven S Raman
- Universty of California Los Angeles Medical Center, Los Angeles, California
| | - Anik Sahni
- Brigham & Women's Hospital, Boston, Massachusetts
| | | | - Robert M Weinfeld
- Oakland University William Beaumont School of Medicine, Troy, Michigan
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Yamashita Y, Murayama S, Okada M, Watanabe Y, Kataoka M, Kaji Y, Imamura K, Takehara Y, Hayashi H, Ohno K, Awai K, Hirai T, Kojima K, Sakai S, Matsunaga N, Murakami T, Yoshimitsu K, Gabata T, Matsuzaki K, Tohno E, Kawahara Y, Nakayama T, Monzawa S, Takahashi S. The essence of the Japan Radiological Society/Japanese College of Radiology Imaging Guideline. Jpn J Radiol 2015; 34:43-79. [DOI: 10.1007/s11604-015-0499-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Utility of MRI in the Characterization of Indeterminate Small Renal Lesions Previously Seen on Screening CT Scans of Potential Renal Donor Patients. AJR Am J Roentgenol 2015. [PMID: 26204282 DOI: 10.2214/ajr.14.13956] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVE The purpose of this study was to determine whether MRI could more confidently characterize indeterminate small renal lesions (< 15 mm) previously seen on CT scans of potential renal donor patients and whether such characterization could impact surgical management and donor candidate status. MATERIALS AND METHODS After dedicated contrast-enhanced renal CT examinations of a population of renal donor patients identified indeterminate small renal lesions (< 15 mm), dedicated renal MRI examinations were performed for 55 of those patients. Two radiologists used consensus reading of established MRI characteristics to characterize indeterminate small lesions as simple cysts, hemorrhagic cysts, angiomyolipomas, or solid renal masses. RESULTS A total of 94 indeterminate small renal lesions were detected on CT. MRI was able to confidently diagnose 93 of those lesions, including 83 cysts, eight hemorrhagic cysts, and two angiomyolipomas. MRI directly affected the surgical management of four of the patients (7%). CONCLUSION For potential renal donor patients, MRI can be an effective means of characterizing lesions that are deemed to be too small to characterize by CT. MRI can also potentially alter the surgical management and donor status of this group of patients.
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Approach to Very Small (< 1.5 cm) Cystic Renal Lesions: Ignore, Observe, or Treat? AJR Am J Roentgenol 2015; 204:1182-9. [DOI: 10.2214/ajr.15.14357] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Ganeshan D, Morani A, Ladha H, Bathala T, Kang H, Gupta S, Lalwani N, Kundra V. Staging, surveillance, and evaluation of response to therapy in renal cell carcinoma: role of MDCT. ACTA ACUST UNITED AC 2015; 39:66-85. [PMID: 24077815 DOI: 10.1007/s00261-013-0037-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Renal cell carcinoma is the most common malignant renal tumor in the adults. Significant advances have been made in the management of localized and advanced renal cell carcinoma. Surgery is the standard of care and accurate pre-operative staging based on imaging is critical in guiding appropriate patient management. Besides staging, imaging plays a key role in the post-operative surveillance and evaluation of response to systemic therapies. Both CT and MR are useful in the staging and follow up of renal cell carcinoma, but CT is more commonly used due to its lower costs and wider availability. In this article, we discuss and illustrate the role of multi-detector CT in pre-operative staging, post-operative surveillance, and evaluation of response to systemic therapy in renal cell carcinoma.
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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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Silverman SG, Israel GM, Trinh QD. Incompletely Characterized Incidental Renal Masses: Emerging Data Support Conservative Management. Radiology 2015; 275:28-42. [DOI: 10.1148/radiol.14141144] [Citation(s) in RCA: 88] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Ellimoottil C, Greco KA, Hart S, Patel T, Sheikh MM, Turk TMT, Flanigan RC. New modalities for evaluation and surveillance of complex renal cysts. J Urol 2014; 192:1604-11. [PMID: 25072181 DOI: 10.1016/j.juro.2014.07.099] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/14/2014] [Indexed: 12/12/2022]
Abstract
PURPOSE The increased use of abdominal imaging has led to more frequent detection of incidental renal cysts. Since the inception of the Bosniak classification system, management of Bosniak I, III and IV cysts has been clearly defined, while evaluation and management of Bosniak II and IIF cysts have remained a clinical dilemma. Discussions of new imaging modalities are becoming increasingly prevalent in the radiological literature. In this context we performed a comprehensive review of the recent literature on complex renal cysts focusing on new imaging modalities, surveillance strategies and biopsy. MATERIALS AND METHODS We performed a comprehensive literature review of articles published from January 1, 1998 through December 31, 2013 via MEDLINE(®), EMBASE and the Cochrane Collection using a predetermined search strategy. All studies included were performed in humans older than 18 years, were written in English and had an abstract available for review. We grouped studies into 1 of 5 categories, ie computerized tomography, magnetic resonance imaging, ultrasound, biopsy and surveillance. RESULTS While computerized tomography and magnetic resonance imaging with and without contrast enhancement remain the gold standard to evaluate cystic lesions of the kidney, diffusion-weighted magnetic resonance imaging and contrast enhanced ultrasound have surfaced as new tools for assessment of complex cysts. Comparative effectiveness studies on these new imaging modalities are limited. Image guided biopsy has increasingly been shown to be useful for evaluation of intermediate (Bosniak II and IIF) complex cysts. We found few studies providing guidance on the duration and/or intensity of surveillance required for intermediate complex renal cysts. CONCLUSIONS Although new and enhanced techniques are in development and may be useful in the future management of complex renal cysts, there is a paucity of data regarding the value of these new techniques. Future research should focus on surveillance of intermediate complex renal cysts, particularly on the ideal frequency and type of imaging required.
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Affiliation(s)
- Chandy Ellimoottil
- Department of Urology, Loyola University Medical Center, Maywood, Illinois.
| | - Kristin A Greco
- Department of Urology, Loyola University Medical Center, Maywood, Illinois
| | - Spencer Hart
- Department of Urology, Loyola University Medical Center, Maywood, Illinois
| | - Tejas Patel
- Department of Radiology, Loyola University Medical Center, Maywood, Illinois
| | - M Mukarram Sheikh
- Department of Radiology, Loyola University Medical Center, Maywood, Illinois
| | - Thomas M T Turk
- Department of Urology, Loyola University Medical Center, Maywood, Illinois
| | - Robert C Flanigan
- Department of Urology, Loyola University Medical Center, Maywood, Illinois
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Dual energy MDCT assessment of renal lesions: an overview. Eur Radiol 2013; 24:353-62. [DOI: 10.1007/s00330-013-3030-8] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2013] [Revised: 08/26/2013] [Accepted: 09/11/2013] [Indexed: 02/07/2023]
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Goenka AH, Remer EM, Smith AD, Obuchowski NA, Klink J, Campbell SC. Development of a Clinical Prediction Model for Assessment of Malignancy Risk in Bosniak III Renal Lesions. Urology 2013; 82:630-5. [DOI: 10.1016/j.urology.2013.05.016] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2013] [Revised: 05/06/2013] [Accepted: 05/14/2013] [Indexed: 11/29/2022]
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Ascenti G, Mileto A, Krauss B, Gaeta M, Blandino A, Scribano E, Settineri N, Mazziotti S. Distinguishing enhancing from nonenhancing renal masses with dual-source dual-energy CT: iodine quantification versus standard enhancement measurements. Eur Radiol 2013; 23:2288-95. [DOI: 10.1007/s00330-013-2811-4] [Citation(s) in RCA: 107] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2012] [Revised: 01/20/2013] [Accepted: 01/24/2013] [Indexed: 01/03/2023]
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[Diagnosis of kidney tumors]. MMW Fortschr Med 2012; 154:41-4. [PMID: 23297538 DOI: 10.1007/s15006-012-1688-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Gontero P, Joniau S, Oderda M, Ruutu M, Van Poppel H, Laguna MP, de la Rosette J, Kirkali Z. Active surveillance for small renal tumors: Have clinical concerns been addressed so far? Int J Urol 2012; 20:356-61. [DOI: 10.1111/j.1442-2042.2012.03227.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2012] [Accepted: 10/05/2012] [Indexed: 01/23/2023]
Affiliation(s)
- Paolo Gontero
- Department of Urology; A.O.U. San Giovanni Battista; University of Turin; Turin; Italy
| | - Steven Joniau
- Department of Urology; University Hospitals Leuven; Leuven; Belgium
| | - Marco Oderda
- Department of Urology; A.O.U. San Giovanni Battista; University of Turin; Turin; Italy
| | - Mirja Ruutu
- Department of Urology; Helsinki University Central Hospital; Helsinki; Finland
| | - Hein Van Poppel
- Department of Urology; University Hospitals Leuven; Leuven; Belgium
| | - M Pilar Laguna
- Department of Urology; AMC University Hospital; Amsterdam; the Netherlands
| | - Jean de la Rosette
- Department of Urology; AMC University Hospital; Amsterdam; the Netherlands
| | - Ziya Kirkali
- Department of Urology; Dokuz Eylül University School of Medicine; Izmir; Turkey
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Comparison of CT Urography and Excretory Urography in the Detection and Localization of Urothelial Carcinoma of the Upper Urinary Tract. AJR Am J Roentgenol 2011; 196:1102-9. [DOI: 10.2214/ajr.10.5249] [Citation(s) in RCA: 77] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Berland LL, Silverman SG, Gore RM, Mayo-Smith WW, Megibow AJ, Yee J, Brink JA, Baker ME, Federle MP, Foley WD, Francis IR, Herts BR, Israel GM, Krinsky G, Platt JF, Shuman WP, Taylor AJ. Managing Incidental Findings on Abdominal CT: White Paper of the ACR Incidental Findings Committee. J Am Coll Radiol 2010; 7:754-73. [DOI: 10.1016/j.jacr.2010.06.013] [Citation(s) in RCA: 512] [Impact Index Per Article: 36.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2010] [Accepted: 06/07/2010] [Indexed: 02/06/2023]
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How not to miss or mischaracterize a renal cell carcinoma: protocols, pearls, and pitfalls. AJR Am J Roentgenol 2010; 194:W307-15. [PMID: 20308475 DOI: 10.2214/ajr.09.3033] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVE MDCT protocol optimization for renal cell carcinoma requires attention to several data acquisition, reconstruction, and display parameters. Specifically, multiple acquisitions with varying coverage, careful timing of each contrast-enhanced phase, and use of 2D and 3D multiplanar displays are required. This article reviews these parameters, supplemented by experience-based pearls and pitfalls. CONCLUSION Proper data acquisition and utilization of postprocessing tools are essential to avoid missed diagnoses or misinterpretation when imaging renal cell carcinoma.
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Silverman SG, Leyendecker JR, Amis ES. What Is the Current Role of CT Urography and MR Urography in the Evaluation of the Urinary Tract? Radiology 2009; 250:309-23. [DOI: 10.1148/radiol.2502080534] [Citation(s) in RCA: 218] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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MDCT Angiography in Abdominal Aortic Aneurysm Treated with Endovascular Repair: Diagnostic Impact of Slice Thickness on Detection of Endoleaks. AJR Am J Roentgenol 2007; 189:1414-20. [DOI: 10.2214/ajr.06.1116] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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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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Salagierski M, Salagierski M, Salagierska-Barwińska A, Sosnowski M. Percutaneous ultrasound-guided radiofrequency ablation for kidney tumors in patients with surgical risk. Int J Urol 2007; 13:1375-9. [PMID: 17083386 DOI: 10.1111/j.1442-2042.2006.01595.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The aim of this study was to describe our experience with percutaneous ultrasound-guided radiofrequency ablation of kidney tumors. METHODS From July 2002 to August 2005, 45 radiofrequency ablations (RFA) in 42 selected patients with kidney tumor were performed. The patients had either contraindications to surgery procedures or had a solitary kidney. The average tumor size was 37.5 mm (range, 18-59 mm) with the mean age of 68 years (range, 28-83 years). RFA were performed based on radiographic findings. Needle biopsy was made only twice. Monopolar Cool-tip Tyco or bipolar Celon Olympus radiofrequency devices were used. The procedure was performed under conscious sedation with local anesthesia. Treatment efficacy was assessed by computed tomography and by Doppler ultrasound. The absence of contrast enhancement on computed tomography was considered to be a successful treatment. RESULTS The average follow up was 14 months (range, 3-36 months). In 42 tumors (93%), total absence of contrast enhancement was obtained after the initial RFA and in three tumors (7%) after the second ablation session. There were no complications following 41 procedures, including all ablations in small (<35 mm) renal masses. In four procedures, minor complications were observed. All patients are alive. There has been no need for chronic hemodialysis and, until now, we have not observed any local recurrences with the exception of one metastasis to an ipsilateral adrenal gland. CONCLUSIONS RFA of kidney tumors is a promising alternative treatment which could be considered for patients who are not suitable for surgery.
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Pavlica P, Derchi L, Martorana G, Brunocilla E, Bertaccini A, Manferrari F, Franceschelli A, Barozzi L. Renal Cell Carcinoma Imaging. ACTA ACUST UNITED AC 2006. [DOI: 10.1016/j.eursup.2006.03.010] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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Gervais DA, McGovern FJ, Arellano RS, McDougal WS, Mueller PR. Radiofrequency ablation of renal cell carcinoma: part 1, Indications, results, and role in patient management over a 6-year period and ablation of 100 tumors. AJR Am J Roentgenol 2005; 185:64-71. [PMID: 15972400 DOI: 10.2214/ajr.185.1.01850064] [Citation(s) in RCA: 417] [Impact Index Per Article: 21.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
OBJECTIVE The objectives of our article are to review our experience with radiofrequency ablation of renal cell carcinoma and to assess size and location as predictors of the ability to achieve complete necrosis by imaging criteria. MATERIALS AND METHODS Over a 6-year period, 100 renal tumors in 85 patients underwent radiofrequency ablation at a single institution. The absence of enhancement on CT or MRI after radiofrequency ablation was interpreted as complete coagulation necrosis. Results were analyzed by tumor size and location using multivariate analysis. A p value of 0.05 or less was considered significant. RESULTS All 52 small (3 cm) and all 68 exophytic tumors underwent complete necrosis regardless of size, although many large tumors (> 3 cm) required a second ablation session. Using multivariate analysis, we found that both small size (p < 0.0001) and noncentral location (p = 0.0049) proved to be independent predictors of complete necrosis after a single ablation session. Location was a significant predictor (p = 0.015) of complete necrosis after any number of sessions, whereas size showed a strong trend (p = 0.059) toward predicting success after any number of sessions. Complications were either self-limited or readily treated and included hemorrhage (major, n = 2; minor, n = 3), inflammatory track mass (n = 1), transient lumbar plexus pain (n = 2), ureteral injury (n = 2), and skin burns (n = 1). CONCLUSION Radiofrequency ablation is a promising minimally invasive therapy for renal cell carcinoma in patients who are not good operative candidates. Small size and noncentral location are favorable tumor characteristics, although large tumors can sometimes be successfully treated with multiple ablation sessions.
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Affiliation(s)
- Debra A Gervais
- Department of Radiology, Massachusetts General Hospital, 55 Fruit St., White 270, Boston, MA 02114, USA
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