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Assessing Trifecta Achievement after Percutaneous Cryoablation of Small Renal Masses: Results from a Multi-Institutional Collaboration. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:medicina58081041. [PMID: 36013508 PMCID: PMC9412454 DOI: 10.3390/medicina58081041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 07/28/2022] [Accepted: 08/01/2022] [Indexed: 11/17/2022]
Abstract
Background and Objectives: To assess efficacy and safety of Percutaneous Cryoablation (PCA) of small renal masses (SRMs) using Trifecta outcomes in a large cohort of patients who were not eligible for surgery. Materials and methods: All PCAs performed in four different centers between September 2009 and September 2019 were retrospectively evaluated. Patients were divided in two different groups depending on masses dimensional criteria: Group-A: diameter ≤ 25 mm and Group-B: diameter > 25 mm. Complications rates were reported and classified according to the Clavien−Dindo system. The estimate glomerular filtration rate (eGFR) was calculated before PCA and during follow-up schedule. Every patient received a Contrast Enhanced Ultrasound (CEUS) evaluation on the first postoperative day. Radiological follow-up was taken at 3, 6, and 12 months for the first year, then yearly. Radiological recurrence was defined as a contrast enhancement persistence and was reported in the study. Finally, Trifecta outcome, which included complications, RFS, and preservation of eGFR class, was calculated for every procedure at a median follow-up of 32 months. Results: The median age of the patients was 74 years. Group-A included 200 procedures while Group-B included 140. Seventy-eight patients were eligible for Trifecta evaluation. Trifecta was achieved in 69.6% of procedures in Group-A, 40.6% in Group-B (p = 0.02). We observed an increased rate of complication in Group-B (13.0% vs. 28.6; p < 0.001). However, 97.5% were <II Clavien−Dindo grade. No differences were found between the two groups regarding eGFR before and after treatment. Further, 24-months RFS rates were respectively 98.0% for Group-A and 92.1% in Group-B, while at 36 months were respectively 94.5% and 87.5% (p = 0.08). Conclusions: PCA seems to be a safe and effective treatment for SRM but in the need of more strict dimensional criteria to achieve a higher possible success rate.
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Granata A, Campo I, Lentini P, Pesce F, Gesualdo L, Basile A, Cantisani V, Zeiler M, Bertolotto M. Role of Contrast-Enhanced Ultrasound (CEUS) in Native Kidney Pathology: Limits and Fields of Action. Diagnostics (Basel) 2021; 11:1058. [PMID: 34201349 PMCID: PMC8226824 DOI: 10.3390/diagnostics11061058] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 05/25/2021] [Accepted: 06/02/2021] [Indexed: 12/12/2022] Open
Abstract
Gray scale ultrasound has an important diagnostic role in native kidney disease. Low cost, absence of ionizing radiation and nephrotoxicity, short performance time, and repeatability even at the bedside, are the major advantages of this technique. The introduction of contrast enhancement ultrasound (CEUS) in daily clinical practice has significantly reduced the use of contrast enhancement computed tomography (CECT) and contrast enhancement magnetic resonance (CEMR), especially in patients with renal disease. Although there are many situations in which CECT and CEMRI are primarily indicated, their use may be limited by the administration of the contrast medium, which may involve a risk of renal function impairment, especially in the elderly, and in patients with acute kidney injury (AKI) and moderate to severe chronic kidney disease (CKD). In these cases, CEUS can be a valid diagnostic choice. To date, numerous publications have highlighted the role of CEUS in the study of parenchymal micro-vascularization and renal pathology by full integration with second level imaging methods (CECT and CEMRI) both in patients with normal renal function and with diseased kidneys. The aim of this review is to offer an updated overview of the limitations and potential applications of CEUS in native kidney disease.
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Affiliation(s)
- Antonio Granata
- Nephrology and Dialysis Unit, “Cannizzaro” Hospital, 95026 Catania, Italy;
| | - Irene Campo
- Department of Radiology, “Civile di Conegliano” Hospital, ULSS 2 Marca Trevigiana, 31015 Conegliano, Italy
| | - Paolo Lentini
- Nephrology and Dialysis Unit, San Bassiano Hospital, 36061 Bassano del Grappa, Italy;
| | - Francesco Pesce
- Nephrology, Dialysis and Transplantation Unit, Department of Emergency and Organ Transplantation, University of Bari, 70124 Bari, Italy; (F.P.); (L.G.)
| | - Loreto Gesualdo
- Nephrology, Dialysis and Transplantation Unit, Department of Emergency and Organ Transplantation, University of Bari, 70124 Bari, Italy; (F.P.); (L.G.)
| | - Antonio Basile
- Radiology Unit I, Department of Medical Surgical Sciences and Advanced Technologies “GF Ingrassia”-University Hospital “Policlinico-San Marco”, University of Catania, 95123 Catania, Italy;
| | - Vito Cantisani
- Department of Radiology, Policlinico Umberto I Hospital, “Sapienza” University of Rome, 00161 Rome, Italy;
| | - Matthias Zeiler
- Nephrology and Dialysis Unit, “Carlo Urbani” Hospital, 60035 Jesi, Italy;
| | - Michele Bertolotto
- Department of Radiology, “Cattinara” Hospital, University of Trieste, 34149 Trieste, Italy;
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Bertolotto M, Campo I, Sachs C, Ciabattoni R, Cicero C, Drudi FM, Derchi LE, Cova MA. Contrast-enhanced ultrasound after successful cryoablation of benign and malignant renal tumours: how long does tumour enhancement persist? J Med Imaging Radiat Oncol 2021; 65:272-278. [PMID: 33547767 DOI: 10.1111/1754-9485.13149] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 12/07/2020] [Accepted: 01/04/2021] [Indexed: 01/20/2023]
Abstract
INTRODUCTION To investigate how long successfully ablated tumours take to become completely avascular at CEUS after cryoablation. METHODS Ninety-five patients had percutaneous cryoablation of 103 renal tumours investigated at CEUS on post-operative day one. If the lesion was avascular, a contrast-CT/MR was scheduled six months after the procedure, while CEUS was repeated if the lesion still displayed enhancement, until the disappearance of intralesional vascularity. Technical success was defined when the tumour was covered completely by the ablation zone. Technique efficacy was assessed at six months of follow-up. RESULTS Technical efficacy was obtained for 101/103 cryoablations, 56% of which (57/101) were avascular on post-operative day one. After one week, two weeks, one month 83%, 91% and 100% of these 101 lesions, respectively, were avascular. Two tumours were unsuccessfully treated. They displayed persistent intralesional vascularity at CEUS one month after the procedure. CONCLUSIONS After cryoablation, obtaining CEUS before one month may be misleading. When technical efficacy is obtained, disappearance of intralesional enhancement is observed within two weeks in the majority of cases (91%), but can persist until one month. Identification of tumour enhancement after one month may be concerning for residual viable tumour.
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Affiliation(s)
- Michele Bertolotto
- Department of Radiology, University of Trieste, Ospedale di Cattinara, Trieste, Italy
| | - Irene Campo
- Department of Radiology, Ospedale Civile di Conegliano, ULSS 2 Marca Trevigiana, Conegliano (TV), Italy
| | - Camilla Sachs
- S.C. Radiologia Pordenone - Sacile, Azienda sanitaria Friuli Occidentale (ASFO), Pordenone (PN), Italy
| | - Riccardo Ciabattoni
- Department of Radiology, University of Trieste, Ospedale di Cattinara, Trieste, Italy
| | - Calogero Cicero
- Department of Radiology, Ospedale San Bassiano, Bassano del Grappa (VI), Italy
| | - Francesco Maria Drudi
- Department of Radiology, University Sapienza of Rome, Policlinico Umberto I, Roma, Italy
| | - Lorenzo E Derchi
- Department of Health Sciences (DISSAL), University of Genoa, Emergency Radiology, Policlinico San Martino IST, Genova, Italy
| | - Maria Assunta Cova
- Department of Radiology, University of Trieste, Ospedale di Cattinara, Trieste, Italy
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Bertolotto M, Bucci S, Valentino M, Currò F, Sachs C, Cova MA. Contrast-enhanced ultrasound for characterizing renal masses. Eur J Radiol 2018; 105:41-48. [PMID: 30017297 DOI: 10.1016/j.ejrad.2018.05.015] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2018] [Revised: 04/28/2018] [Accepted: 05/14/2018] [Indexed: 12/20/2022]
Abstract
On cross-sectional imaging studies performed for other indications, incidental discovery of renal lesions is not uncommon. In daily use, grey-scale ultrasonography (US) and conventional Doppler modes are often the modality of choice for the initial assessment. While simple cysts are fully characterized with US, other lesions require further characterization, which is traditionally obtained by multiphase imaging, such as contrast-enhanced CT and MRI. Contrast-enhanced ultrasound (CEUS) has become a powerful additional tool for imaging renal lesions. With its lack of nephrotoxicity, the absence of ionizing radiation, and the ability to evaluate the enhancement pattern of renal lesions quickly and in real- time, CEUS has unique advantages over traditional modes. Established applications are differentiation between solid tumours, pseudolesions, and complex cysts; characterization of complex cysts with different malignant potential, and evaluation of tumor ablation. Microbubble contrast agents are safe. Adverse reactions are rare. This article provides an overview of the current clinical applications of CEUS in characterizing renal masses, discussing advantages and limitations. The aim is to provide the framework for sonologists to make informed decisions regarding this emerging imaging test in appropriate circumstances.
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Affiliation(s)
- Michele Bertolotto
- Department of Radiology, University of Trieste, Ospedale di Cattinara, Strada di Fiume 447, 34149 Trieste, TS, Italy.
| | - Stefano Bucci
- Department of Urology, University of Trieste, Ospedale di Cattinara, Strada di Fiume 447, 34149 Trieste, TS, Italy
| | - Massimo Valentino
- Department of Radiology, Ospedale Sant'Antonio Abate, Via Giobatta Morgagni 18, 33028 Tolmezzo, UD, Italy
| | - Francesca Currò
- Department of Radiology, University of Trieste, Ospedale di Cattinara, Strada di Fiume 447, 34149 Trieste, TS, Italy
| | - Camilla Sachs
- Department of Radiology, University of Trieste, Ospedale di Cattinara, Strada di Fiume 447, 34149 Trieste, TS, Italy
| | - Maria Assunta Cova
- Department of Radiology, University of Trieste, Ospedale di Cattinara, Strada di Fiume 447, 34149 Trieste, TS, Italy
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Bertolotto M, Cicero C, Catalano O, Currò F, Derchi LE. Solid Renal Tumors Isoenhancing to Kidneys on Contrast-Enhanced Sonography: Differentiation From Pseudomasses. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2018; 37:233-242. [PMID: 28755508 DOI: 10.1002/jum.14335] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Revised: 04/18/2017] [Accepted: 04/21/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVES To estimate the prevalence of solid renal tumors isoenhancing to kidneys in all vascular phases on contrast-enhanced sonography and to investigate whether they can be differentiated from pseudomasses. METHODS A computer search of the databases of 3 institutions identified 31 patients with pseudomasses and 380 patients with solid tumors investigated with contrast-enhanced sonography. Nineteen of 380 (5%) patients had tumors isoenhancing in all phases. Images and clips of these 19 tumors and the 31 pseudomasses were blindly assessed by 2 radiologists. They were asked to differentiate tumors from pseudomasses based on echogenicity, vascular architecture, and the presence of the medulla. RESULTS Isoenhancing tumors were clear cell carcinomas (n = 7), angiomyolipomas (n = 3), papillary tumors (n = 3), metastasis (n = 1), and oncocytoma (n = 1). In the 4 nonoperated tumors, the diagnosis was confirmed by progression during the follow-up. There were 3 markedly hyperechoic, 11 mildly hypo/hyperechoic, and 5 isoechoic masses. Most pseudomasses were isoechoic to kidneys (23 of 31), with the medulla identified in 22 of 31 and 15 of 31 by radiologists 1 and 2, respectively. One and 2 pseudomasses were considered tumors by radiologists 1 and 2, respectively. One isoechoic isoenhancing tumor was not identified on contrast-enhanced sonography. Isoenhancing tumors in all phases were differentiated from pseudomasses by combining grayscale and contrast-enhanced sonography (areas under the receiver operating characteristic curve, 0.997 for reader 1; 0.969 for reader 2), with very good inter-reader agreement (weighted κ = 0.81). CONCLUSIONS In our retrospective study, 5% of solid renal lesions were isoenhancing to kidneys in all phases. Differentiation from pseudomasses was possible by looking at baseline sonographic features and vascular characteristics.
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Affiliation(s)
| | - Calogero Cicero
- Department of Radiology, San Bassiano Hospital, Bassano del Grappa, Italy
| | - Orlando Catalano
- Department of Radiology, National Cancer Institute, Pascale Foundation, Naples, Italy
| | - Francesca Currò
- Department of Radiology, University of Trieste, Trieste, Italy
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