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Zhu Q, Sun J, Ye J, Zhu W, Chen W. Comparison of conventional diffusion-weighted imaging and intravoxel incoherent motion in differentiating between chromophobe renal cell carcinoma and renal oncocytoma: a preliminary study. Br J Radiol 2024; 97:1146-1152. [PMID: 38688580 PMCID: PMC11135799 DOI: 10.1093/bjr/tqae088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 03/06/2024] [Accepted: 04/27/2024] [Indexed: 05/02/2024] Open
Abstract
OBJECTIVE Quantitative comparison of the diagnostic efficacy of conventional diffusion-weighted imaging (DWI) and intravoxel incoherent motion (IVIM) in differentiating between chromophobe renal cell carcinoma (ChRCC) from renal oncocytoma (RO). METHODS A total of 48 patients with renal tumours who had undergone DWI and IVIM were divided into two groups-ChRCC (n = 28) and RO (n = 20) groups, and the apparent diffusion coefficient (ADC), true diffusivity (D), pseudo-diffusion coefficient (D*), perfusion fraction (f) and their diagnostic efficacy were compared between the two groups. RESULTS The D* values were higher in the ChRCCs group compared to the RO groups (0.019 ± 0.003 mm2/s vs 0.008 ± 0.002 mm2/s, P < .05). Moreover, the ADC, D and f values were higher in ROs compared to ChRCCs (0.61 ± 0.08 × 10-3 mm2/s vs 0.51 ± 0.06 × 10-3 mm2/s, 1.02 ± 0.15 × 10-3 mm2/s vs 0.86 ± 0.07 × 10-3 mm2/s, 0.41 ± 0.05 vs 0.28 ± 0.02, P < .05). The areas of the ADC, D, D* and f values under the ROC curves in differentiating ChRCCs from ROs were 0.713, 0.839, 0.856 and 0.906, respectively. The cut-off values of ADC, D, D* and f were 0.54, 0.91, 0.013 and 0.31, respectively. The AUC, sensitivity, specificity and accuracy of the f values were 0.906, 89.3%, 80.0% and 89.6%, respectively. For pairwise comparisons of ROC curves and diagnostic efficacy, IVIM parameters, that is, D, D* and f offered better diagnostic accuracy than ADC in differentiating ChRCCs from ROs (P = .013, .016, and .008) with f having the highest diagnostic accuracy. CONCLUSION IVIM parameters presented better performance than ADC in differentiating ChRCCs from ROs. ADVANCES IN KNOWLEDGE (1) D* values of ChRCCs were higher, while ADC, D and f values were lower than those of RO tumours. (2) f values had the highest diagnostic efficacy in differentiating ChRCC from RO. (3) IVIM parameters, that is, D, D* and f offered better diagnostic accuracy than ADC in differentiating ChRCC from RO (P=.013, .016, and .008).
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Affiliation(s)
- Qingqiang Zhu
- Northern Jiangsu People's Hospital Affiliated to Yangzhou University, Yangzhou 225001, China
| | - Jun Sun
- Northern Jiangsu People's Hospital Affiliated to Yangzhou University, Yangzhou 225001, China
| | - Jing Ye
- Northern Jiangsu People's Hospital Affiliated to Yangzhou University, Yangzhou 225001, China
| | - Wenrong Zhu
- Northern Jiangsu People's Hospital Affiliated to Yangzhou University, Yangzhou 225001, China
| | - Wenxin Chen
- Northern Jiangsu People's Hospital Affiliated to Yangzhou University, Yangzhou 225001, China
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Qu JY, Jiang H, Song XH, Wu JK, Ma H. Four-phase computed tomography helps differentiation of renal oncocytoma with central hypodense areas from clear cell renal cell carcinoma. Diagn Interv Radiol 2023; 29:205-211. [PMID: 36960636 PMCID: PMC10679699 DOI: 10.5152/dir.2022.21834] [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: 08/23/2021] [Accepted: 12/16/2021] [Indexed: 01/15/2023]
Abstract
PURPOSE To explore the utility of four-phase computed tomography (CT) in distinguishing renal oncocytoma with central hypodense areas from clear cell renal cell carcinoma (ccRCC). METHODS Eighteen patients with oncocytoma and 63 patients with ccRCC presenting with central hypodense areas were included in this study. All patients underwent four-phase CT imaging including the excretory phases later than 20 min after contrast injection. Two blinded experienced radiologists visually reviewed the enhancement features of the central hypodense areas in the excretory phase images and selected the area demonstrating the greatest degree of enhancement of the tumor in the corticomedullary phase images. Regions of interest (ROIs) were placed in the same location in each of the three contrast-enhanced imaging phases. Additionally, ROIs were placed in the adjacent normal renal cortex for normalization. The ratio of the lesion to cortex attenuation (L/C) for the three contrast-enhanced imaging phases and absolute de-enhancement were calculated. The receiver operating characteristic curve was used to obtain the cut-off values. RESULTS Complete enhancement inversion of the central areas was observed in 12 oncocytomas (66.67%) and 16 ccRCCs (25.40%) (P = 0.003). Complete enhancement inversion combined with L/C in the corticomedullary phase lower than 1.0 (P < 0.001) or absolute de-enhancement lower than 42.5 HU (P < 0.001) provided 86.42% and 85.19% accuracy, 61.11% and 55.56% sensitivity, 93.65% and 93.65% specificity, 73.33% and 71.43% positive predictive value (PPV), and 89.39% and 88.06% negative predictive value (NPV), respectively, for the diagnosis of oncocytomas. Combined with complete enhancement inversion, L/C in the corticomedullary phase lower than 1.0 and absolute de-enhancement lower than 42.5 HU provided 87.65%, 55.56%, 96.83%, 83.33%, and 88.41% of accuracy, sensitivity, specificity, PPV, and NPV, respectively, for the diagnosis of oncocytomas. CONCLUSION The combination of enhancement features of the central hypodense areas and the peripheral tumor parenchyma can help distinguish oncocytoma with central hypodense areas from ccRCC.
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Affiliation(s)
- Jian-Yi Qu
- Department of Radiology, Yantai Yuhuangding Hospital, Qingdao University School of Medicine, Yantai, China
| | - Hong Jiang
- Department of Radiology, Yantai Yuhuangding Hospital, Qingdao University School of Medicine, Yantai, China
| | - Xin-Hong Song
- Department of Radiology, Yantai Yuhuangding Hospital, Qingdao University School of Medicine, Yantai, China
| | - Jin-Kun Wu
- Department of Pathology, Yantai Yuhuangding Hospital, Qingdao University School of Medicine, Yantai, China
| | - Heng Ma
- Department of Radiology, Yantai Yuhuangding Hospital, Qingdao University School of Medicine, Yantai, China
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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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4
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Qu JY, Jiang H, Wang XF, Song XH, Hao CJ. Use of specific contrast-enhanced CT regions of interest to differentiate renal oncocytomas from small clear cell and chromophobe renal cell carcinomas. Diagn Interv Radiol 2022; 28:555-562. [PMID: 36550755 PMCID: PMC9885643 DOI: 10.5152/dir.2022.2111504] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
PURPOSE We aimed to examine the usefulness of utilizing a specific contrast-enhanced computed tomog raphy (CT) region of interest (ROI) to differentiate renal oncocytoma (RO) from small clear cell renal cell carcinoma (ccRCC) and chromophobe renal cell carcinoma (chRCC). METHODS A retrospective analysis of pre-contrast phase (PCP), corticomedullary phase (CMP), and nephro graphic phase (NP) contrast-enhanced CT images of the histopathologically confirmed initial cohort (27 ROs, 74 ccRCCs, and 36 chRCCs) was conducted. Small, medium, large, and whole ROIs (S-ROI, M-ROI, L-ROI, and W-ROI, respectively) were utilized for CT attenuation value of tumor (AVT), lesion-to-cortex attenuation (L/C), and heterogeneous degree of tumor (HDT) calcula tions. Differences in these parameters were then compared between RO and ccRCC/chRCC, with receiver operating characteristic (ROC) curves being utilized to gauge the diagnostic utility of the statistically significant parameters. Logistic regression analyses were employed to identify key factors capable of differentiating RO and ccRCC/chRCC, with predictive models further being established. A validation cohort (6 ROs, 30 ccRCCs, and 12 chRCCs) was then employed to vali date the performance of the predictive models. RESULTS Of the parameters evaluated using different ROIs, L/C-CMP (S-ROI) (0.88 ± 0.15 vs. 1.13 ± 0.25, P < .001) and HDT-CMP (W-ROI) (23.02 (12.00-51.21) vs. 37.81 (16.09-89.45), P < .001) were best suited to differentiating RO and ccRCC, yielding respective area under the curve (AUC) values of 0.803 and 0.834. AVT-NP (S-ROI) (122.85 ± 18.87 vs. 86.50 ± 18.65, P < .001) and AVT-NP (M-ROI) (119 (86-167) vs. 81.5 (53-142), P < .001) were better able to differentiate RO and chRCC, yielding respective AUC values of 0.918 and 0.906. Logistic regression analyses revealed that L/C-CMP (S-ROI) and HDT-PCP, as well as AVT-NP (S-ROI) and HDT-CMP, were the primary factors capable of differentiating RO from ccRCC and chRCC, respectively. The predictive model developed to dif ferentiate between RO and ccRCC exhibited a sensitivity of 66.67% and 55.14% in the initial and validation cohorts, respectively, with corresponding specificity of 94.59% and 93.55%, accuracy of 87.13% and 86.84%, and AUC of 0.908 and 0.876. The predictive model developed to differ entiate between RO and chRCC exhibited a sensitivity of 85.19% and 100.00% in the initial and validation cohorts, respectively, with corresponding specificity of 94.59% and 92.86%, accuracy of 87.30% and 95.24%, and AUC of 0.944 and 0.959. CONCLUSION These data demonstrate that a combination of quantitative parameters measured with particu lar ROIs can enable the efficient and reliable differentiation of RO from ccRCC and chRCC for use in routine patient differential diagnosis.
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Affiliation(s)
- Jian-Yi Qu
- Department of Radiology, Yantai Yuhuangding Hospital, Qingdao University School of Medicine, Yantai, China
| | - Hong Jiang
- Department of Radiology, Yantai Yuhuangding Hospital, Qingdao University School of Medicine, Yantai, China
| | - Xiao-Fei Wang
- Department of Urology, Yantaishan Hospital, Binzhou Medical University, Yantai, China
| | - Xin-Hong Song
- Department of Radiology, Yantai Yuhuangding Hospital, Qingdao University School of Medicine, Yantai, China
| | - Cui-Juan Hao
- Department of Radiology, Yantai Yuhuangding Hospital, Qingdao University School of Medicine, Yantai, China
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5
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Renal oncocytoma: a challenging diagnosis. Curr Opin Oncol 2022; 34:243-252. [DOI: 10.1097/cco.0000000000000829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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6
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Gündüz N, Eser MB, Yıldırım A, Kabaalioğlu A. Radiomics improves the utility of ADC for differentiation between renal oncocytoma and chromophobe renal cell carcinoma: Preliminary findings. Actas Urol Esp 2022; 46:167-177. [PMID: 35216964 DOI: 10.1016/j.acuroe.2022.02.001] [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: 11/08/2020] [Revised: 01/17/2021] [Accepted: 04/18/2021] [Indexed: 06/14/2023]
Abstract
OBJECTIVE Differentiation between renal oncocytoma (RON) and chromophobe renal cell carcinoma (chRCC) remains challenging. We aimed to assess the accurate apparent diffusion coefficient (ADC) radiomics features in differentiating these tumors. MATERIALS AND METHODS This single-center retrospective study included 14 patients with histopathologically proven RON (n = 6) and chRCC (n = 8) who underwent magnetic resonance imaging. Features were extracted from ADC maps. Features with an intraclass correlation coefficient >0.90, an intergroup p < 0.01 and interrater differences with normal distribution underwent agreement and receiver operating characteristic curve analyses. RESULTS Overall, 6 features qualified for further analysis and Bland-Altman plots revealed acceptable agreement for all. Only 1 first order feature and 5 high order texture features successfully predicted RON with more than 90% sensitivities and specificities more than 80%. CONCLUSION Squared mean ADC and certain gray level run length matrix features extracted by radiomics of ADC mapping provide quite high diagnostic precision in terms of distinguishing between RON and chRCC.
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Affiliation(s)
- N Gündüz
- Istanbul Medeniyet University, Faculty of Medicine, Department of Radiology, Istanbul, Turkey.
| | - M B Eser
- Istanbul Medeniyet University, Prof. Dr. Süleyman Yalçın City Hospital, Department of Radiology, Istanbul, Turkey
| | - A Yıldırım
- Istanbul Medeniyet University, Faculty of Medicine, Department of Urology, Istanbul, Turkey
| | - A Kabaalioğlu
- Istanbul Medeniyet University, Faculty of Medicine, Department of Radiology, Istanbul, Turkey
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Tuberous Sclerosis Complex (TSC): Renal and Extrarenal Imaging. Acad Radiol 2022; 29:439-449. [PMID: 33487538 DOI: 10.1016/j.acra.2020.12.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 12/22/2020] [Accepted: 12/26/2020] [Indexed: 11/21/2022]
Abstract
Tuberous sclerosis complex is a multiorgan syndrome manifesting with several benign and malignant tumors. Complications arising from renal abnormalities are a leading cause of death in patients with tuberous sclerosis complex. Renal cell carcinoma is relatively uncommon, occurring in 2%-4% of patients with tuberous sclerosis complex syndrome, but nonetheless can significantly contribute to morbidity and mortality. Extrarenal manifestations of tuberous sclerosis complex, including within the chest, abdomen and central nervous system, aid in diagnosis. Pathogenesis and management are also discussed, including the importance of the types of renal masses found in these patients.
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8
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Trevisani F, Floris M, Minnei R, Cinque A. Renal Oncocytoma: The Diagnostic Challenge to Unmask the Double of Renal Cancer. Int J Mol Sci 2022; 23:ijms23052603. [PMID: 35269747 PMCID: PMC8910282 DOI: 10.3390/ijms23052603] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 02/23/2022] [Accepted: 02/24/2022] [Indexed: 11/16/2022] Open
Abstract
Renal oncocytoma represents the most common type of benign neoplasm that is an increasing concern for urologists, oncologists, and nephrologists due to its difficult differential diagnosis and frequent overtreatment. It displays a variable neoplastic parenchymal and stromal architecture, and the defining cellular element is a large polygonal, granular, eosinophilic, mitochondria-rich cell known as an oncocyte. The real challenge in the oncocytoma treatment algorithm is related to the misdiagnosis due to its resemblance, at an initial radiological assessment, to malignant renal cancers with a completely different prognosis and medical treatment. Unfortunately, percutaneous renal biopsy is not frequently performed due to the possible side effects related to the procedure. Therefore, the majority of oncocytoma are diagnosed after the surgical operation via partial or radical nephrectomy. For this reason, new reliable strategies to solve this issue are needed. In our review, we will discuss the clinical implications of renal oncocytoma in daily clinical practice with a particular focus on the medical diagnosis and treatment and on the potential of novel promising molecular biomarkers such as circulating microRNAs to distinguish between a benign and a malignant lesion.
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Affiliation(s)
- Francesco Trevisani
- Urological Research Institute, San Raffaele Scientific Institute, 20132 Milan, Italy;
- Unit of Urology, San Raffaele Scientific Institute, 20132 Milan, Italy
- Biorek S.r.l., San Raffaele Scientific Institute, 20132 Milan, Italy
| | - Matteo Floris
- Nephrology, Dialysis and Transplantation, G. Brotzu Hospital, Università degli Studi di Cagliari, 09134 Cagliari, Italy; (M.F.); (R.M.)
| | - Roberto Minnei
- Nephrology, Dialysis and Transplantation, G. Brotzu Hospital, Università degli Studi di Cagliari, 09134 Cagliari, Italy; (M.F.); (R.M.)
| | - Alessandra Cinque
- Biorek S.r.l., San Raffaele Scientific Institute, 20132 Milan, Italy
- Correspondence:
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Gündüz N, Eser M, Yıldırım A, Kabaalioğlu A. La radiómica mejora la utilidad del ADC en la diferenciación entre el oncocitoma renal y el carcinoma cromófobo de células renales: resultados preliminares. Actas Urol Esp 2022. [DOI: 10.1016/j.acuro.2021.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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10
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Renal Cell Carcinoma or Oncocytoma? The Contribution of Diffusion-Weighted Magnetic Resonance Imaging to the Differential Diagnosis of Renal Masses. Medicina (B Aires) 2022; 58:medicina58020221. [PMID: 35208545 PMCID: PMC8878185 DOI: 10.3390/medicina58020221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 12/17/2021] [Accepted: 12/20/2021] [Indexed: 11/30/2022] Open
Abstract
Background and Objectives: Renal Cell Carcinoma (RCC) accounts for 85% and oncocytomas constitute 3–7% of solid renal masses. Oncocytomas can be confused, especially with hypovascular RCC. The purpose of this research was to evaluate the contribution of diffusion-weighted imaging (DWI) and contrast-enhanced MRI sequences in the differential diagnosis of RCC and oncocytoma Materials and Methods: 465 patients with the diagnosis of RCC and 45 patients diagnosed with oncocytoma were retrospectively reviewed between 2009 to 2020. All MRI acquisitions were handled by a 1.5 T device (Achieva, Philips Healthcare, Best, The Netherlands) and all images were evaluated by the consensus of two radiologists with 10–15 years’ experience. The SPSS package program version 15.0 software was used for statistical analysis of the study. Chi-square test, Mann–Whitney U test or the Kruskal–Wallis tests were used in the statistical analysis. A receiver operating characteristic (ROC) curve was used to calculate the cut-off values Results: The results were evaluated with a 95% confidence interval and a significance threshold of p < 0.05. ADC values (p < 0.001) and enhancement index (p < 0.01) were significantly lower in the RCC group than the oncocytoma group. Conclusion: DWI might become an alternative technique to the contrast-enhanced MRI in patients with contrast agent nephropathy or with a high risk of nephrogenic systemic fibrosis, calculation of CI of the oncocytoma and RCCs in the contrast-enhanced acquisitions would contribute to the differential diagnosis.
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Li X, Ma Q, Nie P, Zheng Y, Dong C, Xu W. A CT-based radiomics nomogram for differentiation of renal oncocytoma and chromophobe renal cell carcinoma with a central scar-matched study. Br J Radiol 2022; 95:20210534. [PMID: 34735296 PMCID: PMC8722238 DOI: 10.1259/bjr.20210534] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVE Pre-operative differentiation between renal oncocytoma (RO) and chromophobe renal cell carcinoma (chRCC) is critical due to their different clinical behavior and different clinical treatment decisions. The aim of this study was to develop and validate a CT-based radiomics nomogram for the pre-operative differentiation of RO from chRCC. METHODS A total of 141 patients (84 in training data set and 57 in external validation data set) with ROs (n = 47) or chRCCs (n = 94) were included. Radiomics features were extracted from tri-phasic enhanced-CT images. A clinical model was developed based on significant patient characteristics and CT imaging features. A radiomics signature model was developed and a radiomics score (Rad-score) was calculated. A radiomics nomogram model incorporating the Rad-score and independent clinical factors was developed by multivariate logistic regression analysis. The diagnostic performance was evaluated and validated in three models using ROC curves. RESULTS Twelve features from CT images were selected to develop the radiomics signature. The radiomics nomogram combining a clinical factor (segmental enhancement inversion) and radiomics signature showed an AUC value of 0.988 in the validation set. Decision curve analysis revealed that the diagnostic performance of the radiomics nomogram was better than the clinical model and the radiomics signature. CONCLUSIONS The radiomics nomogram combining clinical factors and radiomics signature performed well for distinguishing RO from chRCC. ADVANCES IN KNOWLEDGE Differential diagnosis between renal oncocytoma (RO) and chromophobe renal cell carcinoma (chRCC) is rather difficult by conventional imaging modalities when a central scar was present.A radiomics nomogram integrated with the radiomics signature, demographics, and CT findings facilitates differentiation of RO from chRCC with improved diagnostic efficacy.The CT-based radiomics nomogram might spare unnecessary surgery for RO.
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Affiliation(s)
- Xiaoli Li
- Department of Radiology, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Qianli Ma
- Department of Radiology, Qingdao Municipal Hospital, Qingdao, Shandong, China
| | - Pei Nie
- Department of Radiology, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Yingmei Zheng
- Health Management Center, The Affiliated Hospital of Qingdao University, Qingdao Shandong, China
| | - Cheng Dong
- Department of Radiology, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Wenjian Xu
- Department of Radiology, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
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12
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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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13
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Fuhrmann C, Czerner CP, Ripperger T, Imkamp F. [Hereditary kidney cancer - easily clarified and diagnosed with ToSCaNA]. Aktuelle Urol 2021; 53:416-422. [PMID: 34670316 DOI: 10.1055/a-1466-9326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND In recent years great improvements in the diagnosis and differentiation of hereditary syndroms with predisposition for kidney cancer have been achieved. It has been assumed that 5-8% of all kidney cancer have a hereditary origin. In reality, this number will probably be much higher as many genetic aspects of kidney cancer are still not entirely known. Hereditary kidney cancer usually shows two characteristic properties: While the median age of diagnosis of sporadic renal cell carcinoma is 64 years, patients with a hereditary tumor predisposition are about 20 years younger at the time of diagnosis. Additionally, their tumors often occur multifocal/bilateral. Therefore, a special management with extended diagnostics is necessary for these young kidney cancer patients. In literature many reports on hereditary syndromes with kidney cancer predisposition exist. Though, these papers usually put their focus on single syndromes rather than on the aspects of kidney cancer. The goal of this article is to present the practicing urologist with a compact overview of the most important hereditary syndromes with kidney cancer predisposition and by this improve the primary diagnostic and treatment of renal cancer patients and their relatives. MATERIAL/METHODS We conducted a literature search on the five most important hereditary syndromes with kidney cancer association and summarized the results in a chart. Additionally, we formed the acronym ToSCaNA combining the most important extrarenal manifestations of the syndromes. Based on this data, a diagnostic workflow and treatment path was established. RESULTS All in all, hereditary kidney cancer is a rare entity, which nonetheless could present as a significant number in high-volume centers. For doctors who scarcely get in contact with these types of tumors, the acronym and workflow could pose a valuable asset for their clinical diagnostic portfolio. An early identification and diagnostic work-up of affected patients and their relatives is crucial for appropriate treatment and surveillance and allows the identification/treatment of additionally affected relatives. CONCLUSION In patients with young age of onset and multifocal/bilateral occurrence of kidney cancer, hereditary syndromes should always be considered. The initial suspicion of a hereditary genesis of the cancer can be further evaluated by the acronym ToSCaNA and the presented workflow.
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Affiliation(s)
- Christian Fuhrmann
- Klinik für Urologie und urologische Onkologie, Medizinische Hochschule Hannover, Hannover, Germany
| | - Christoph P. Czerner
- Institut für Diagnostische und Interventionelle Radiologie, Medizinische Hochschule Hannover, Hannover, Germany
| | - Tim Ripperger
- Institut für Humangenetik, Medizinische Hochschule Hannover, Hannover, Germany
| | - Florian Imkamp
- Urologische Klinik, Vinzenzkrankenhaus Hannover GmbH, Hannover, Germany
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Marko J, Craig R, Nguyen A, Udager AM, Wolfman DJ. Chromophobe Renal Cell Carcinoma with Radiologic-Pathologic Correlation. Radiographics 2021; 41:1408-1419. [PMID: 34388049 DOI: 10.1148/rg.2021200206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Renal cell carcinoma (RCC) is a heterogeneous group of neoplasms derived from the renal tubular epithelial cells. Chromophobe RCC (chRCC) is the third most common subtype of RCC, accounting for 5% of cases. chRCC may be detected as an incidental finding or less commonly may manifest with clinical symptoms. The mainstay of therapy for chRCC is surgical resection. chRCC has a better prognosis compared with the more common clear cell RCC. At gross pathologic analysis, chRCC is a solid well-defined mass with lobulated borders. Histologic findings vary by subtype but include large pale polygonal cells with abundant transparent cytoplasm, crinkled "raisinoid" nuclei with perinuclear halos, and prominent cell membranes. Pathologic analysis reveals only moderate vascularity. The most common imaging pattern is a predominantly solid renal mass with circumscribed margins and enhancement less than that of the renal cortex. The authors discuss chRCC with emphasis on correlative pathologic findings and illustrate the multimodality imaging appearances of chRCC by using cases from the Radiologic Pathology Archives of the American Institute for Radiologic Pathology. ©RSNA, 2021.
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Affiliation(s)
- Jamie Marko
- From the Department of Radiology and Imaging Sciences, National Institutes of Health Clinical Center, Bethesda, Md, and American Institute for Radiologic Pathology, Silver Spring, Md (J.M.); F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Md (R.C.); George Washington University School of Medicine and Health Sciences, Washington, DC (A.N.); Department of Pathology, University of Michigan Medical School, Ann Arbor, Mich (A.M.U.); and Department of Radiology, Johns Hopkins Hospital and Health System, 5255 Loughboro Rd NW, Washington, DC 20016 (D.J.W.)
| | - Ryan Craig
- From the Department of Radiology and Imaging Sciences, National Institutes of Health Clinical Center, Bethesda, Md, and American Institute for Radiologic Pathology, Silver Spring, Md (J.M.); F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Md (R.C.); George Washington University School of Medicine and Health Sciences, Washington, DC (A.N.); Department of Pathology, University of Michigan Medical School, Ann Arbor, Mich (A.M.U.); and Department of Radiology, Johns Hopkins Hospital and Health System, 5255 Loughboro Rd NW, Washington, DC 20016 (D.J.W.)
| | - Andrew Nguyen
- From the Department of Radiology and Imaging Sciences, National Institutes of Health Clinical Center, Bethesda, Md, and American Institute for Radiologic Pathology, Silver Spring, Md (J.M.); F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Md (R.C.); George Washington University School of Medicine and Health Sciences, Washington, DC (A.N.); Department of Pathology, University of Michigan Medical School, Ann Arbor, Mich (A.M.U.); and Department of Radiology, Johns Hopkins Hospital and Health System, 5255 Loughboro Rd NW, Washington, DC 20016 (D.J.W.)
| | - Aaron M Udager
- From the Department of Radiology and Imaging Sciences, National Institutes of Health Clinical Center, Bethesda, Md, and American Institute for Radiologic Pathology, Silver Spring, Md (J.M.); F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Md (R.C.); George Washington University School of Medicine and Health Sciences, Washington, DC (A.N.); Department of Pathology, University of Michigan Medical School, Ann Arbor, Mich (A.M.U.); and Department of Radiology, Johns Hopkins Hospital and Health System, 5255 Loughboro Rd NW, Washington, DC 20016 (D.J.W.)
| | - Darcy J Wolfman
- From the Department of Radiology and Imaging Sciences, National Institutes of Health Clinical Center, Bethesda, Md, and American Institute for Radiologic Pathology, Silver Spring, Md (J.M.); F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Md (R.C.); George Washington University School of Medicine and Health Sciences, Washington, DC (A.N.); Department of Pathology, University of Michigan Medical School, Ann Arbor, Mich (A.M.U.); and Department of Radiology, Johns Hopkins Hospital and Health System, 5255 Loughboro Rd NW, Washington, DC 20016 (D.J.W.)
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15
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de Silva S, Lockhart KR, Aslan P, Nash P, Hutton A, Malouf D, Lee D, Cozzi P, MacLean F, Thompson J. The diagnostic utility of diffusion weighted MRI imaging and ADC ratio to distinguish benign from malignant renal masses: sorting the kittens from the tigers. BMC Urol 2021; 21:67. [PMID: 33888122 PMCID: PMC8063409 DOI: 10.1186/s12894-021-00832-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Accepted: 03/15/2021] [Indexed: 12/18/2022] Open
Abstract
Background MRI is playing an increasing role in risk stratification and non-invasive diagnosis of the undifferentiated small renal mass. This study was designed to assess the reliability of MRI in diagnostic evaluation of renal masses, specifically characterising lesions with diffusion weighted imaging (DWI) and apparent diffusion coefficient (ADC) values. Methods This is a retrospective analysis of patients undergoing MRI as part of their clinical workup for a renal mass suspicious for renal cell carcinoma (RCC) on CT or ultrasound followed by biopsy and/or surgical excision. All cases were conducted on 3 Tesla MRI, with conventional breath-held sequences, DWI and dynamic contrast enhanced phases. Tumour regions of interest were evaluated on ADC maps and compared with T2 weighted and post-contrast images. Results Of the 66 renal tumours included, 33 (50.0%) were Clear Cell RCC, 11 (16.7%) were Oncocytoma, nine (13.6%) were Angiomyolipoma (AML), nine (13.6%) were Papillary RCC and four (6.1%) were Chromophobe RCC. Oncocytoma had the largest ADC values, significantly larger than AMLs and all RCC subtypes (p < 0.001). The average ADC value was also significantly larger in Clear Cell RCCs compared to AMLs, and other RCC subtypes (p < 0.001). Conclusions MRI with DWI/ADC imaging may aid the differentiation of oncocytomas from RCCs and stratify RCC subtypes, Further studies are required to validate these findings. Trial registration: Not applicable/retrospective study.
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Affiliation(s)
- Suresh de Silva
- Faculty of Medicine, University of NSW, Kensington, NSW, Australia. .,Department of Radiology, I-MED Radiology Network, Sydney, Australia.
| | | | - Peter Aslan
- Department of Urology, St George Hospital, Kogarah, NSW, Australia
| | - Peter Nash
- Department of Urology, St George Hospital, Kogarah, NSW, Australia
| | - Anthony Hutton
- Faculty of Medicine, University of NSW, Kensington, NSW, Australia.,Department of Urology, St George Hospital, Kogarah, NSW, Australia
| | - David Malouf
- Department of Urology, St George Hospital, Kogarah, NSW, Australia
| | - Dominic Lee
- Department of Urology, St George Hospital, Kogarah, NSW, Australia
| | - Paul Cozzi
- Hurstville Private Hospital, Hurstville, NSW, Australia
| | - Fiona MacLean
- Department of Anatomical Pathology, Sonic Healthcare, Ryde, NSW, Australia
| | - James Thompson
- Faculty of Medicine, University of NSW, Kensington, NSW, Australia.,Department of Urology, St George Hospital, Kogarah, NSW, Australia
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Mario S M, Elisa C, Gian D C, Matteo C, Biagio T. Active surveillance for bilateral renal oncocytomas already resected on one side: a case report. Urologia 2020; 88:122-124. [PMID: 33292059 DOI: 10.1177/0391560320978038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
INTRODUCTION To report our experience of active surveillance of new bilateral masses after left laparoscopic partial nephrectomy for oncocytoma. METHOD A 67-year old man underwent left laparoscopic partial nephrectomy for a renal mass and histology confirmed oncocytoma. At follow-up magnetic resonance imaging (MRI) showed new renal bilateral masses: hence, sonogram-guided percutaneous core renal biopsies were performed confirming the presence of oncocytoma in both kidneys. A re-biopsy was required because of an increasing of the left mass while a histological was also consistent with oncocytoma. RESULT At follow of 8 years the patient is well and shows a normal renal function. CONCLUSION Oncocytomas show minimal growth rate or progression. MRI has an important role in the appropriate follow-up of renal oncocytomas. Patients with biopsy proven oncocytoma may be managed conservatively by active surveillance (AS).
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Affiliation(s)
- Mangano Mario S
- Dipartimento di Chirurgia Specialistica, Unità Complessa di Urologia, Ospedale Ca'Foncello, Treviso, Italy
| | - Cicerello Elisa
- Dipartimento di Chirurgia Specialistica, Unità Complessa di Urologia, Ospedale Ca'Foncello, Treviso, Italy
| | - Cova Gian D
- Dipartimento di Chirurgia Specialistica, Unità Complessa di Urologia, Ospedale Ca'Foncello, Treviso, Italy
| | - Ciaccia Matteo
- Dipartimento di Chirurgia Specialistica, Unità Complessa di Urologia, Ospedale Ca'Foncello, Treviso, Italy
| | - Tomasi Biagio
- Dipartimento di Chirurgia Specialistica, Unità Complessa di Urologia, Ospedale Ca'Foncello, Treviso, Italy
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17
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Analysis of expression, epigenetic, and genetic changes of HNF1B in 130 kidney tumours. Sci Rep 2020; 10:17151. [PMID: 33051485 PMCID: PMC7555858 DOI: 10.1038/s41598-020-74059-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Accepted: 09/23/2020] [Indexed: 12/18/2022] Open
Abstract
Hepatocyte nuclear factor 1 beta (HNF1B) is a transcription factor which plays a crucial role in nephronogenesis, and its germline mutations have been associated with kidney developmental disorders. However, the effects of HNF1B somatic exonic mutations and its role in the pathogenesis of kidney tumours has not yet been elucidated. Depending on the type of the tumour HNF1B may act as a tumour suppressor or oncogene, although the exact mechanism by which HNF1B participates in the process of cancerogenesis is unknown. Using an immunohistochemical approach, and methylation and mutation analysis, we have investigated the expression, epigenetic, and genetic changes of HNF1B in 130 cases of renal tumours (121 renal cell carcinomas, 9 oncocytomas). In the subset of clear cell renal cell carcinoma (ccRCC), decreased HNF1B expression was associated with a higher tumour grade and higher T stage. The mutation analysis revealed no mutations in the analysed samples. Promoter methylation was detected in two ccRCCs and one oncocytoma. The results of our work on a limited sample set suggest that while in papillary renal cell carcinoma HNF1B functions as an oncogene, in ccRCC and chRCC it may act in a tumour suppressive fashion.
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18
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Lopes Vendrami C, McCarthy RJ, Villavicencio CP, Miller FH. Predicting common solid renal tumors using machine learning models of classification of radiologist-assessed magnetic resonance characteristics. Abdom Radiol (NY) 2020; 45:2797-2809. [PMID: 32666233 DOI: 10.1007/s00261-020-02637-w] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 06/23/2020] [Accepted: 07/04/2020] [Indexed: 02/06/2023]
Abstract
PURPOSE Solid renal masses (SRM) are difficult to differentiate based on standard MR features. The purpose of this study was to assess MR imaging features of SRM to evaluate performance of ensemble methods of classifying SRM subtypes. MATERIALS AND METHODS MR images of SRM (n = 330) were retrospectively evaluated for standard and multiparametric (mp) features. Models of MR features for predicting malignant and benign lesions as well as subtyping SRM were developed using a training dataset and performance was evaluated in a test data-set using recursive partitioning (RP), gradient booting machine (GBM), and random forest (RF) methods. RESULTS In the test dataset, GBM and RF models demonstrated an accuracy of 86% (95% CI 75% to 93%) for predicting benign versus malignant SRM compared to 83% (95% CI 71% to 91%) for the RP model. RF had the greatest accuracy in predicting SRM subtypes, 81.2% (95% CI 69.5% to 89.9%) compared with GBM 73.4% (95% CI 60.9% to 83.7%) or RP 70.3% (95% CI 57.6% to 81.1%). Marginal homogeneity was reduced by the RF model compared with the RP model (P < 0.001), but not the GBM model (P = 0.135). All models had high sensitivity and specificity for clear cell and papillary renal cell carcinomas (RCC), but performed less well in differentiating chromophobe RCC, oncocytomas, and fat-poor angiomyolipomas. CONCLUSION Ensemble methods for prediction of SRM from radiologist-assessed image characteristics have high accuracy for distinguishing benign and malignant lesions. SRM subtype classification is limited by the ability to categorize chromophobe RCCs, oncocytomas, and fat-poor angiomyolipomas.
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Affiliation(s)
- Camila Lopes Vendrami
- Department of Radiology, Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, 676 N. St. Clair St. Suite 800, Chicago, IL, 60611, USA
| | - Robert J McCarthy
- Department of Anesthesiology, Rush University, Chicago, IL, 60612, USA
| | - Carolina Parada Villavicencio
- Department of Radiology, Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, 676 N. St. Clair St. Suite 800, Chicago, IL, 60611, USA
| | - Frank H Miller
- Department of Radiology, Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, 676 N. St. Clair St. Suite 800, Chicago, IL, 60611, USA.
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Razik A, Goyal A, Sharma R, Kandasamy D, Seth A, Das P, Ganeshan B. MR texture analysis in differentiating renal cell carcinoma from lipid-poor angiomyolipoma and oncocytoma. Br J Radiol 2020; 93:20200569. [PMID: 32667833 DOI: 10.1259/bjr.20200569] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVES To assess the utility of magnetic resonance texture analysis (MRTA) in differentiating renal cell carcinoma (RCC) from lipid-poor angiomyolipoma (lpAML) and oncocytoma. METHODS After ethical approval, 42 patients with 54 masses (34 RCC, 14 lpAML and six oncocytomas) who underwent MRI on a 1.5 T scanner (Avanto, Siemens, Erlangen, Germany) between January 2011 and December 2012 were retrospectively included in the study. MRTA was performed on the TexRAD research software (Feedback Plc., Cambridge, UK) using free-hand polygonal region of interest (ROI) drawn on the maximum cross-sectional area of the tumor to generate six first-order statistical parameters. The Mann-Whitney U test was used to look for any statically significant difference. The receiver operating characteristic (ROC) curve analysis was done to select the parameter with the highest class separation capacity [area under the curve (AUC)] for each MRI sequence. RESULTS Several texture parameters on MRI showed high-class separation capacity (AUC > 0.8) in differentiating RCC from lpAML and oncocytoma. The best performing parameter in differentiating RCC from lpAML was mean of positive pixels (MPP) at SSF 2 (AUC: 0.891) on DWI b500. In differentiating RCC from oncocytoma, the best parameter was mean at SSF 0 (AUC: 0.935) on DWI b1000. CONCLUSIONS MRTA could potentially serve as a useful non-invasive tool for differentiating RCC from lpAML and oncocytoma. ADVANCES IN KNOWLEDGE There is limited literature addressing the role of MRTA in differentiating RCC from lpAML and oncocytoma. Our study demonstrated several texture parameters which were useful in this regard.
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Affiliation(s)
- Abdul Razik
- Departments of Radiology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
| | - Ankur Goyal
- Departments of Radiology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
| | - Raju Sharma
- Departments of Radiology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
| | | | - Amlesh Seth
- Departments of Urology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
| | - Prasenjit Das
- Departments of Pathology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
| | - Balaji Ganeshan
- Institute of Nuclear Medicine, University College London Hospital NHS Trust, London, United Kingdom
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20
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de Silva S, Lockhart K, Aslan P, Nash P, Hutton A, Malouf D, Lee D, Cozzi P, Maclean F, Thompson J. Chemical shift imaging in the identification of those renal tumours that contain microscopic fat and the utility of multiparametric MRI in their differentiation. J Med Imaging Radiat Oncol 2020; 64:762-768. [PMID: 32743914 DOI: 10.1111/1754-9485.13082] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Accepted: 06/18/2020] [Indexed: 11/27/2022]
Abstract
INTRODUCTION The aim of this study was to assess the qualitative and MRI findings of renal tumours, to determine which lesions contain microscopic fat, one of the potential differentiating factors between tumour types. METHODS 73 patients who underwent 3 Tesla MRI including chemical shift imaging, with subsequent biopsy or excision for histopathological diagnosis, were included in the study. The images were reviewed for a decrease in signal intensity (SI) on the opposed phase compared with the in-phase gradient echo T1 images, indicating the presence of microscopic fat. The chemical shift index was then calculated as a percentage of SI change and compared with the pathological diagnosis. RESULTS In total, 38 (52%) of lesions demonstrated a decrease in SI, consistent with microscopic fat. Microscopic fat was found in 28 (80%) clear cell renal cell carcinomas (RCCs), 6 (66.7%) angiomyolipomas, 2 (20%) papillary RCCs, 1 (20%) chromophobe RCC and 1 (9.1%) oncocytoma. Pairwise comparison of means indicated that the amount of microscopic fat was significantly larger only for angiomyolipomas compared with clear cell RCCs (P < 0.001) and other renal lesions (P < 0.001). CONCLUSIONS A decrease in SI on opposed phase compared with in-phase chemical shift imaging favours the diagnosis of either clear cell RCC or an angiomyolipoma. When combined with other parameters in mpMRI, this may aid differentiation of benign from malignant tumours and differentiation of aggressive from indolent RCC subtypes. This may be of value where biopsy is non-diagnostic, not feasible due to location or in high-risk patients.
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Affiliation(s)
- Suresh de Silva
- Faculty of Medicine, University of NSW, Sydney, New South Wales, Australia.,Department of Radiology, I-MED Radiology Network, Sydney, New South Wales, Australia
| | - Kathleen Lockhart
- Department of Urology, St George Hospital, Sydney, New South Wales, Australia
| | - Peter Aslan
- Department of Urology, St George Hospital, Sydney, New South Wales, Australia
| | - Peter Nash
- Department of Urology, St George Hospital, Sydney, New South Wales, Australia
| | - Anthony Hutton
- Faculty of Medicine, University of NSW, Sydney, New South Wales, Australia.,Department of Urology, St George Hospital, Sydney, New South Wales, Australia
| | - David Malouf
- Department of Urology, St George Hospital, Sydney, New South Wales, Australia
| | - Dominic Lee
- Department of Urology, St George Hospital, Sydney, New South Wales, Australia
| | - Paul Cozzi
- Faculty of Medicine, University of Notre Dame, Sydney, New South Wales, Australia
| | - Fiona Maclean
- Department of Anatomical Pathology, Sonic Healthcare, Sydney, New South Wales, Australia
| | - James Thompson
- Faculty of Medicine, University of NSW, Sydney, New South Wales, Australia.,Department of Urology, St George Hospital, Sydney, New South Wales, Australia
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An overview of non-invasive imaging modalities for diagnosis of solid and cystic renal lesions. Med Biol Eng Comput 2019; 58:1-24. [DOI: 10.1007/s11517-019-02049-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Accepted: 09/17/2019] [Indexed: 12/22/2022]
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