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Laothamatas I, Al Mubarak H, Reddy A, Wax R, Badani K, Taouli B, Bane O, Lewis S. Multiparametric MRI of Solid Renal Masses: Principles and Applications of Advanced Quantitative and Functional Methods for Tumor Diagnosis and Characterization. J Magn Reson Imaging 2023. [PMID: 37052601 DOI: 10.1002/jmri.28718] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 03/23/2023] [Accepted: 03/23/2023] [Indexed: 04/14/2023] Open
Abstract
Solid renal masses (SRMs) are increasingly detected and encompass both benign and malignant masses, with renal cell carcinoma (RCC) being the most common malignant SRM. Most patients with SRMs will undergo management without a priori pathologic confirmation. There is an unmet need to noninvasively diagnose and characterize RCCs, as significant variability in clinical behavior is observed and a wide range of differing management options exist. Cross-sectional imaging modalities, including magnetic resonance imaging (MRI), are increasingly used for SRM characterization. Multiparametric (mp) MRI techniques can provide insight into tumor biology by probing different physiologic/pathophysiologic processes noninvasively. These include sequences that probe tissue microstructure, including intravoxel incoherent motion diffusion-weighted imaging (IVIM-DWI) and T1 relaxometry; oxygen metabolism (blood oxygen level dependent [BOLD-MRI]); as well as vascular flow and perfusion (dynamic contrast-enhanced MRI [DCE-MRI] and arterial spin labeling [ASL]). In this review, we will discuss each mpMRI method in terms of its principles, roles, and discuss the results of human studies for SRM assessment. Future validation of these methods may help to enable a personalized management approach for patients with SRM in the emerging era of precision medicine. EVIDENCE LEVEL: 5. TECHNICAL EFFICACY: 2.
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Affiliation(s)
- Indira Laothamatas
- Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Haitham Al Mubarak
- BioMedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Arthi Reddy
- Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Rebecca Wax
- Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Ketan Badani
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Bachir Taouli
- Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- BioMedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Octavia Bane
- Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- BioMedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Sara Lewis
- Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- BioMedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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Li A, Li S, Hu Y, Shen Y, Hu X, Hu D, Kamel IR, Li Z. Bosniak classification of cystic renal masses, version 2019: Is it helpful to incorporate the diffusion weighted imaging characteristic of lesions into the guideline? Front Oncol 2022; 12:1004690. [PMID: 36330478 PMCID: PMC9623058 DOI: 10.3389/fonc.2022.1004690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 09/16/2022] [Indexed: 11/23/2022] Open
Abstract
Objective To improve understanding of diffusion weighted imaging (DWI) characteristic of MRI and clinical variables, further optimize the Bosniak classification for diagnosis of cystic renal masses (CRMs). Methods This study retrospectively analyzed 130 CRMs in 125 patients with CT or MRI, including 87 patients with DWI (b = 600, 1000 s/mm2). Clinical variables and histopathological results were recorded. Two radiologists in consensus analyzed images of each lesion for the size, thickness of wall, number of septum, enhancement of wall/septum, wall nodule, signal intensity on DWI, calcification, and cyst content. Clinical variables, CT and MRI image characteristics were compared with pathology or follow-up results to evaluate the diagnostic performance for CRMs. Results Of the 130 lesions in 125 patients, histological analysis reported that 36 were malignant, 38 were benign, and no change was found in 56 followed-up lesions (mean follow-up of 24 months). The incidences of cystic wall thickened, more septa, measurable enhancement of wall/septum, nodule(s) on CT/MRI, and high signal intensity on DWI were significantly higher in malignant than in benign CRMs (CT: p = 0.005, p < 0.001, p < 0.001, p < 0.001, p < 0.001; MRI: p < 0.001, p < 0.001, p < 0.001, p < 0.001, p < 0.001, p < 0.001). Combination of MRI including DWI features with CT findings showed the highest area under ROC curve (0.973) in distinguishing benign and malignant CRMs. Conclusions Incorporating DWI characteristic of CRMs into Bosniak classification helps to improve diagnostic efficiency.
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Affiliation(s)
- Anqin Li
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Shichao Li
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yao Hu
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yaqi Shen
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xuemei Hu
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Daoyu Hu
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Ihab R. Kamel
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Medical Institutions, Baltimore, MD, United States
| | - Zhen Li
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- *Correspondence: Zhen Li,
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Zeng SE, Du MY, Yu Y, Huang SY, Zhang D, Cui XW, Dietrich CF. Ultrasound, CT, and MR Imaging for Evaluation of Cystic Renal Masses. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2022; 41:807-819. [PMID: 34101225 DOI: 10.1002/jum.15762] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 05/12/2021] [Accepted: 05/23/2021] [Indexed: 06/12/2023]
Abstract
Cystic renal masses are often encountered during abdominal imaging. Although most of them are benign simple cysts, some cystic masses have malignant characteristics. The Bosniak classification system provides a useful way to classify cystic masses. The Bosniak classification is based on the results of a well-established computed tomography protocol. Over the past 30 years, the classification system has been refined and improved. This paper reviews the literature on this topic and compares the advantages and disadvantages of different screening and classification methods. Patients will benefit from multimodal diagnosis for lesions that are difficult to classify after a single examination.
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Affiliation(s)
- Shu-E Zeng
- Department of Ultrasound Medicine, Hubei Cancer Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Ming-Yue Du
- Department of Ultrasound Medicine, Hubei Cancer Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yang Yu
- Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Shu-Yan Huang
- Department of Ultrasound, The First People's Hospital of Huaihua, Huaihua, China
| | - Di Zhang
- Department of Medical Ultrasound, Affiliated Hospital of Nantong University, Nantong, China
| | - Xin-Wu Cui
- Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Tsili AC, Andriotis E, Gkeli MG, Krokidis M, Stasinopoulou M, Varkarakis IM, Moulopoulos LA. The role of imaging in the management of renal masses. Eur J Radiol 2021; 141:109777. [PMID: 34020173 DOI: 10.1016/j.ejrad.2021.109777] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 05/09/2021] [Accepted: 05/14/2021] [Indexed: 12/26/2022]
Abstract
The wide availability of cross-sectional imaging is responsible for the increased detection of small, usually asymptomatic renal masses. More than 50 % of renal cell carcinomas (RCCs) represent incidental findings on noninvasive imaging. Multimodality imaging, including conventional US, contrast-enhanced US (CEUS), CT and multiparametric MRI (mpMRI) is pivotal in diagnosing and characterizing a renal mass, but also provides information regarding its prognosis, therapeutic management, and follow-up. In this review, imaging data for renal masses that urologists need for accurate treatment planning will be discussed. The role of US, CEUS, CT and mpMRI in the detection and characterization of renal masses, RCC staging and follow-up of surgically treated or untreated localized RCC will be presented. The role of percutaneous image-guided ablation in the management of RCC will be also reviewed.
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Affiliation(s)
- Athina C Tsili
- Department of Clinical Radiology, School of Health Sciences, Faculty of Medicine, University of Ioannina, 45110, Ioannina, Greece.
| | - Efthimios Andriotis
- Department of Newer Imaging Methods of Tomography, General Anti-Cancer Hospital Agios Savvas, 11522, Athens, Greece.
| | - Myrsini G Gkeli
- 1st Department of Radiology, General Anti-Cancer Hospital Agios Savvas, 11522, Athens, Greece.
| | - Miltiadis Krokidis
- 1st Department of Radiology, School of Medicine, National and Kapodistrian University of Athens, Areteion Hospital, 11528, Athens, Greece; Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital Bern University Hospital, University of Bern, 3010, Bern, Switzerland.
| | - Myrsini Stasinopoulou
- Department of Newer Imaging Methods of Tomography, General Anti-Cancer Hospital Agios Savvas, 11522, Athens, Greece.
| | - Ioannis M Varkarakis
- 2nd Department of Urology, National and Kapodistrian University of Athens, Sismanoglio Hospital, 15126, Athens, Greece.
| | - Lia-Angela Moulopoulos
- 1st Department of Radiology, School of Medicine, National and Kapodistrian University of Athens, Areteion Hospital, 11528, Athens, Greece.
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Cantisani V, Bertolotto M, Clevert DA, Correas JM, Drudi FM, Fischer T, Gilja OH, Granata A, Graumann O, Harvey CJ, Ignee A, Jenssen C, Lerchbaumer MH, Ragel M, Saftoiu A, Serra AL, Stock KF, Webb J, Sidhu PS. EFSUMB 2020 Proposal for a Contrast-Enhanced Ultrasound-Adapted Bosniak Cyst Categorization - Position Statement. ULTRASCHALL IN DER MEDIZIN (STUTTGART, GERMANY : 1980) 2021; 42:154-166. [PMID: 33307594 DOI: 10.1055/a-1300-1727] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
The well-established Bosniak renal cyst classification is based on contrast-enhanced computed tomography determining the malignant potential of cystic renal lesions. Ultrasound has not been incorporated into this pathway. However, the development of ultrasound contrast agents coupled with the superior resolution of ultrasound makes it possible to redefine the imaging of cystic renal lesions. In this position statement, an EFSUMB Expert Task Force reviews, analyzes, and describes the accumulated knowledge and limitations and presents the current position on the use of ultrasound contrast agents in the evaluation of cystic renal lesions.
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Affiliation(s)
- Vito Cantisani
- Department of Radiology, "Sapienza" University of Rome, Rome, Italy
| | - Michele Bertolotto
- Department of Radiology, University of Trieste, Ospedale di Cattinara, Trieste, IT
| | - Dirk-André Clevert
- Department of Clinical Radiology, University of Munich-Großhadern Campus, Munich, Germany
| | - Jean-Michel Correas
- Service de Radiologie adultes, Hôpital Necker, Université Paris Descartes, Paris, France
| | | | - Thomas Fischer
- Department of Radiology, University Berlin, Charité, Berlin, Germany
| | - Odd Helge Gilja
- Haukeland University Hospital, National Centre for Ultrasound in Gastroenterology, Bergen, Norway
| | - Antonio Granata
- Nephrology and Dialysis Unit, Emergency Hospital "Cannizzaro", Catania - Italy
| | - Ole Graumann
- Research and Innovation Unit of Radiology, University of Southern Denmark, Odense C, Denmark
| | - Christopher J Harvey
- Department of Imaging, Imperial College NHS Healthcare Trust, London, United Kingdom of Great Britain and Northern Ireland
| | - Andre Ignee
- Innere Medizin 2, Caritas-Krankenhaus, Bad Mergentheim, Germany
| | - Christian Jenssen
- Klinik für Innere Medizin, Krankenhaus Märkisch Oderland Strausberg/Wriezen, Germany
| | - Markus Herbert Lerchbaumer
- Department of Radiology, Charité Centrum 6 - Diagnostische und interventionelle Radiologie und Nuklearmedizin, Berlin, Germany
| | - Matthew Ragel
- Radiology Department, Aintree University Hospitals NHS Foundation Trust, Liverpool, United Kingdom of Great Britain and Northern Ireland
| | - Adrian Saftoiu
- Research Center in Gastroenterology and Hepatology, University of Medicine and Pharmacy Craiova, Romania
| | - Andreas L Serra
- Department of Internal Medicine and Nephrology, Klinik Hirslanden, Zürich, Switzerland
| | | | - Jolanta Webb
- Radiology Department, Aintree University Hospitals NHS Foundation Trust, Liverpool, United Kingdom of Great Britain and Northern Ireland
| | - Paul S Sidhu
- Department of Radiology, King's College Hospital London, United Kingdom of Great Britain and Northern Ireland
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Nicolau C, Antunes N, Paño B, Sebastia C. Imaging Characterization of Renal Masses. ACTA ACUST UNITED AC 2021; 57:medicina57010051. [PMID: 33435540 PMCID: PMC7827903 DOI: 10.3390/medicina57010051] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 12/28/2020] [Accepted: 01/04/2021] [Indexed: 01/10/2023]
Abstract
The detection of a renal mass is a relatively frequent occurrence in the daily practice of any Radiology Department. The diagnostic approaches depend on whether the lesion is cystic or solid. Cystic lesions can be managed using the Bosniak classification, while management of solid lesions depends on whether the lesion is well-defined or infiltrative. The approach to well-defined lesions focuses mainly on the differentiation between renal cancer and benign tumors such as angiomyolipoma (AML) and oncocytoma. Differential diagnosis of infiltrative lesions is wider, including primary and secondary malignancies and inflammatory disease, and knowledge of the patient history is essential. Radiologists may establish a possible differential diagnosis based on the imaging features of the renal masses and the clinical history. The aim of this review is to present the contribution of the different imaging techniques and image guided biopsies in the diagnostic management of cystic and solid renal lesions.
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Affiliation(s)
- Carlos Nicolau
- Radiology Department, Hospital Clinic, University of Barcelona (UB), 08036 Barcelona, Spain; (B.P.); (C.S.)
- Correspondence:
| | - Natalie Antunes
- Radiology Department, Hospital de Santa Marta, 1169-024 Lisboa, Portugal;
| | - Blanca Paño
- Radiology Department, Hospital Clinic, University of Barcelona (UB), 08036 Barcelona, Spain; (B.P.); (C.S.)
| | - Carmen Sebastia
- Radiology Department, Hospital Clinic, University of Barcelona (UB), 08036 Barcelona, Spain; (B.P.); (C.S.)
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7
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Bosniak Classification of Cystic Renal Masses Version 2019: Comparison of Categorization Using CT and MRI. AJR Am J Roentgenol 2020; 216:412-420. [PMID: 32755181 DOI: 10.2214/ajr.20.23656] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND. Bosniak classification version 2019 proposed refinements for cystic renal mass characterization and now formally incorporates MRI, which may improve concordance with CT. OBJECTIVE. The purpose of this study is to compare concordance of CT and MRI in evaluation of cystic renal masses using Bosniak classification version 2019. METHODS. Three abdominal radiologists retrospectively reviewed 68 consecutive cystic renal masses from 45 patients assessed with both CT and MRI renal mass protocols within a year between 2005 and 2019. CT and MRI were reviewed independently and in separate sessions, using both the original and 2019 versions of Bosniak classification systems. RESULTS. Using Bosniak classification version 2019, cystic renal masses were classified into 12 category I, 19 category II, 13 category IIF, four category III, and 20 category IV by CT and eight category I, 15 category II, 23 category IIF, nine category III, and 13 category IV by MRI. Among individual features, MRI showed more septa (p < 0.001, p = 0.046, p = 0.005; McNemar test) for all three radiologists, although both CT and MRI showed a similar number of protrusions (p = 0.823, p = 1.0, p = 0.302) and maximal septa and wall thickness (p = 1.0, p = 1.0, p = 0.145). Of the discordant cases with version 2019, MRI led to a higher categorization in 12 masses. The reason for upgrade was most commonly because of protrusions identified only on MRI (n = 4), an increased number of septa (n = 3), and a new category: heterogeneously T1-weighted hyperintensity (n = 3). Neither modality was more likely to lead to a categorization change for either version 2019 (p = 0.502; McNemar test) or the original (p = 0.823) Bosniak classification system. Overall interrater agreement was substantial for both CT (κ = 0.745) and MRI (κ = 0.655) using version 2019 and was slightly higher than that of the original system for CT (κ = 0.707) and MRI (κ = 0.623). CONCLUSION. CT and MRI were concordant in the majority of cases using Bosniak classification version 2019, and category changes by modality were not statistically significant. Interrater agreements were substantial for both CT and MRI. CLINICAL IMPACT. Bosniak classification version 2019 as applied to cystic renal masses has substantial interrater agreement and does not lead to systematic category upgrades with either CT or MRI.
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Krishna S, Schieda N, Pedrosa I, Hindman N, Baroni RH, Silverman SG, Davenport MS. Update on MRI of Cystic Renal Masses Including Bosniak Version 2019. J Magn Reson Imaging 2020; 54:341-356. [PMID: 33009722 DOI: 10.1002/jmri.27364] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Revised: 08/27/2020] [Accepted: 08/28/2020] [Indexed: 12/15/2022] Open
Abstract
Incidental cystic renal masses are common, usually benign, and almost always indolent. Since 1986, the Bosniak classification has been used to express the risk of malignancy in a cystic renal mass detected at imaging. Historically, magnetic resonance imaging (MRI) was not included in that classification. The proposed Bosniak v.2019 update has formally incorporated MRI, included definitions of imaging terms designed to improve interobserver agreement and specificity for malignancy, and incorporated a variety of masses that were incompletely defined or not included in the original classification. For example, at unenhanced MRI, homogeneous masses markedly hyperintense at T2 -weighted imaging (similar to cerebrospinal fluid) and homogeneous masses markedly hyperintense at fat suppressed T1 -weighted imaging (approximately ≥2.5 times more intense than adjacent renal parenchyma) are classified as Bosniak II and may be safely ignored, even when they have not been imaged with a complete renal mass MRI protocol. MRI has specific advantages and is recommended to evaluate masses that at computed tomography (CT) 1) have abundant thick or nodular calcifications; 2) are homogeneous, hyperattenuating, ≥3 cm, and nonenhancing; or 3) are heterogeneous and nonenhancing. Although MRI is generally excellent for characterizing cystic renal masses, there are unique weaknesses of MRI that bear consideration. These details and others related to MRI of cystic renal masses are described in this review, with an emphasis on Bosniak v.2019. A website (https://bosniak-calculator.herokuapp.com/) and mobile phone apps named "Bosniak Calculator" have been developed for ease of assignment of Bosniak classes. LEVEL OF EVIDENCE: 5 TECHNICAL EFFICACY STAGE: 3.
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Affiliation(s)
- Satheesh Krishna
- Joint Department of Medical Imaging, University Health Network, Mount Sinai Hospital and Women's College Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Nicola Schieda
- Department of Medical Imaging, The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada
| | - Ivan Pedrosa
- Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Nicole Hindman
- Department of Radiology, New York University Langone Medical Center, New York, New York, USA
| | - Ronaldo H Baroni
- Department of Radiology and Diagnostic Imaging, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Stuart G Silverman
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Matthew S Davenport
- Departments of Radiology and Urology, Michigan Medicine, University of Michigan, Ann Arbor, Michigan, USA
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Contrast-Enhanced Ultrasound (CEUS) for Follow-Up of Bosniak 2F Complex Renal Cystic Lesions-A 12-Year Retrospective Study in a Specialized European Center. Cancers (Basel) 2020; 12:cancers12082170. [PMID: 32759819 PMCID: PMC7465614 DOI: 10.3390/cancers12082170] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 07/28/2020] [Accepted: 08/03/2020] [Indexed: 02/07/2023] Open
Abstract
Bosniak 2F renal cystic lesions feature morphologic characteristics between Bosniak I and III categories, the majority of which remain benign. However, a minor part of Bosniak 2F lesions may progress to malignancy. The purpose of this study was to assess Bosniak 2F cystic lesions during follow-up examinations by CEUS. One-hundred-and-twelve out of 364 patients with Bosniak 2F lesions underwent follow-up CEUS examinations between February 2008 and February 2020. Twelve out of 364 patients underwent renal surgery without follow-up CEUS. The progression rate of Bosniak 2F renal lesions detected by CEUS accounted for 7.1% (8/112 patients) after a mean of 12.9 months. The first follow-up CEUS revealed 75% of progressions (6/8), the remaining 25% (2/8) of progressions were detected during second follow-up CEUS. Underlying clear-cell renal cell carcinoma was histopathologically validated in 5/8 progressive complex cystic renal lesions. Stable sonomorphologic features were observed in 92.1% (104/112 patients). CEUS depicts a promising diagnostic imaging modality in the diagnostic work-up and follow-up of complex renal cystic lesions at higher spatial and temporal resolutions than CT or MRI. Its excellent safety profile, its easy and repeatable accessibility, and low financial costs render CEUS an attractive and powerful alternative imaging tool for monitoring complex renal cystic lesions.
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Diffusion-Weighted Imaging in Oncology: An Update. Cancers (Basel) 2020; 12:cancers12061493. [PMID: 32521645 PMCID: PMC7352852 DOI: 10.3390/cancers12061493] [Citation(s) in RCA: 73] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 05/28/2020] [Accepted: 06/01/2020] [Indexed: 02/06/2023] Open
Abstract
To date, diffusion weighted imaging (DWI) is included in routine magnetic resonance imaging (MRI) protocols for several cancers. The real additive role of DWI lies in the "functional" information obtained by probing the free diffusivity of water molecules into intra and inter-cellular spaces that in tumors mainly depend on cellularity. Although DWI has not gained much space in some oncologic scenarios, this non-invasive tool is routinely used in clinical practice and still remains a hot research topic: it has been tested in almost all cancers to differentiate malignant from benign lesions, to distinguish different malignant histotypes or tumor grades, to predict and/or assess treatment responses, and to identify residual or recurrent tumors in follow-up examinations. In this review, we provide an up-to-date overview on the application of DWI in oncology.
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12
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Diagnostic test accuracy of ADC values for identification of clear cell renal cell carcinoma: systematic review and meta-analysis. Eur Radiol 2020; 30:4023-4038. [PMID: 32144458 DOI: 10.1007/s00330-020-06740-w] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 01/14/2020] [Accepted: 02/11/2020] [Indexed: 12/11/2022]
Abstract
OBJECTIVES To perform a systematic review on apparent diffusion coefficient (ADC) values of renal tumor subtypes and meta-analysis on the diagnostic performance of ADC for differentiation of localized clear cell renal cell carcinoma (ccRCC) from other renal tumor types. METHODS Medline, Embase, and the Cochrane Library databases were searched for studies published until May 1, 2019, that reported ADC values of renal tumors. Methodological quality was evaluated. For the meta-analysis on diagnostic test accuracy of ADC for differentiation of ccRCC from other renal lesions, we applied a bivariate random-effects model and compared two subgroups of ADC measurement with vs. without cystic and necrotic areas. RESULTS We included 48 studies (2588 lesions) in the systematic review and 13 studies (1126 lesions) in the meta-analysis. There was no significant difference in ADC of renal parenchyma using b values of 0-800 vs. 0-1000 (p = 0.08). ADC measured on selected portions (sADC) excluding cystic and necrotic areas differed significantly from whole-lesion ADC (wADC) (p = 0.002). Compared to ccRCC, minimal-fat angiomyolipoma, papillary RCC, and chromophobe RCC showed significantly lower sADC while oncocytoma exhibited higher sADC. Summary estimates of sensitivity and specificity to differentiate ccRCC from other tumors were 80% (95% CI, 0.76-0.88) and 78% (95% CI, 0.64-0.89), respectively, for sADC and 77% (95% CI, 0.59-0.90) and 77% (95% CI, 0.69-0.86) for wADC. sADC offered a higher area under the receiver operating characteristic curve than wADC (0.852 vs. 0.785, p = 0.02). CONCLUSIONS ADC values of kidney tumors that exclude cystic or necrotic areas more accurately differentiate ccRCC from other renal tumor types than whole-lesion ADC values. KEY POINTS • Selective ADC of renal tumors, excluding cystic and necrotic areas, provides better discriminatory ability than whole-lesion ADC to differentiate clear cell RCC from other renal lesions, with area under the receiver operating characteristic curve (AUC) of 0.852 vs. 0.785, respectively (p = 0.02). • Selective ADC of renal masses provides moderate sensitivity and specificity of 80% and 78%, respectively, for differentiation of clear cell renal cell carcinoma (RCC) from papillary RCC, chromophobe RCC, oncocytoma, and minimal-fat angiomyolipoma. • Selective ADC excluding cystic and necrotic areas are preferable to whole-lesion ADC as an additional tool to multiphasic MRI to differentiate clear cell RCC from other renal lesions whether the highest b value is 800 or 1000.
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Zhang H, Pan J, Shen Y, Bai X, Wang Y, Wang H, Ye H. High signal renal tumors on DWI: the diagnostic value of morphological characteristics. Abdom Radiol (NY) 2019; 44:239-246. [PMID: 30141057 DOI: 10.1007/s00261-018-1728-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
PURPOSE To assess the usefulness of morphological characteristics of diffusion-weighted imaging (DWI) for differentiating malignant renal tumors from benign renal tumors, and clear cell renal cell carcinoma (RCC) from non-clear cell RCC at 3.0 T. METHODS The study included 249 patients with 251 histopathologically confirmed renal tumors that showed high signal on DWI. For each tumor, two radiologists independently evaluated apparent diffusion coefficient (ADC) values and morphological characteristics of DWI. The differences in the quantitative and qualitative magnetic resonance imaging (MRI) features determined by the readers were assessed. The ADC values between malignant and benign renal tumors and between clear cell and non-clear cell RCC were compared using Mann-Whitney tests. The proportional differences of morphological characteristics of DWI between malignant and benign renal tumors and between clear cell and non-clear cell RCC were compared using Chi-square tests. RESULTS There were no significant differences in the quantitative and qualitative MRI features determined by the readers. The ADC values for malignant renal tumors were statistically significantly higher than those for benign renal tumors (p < 0.05), and the ADC values for clear cell RCC were statistically significantly higher than those for non-clear cell RCC (p < 0.05). The proportion of morphological characteristics of DWI between malignant and benign renal tumors was statistically significantly different at ring, nodular, flaky high signal. The proportion of morphological characteristics of DWI between clear cell and non-clear cell RCC was statistically significantly different at uniform high signal. CONCLUSIONS The morphological characteristics of DWI are useful in differentiating renal tumors.
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Affiliation(s)
- Hongtao Zhang
- Department of Radiology, Chinese PLA General Hospital, Fuxing Road 28, Beijing, 100853, China
- Department of Radiology, 307 Hospital, PLA, Beijing, China
| | - Jingjing Pan
- Department of Radiology, Chinese PLA General Hospital, Fuxing Road 28, Beijing, 100853, China
- Department of Radiology, General Hospital of the PLA Rocket Force, Beijing, China
| | - Yanguang Shen
- Department of Radiology, Chinese PLA General Hospital, Fuxing Road 28, Beijing, 100853, China
| | - Xu Bai
- Department of Radiology, Chinese PLA General Hospital, Fuxing Road 28, Beijing, 100853, China
| | - Yingwei Wang
- Department of Radiology, Chinese PLA General Hospital, Fuxing Road 28, Beijing, 100853, China
| | - Haiyi Wang
- Department of Radiology, Chinese PLA General Hospital, Fuxing Road 28, Beijing, 100853, China.
| | - Huiyi Ye
- Department of Radiology, Chinese PLA General Hospital, Fuxing Road 28, Beijing, 100853, China.
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van Baalen S, Froeling M, Asselman M, Klazen C, Jeltes C, van Dijk L, Vroling B, Dik P, ten Haken B. Mono, bi- and tri-exponential diffusion MRI modelling for renal solid masses and comparison with histopathological findings. Cancer Imaging 2018; 18:44. [PMID: 30477587 PMCID: PMC6260899 DOI: 10.1186/s40644-018-0178-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Accepted: 11/07/2018] [Indexed: 02/07/2023] Open
Abstract
PURPOSE To compare diffusion tensor imaging (DTI), intravoxel incoherent motion (IVIM), and tri-exponential models of the diffusion magnetic resonance imaging (MRI) signal for the characterization of renal lesions in relationship to histopathological findings. METHODS Sixteen patients planned to undergo nephrectomy for kidney tumour were scanned before surgery at 3 T magnetic resonance imaging (MRI), with T2-weighted imaging, DTI and diffusion weighted imaging (DWI) using ten b-values. DTI parameters (mean diffusivity [MD] and fractional anisotropy [FA]) were obtained by iterative weighted linear least squared fitting of the DTI data and bi-, and tri-exponential fit parameters (Dbi, fstar,and Dtri, ffast,finterm) using a nonlinear fit of the multiple b-value DWI data. Average parameters were calculated for regions of interest, selecting the lesions and healthy kidney tissue. Tumour type and specificities were determined after surgery by histological examination. Mean parameter values of healthy tissue and solid lesions were compared using a Wilcoxon-signed ranked test and MANOVA. RESULTS Thirteen solid lesions (nine clear cell carcinomas, two papillary renal cell carcinoma, one haemangioma and one oncocytoma) and four cysts were included. The mean MD of solid lesions are significantly (p < 0.05) lower than healthy cortex and medulla, (1.94 ± 0.32*10- 3 mm2/s versus 2.16 ± 0.12*10- 3 mm2/s and 2.21 ± 0.14*10- 3 mm2/s, respectively) whereas ffast is significantly higher (7.30 ± 3.29% versus 4.14 ± 1.92% and 4.57 ± 1.74%) and finterm is significantly lower (18.7 ± 5.02% versus 28.8 ± 5.09% and 26.4 ± 6.65%). Diffusion coefficients were high (≥2.0*10- 3 mm2/s for MD, 1.90*10- 3 mm2/s for Dbi and 1.6*10- 3 mm2/s for Dtri) in cc-RCCs with cystic structures and/or haemorrhaging and low (≤1.80*10- 3 mm2/s for MD, 1.40*10- 3 mm2/s for Dbi and 1.05*10- 3 mm2/s for Dtri) in tumours with necrosis or sarcomatoid differentiation. CONCLUSION Parameters derived from a two- or three-component fit of the diffusion signal are sensitive to histopathological features of kidney lesions.
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Affiliation(s)
- Sophie van Baalen
- Magnetic Detection & Imaging, University of Twente, Drienerlolaan 5, 7522 NB Enschede, Netherlands
| | - Martijn Froeling
- Radiology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, Netherlands
| | - Marino Asselman
- Urology, Medisch Spectrum Twente, Koningsplein 1, 7512 KZ Enschede, Netherlands
| | - Caroline Klazen
- Radiology, Medisch Spectrum Twente, Koningsplein 1, 7512 KZ Enschede, Netherlands
| | - Claire Jeltes
- Magnetic Detection & Imaging, University of Twente, Drienerlolaan 5, 7522 NB Enschede, Netherlands
| | - Lotte van Dijk
- Magnetic Detection & Imaging, University of Twente, Drienerlolaan 5, 7522 NB Enschede, Netherlands
| | - Bart Vroling
- Magnetic Detection & Imaging, University of Twente, Drienerlolaan 5, 7522 NB Enschede, Netherlands
| | - Pieter Dik
- Pediatric Urology, Wilhemina Children’s Hospital, Lundlaan 6, 3584 EA Utrecht, Netherlands
| | - Bennie ten Haken
- Magnetic Detection & Imaging, University of Twente, Drienerlolaan 5, 7522 NB Enschede, Netherlands
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Zhou JY, Wang YC, Zeng CH, Ju SH. Renal Functional MRI and Its Application. J Magn Reson Imaging 2018; 48:863-881. [PMID: 30102436 DOI: 10.1002/jmri.26180] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Accepted: 04/10/2018] [Indexed: 12/11/2022] Open
Abstract
Renal function varies according to the nature and stage of diseases. Renal functional magnetic resonance imaging (fMRI), a technique considered superior to the most common method used to estimate the glomerular filtration rate, allows for noninvasive, accurate measurements of renal structures and functions in both animals and humans. It has become increasingly prevalent in research and clinical applications. In recent years, renal fMRI has developed rapidly with progress in MRI hardware and emerging postprocessing algorithms. Function-related imaging markers can be acquired via renal fMRI, encompassing water molecular diffusion, perfusion, and oxygenation. This review focuses on the progression and challenges of the main renal fMRI methods, including dynamic contrast-enhanced MRI, blood oxygen level-dependent MRI, diffusion-weighted imaging, diffusion tensor imaging, arterial spin labeling, fat fraction imaging, and their recent clinical applications. LEVEL OF EVIDENCE 5 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2018;48:863-881.
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Affiliation(s)
- Jia-Ying Zhou
- Jiangsu Key Laboratory of Molecular and Functional Imaging, Department of Radiology, Zhongda Hospital, Medical School, Southeast University, Nanjing, China
| | - Yuan-Cheng Wang
- Jiangsu Key Laboratory of Molecular and Functional Imaging, Department of Radiology, Zhongda Hospital, Medical School, Southeast University, Nanjing, China
| | - Chu-Hui Zeng
- Jiangsu Key Laboratory of Molecular and Functional Imaging, Department of Radiology, Zhongda Hospital, Medical School, Southeast University, Nanjing, China
| | - Sheng-Hong Ju
- Jiangsu Key Laboratory of Molecular and Functional Imaging, Department of Radiology, Zhongda Hospital, Medical School, Southeast University, Nanjing, China
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Hélénon O, Crosnier A, Verkarre V, Merran S, Méjean A, Correas JM. Simple and complex renal cysts in adults: Classification system for renal cystic masses. Diagn Interv Imaging 2018; 99:189-218. [DOI: 10.1016/j.diii.2017.10.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Accepted: 09/26/2017] [Indexed: 02/08/2023]
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Abstract
Background Cases of primary renal lymphoma (PRL) are quite rare and are often mistaken for renal cell carcinoma. Purpose To determine the multislice computed tomography (MSCT) and magnetic resonance imaging (MRI) characteristics of PRL. Materials and Methods Twenty-three patients with PRL were identified by CT and MRI, and their tumor characteristics were assessed. Results Tumors exhibited single or multifocal nodules (n = 19) and diffuse renal enlargement (n = 4). Twenty-two tumors exhibited an infiltrative appearance. There was no evidence of calcification in any of the cases. Twenty-one tumors displaced or wrapped around abdominal vessels rather than encasing them. Enlarged retroperitoneal nodes were observed in three cases. Neither extension into the venous system nor distant metastasis was found. Tumor enhancement was of low attenuation compared with that of normal renal cortex and medulla ( P < 0.05). PRL was isointense on T1-weighted imaging, slightly hypointense on T2-weighted imaging and hyperintense on diffusion-weighted imaging. Twenty-two patients exhibited biopsy-confirmed PRN. There were four, 12, and seven cases of low-grade, intermediate-grade, and high-grade tumors, respectively. Patient were followed up over 16 to 166 months. Six patients died within three years and five patients died within five years. Conclusion Infiltrative appearance and tumor displacement or extension around abdominal vessels rather than vessel encasement are common findings on CT or MRI imaging and may suggest a diagnosis of PRL.
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Affiliation(s)
- Qingqiang Zhu
- 1 Department of Radiology, Second Xiangya Hospital, Central South University, Changsha, PR China
| | - Wenrong Zhu
- 2 Department of Medical Imaging, Subei People's Hospital, Medical School of Yangzhou University, Yangzhou, PR China
| | - Jingtao Wu
- 2 Department of Medical Imaging, Subei People's Hospital, Medical School of Yangzhou University, Yangzhou, PR China
| | - Wenxin Chen
- 2 Department of Medical Imaging, Subei People's Hospital, Medical School of Yangzhou University, Yangzhou, PR China
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Hassanen O, Ghieda U, Eltomey MA. Contrast enhanced MRI and Diffusion Weighted Imaging (DWI) in the evaluation of renal cell carcinoma and differentiation of its subtypes. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2017. [DOI: 10.1016/j.ejrnm.2017.03.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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19
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Simultaneous Multislice Diffusion-Weighted Imaging of the Kidney: A Systematic Analysis of Image Quality. Invest Radiol 2017; 52:163-169. [PMID: 27662577 DOI: 10.1097/rli.0000000000000323] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVES The aims of this study were to implement a protocol for simultaneous multislice (SMS) accelerated diffusion-weighted imaging (DWI) of the kidneys and to perform a systematic analysis of image quality of the data sets. MATERIALS AND METHODS Ten healthy subjects and 5 patients with renal masses underwent DWI of the kidney in this prospective institutional review board-approved study on a 3 T magnetic resonance scanner. Simultaneous multislice DWI echo-planar sequences (acceleration factors [AFs] 2 and 3) were compared with conventional echo-planar DWI as reference standard for each acquisition scheme. The following 3 acquisition schemes were applied: comparison A, with increased number of acquisitions at constant scan time; comparison B, with reduction of acquisition time; and comparison C, with increased slice resolution (constant acquisition time, increasing number of slices). Interreader reliability was analyzed by calculating the intraclass correlation coefficient (ICC). Qualitative image quality features were evaluated by 2 independent radiologists on a 5-point Likert scale. Quantification accuracy of the apparent diffusion coefficients (ADCs) and signal-to-noise ratios (SNRs) were assessed by region of interest analysis. Furthermore, lesion conspicuity in the 5 patients was assessed using a 5-point Likert scale by 2 independent radiologists. RESULTS Interreader agreement was substantial with an ICC of 0.68 for the overall image quality and an ICC of 0.73 for the analysis of artifacts. In comparison A, AF2 resulted in increased SNR (P < 0.05) by 21% at stable image quality scores (image quality: P = 0.76, artifacts: P = 0.21). In comparison B, applying AF2, the scan time could be reduced by 46% without significant reduction in qualitative image quality scores (P = 0.059) or SNR (P = 0.126). In comparison C, slice resolution could be improved by 28% using AF2 with stable image quality scores and SNR. In general, AF3 resulted in reduced image quality and SNR. Significantly reduced ADC values were observed for AF3 in comparison C (cortex: P = 0.003; medulla: P = 0.001) compared with the standard echo-planar imaging sequence. The conventional DWI and the SMS DWI with AF2 showed stable lesion conspicuity ([AF1/AF2]: reader 1 [1.8/1.4] and reader 2 [1.8/1.4]). The lesion conspicuity was lower using AF3 (reader 1: 2.2 and reader 2: 1.8). CONCLUSIONS In conclusion, SMS DWI of the kidney is a potential tool to substantially reduce scan time without negative effects on SNR, ADC quantification accuracy, and image quality if an AF2 is used. Although AF3 results in even higher scan time reduction, a negative impact on image quality, SNR, ADC quantification accuracy, and lesion conspicuity must be considered.
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The role of magnetic resonance diffusion tensor imaging in differentiation of benign from malignant focal renal lesions. MARMARA MEDICAL JOURNAL 2017. [DOI: 10.5472/marumj.344825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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21
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Öztürk M, Ekinci A, Elbir ŞF, Okur A, Doğan S, Karahan ÖI. Usefulness of Apparent Diffusion Coefficient of Diffusion-Weighted Imaging for Differential Diagnosis of Primary Solid and Cystic Renal Masses. Pol J Radiol 2017; 82:209-215. [PMID: 28469737 PMCID: PMC5398682 DOI: 10.12659/pjr.899984] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Accepted: 08/16/2016] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND To evaluate the value of diffusion-weighted imaging (DWI) for distinguishing between benign and malignant renal masses. MATERIAL/METHODS Seventy-five patients with 75 unilateral renal lesions were included, and 75 normal contralateral kidneys served as controls. The lesions were categorized into four groups as malignant cystic, malignant solid, benign cystic and benign solid. The apparent diffusion coefficients (ADCs) were evaluated for two different b values (b=600 s/mm2 and b=1000 s/mm2). Receiving operating characteristic analysis was performed to identify threshold ADCs. RESULTS Sensitivity and specificity were 67% and 77% (p=0.003) at the cutoff value of 1.5 for b=600 s/mm2, and 79% and 62% (p=0.004) at the cutoff value of 1.99 for b=1000 s/mm2 as regards the differentiation between solid benign and malignant renal lesions. Sensitivity and specificity were 78% and 79% (p=0.001) at the cutoff value of 3.1 for b=600 s/mm2, and 86% and 61% (p=0.003) at the cutoff value of 2.9 for b=1000 s/mm2 as regrads the differentiation between benign and malignant cystic renal lesions. CONCLUSIONS DWI can be an effective diagnostic method for distinguishing between benign and malignant renal masses.
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Affiliation(s)
- Mehmet Öztürk
- Department of Radiology, Diyarbakır Children's Hospital, Diyarbakır, Turkey
| | - Afra Ekinci
- Department of Radiology, Erciyes University Medical Faculty, Kayseri, Turkey
| | - Şenol Fatih Elbir
- Department of Radiology, Private Gözde Academy Hospital, Malatya, Turkey
| | - Aylin Okur
- Department of Radiology, Bozok University Medical Faculty, Yozgat, Turkey
| | - Serap Doğan
- Department of Radiology, Erciyes University Medical Faculty, Kayseri, Turkey
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Balyemez F, Aslan A, Inan I, Ayaz E, Karagöz V, Özkanli SŞ, Acar M. Diffusion-weighted magnetic resonance imaging in cystic renal masses. Can Urol Assoc J 2017; 11:E8-E14. [PMID: 28163806 DOI: 10.5489/cuaj.3888] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
INTRODUCTION We aimed to introduce the diagnostic value of diffusion-weighted (DWI) magnetic resonance imaging (MRI) for distinguishing benign and malignant renal cystic masses. METHODS Abdominal DWI-MRIs of patients with Bosniak categories 2F, 3, and 4 cystic renal masses were evaluated retrospectively. Cystic masses were assigned as benign or malignant according to histopathological or followup MRI findings and compared with apparent diffusion coefficient (ADC) values. RESULTS There were 30 patients (18 males and 12 females, mean age was 59.23 ± 12.08 years [range 38-83 years]) with cystic renal masses (eight Bosniak category 2F, 12 Bosniak category 3, 10 Bosniak category 4). Among them, 14 cysts were diagnosed as benign and 16 as malignant by followup imaging or histopathological findings. For the malignant lesions, the mean ADC values were lower than for benign lesions (p=0.001). An ADC value of ≤2.28 ×10-6 mm2/s or less had a sensitivity of 75% and a specificity of 92.86% for detecting malignancy. CONCLUSIONS ADC can improve the diagnostic performance of MRI in the evaluation of complex renal cysts when used together with conventional MRI sequences.
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Affiliation(s)
- Fikret Balyemez
- Department of Radiology, Göztepe Training and Research Hospital, Medical School of Istanbul Medeniyet University, Istanbul, Turkey
| | - Ahmet Aslan
- Department of Radiology, Ümraniye Training and Research Hospital, Istanbul, Turkey
| | - Ibrahim Inan
- Department of Radiology, Göztepe Training and Research Hospital, Medical School of Istanbul Medeniyet University, Istanbul, Turkey
| | - Ercan Ayaz
- Department of Radiology, Göztepe Training and Research Hospital, Medical School of Istanbul Medeniyet University, Istanbul, Turkey
| | - Vildan Karagöz
- Department of Radiology, Göztepe Training and Research Hospital, Medical School of Istanbul Medeniyet University, Istanbul, Turkey
| | - Sıdıka Şeyma Özkanli
- Department of Pathology, Göztepe Training and Research Hospital, Medical School of Istanbul, Medeniyet University, Istanbul, Turkey
| | - Murat Acar
- Department of Radiology, Göztepe Training and Research Hospital, Medical School of Istanbul Medeniyet University, Istanbul, Turkey;; Department of Radiology, King Hamad University Hospital, Bahrain
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Sobh DM, El Hawary GESM, Abou El Ghar M, El-Diasty TAEM, El-Sayed Settein M, ElShaer S, Tantawy MSE. Role of diffusion weighted MR imaging in characterization of focal kidney and upper urinary tract lesions. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2016. [DOI: 10.1016/j.ejrnm.2016.09.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Graumann O, Osther SS, Karstoft J, Hørlyck A, Osther PJS. Bosniak classification system: a prospective comparison of CT, contrast-enhanced US, and MR for categorizing complex renal cystic masses. Acta Radiol 2016; 57:1409-1417. [PMID: 26019242 DOI: 10.1177/0284185115588124] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Background The Bosniak classification was originally based on computed tomographic (CT) findings. Magnetic resonance (MR) and contrast-enhanced ultrasonography (CEUS) imaging may demonstrate findings that are not depicted at CT, and there may not always be a clear correlation between the findings at MR and CEUS imaging and those at CT. Purpose To compare diagnostic accuracy of MR, CEUS, and CT when categorizing complex renal cystic masses according to the Bosniak classification. Material and Methods From February 2011 to June 2012, 46 complex renal cysts were prospectively evaluated by three readers. Each mass was categorized according to the Bosniak classification and CT was chosen as gold standard. Kappa was calculated for diagnostic accuracy and data was compared with pathological results. Results CT images found 27 BII, six BIIF, seven BIII, and six BIV. Forty-three cysts could be characterized by CEUS, 79% were in agreement with CT (κ = 0.86). Five BII lesions were upgraded to BIIF and four lesions were categorized lower with CEUS. Forty-one lesions were examined with MR; 78% were in agreement with CT (κ = 0.91). Three BII lesions were upgraded to BIIF and six lesions were categorized one category lower. Pathologic correlation in six lesions revealed four malignant and two benign lesions. Conclusion CEUS and MR both up- and downgraded renal cysts compared to CT, and until these non-radiation modalities have been refined and adjusted, CT should remain the gold standard of the Bosniak classification.
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Affiliation(s)
- Ole Graumann
- Urological Research Center, Department of Urology, Fredericia Hospital, Denmark
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25
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Ding Y, Zeng M, Rao S, Chen C, Fu C, Zhou J. Comparison of Biexponential and Monoexponential Model of Diffusion-Weighted Imaging for Distinguishing between Common Renal Cell Carcinoma and Fat Poor Angiomyolipoma. Korean J Radiol 2016; 17:853-863. [PMID: 27833401 PMCID: PMC5102913 DOI: 10.3348/kjr.2016.17.6.853] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2015] [Accepted: 06/26/2016] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVE To compare the diagnostic accuracy of intravoxel incoherent motion (IVIM)-derived parameters and apparent diffusion coefficient (ADC) in distinguishing between renal cell carcinoma (RCC) and fat poor angiomyolipoma (AML). MATERIALS AND METHODS Eighty-three patients with pathologically confirmed renal tumors were included in the study. All patients underwent renal 1.5T MRI, including IVIM protocol with 8 b values (0-800 s/mm2). The ADC, diffusion coefficient (D), pseudodiffusion coefficient (D*), and perfusion fraction (f) were calculated. One-way ANOVA was used for comparing ADC and IVIM-derived parameters among clear cell RCC (ccRCC), non-ccRCC and fat poor AML. The diagnostic performance of these parameters was evaluated by using receiver operating characteristic (ROC) analysis. RESULTS The ADC were significantly greater in ccRCCs than that of non-ccRCCs and fat poor AMLs (each p < 0.010, respectively). The D and D* among the three groups were significantly different (all p < 0.050). The f of non-ccRCCs were less than that of ccRCCs and fat poor AMLs (each p < 0.050, respectively). In ROC analysis, ADC and D showed similar area under the ROC curve (AUC) values (AUC = 0.955 and 0.964, respectively, p = 0.589) in distinguishing between ccRCCs and fat poor AMLs. The combination of D > 0.97 × 10-3 mm2/s, D* < 28.03 × 10-3 mm2/s, and f < 13.61% maximized the diagnostic sensitivity for distinguishing non-ccRCCs from fat poor AMLs. The final estimates of AUC (95% confidence interval), sensitivity, specificity, positive predictive value, negative predictive value and accuracy for the entire cohort were 0.875 (0.719-0.962), 100% (23/23), 75% (9/12), 88.5% (23/26), 100% (9/9), and 91.4% (32/35), respectively. CONCLUSION The ADC and D showed similar diagnostic accuracy in distinguishing between ccRCCs and fat poor AMLs. The IVIM-derived parameters were better than ADC in discriminating non-ccRCCs from fat poor AMLs.
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Affiliation(s)
- Yuqin Ding
- Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Medical Imaging, Shanghai 200032, China
| | - Mengsu Zeng
- Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Medical Imaging, Shanghai 200032, China
| | - Shengxiang Rao
- Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Medical Imaging, Shanghai 200032, China
| | - Caizhong Chen
- Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Medical Imaging, Shanghai 200032, China
| | - Caixia Fu
- Siemens Shenzhen Magnetic Resonance Ltd., Shenzhen 518057, China
| | - Jianjun Zhou
- Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Medical Imaging, Shanghai 200032, China
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Hélénon O, Delavaud C, Dbjay J, Gregory J, Rasouli N, Correas JM. A Practical Approach to Indeterminate and Cystic Renal Masses. Semin Ultrasound CT MR 2016; 38:10-27. [PMID: 28237276 DOI: 10.1053/j.sult.2016.09.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Cystic renal masses are a common entity with a wide differential diagnosis encountered by the radiologist in daily practice. Their characterization relies on the Bosniak classification system that has been widely accepted by radiologists and urologists as a pertinent diagnostic and communication tool. It has been designed to separate cystic lesions requiring surgery (categories III and IV) from those that can be ignored and left alone (categories I and II) or followed (category IIF). Utilization of the Bosniak classification requires, first, previous identification of the cystic nature of a renal mass with the exception of very small lesions.
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Affiliation(s)
- Olivier Hélénon
- Paris Descartes Medical School, Paris Descartes University, Paris, France; Department of Adult Radiology, Necker Hospital, Paris, France.
| | - Christophe Delavaud
- Paris Descartes Medical School, Paris Descartes University, Paris, France; Department of Adult Radiology, Necker Hospital, Paris, France
| | - Jonathan Dbjay
- Paris Descartes Medical School, Paris Descartes University, Paris, France; Department of Adult Radiology, Necker Hospital, Paris, France
| | - Jules Gregory
- Paris Descartes Medical School, Paris Descartes University, Paris, France; Department of Adult Radiology, Necker Hospital, Paris, France
| | | | - Jean-Michel Correas
- Paris Descartes Medical School, Paris Descartes University, Paris, France; Department of Adult Radiology, Necker Hospital, Paris, France
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Chen X, Hu D, Fang L, Chen Y, Che X, Tao J, Weng G, Ye X. Primary renal lymphoma: A case report and literature review. Oncol Lett 2016; 12:4001-4008. [PMID: 27895762 DOI: 10.3892/ol.2016.5173] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2015] [Accepted: 07/04/2016] [Indexed: 02/07/2023] Open
Abstract
Primary renal lymphoma (PRL) is a rare disease, with no more than 70 cases reported in the literature. The present study reports the case of a 70-year-old woman with PRL. The patient was asymptomatic, however, a mass on the right kidney was identified incidentally during routine physical examination. Computed tomography revealed a mass in the right kidney that was 3.6 cm in diameter. Subsequently, right nephrectomy was performed. The histological evaluation of the nephrectomy specimen showed diffuse large B-cell non-Hodgkin's lymphoma. The patient was treated with 6-8 cycles of a cyclophosphamide, epirubicin, vindesine and dexamethasone regimen. Follow-up examination performed after 2 months of treatment revealed no evidence of local recurrence. The present study also reviewed 49 cases of PRL that have been reported since 1989. It was found that a shorter survival time was experienced by patients with bilateral PRL (mean, 21 months) compared with unilateral PRL (mean, 68 months). A shorter survival time was also experienced by patients who were treated with chemotherapy only (mean, 15.8 months) compared with those who were treated with combination chemotherapy and surgery (mean, 49.4 months).
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Affiliation(s)
- Xiaodong Chen
- Department of Urology, Ningbo Urology and Nephrology Hospital, Ningbo University, Ningbo, Zhejiang 315100, P.R. China
| | - Danfei Hu
- Department of Radiation Therapy, Ningbo Medical Treatment Center Lihuili Hospital, Ningbo, Zhejiang 315020, P.R. China
| | - Laifu Fang
- Department of Pathology, Ningbo Yin Zhou Hospital, Ningbo, Zhejiang 315020, P.R. China
| | - Yichen Chen
- Division of Drugs and Pharmacology, Ningbo Institute of Medical Sciences, Ningbo, Zhejiang 315020, P.R. China
| | - Xiaohang Che
- Division of Drugs and Pharmacology, Ningbo Institute of Medical Sciences, Ningbo, Zhejiang 315020, P.R. China
| | - Jin Tao
- Division of Drugs and Pharmacology, Ningbo Institute of Medical Sciences, Ningbo, Zhejiang 315020, P.R. China
| | - Guobin Weng
- Department of Urology, Ningbo Urology and Nephrology Hospital, Ningbo University, Ningbo, Zhejiang 315100, P.R. China
| | - Xiaolei Ye
- Division of Drugs and Pharmacology, Ningbo Institute of Medical Sciences, Ningbo, Zhejiang 315020, P.R. China
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He YL, Hausmann D, Morelli JN, Attenberger UI, Schoenberg SO, Riffel P. Renal zoomed EPI-DWI with spatially-selective radiofrequency excitation pulses in two dimensions. Eur J Radiol 2016; 85:1773-1777. [PMID: 27666615 DOI: 10.1016/j.ejrad.2016.07.022] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Revised: 07/27/2016] [Accepted: 07/31/2016] [Indexed: 01/25/2023]
Abstract
PURPOSE To evaluate the feasibility and clinical robustness of zoomed diffusion-weighted echo planar imaging (z-EPI) relative to conventional single-shot EPI (c-EPI) for DWI of the kidneys. MATERIALS AND METHODS This retrospective study was approved by the institutional research ethics board. 66 patients (median age 58.5 years±13.4, range 23-83 years, 45 men, 21 women) undergoing 3T (Magnetom Skyra(®), Siemens Healthcare, Erlangen, Germany) using a dynamic parallel transmit array (TimTX TrueShape, Siemens Healthcare, Erlangen, Germany) for renal MRI were included in this study. Both c-EPI and z-EPI images were obtained. For z-EPI, a two-dimensional spatially-selective radiofrequency (RF) pulse was applied for echo planar imaging with the FOV reduced by a factor of 3. Two radiologists, blinded to clinical data and scan parameters evaluated the images with respect to their diagnostic confidence, overall preference, overall image quality, delineation of the kidney, spatial distortion, and image blur. Sequences were compared using a paired Wilcoxon test. ADC values for the upper pole, mid-zone, lower pole of the normal kidneys were compared between sequences as well as ADC values for renal lesions, using a paired t-test. RESULTS With z-EPI, the kidney was significantly better delineated with sharper boundaries, less image blur and distortion, and overall better image quality relative to c-EPI (all p<0.001). The z-EPI technique led to greater diagnostic confidence than c-EPI (p=0.020). z-EPI was preferred to c-EPI in 60 cases (90.9%, 60/66). No statistically significant differences in the ADC values of renal parenchyma or of renal lesions were observed between the two sequences (all p>0.05). CONCLUSION Image quality, distortion, and susceptibility artifacts might be improved by using z-EPI rather than c-EPI for DWI of the kidney.
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Affiliation(s)
- Yong-Lan He
- Department of Radiology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, PR China.
| | - Daniel Hausmann
- Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim - Heidelberg University, Mannheim, Germany.
| | | | - Ulrike I Attenberger
- Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim - Heidelberg University, Mannheim, Germany.
| | - Stefan O Schoenberg
- Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim - Heidelberg University, Mannheim, Germany.
| | - Philipp Riffel
- Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim - Heidelberg University, Mannheim, Germany.
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Ponhold L, Javor D, Heinz-Peer G, Sevcenco S, Hofstetter M, Baltzer PA. Inter-observer variation and diagnostic efficacy of apparent diffusion coefficient (ADC) measurements obtained by diffusion-weighted imaging (DWI) in small renal masses. Acta Radiol 2016; 57:1014-20. [PMID: 26486599 DOI: 10.1177/0284185115610934] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2015] [Accepted: 09/18/2015] [Indexed: 12/19/2022]
Abstract
BACKGROUND Diffusion-weighted imaging (DWI) is increasingly used to diagnose renal lesion subtypes. Especially in small renal masses, identification of less aggressive tumor types is of clinical interest, as active surveillance strategies can be applied. PURPOSE To evaluate the inter-observer variation and diagnostic efficacy of apparent diffusion coefficient (ADC) measurements obtained by DWI in small renal masses ≤4 cm (SRM). MATERIAL AND METHODS This retrospective IRB-approved study included 39 patients (46 SRM: 12 benign, 34 malignant). All underwent a 3 T DWI of SRM prior to surgery. Two radiologists independently analyzed all imaging data by three measurements. Limits of agreement, intraclass correlation coefficients (ICC), group comparisons by t-tests, and ROC analysis were performed. RESULTS Reliability of ADC measurements was very high with an ICC of >0.9 for both observers. Inter-rater reliability was high with an ICC of 0.82. Limits of agreement for average ADC values between both observers were -23.5% to 38.3% with a mean difference of 7.5% between both observers. No significant differences were found between benign and malignant lesions (P value Observer 1: 0.362, Observer 2: 0.622). Papillary carcinoma showed lower ADC values compared to non-papillary carcinoma (P value Observer 1: 0.008, Observer 2: 0.012). Consequently, ROC analysis revealed a significant (P < 0.001, respectively) area under the ROC curve of 0.853 (Observer 1) and 0.837 (Observer 2) without significant differences between both readers (P = 0.772). CONCLUSION ADC measurements of SRM at 3 T show a high reproducibility and differentiate papillary from non-papillary carcinoma subtypes. However, measurement variability may limit the application of fixed ADC thresholds for lesion diagnosis.
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Affiliation(s)
- Lothar Ponhold
- Department of Radiology, University Hospital of Sankt-Pölten, St. Pölten, Austria
| | - Domagoj Javor
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Gertraud Heinz-Peer
- Department of Radiology, University Hospital of Sankt-Pölten, St. Pölten, Austria
| | - Sabina Sevcenco
- Department of Urology, Medical University of Vienna, Vienna, Austria
| | - Martin Hofstetter
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Pascal Andreas Baltzer
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
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Dai Y, Yao Q, Wu G, Wu D, Wu L, Zhu L, Xue R, Xu J. Characterization of clear cell renal cell carcinoma with diffusion kurtosis imaging: correlation between diffusion kurtosis parameters and tumor cellularity. NMR IN BIOMEDICINE 2016; 29:873-881. [PMID: 27119793 DOI: 10.1002/nbm.3535] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/31/2015] [Revised: 03/12/2016] [Accepted: 03/16/2016] [Indexed: 06/05/2023]
Abstract
The aim of this study was to evaluate the role of diffusion kurtosis imaging (DKI) in the characterization of clear cell renal cell carcinoma (ccRCC) and to correlate DKI parameters with tumor cellularity. Fifty-nine patients with pathologically diagnosed ccRCCs were evaluated by DKI on a 3-T scanner. Regions of interest were drawn on the maps of the mean diffusion coefficient (MD) and mean diffusion kurtosis (MK). All ccRCCs were histologically graded according to the Fuhrman classification system. Tumor cellularity was measured by the nuclear-to-cytoplasm (N/C) ratio and the number of tumor cell nuclei (NTCN). ccRCCs were classified as grade 1 (n = 23), grade 2 (n = 24), grade 3 (n = 10) and grade 4 (n = 3). Both MD and MK could readily discriminate between normal renal parenchyma and ccRCCs (p < 0.001), and receiver operating characteristic (ROC) curve analysis showed that MK exhibited a better performance with an area under the ROC curve of 0.874 and sensitivity/specificity of 68.33%/100% (p < 0.001). Further, MD and MK were significantly different between grade 1 and grades 3 and 4 (p = 0.01, p < 0.001) and between grade 2 and grades 3 and 4 (p = 0.015, p < 0.005), respectively. However, no significant difference was found between grade 1 and grade 2 (p > 0.05) for both MD and MK. With regard to NTCN, no significant difference was found between any two grades (p > 0.05), and the N/C ratio changed significantly with grade (p < 0.01, between any two grades). Negative correlations were found between MK and MD (r = -0.56, p < 0.001), and between MD and N/C ratio (r = -0.36, p < 0.005), whereas MK and the N/C ratio were positively correlated (r = 0.45, p = 0.003). DKI could quantitatively characterize ccRCC with different grades by probing non-Gaussian diffusion properties related to changes in the tumor microenvironment or tissue complexities in the tumor. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
- Yongming Dai
- Magnetic Resonance Imaging Institute for Biomedical Research, Wayne State University, Detroit, MI, USA
| | - Qiuying Yao
- Department of Radiology, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Guangyu Wu
- Department of Radiology, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Dongmei Wu
- Shanghai Key Laboratory of Magnetic Resonance, East China Normal University, Shanghai, China
| | - Lianming Wu
- Department of Radiology, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Li Zhu
- Department of Urology, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Rong Xue
- State Key Laboratory of Brain and Cognitive Science, Beijing MRI Center for Brain Research, Institute of Biophysics, Chinese Academy of Science, Beijing, China
- Beijing Institute for Brain Disorders, Beijing, China
| | - Jianrong Xu
- Department of Radiology, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
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Abstract
OBJECTIVE The purpose of this study was to differentiate clear cell renal cell carcinoma (RCC) from other common renal cortical tumors by use of DWI. MATERIALS AND METHODS The study included 117 patients (mean age, 60 years) with 122 histopathologically confirmed renal cortical tumors who underwent 1.5-T MRI that included DWI before they underwent nephrectomy between 2006 and 2013. For each tumor, two radiologists independently evaluated apparent diffusion coefficient (ADC) values on the basis of a single ROI in a nonnecrotic area of the tumor and also by assessment of the whole tumor. The concordance correlation coefficient (CCC) was calculated to assess interreader agreement. The mean ADC values of clear cell RCC and every other tumor subtype were compared using an exact Wilcoxon rank sum test. RESULTS Interreader agreement was excellent and higher in whole-tumor assessment (CCC, 0.982) than in single-ROI analysis (CCC, 0.756). For both readers, ADC values for clear cell RCC found on single-ROI assessment (2.19 and 2.08 × 10(-3) mm(2)/s) and whole-tumor assessment (2.30 and 2.32 × 10(-3) mm(2)/s) were statistically significantly higher than those for chromophobe, papillary, or unclassified RCC (p < 0.05) but were similar to those for oncocytoma found on single-ROI assessment (2.14 and 2.32 × 10(-3) mm(2)/s) and whole-tumor assessment (2.38 and 2.24 × 10(-3) mm(2)/s). ADC values were also higher for clear cell RCC than for angiomyolipoma, but the difference was statistically significant only in whole-tumor assessment (p < 0.03). CONCLUSION ADC values were statistically significantly higher for clear cell RCC than for chromophobe, papillary, or unclassified RCC subtypes; however, differentiating clear cell RCC from oncocytoma by use of DWI remains especially challenging, because similar ADC values have been shown for these two tumor types.
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Usefulness of diffusion-weighted magnetic resonance imaging for the characterization of benign and malignant renal lesions. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2016. [DOI: 10.1016/j.ejrnm.2015.10.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
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Ye J, Kumar BS, Li XB, Li HM, Zhou YW, Liu LQ. Clinical applications of diffusion-weighted magnetic resonance imaging in diagnosis of renal lesions - a systematic review. Clin Physiol Funct Imaging 2015; 37:459-473. [PMID: 26648310 DOI: 10.1111/cpf.12313] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2015] [Accepted: 09/21/2015] [Indexed: 01/07/2023]
Abstract
Diffusion-weighted magnetic resonance imaging (DW-MRI) is an established technique to detect the changes of the diffusion of water in biological tissues and reflect the pathophysiological process on the molecular level. It is a promising non-invasive imaging modality in detection of microstructural and functional changes in pathologies of kidney. To systematically review the research advancement of the DW-MRI in diagnosis of renal lesions, a systematic literature search was performed up to 8 October 2014 using the MEDLINE/PubMed and Embase databases for articles reporting on DW-MRI in diagnosis of renal lesions. Only articles with full data about DW-MRI application with potential implication in solving usually encountered clinical challenges about renal lesions were finally examined. The clinical application of DW-MRI allows a better understanding of some pathologic conditions of the kidney including renal insufficiency, renal artery stenosis, ureteral obstruction, foetal kidney disease, hydronephrosis and pyonephrosis. In addition, DW-MRI can also provide clinicians with the information of function evaluation of renal allograft and curative effect assessment of renal tumour. In summary, performance of renal DW-MRI, presuming that measurements are high quality, will further boost this modality, particularly for early detection of diffusion renal conditions, as well as more accurate characterization of renal lesions.
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Affiliation(s)
- Jing Ye
- Department of Imaging, Northern Jiangsu People's Hospital, Yangzhou, China
| | | | - Xiao-Bo Li
- Department of Neurology, Northern Jiangsu People's Hospital, Yangzhou, China
| | - Hong-Mei Li
- Department of Imaging, Northern Jiangsu People's Hospital, Yangzhou, China
| | - Ying-Wen Zhou
- Department of Imaging, Northern Jiangsu People's Hospital, Yangzhou, China
| | - Li-Qin Liu
- Department of Oncology, Northern Jiangsu People's Hospital, Yangzhou, China
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Göya C, Hamidi C, Bozkurt Y, Yavuz A, Kuday S, Gümüş H, Türkçü G, Hattapoğlu S, Bilici A. The Role of Apparent Diffusion Coefficient Quantification in Differentiating Benign and Malignant Renal Masses by 3 Tesla Magnetic Resonance Imaging. Balkan Med J 2015; 32:273-8. [PMID: 26185715 DOI: 10.5152/balkanmedj.2015.15475] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2014] [Accepted: 12/18/2014] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Diffusion-weighted magnetic resonance imaging (DWI) is a widely-accepted diagnostic modality whose efficacy has been investigated by numerous past studies in the differentiation of malignant lesions from benign entities. AIMS The aim of this study was to evaluate the efficiency of diffusion-weighted magnetic resonance imaging in the characterization of renal lesions. STUDY DESIGN Diagnostic accuracy study. METHODS A total of 137 patients with renal lesions were included in this study. The median apparent diffusion coefficient (ADC) values as well as the b 800 and b 1600 signal intensities of normal kidneys, solid components of mixed renal masses, and total cystic lesions were evaluated. RESULTS There were significant differences between the ADC values of lesions and normal renal parenchyma, and between the ADC values of benign and malignant renal lesions on DWIs at b values of 800 and 1600 s/mm(2) (p<0.001 and p<0.001, respectively). There were significant differences between the ADC values of Bosniak Category 1 and 2 cysts and the ADC values of Bosniak Category 1 and 3 cysts on DWIs at b values of 800 s/mm(2) (p<0.001) and 1600 s/mm(2) (p<0.001). A cutoff value of 1.902 × 10(-3) mm(2)/s for the ADC with a b value of 800 s/mm(2) provided 88% sensitivity and 96% specificity for differentiation between benign and malignant renal lesions. A cutoff value of 1.623 × 10(-3) mm(2)/s for the ADC with a b value of 1600 s/mm(2) provided 79% sensitivity and 96% specificity (p<0.001) for the differentiation between benign and malignant renal lesions. CONCLUSION Accurate assessment of renal masses is important for determining the necessity for surgical intervention. DWI provides additional value by differentiating benign from malignant renal tumors and can be added to routine kidney MRI protocols.
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Affiliation(s)
- Cemil Göya
- Department of Radiology, Dicle University Faculty of Medicine, Diyarbakır, Turkey
| | - Cihad Hamidi
- Department of Radiology, Dicle University Faculty of Medicine, Diyarbakır, Turkey
| | - Yaşar Bozkurt
- Department of Urology, Dicle University Faculty of Medicine, Diyarbakır, Turkey
| | - Alpaslan Yavuz
- Department of Radiology, Yüzüncü Yıl University Faculty of Medicine, Van, Turkey
| | - Suzan Kuday
- Department of Radiology, Bismil State Hospital, Diyarbakır, Turkey
| | - Hatice Gümüş
- Department of Radiology, Dicle University Faculty of Medicine, Diyarbakır, Turkey
| | - Gül Türkçü
- Department of Pathology, Dicle University Faculty of Medicine, Diyarbakır, Turkey
| | - Salih Hattapoğlu
- Department of Radiology, Dicle University Faculty of Medicine, Diyarbakır, Turkey
| | - Aslan Bilici
- Department of Radiology, Dicle University Faculty of Medicine, Diyarbakır, Turkey
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Diagnostic Significance of Diffusion-Weighted MRI in Renal Cancer. BIOMED RESEARCH INTERNATIONAL 2015; 2015:172165. [PMID: 26064881 PMCID: PMC4430628 DOI: 10.1155/2015/172165] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/28/2014] [Accepted: 01/16/2015] [Indexed: 12/21/2022]
Abstract
Background. This study aimed to investigate whether diffusion-weighted imaging (DWI) could contribute to the discrimination between benign and malignant renal cancer. Methods. We searched the PubMed electronic database for eligible studies. STATA 12.0 software was used for statistical analysis. The SMD and 95% CI were calculated. Results. Decreased ADC signal was seen in all renal cancer patients (cancer tissue versus normal tissue: SMD = 1.63 and 95% CI = 0.96~2.29, P < 0.001; cancer tissue versus benign tissue: SMD = 2.22 and 95% CI = 1.53~2.90 and P < 0.001, resp.). MRI machine type-stratified analysis showed that decreased ADC signal was found by all included MRI machine types in cancer tissues compared with benign cancer tissues (all P < 0.05). The ADC values of renal cancer patients were significantly lower than those of normal controls for all included P values (all P < 0.05), and there was a decreased ADC signal at b-500, b-600, b-1000, b-500, and 1000 gradients compared with benign cancer tissues (all P < 0.05). Conclusion. Our study concluded that decreased ADC signal presented in DWI may be essential for the differential diagnosis of renal cancer.
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Liu JH, Tian SF, Ju Y, Li Y, Chen AL, Chen LH, Liu AL. Apparent diffusion coefficient measurement by diffusion weighted magnetic resonance imaging is a useful tool in differentiating renal tumors. BMC Cancer 2015; 15:292. [PMID: 25886301 PMCID: PMC4403953 DOI: 10.1186/s12885-015-1221-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2014] [Accepted: 03/19/2015] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND To determine the clinical value of apparent diffusion coefficient (ADC) measurement by diffusion weighted magnetic resonance imaging (DW-MRI) in differentiating renal tumors. METHODS Electronic databases were searched using combinations of keywords and free words relating to renal tumor, ADC and DW-MRI. Based on carefully selected inclusion and exclusion criteria, relevant case-control studies were identified and the related clinical data was acquired. Statistical analyses were performed using STATA 12.0 (Stata Corporation, College station, TX). RESULTS Sixteen case-control studies were ultimately included in the present meta-analysis. These 16 high quality studies contained a combined total of 438 normal renal tissues and 832 renal tumor lesions (597 malignant and 235 benign). The results revealed that ADC values of malignant renal tumor tissues were markedly lower than normal renal tissues and benign renal tumor tissues. ADC values of benign renal tumor tissues were also significantly lower than normal renal tissue. CONCLUSIONS ADC measurement by DW-MRI provided clinically useful information on the internal structure of renal tumors and could be an important radiographic index for differentiation of malignant renal tumors from benign renal tumors.
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Affiliation(s)
- Jing-Hong Liu
- Department of Radiology, The First Affiliated Hospital of Dalian Medical University, Zhongshan Road No. 222, Xigang District, Dalian, 116011, P. R China.
| | - Shi-Feng Tian
- Department of Radiology, The First Affiliated Hospital of Dalian Medical University, Zhongshan Road No. 222, Xigang District, Dalian, 116011, P. R China.
| | - Ye Ju
- Department of Radiology, The First Affiliated Hospital of Dalian Medical University, Zhongshan Road No. 222, Xigang District, Dalian, 116011, P. R China.
| | - Ye Li
- Department of Radiology, Dalian Medical University, Dalian, 116044, P. R China.
| | - An-Liang Chen
- Department of Radiology, Dalian Medical University, Dalian, 116044, P. R China.
| | - Li-Hua Chen
- Department of Radiology, Dalian Medical University, Dalian, 116044, P. R China.
| | - Ai-Lian Liu
- Department of Radiology, The First Affiliated Hospital of Dalian Medical University, Zhongshan Road No. 222, Xigang District, Dalian, 116011, P. R China.
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Abstract
Urology, as a specialty, has always been at the forefront of innovation and research. Newer technologies have been rapidly embraced and, in many cases, improved upon in order to achieve better patient outcomes. This review addresses the possible future directions that technological advances in urology may take. The role of further miniaturization of urolithiasis treatment, robotic surgery and other minimally invasive techniques is addressed. The potential for enhanced imaging and diagnostic techniques like magnetic resonance imaging and ultrasonography modifications, as well as the potential applications of nanotechnology and tissue engineering, are reviewed. This article is based on the Dr. Sitharaman Best Essay award of the Urological Society of India for 2013.
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Affiliation(s)
- Vivek Venkatramani
- Department of Urology, Christian Medical College, Vellore, Tamil Nadu, India
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Muglia VF, Westphalen AC. Bosniak classification for complex renal cysts: history and critical analysis. Radiol Bras 2015; 47:368-73. [PMID: 25741120 PMCID: PMC4341374 DOI: 10.1590/0100-3984.2013.1797] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2013] [Accepted: 01/08/2014] [Indexed: 12/13/2022] Open
Abstract
The Bosniak classification for renal cysts was developed in the late 1980s in an
attempt to standardize the description and management of complex cystic renal
lesions. Alterations were made to such a classification in the 1990s and, the last
one, in 2005. Currently, five categories of cystic renal lesions are defined -
namely, I, II, II-F, III and IV –, according to their degree of complexity and
likelihood of malignancy. Despite being initially described for computed tomography,
this classification has been also utilized with some advantages also for magnetic
resonance imaging. The present article reviews the different phases of this
classification, its diagnostic efficacy and the most controversial features of its
use.
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Affiliation(s)
- Valdair F Muglia
- Fellow PhD degree, Associate Professor, Department of Medical Practice, Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo (FMRP-USP) - Centro de Ciências da Imagem e Física Médica (CCIFM), Ribeirão Preto, SP, Brazil
| | - Antonio Carlos Westphalen
- PhD, Associate Professor of Radiology, Department of Radiology and Biomedical Imaging - University of California, San Francisco (UCSF), San Francisco, CA, USA
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Graumann O, Osther SS, Karstoft J, Hørlyck A, Osther PJS. Bosniak classification system: inter-observer and intra-observer agreement among experienced uroradiologists. Acta Radiol 2015; 56:374-83. [PMID: 24682404 DOI: 10.1177/0284185114529562] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND The Bosniak classification is a diagnostic tool for the differentiation of cystic changes in the kidney. The process of categorizing renal cysts may be challenging, involving a series of decisions that may affect the final diagnosis and clinical outcome such as surgical management. PURPOSE To investigate the inter- and intra-observer agreement among experienced uroradiologists when categorizing complex renal cysts according to the Bosniak classification. MATERIAL AND METHODS The original categories of 100 cystic renal masses were chosen as "Gold Standard" (GS), established in consensus by two experienced uroradiologists. Three experienced uroradiological readers were blinded from the previous CT reports. Weighted κ was calculated to assess agreement, defined as: fair, 0.21-0.40; moderate, 0.41-0.60; good, 0.61-0.80; and very good, 0.81-1.00. RESULTS For readers the distribution of correctly classified lesions were as follows: BI, 95-100%; BII, 59-93%; BIIF, 54-92%; BIII, 58-95%; and B IV, 77-100% for the first review. Weighted κ for inter-observer/intra-observer variation was for Reader A: 0.85/0.99, Reader B: 0.97/0.99, and Reader C: 0.98/0.99, (P ≤ 0.001). CONCLUSION According to the calculated weighted κ all readers performed "very good" for both inter-observer and intra-observer variation. Most variation was seen in cysts catagorized as Bosniak II, IIF, and III. These results show that radiologists who evaluate complex renal cysts routinely may apply the Bosniak classification reproducibly.
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Affiliation(s)
- Ole Graumann
- Urological Research Center, Department of Urology, Fredericia Hospital, Fredericia, and Institute of Regional Health Services Research, University of Southern Denmark, Denmark
| | - Susanne S Osther
- Urological Research Center, Department of Urology, Fredericia Hospital, Fredericia, and Institute of Regional Health Services Research, University of Southern Denmark, Denmark
| | - Jens Karstoft
- Department of Radiology, Odense University Hospital, Odense, Denmark
| | - Arne Hørlyck
- Department of Radiology, Aarhus University Hospital, Skejby, Denmark
| | - Palle JS Osther
- Urological Research Center, Department of Urology, Fredericia Hospital, Fredericia, and Institute of Regional Health Services Research, University of Southern Denmark, Denmark
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In-Phase Signal Intensity Loss in Solid Renal Masses on Dual-Echo Gradient-Echo MRI: Association With Malignancy and Pathologic Classification. AJR Am J Roentgenol 2014; 203:W421-8. [DOI: 10.2214/ajr.13.11113] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
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Mytsyk Y, Borys Y, Komnatska I, Dutka I, Shatynska-Mytsyk I. Value of the diffusion-weighted MRI in the differential diagnostics of malignant and benign kidney neoplasms - our clinical experience. Pol J Radiol 2014; 79:290-5. [PMID: 25202435 PMCID: PMC4156335 DOI: 10.12659/pjr.890604] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2014] [Accepted: 03/24/2014] [Indexed: 11/20/2022] Open
Abstract
Background Diffusion-weighted imaging (DWI) is an MRI modality using strong bipolar gradients to create a sensitivity of the signal to the thermally-induced Brownian motions of water molecules and in vivo measurement of molecular diffusion. The apparent diffusion coefficient (ADC) is a quantitative parameter calculated from DWI images which is used as a measure of diffusion. DWI allows to obtain comprehensive information on morphological and functional state of the kidney during a single examination without contrast medium administration. The purpose of the study was to evaluate the value of DWI in differentiating benign and malignant solid kidney tumors based on the initial stage of the study. Material/Methods The study included 19 adult patients with pathologically verified renal tumors: 9 patients with clear cell subtype of the renal cell carcinoma, 5 patients with oncocytoma and 5 patients with angiomyolipoma (AML). In addition, 5 healthy volunteers with completely normal findings according to kidney ultrasound were included into this study and set as reference. All patients underwent renal MR imaging which included DWI with subsequent ADC measurement. MR imaging was performed with a 1.5 T body scanner using an eight-channel phased-array body coil. Results The mean ADC value of ccRCC was significantly lower than that of normal renal parenchyma (2.11±0.25×10−3 mm2/s vs. 3.36±0.41×10−3 mm2/s, p<0.01). There was a significant difference in ADC between the malignant and benign renal lesions: in patients with angiomyolipoma the ADC value was 2.36±0.32×10−3 mm2/s vs. 2.11±0.25×10−3 mm2/s; p<0.05 and in patients with oncocytoma – 2.75±0.27×10−3 mm2/s vs. 2.11±0.25×10−3 mm2/s; p<0.05. The difference in ADC values in patients with high and low ccRCC grades was observed. Conclusions DWI can be used to characterize renal lesions; the ADC of a renal lesion can be potentially used as an additional parameter to help determine the appropriate clinical management.
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Affiliation(s)
- Yulian Mytsyk
- Department of Radiology, Lviv National Medical University, Lviv, Ukraine
| | - Yuriy Borys
- Department of Urology, Lviv National Medical University, Lviv, Ukraine
| | | | - Ihor Dutka
- Euroclinic Medical Center, Lviv, Ukraine
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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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Sahni VA, Silverman SG. Imaging management of incidentally detected small renal masses. Semin Intervent Radiol 2014; 31:9-19. [PMID: 24596435 DOI: 10.1055/s-0033-1363838] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Both imaging and intervention play an increasingly important role in the management of renal masses in general and renal cancer in particular. Indeed, radiologists are often the first to detect and diagnose renal cancer, and now with the burgeoning role of percutaneous ablation, they are often the treating physicians. Renal mass management begins with imaging, and although most can be diagnosed with a high degree of certainty using imaging, some remain indeterminate and require biopsy or observation, now referred to as active surveillance. Although active surveillance strategies have been employed for indeterminate renal masses that have a reasonable chance of being benign, recent data suggest that some renal cancers can undergo active surveillance safely. This article reviews the current imaging-based diagnostic evaluation of incidentally detected small renal masses, the burgeoning role of percutaneous biopsy, and how both imaging and biopsy are used to help select which patients need treatment and which can undergo active surveillance.
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Affiliation(s)
- V Anik Sahni
- Division of Abdominal Imaging and Intervention, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Stuart G Silverman
- Division of Abdominal Imaging and Intervention, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
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Sevcenco S, Heinz-Peer G, Ponhold L, Javor D, Kuehhas F, Klingler H, Remzi M, Weibl P, Shariat S, Baltzer P. Utility and limitations of 3-Tesla diffusion-weighted magnetic resonance imaging for differentiation of renal tumors. Eur J Radiol 2014; 83:909-913. [DOI: 10.1016/j.ejrad.2014.02.026] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2013] [Revised: 02/21/2014] [Accepted: 02/27/2014] [Indexed: 01/25/2023]
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Wang WJ, Pui MH, Guo Y, Hu XS, Wang HJ, Yang D. MR diffusion tensor imaging of normal kidneys. J Magn Reson Imaging 2013; 40:1099-102. [PMID: 24925441 DOI: 10.1002/jmri.24450] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2013] [Accepted: 09/11/2013] [Indexed: 01/24/2023] Open
Abstract
PURPOSE To assess the feasibility of diffusion tensor imaging (DTI) of normal kidneys and the influence of hydration state. MATERIALS AND METHODS Ten healthy volunteers underwent renal DTI after fasting for 12 hours and 4 hours, without fasting, and following water diuresis. Medullary and cortical apparent diffusion coefficient (ADC) and fractional anisotropy (FA) values were measured and compared in the four different states of hydration. DTI was performed with a 3T magnetic resonance imaging (MRI) system using fat-saturated single-shot spin-echo echo planar imaging sequence. RESULTS ADC of normal cortex (2.387 ± 0.081 × 10(-3) mm(2) /s) was significantly higher (t = 20.126, P = 0) than that of medulla (1.990 ± 0.063 × 10(-3) mm(2) /s). The FA value of normal cortex (0.282 ± 0.017) was significantly lower (t = -42.713, P = 0) than that of medulla (0.447 ± 0.022). The ADC and FA values of the left renal cortex (2.404 ± 0.082 × 10(-3) mm(2) /s, 0.282 ± 0.017) and medulla (2.002 ± 0.081 × 10(-3) mm(2) /s, 0.452 ± 0.024) were not significantly different (P > 0.05) from those of right renal cortex (2.369 ± 0.080 × 10(-3) mm(2) /s, 0.283 ± 0.018) and medulla (1.978 ± 0.039 × 10(-3) mm(2) /s, 0.443 ± 0.019). Values for ADC (×10(-3) mm(2) /s) and FA in the 12-hour fasting, 4-hour fasting, nonfasting, and water diuresis states were 2.372 ± 0.095 and 0.278 ± 0.018, 2.387 ± 0.081 and 0.282 ± 0.017, 2.416 ± 0.051 and 0.279 ± 0.023, 2.421 ± 0.068, and 0.270 ± 0.021, respectively, in cortex, 1.972 ± 0.084 and 0.438 ± 0.014, 1.990 ± 0.063 and 0.447 ± 0.022, 2.021 ± 0.081 and 0.450 ± 0.031, 2.016 ± 0.076 and 0.449 ± 0.028, respectively, in medulla. The ADC and FA values in different hydration states were not significantly different (P > 0.05). CONCLUSION DTI of normal kidneys is feasible with reproducible ADC and FA values independent of hydration states.
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Affiliation(s)
- Wen-juan Wang
- Department of Radiology, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China; Department of Radiology, Weifang People's Hospital, Weifang, Shandong, China
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Diffusion-weighted imaging of focal renal lesions: a meta-analysis. Eur Radiol 2013; 24:241-9. [PMID: 24337912 DOI: 10.1007/s00330-013-3004-x] [Citation(s) in RCA: 99] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2013] [Revised: 08/07/2013] [Accepted: 08/08/2013] [Indexed: 12/23/2022]
Abstract
OBJECTIVES Contrast-enhanced MRI can only distinguish to a limited extent between malignant and benign focal renal lesions. The aim of this meta-analysis is to review renal diffusion-weighted imaging (DWI) to compare apparent diffusion coefficient (ADC) values for different renal lesions that can be applied in clinical practice. METHODS A PubMed search was performed to identify relevant articles published 2004-2011 on renal DWI of focal renal lesions. ADC values were extracted by lesion type to determine whether benign or malignant. The data table was finalised in a consensus read. ADC values were evaluated statistically using meta-regression based on a linear mixed model. Two-sided P value <5 % indicated statistical significance. RESULTS The meta-analysis is based on 17 studies with 764 patients. Renal cell carcinomas have significant lower ADC values than benign tissue (1.61 ± 0.08 × 10(-3) mm(2)/s vs 2.10 ± 0.09 × 10(-3) mm(2)/s; P < 0.0001). Uroepithelial malignancies can be differentiated by lowest ADC values (1.30 ± 0.11 × 10(-3) mm(2)/s). There is a significant difference between ADC values of renal cell carcinomas and oncocytomas (1.61 ± 0.08 × 10(-3) mm(2)/s vs 2.00 ± 0.08 × 10(-3) mm(2)/s; P < 0.0001). CONCLUSIONS Evaluation of ADC values can help to determine between benign and malignant lesions in general but also seems able to differentiate oncocytomas from malignant tumours, hence potentially reducing the number of unnecessarily performed nephrectomies. KEY POINTS • This meta-analysis assesses the role of diffusion-weighted MRI in renal lesions. • ADC values obtained by DW MRI have been compared for different renal lesions. • ADC values can help distinguish between benign and malignant tumours. • Differentiating oncocytomas from malignant tumours can potentially reduce inappropriate nephrectomies.
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Kim WB, Lee SW, Doo SW, Yang WJ, Song YS, Jeon JS, Choi IH, Jin SY. Category migration of renal cystic masses with use of gadolinium-enhanced magnetic resonance imaging. Korean J Urol 2012; 53:573-6. [PMID: 22950004 PMCID: PMC3427844 DOI: 10.4111/kju.2012.53.8.573] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2011] [Accepted: 07/28/2011] [Indexed: 12/05/2022] Open
Abstract
The Bosniak renal cyst classification has been accepted by urologists and radiologists as a way of diagnosing cystic renal masses and determining the management approach. We report two cases of a renal cystic mass that showed a category change from category II on the basis of enhanced computed tomography to category IV after further gadolinium-enhanced magnetic resonance imaging. In both cases, the cysts were later confirmed as kidney cancer by pathology.
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Affiliation(s)
- Woong Bin Kim
- Department of Urology, Soonchunhyang University College of Medicine, Seoul, Korea
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Rheinheimer S, Stieltjes B, Schneider F, Simon D, Pahernik S, Kauczor HU, Hallscheidt P. Investigation of renal lesions by diffusion-weighted magnetic resonance imaging applying intravoxel incoherent motion-derived parameters--initial experience. Eur J Radiol 2011; 81:e310-6. [PMID: 22104090 DOI: 10.1016/j.ejrad.2011.10.016] [Citation(s) in RCA: 81] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2011] [Revised: 10/16/2011] [Accepted: 10/17/2011] [Indexed: 12/16/2022]
Abstract
PURPOSE Usefulness of biexponentially fitted signal attenuation at different b-values for differentiating the histological characteristics of renal tumors. MATERIALS AND METHODS A total of 26 patients with 28 renal masses (histologically proven: 20 clear cell renal cell carcinomas [ccRCC], three transitional cell carcinomas, two oncocytomas, and one papillary RCC) and 30 volunteers with healthy kidneys were examined at 1.5 Tesla using an echo-planar DWI sequence. Using the IVIM model, we calculated the perfusion fraction f and the diffusion coefficient D. Furthermore, the ADC was obtained. These tumor parameters were compared to healthy renal tissue nonparametrically, and a receiver operating characteristic (ROC) analysis was performed. RESULTS Healthy renal parenchyma showed higher ADC and D values (p<0.001) than ccRCC (ADC 1.95±0.10 [SD] μm2/ms, f 18.32±2.52%, and D 1.88±0.11 μm2/ms versus ADC 1.45±0.38 μm2/ms, f 18.59±6.16%, and D 1.34±0.38 μm2/ms). When detecting malignancies the area under the curve for D was higher than for ADC. The f values for ccRCC were higher (p<0.001) than for non-ccRCC (ADC 1.52±0.47 μm2/ms, f 8.44±1.24%, and D 1.30±0.18 μm2/ms). Both f and D correlated with ccRCC grading. CONCLUSION IVIM imaging is able to provide reliable diffusion values in the human kidney and may enhance the accuracy of tumor diagnosis. The D value was the best parameter to distinguish renal tumors from healthy renal tissue. The f value is promising for determining the histological subgroups.
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Affiliation(s)
- S Rheinheimer
- Diagnostic and Interventional Radiology, University of Heidelberg, Im Neuenheimer Feld 110, D-69120 Heidelberg, Germany.
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Bakan AA, Inci E, Bakan S, Gokturk S, Cimilli T. Utility of diffusion-weighted imaging in the evaluation of liver fibrosis. Eur Radiol 2011; 22:682-7. [PMID: 21984447 DOI: 10.1007/s00330-011-2295-z] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2011] [Revised: 08/13/2011] [Accepted: 09/13/2011] [Indexed: 12/13/2022]
Abstract
OBJECTIVES To evaluate the usefulness of diffusion- weighted MRI (DWI) in the detection and staging of liver fibrosis and inflammation. METHODS DWI was performed with b-factors of 0, 500 and 1000 s/mm². ADC values were obtained by placing circular regions of interest in four segments of the liver. Differences between the study (n = 34) and control groups' (n = 25) ADC values were examined. Further, this study investigated if and how ADC values were related to fibrosis stages and histological activity index (HAI) scores. RESULTS The mean ADC value of the liver was smaller in the study group compared with the control group (P < 0.001). Spearman rho correlation analyses showed lower ADC values were associated with higher fibrosis and HAI scores (P < 0.01). There were statistically significant differences in liver ADC values between each combination of fibrosis stages (e.g. stages 0 and 1, 0 and 2) except for stages 1 and 2. CONCLUSIONS ADC values prove to be a valuable technique for the diagnosis of liver fibrosis and inflammation. They can also be useful in fibrosis staging, particularly in distinguishing later stages of fibrosis from intermediate and early stages. KEY POINTS Diffusion Weighted MRI is a promising technique for diagnosis of liver fibrosis. Apparent Diffusion Coefficients provide valuable information for staging of liver fibrosis. DWI may offer alternative to biopsy for assessing liver fibrosis.
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Affiliation(s)
- Ayse Ahsen Bakan
- Department of Radiology, Istanbul Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey.
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