1
|
Bai Y, An ZC, Li F, Du LF, Xie TW, Zhang XP, Cai YY. Deep learning using contrast-enhanced ultrasound images to predict the nuclear grade of clear cell renal cell carcinoma. World J Urol 2024; 42:184. [PMID: 38512539 DOI: 10.1007/s00345-024-04889-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Accepted: 02/12/2024] [Indexed: 03/23/2024] Open
Abstract
PURPOSE To assess the effectiveness of a deep learning model using contrastenhanced ultrasound (CEUS) images in distinguishing between low-grade (grade I and II) and high-grade (grade III and IV) clear cell renal cell carcinoma (ccRCC). METHODS A retrospective study was conducted using CEUS images of 177 Fuhrmangraded ccRCCs (93 low-grade and 84 high-grade) from May 2017 to December 2020. A total of 6412 CEUS images were captured from the videos and normalized for subsequent analysis. A deep learning model using the RepVGG architecture was proposed to differentiate between low-grade and high-grade ccRCC. The model's performance was evaluated based on sensitivity, specificity, positive predictive value, negative predictive value and area under the receiver operating characteristic curve (AUC). Class activation mapping (CAM) was used to visualize the specific areas that contribute to the model's predictions. RESULTS For discriminating high-grade ccRCC from low-grade, the deep learning model achieved a sensitivity of 74.8%, specificity of 79.1%, accuracy of 77.0%, and an AUC of 0.852 in the test set. CONCLUSION The deep learning model based on CEUS images can accurately differentiate between low-grade and high-grade ccRCC in a non-invasive manner.
Collapse
Affiliation(s)
- Yun Bai
- Department of Ultrasound, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, No. 85/86 Wujin Road, Shanghai, 200080, China
| | - Zi-Chen An
- Department of Ultrasound, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, No. 85/86 Wujin Road, Shanghai, 200080, China
| | - Fan Li
- Department of Ultrasound, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, No. 85/86 Wujin Road, Shanghai, 200080, China
| | - Lian-Fang Du
- Department of Ultrasound, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, No. 85/86 Wujin Road, Shanghai, 200080, China
| | - Tian-Wu Xie
- Institute of Radiation Medicine, Fudan University, No. 2094 Xietu Road, Shanghai, 200032, China.
| | - Xi-Peng Zhang
- School of Computer Science and Technology, Taiyuan Normal University, No. 319 Daxue Street, Taiyuan, 030619, China.
| | - Ying-Yu Cai
- Department of Ultrasound, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, No. 85/86 Wujin Road, Shanghai, 200080, China.
| |
Collapse
|
2
|
Nalbant MO, Inci E. Assessment of Imaging Findings of Renal Carcinoma Subtypes with 3.0T MRI. Niger J Clin Pract 2023; 26:1750-1757. [PMID: 38044783 DOI: 10.4103/njcp.njcp_373_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 07/06/2023] [Indexed: 12/05/2023]
Abstract
BACKGROUND The prevalence of renal masses has escalated as a result of the augmented utilization of cross-sectional imaging techniques. The approach to managing renal masses may exhibit variability contingent upon the subtype of renal cell carcinoma (RCC). AIM This research aimed to distinguish between clear cell and papillary RCCs, utilizing dynamic contrast magnetic resonance imaging (MRI) and diffusion-weighted imaging (DWI). MATERIALS AND METHODS The study assessed the MR images of 112 patients with RCC. Two radiologists independently analyzed tumor size, vascular involvement, signal characteristics in T1- and T2-weighted sequences, the presence of hemosiderin, both microscopic and macroscopic fat content, enhancement patterns, and apparent diffusion coefficient (ADC) values derived from b-values of 1000 s/mm². RESULTS Seventy patients had clear cell RCC, and 42 had papillary. In the clear cell RCC, microscopic fat content was significantly higher than the papillary RCC (P < 0.001). However, in papillary RCC, hemosiderin content was substantially greater (P = 0.001). On T2-weighted MR images, clear cell RCCs were usually hyperintense, while papillary RCCs were hypointense (P < 0.001). Even though the rapid enhancement pattern was observed in clear cell RCCs, the progressive enhancement pattern was more prevalent in papillary RCCs (P < 0.001). CONCLUSION Hyperintensity on T2-weighted images, microscopic fat content, and rapid enhancement pattern may be indicative of clear cell RCC, whereas hypointensity on T2-weighted images, hemosiderin content, and a progressive contrast pattern may be diagnostic for papillary RCC.
Collapse
Affiliation(s)
- M O Nalbant
- Department of Radiology, University of Health Sciences, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | | |
Collapse
|
3
|
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: 7] [Impact Index Per Article: 3.5] [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.
Collapse
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
| |
Collapse
|
4
|
The relationship of apparent diffusion coefficient values of renal cell carcinoma before and after cryotherapy ablation. Radiography (Lond) 2023; 29:473-478. [PMID: 36871473 DOI: 10.1016/j.radi.2023.02.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Revised: 01/11/2023] [Accepted: 02/05/2023] [Indexed: 03/06/2023]
Abstract
INTRODUCTION The diagnosis of renal cell carcinoma (RCC) is increasing due to incidental findings with more frequent use of cross-sectional imaging. Therefore improvements to diagnostic and follow up imaging techniques is necessary. MRI diffusion weighted imaging (DWI) is a recognised method of measuring the diffusion of water within lesions using the apparent diffusion coefficient (ADC), and may have a role in monitoring the efficacy of cryotherapy ablation of RCC. METHODS A retrospective cohort study of 50 patients was approved to investigate if the ADC value can determine the success of cryotherapy ablation treatment for RCC. DWI was performed at a single centre using 1.5 T MRI before and after cryotherapy ablation to the RCC. The control group was considered as the unaffected kidney. The ADC value of the RCC tumour and normal kidney tissue prior to and after cryotherapy ablation was measured, and compared to the result of the MRI. RESULTS A statistically significant change in the ADC values was observed, pre ablation (1.562 × 10¯mm2/sec) to the post ablation (1.126 × 10¯³mm2/sec), p < 0.0005. There was no statistical significance in any of the other outcomes measured. CONCLUSION Although a change of ADC value occurred this is likely due to cryotherapy ablation causing coagulative necrosis at the site, and does not determine the success of the cryotherapy ablation. This can be considered a feasibility study for future research. IMPLICATIONS FOR PRACTICE DWI is a quick addition to routine protocols, does not require intravenous gadolinium based contrast agent, and provides qualitative and quantitative data. Further research is required to establish the role of ADC for treatment monitoring.
Collapse
|
5
|
Wakle DU, Choudhury S, Chakraborty S, Ganguly A, Pal DK. Evaluation of renal space occupying lesions with multiparametric MRI and its correlation with histopathology findings- an observational study. Urologia 2023; 90:42-50. [PMID: 36314948 DOI: 10.1177/03915603221131733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023]
Abstract
The term multiparametric MRI, is a useful tool in reference to an approach that takes advantage of the added value of different MR imaging acquisitions to yield anatomic and pathophysiologic information about renal space occupying lesions and to evaluate patients with different tumors, including genitourinary malignancies. The role of multiparametric MRI is continuously growing because of its ability to detect and characterize renal space occupying lesions as well as to assess response to treatment. An observational study was carried out in 50 patients who presented with renal mass, based on clinical suspicion and prior imaging diagnosis of neoplastic renal space occupying lesion. Total renal space occupying lesions were 50, of which, 38 were males & 12 were females. The age range of the study population was 30-80 years. In our study, Agreement analysis between mpMRI diagnosis and HPE diagnosis of different RCC subtypes was statistically significant. So, multiparametric MRI had a role in differentiating the subtypes of RCC which had fair agreement with HPE. The present study results state that the renal mass lesions has different ADC values for different lesions because of the change in tissue contents and there was a statistically significant difference in ADC values between low and high-stage RCCs. Histologic and radiologic profiles of renal space occupying lesions and diverse subtypes of RCC can be used as biologic indicators of clinical behavior, response to treatment, and prognosis.
Collapse
|
6
|
Elsorougy A, Farg H, Bayoumi D, El-Ghar MA, Shady M. Quantitative 3-tesla multiparametric MRI in differentiation between renal cell carcinoma subtypes. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2021; 52:49. [DOI: 10.1186/s43055-020-00405-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 12/28/2020] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
MRI provides several distinct quantitative parameters that may better differentiate renal cell carcinoma (RCC) subtypes. The purpose of the study is to evaluate the diagnostic accuracy of apparent diffusion coefficient (ADC), chemical shift signal intensity index (SII), and contrast enhancement in differentiation between different subtypes of renal cell carcinoma.
Results
There were 63 RCC as regard surgical histopathological analysis: 43 clear cell (ccRCC), 12 papillary (pRCC), and 8 chromophobe (cbRCC). The mean ADC ratio for ccRCC (0.75 ± 0.13) was significantly higher than that of pRCC (0.46 ± 0.12, P < 0.001) and cbRCC (0.41 ± 0.15, P < 0.001). The mean ADC value for ccRCC (1.56 ± 0.27 × 10−3 mm2/s) was significantly higher than that of pRCC (0.96 ± 0.25 × 10−3 mm2/s, P < 0.001) and cbRCC (0.89 ± 0.29 × 10−3 mm2/s, P < 0.001). The mean SII of pRCC (1.49 ± 0.04) was significantly higher than that of ccRCC (0.93 ± 0.01, P < 0.001) and cbRCC (1.01 ± 0.16, P < 0.001). The ccRCC absolute corticomedullary enhancement (196.7 ± 81.6) was significantly greater than that of cbRCC (177.8 ± 77.7, P < 0.001) and pRCC (164.3 ± 84.6, P < 0.001).
Conclusion
Our study demonstrated that multiparametric MRI is able to afford some quantitative features such as ADC ratio, SII, and absolute corticomedullary enhancement which can be used to accurately distinguish different subtypes of renal cell carcinoma.
Collapse
|
7
|
Tsili AC, Moulopoulos LA, Varakarakis IΜ, Argyropoulou MI. Cross-sectional imaging assessment of renal masses with emphasis on MRI. Acta Radiol 2021; 63:1570-1587. [PMID: 34709096 DOI: 10.1177/02841851211052999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Magnetic resonance imaging (MRI) is a useful complementary imaging tool for the diagnosis and characterization of renal masses, as it provides both morphologic and functional information. A core MRI protocol for renal imaging should include a T1-weighted sequence with in- and opposed-phase images (or, alternatively with DIXON technique), T2-weighted and diffusion-weighted images as well as a dynamic contrast-enhanced sequence with subtraction images, followed by a delayed post-contrast T1-weighted sequence. The main advantages of MRI over computed tomography include increased sensitivity for contrast enhancement, less sensitivity for detection of calcifications, absence of pseudoenhancement, and lack of radiation exposure. MRI may be applied for renal cystic lesion characterization, differentiation of renal cell carcinoma (RCC) from benign solid renal tumors, RCC histologic grading, staging, post-treatment follow-up, and active surveillance of patients with treated or untreated RCC.
Collapse
Affiliation(s)
- Athina C Tsili
- Department of Clinical Radiology, School of Medicine, University of Ioannina, Ioannina, Greece
| | - Lia-Angela Moulopoulos
- 1st Department of Radiology, School of Medicine, National and Kapodistrian University of Athens, Areteion Hospital, Athens, Greece
| | - Ioannis Μ Varakarakis
- 2nd Department of Urology, National and Kapodistrian University of Athens, Sismanoglio Hospital, Athens, Greece
| | - Maria I Argyropoulou
- Department of Clinical Radiology, School of Medicine, University of Ioannina, Ioannina, Greece
| |
Collapse
|
8
|
Serter A, Onur MR, Coban G, Yildiz P, Armagan A, Kocakoc E. The role of diffusion-weighted MRI and contrast-enhanced MRI for differentiation between solid renal masses and renal cell carcinoma subtypes. Abdom Radiol (NY) 2021; 46:1041-1052. [PMID: 32930832 DOI: 10.1007/s00261-020-02742-w] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Revised: 08/22/2020] [Accepted: 09/03/2020] [Indexed: 12/23/2022]
Abstract
PURPOSE To assess the value of diffusion-weighted magnetic resonance imaging (DW-MRI) and contrast-enhanced MRI (CE-MRI) for differentiation between benign and malignant solid renal masses, renal cell carcinoma (RCC) subtypes, oncocytomas, and lipid-poor angiomyolipomas (LP-AML). METHODS Minimum or lowest 'apparent diffusion coefficient' (ADC1) and representative ADC values (ADC2) of 112 renal masses (n: 46 benign renal mass, n: 66 malignant renal mass) were measured on DW-MRI images (b 50, 400, 800 s/mm2). Signal intensity (SI) measurements were performed in normal renal parenchyma and most avid enhanced area of the renal masses at precontrast, corticomedullary, and nephrographic phases on CE-MRI. Contrast enhancement rate (CER) and contrast enhancement index (CEI) values of renal masses were compared between benign-malignant renal masses and RCC subtypes, oncocytomas, and LP-AMLs. RESULTS There was no significant difference between ADC1, ADC2 values, and SI of benign and malignant renal masses (p = 0.721, p = 0.255, p = 0.872). Mean ADC1 and ADC2 values of clear cell RCCs were significantly higher than nonclear cell RCCs (p = 0.005 p = 0.002). Mean CER value of clear cell RCCs was significantly higher than nonclear cell RCCs in nephrographic phase (p = 0.003). Mean CEI values of clear cell RCCs were significantly higher than nonclear cell RCCs in the corticomedullary and nephrographic phase (p = 0.027 vs. 0.008). LP-AMLs were differentiated from other renal masses with wash-out phenomenon. CONCLUSION Combined usage of ADC, SI, CER, and CEI values may be useful for discrimination between RCC subtypes, oncocytomas, and lipid-poor AMLs.
Collapse
Affiliation(s)
- Aslı Serter
- Private Lokman Hekim Esnaf Hospital, Fethiye, Muğla, Turkey
| | - Mehmet Ruhi Onur
- Faculty of Medicine, Department of Radiology, Hacettepe University, Ankara, Turkey.
| | - Ganime Coban
- Department of Pathology, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Turkey
| | - Pelin Yildiz
- Department of Pathology, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Turkey
| | | | - Ercan Kocakoc
- Bahcelievler Medical Park Hospital, Istanbul, Turkey
| |
Collapse
|
9
|
Lopes Vendrami C, McCarthy RJ, Villavicencio CP, Miller FH. Predicting common solid renal tumors using machine learning models of classification of radiologist-assessed magnetic resonance characteristics. Abdom Radiol (NY) 2020; 45:2797-2809. [PMID: 32666233 DOI: 10.1007/s00261-020-02637-w] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 06/23/2020] [Accepted: 07/04/2020] [Indexed: 02/06/2023]
Abstract
PURPOSE Solid renal masses (SRM) are difficult to differentiate based on standard MR features. The purpose of this study was to assess MR imaging features of SRM to evaluate performance of ensemble methods of classifying SRM subtypes. MATERIALS AND METHODS MR images of SRM (n = 330) were retrospectively evaluated for standard and multiparametric (mp) features. Models of MR features for predicting malignant and benign lesions as well as subtyping SRM were developed using a training dataset and performance was evaluated in a test data-set using recursive partitioning (RP), gradient booting machine (GBM), and random forest (RF) methods. RESULTS In the test dataset, GBM and RF models demonstrated an accuracy of 86% (95% CI 75% to 93%) for predicting benign versus malignant SRM compared to 83% (95% CI 71% to 91%) for the RP model. RF had the greatest accuracy in predicting SRM subtypes, 81.2% (95% CI 69.5% to 89.9%) compared with GBM 73.4% (95% CI 60.9% to 83.7%) or RP 70.3% (95% CI 57.6% to 81.1%). Marginal homogeneity was reduced by the RF model compared with the RP model (P < 0.001), but not the GBM model (P = 0.135). All models had high sensitivity and specificity for clear cell and papillary renal cell carcinomas (RCC), but performed less well in differentiating chromophobe RCC, oncocytomas, and fat-poor angiomyolipomas. CONCLUSION Ensemble methods for prediction of SRM from radiologist-assessed image characteristics have high accuracy for distinguishing benign and malignant lesions. SRM subtype classification is limited by the ability to categorize chromophobe RCCs, oncocytomas, and fat-poor angiomyolipomas.
Collapse
Affiliation(s)
- Camila Lopes Vendrami
- Department of Radiology, Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, 676 N. St. Clair St. Suite 800, Chicago, IL, 60611, USA
| | - Robert J McCarthy
- Department of Anesthesiology, Rush University, Chicago, IL, 60612, USA
| | - Carolina Parada Villavicencio
- Department of Radiology, Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, 676 N. St. Clair St. Suite 800, Chicago, IL, 60611, USA
| | - Frank H Miller
- Department of Radiology, Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, 676 N. St. Clair St. Suite 800, Chicago, IL, 60611, USA.
| |
Collapse
|
10
|
Heller MT, Furlan A, Kawashima A. Multiparametric MR for Solid Renal Mass Characterization. Magn Reson Imaging Clin N Am 2020; 28:457-469. [PMID: 32624162 DOI: 10.1016/j.mric.2020.03.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Multiparametric MR provides a noninvasive means for improved differentiation between benign and malignant solid renal masses. Although most large, heterogeneous renal masses are due to renal cell carcinoma, smaller "indeterminate" renal masses are being identified on cross-sectional imaging. Although definitive diagnosis of a solid renal mass may not always be possible by MR imaging, integrated evaluation of multiple MR imaging parameters can result in concise differential diagnosis. Multiparametric MR should be considered a critical step in the triage of patients with a solid renal mass for whom treatment options are being considered in the context of morbidity, prognosis, and mortality.
Collapse
Affiliation(s)
- Matthew T Heller
- Department of Radiology, Mayo Clinic, Mayo Clinic Hospital, 5777 East Mayo Boulevard, PX SS 01 RADLGY, Phoenix, AZ 85054, USA.
| | - Alessandro Furlan
- Department of Radiology, University of Pittsburgh, University of Pittsburgh Medical Center, 200 Lothrop Street, Pittsburgh, PA 15213, USA
| | - Akira Kawashima
- Department of Radiology, Mayo Clinic, Mayo Clinic Hospital, 5777 East Mayo Boulevard, PX SS 01 RADLGY, Phoenix, AZ 85054, USA
| |
Collapse
|
11
|
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: 3.6] [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.
Collapse
|
12
|
Predictive Value of In Vivo MR Spectroscopy With Semilocalization by Adiabatic Selective Refocusing in Differentiating Clear Cell Renal Cell Carcinoma From Other Subtypes. AJR Am J Roentgenol 2020; 214:817-824. [PMID: 32045306 DOI: 10.2214/ajr.19.22023] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE. The purpose of this study is to evaluate the diagnostic value of in vivo MR spectroscopy (MRS) with semilocalization by adiabatic selective refocusing (semi-LASER MRS) in differentiating clear cell renal cell carcinoma (RCC) from the non-clear cell subtype. SUBJECTS AND METHODS. Sixteen patients with biopsy-proven RCC or masses highly suspicious for RCC were prospectively recruited to participate in the study. Single-voxel 1H spectra were acquired using a 3-T MRI system, with a semi-LASER sequence acquired for renal tumors in 14 patients and for healthy renal tissue (control tissue) in 12 patients. Offline processing of the MR spectra was performed. MRI and spectra analysis were performed independently by radiologists who were blinded to the reference histopathologic findings. RESULTS. Semi-LASER MRS was diagnostic for nine of 11 patients (82%) with histopathologically proven clear cell RCC, showing a strong lipid peak in seven patients and a weaker lipid resonance in two others, whereas control spectra showed weakly positive findings in only one patient. MRS findings were negative for lipid resonance in two of three patients (67%) with non-clear cell tumors and were weakly positive in another patient. Semi-LASER MRS had a high sensitivity and positive predictive value of 82% and 90%, respectively, in addition to a specificity of 67%, a negative predictive value of 50%, and overall accuracy of 79% for the detection of clear cell RCC. Lipid resonance was detected by MRS for four of six clear cell RCCs with no intravoxel fat on chemical-shift MRI. CONCLUSION. The preliminary results of the present study show that semi-LASER MRS is promising for the noninvasive discrimination of clear cell RCC from non-clear cell RCC on the basis of detection of lipid resonance and that it provides an incremental yield compared with chemical-shift MRI.
Collapse
|
13
|
Mohammad Ahmad MI, Sabr M, Roshy E. Assessment of apparent diffusion coefficient value as prognostic factor for renal cell carcinoma aggressiveness. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2019. [DOI: 10.1186/s43055-019-0038-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Assurance of prognostic elements is important for the management of renal cell carcinoma (RCC). Our goal was to check the relation between apparent diffusion coefficient (ADC) values and parameters predicting prognosis of RCC. Fifty pathologically confirmed RCC underwent diffusion-weighted (DW) MRI. ADC values were calculated using b factor (800 s/mm2). The correlation between ADC values and tumor size, cystic/necrotic feature, growth pattern, unenhanced T1, histological grade, clinical stage, and distant metastasis were analyzed.
Results
The optimal ADC threshold for prognosis of RCC appeared to be 1.4 × 10−3 mm2/s. There was a significant inverse correlation between ADC values and growth pattern (R = − 0, P = 0.05), unenhanced T1(R = − 0.41, P = 0.01), cystic/necrotic feature (R = − 0.4, P = 0.01), histological grade (R = − 0.37, P = 0.02), clinical stage (r = − 0.4, P = 0.01), and distant metastasis (R = − 0.33, P = 0.04), and significant linear correlation with tumor size (R = 0.39, P < 0.02).
Conclusion
The performance of ADC value as a newly proposed prognostic parameter follows with the degree of tumor differentiation and that may recognize extremely aggressive RCC. RCC with low ADC values should be inspected extensively for the risk of high pathological grade, high clinical stage, and distant metastasis.
Collapse
|
14
|
Scrima AT, Lubner MG, Abel EJ, Havighurst TC, Shapiro DD, Huang W, Pickhardt PJ. Texture analysis of small renal cell carcinomas at MDCT for predicting relevant histologic and protein biomarkers. Abdom Radiol (NY) 2019; 44:1999-2008. [PMID: 29804215 DOI: 10.1007/s00261-018-1649-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
PURPOSE To assess CT texture features of small renal cell carcinomas (≤ 4cm) for association with key pathologic features including protein biomarkers. METHODS Quantitative CT texture analysis (CTTA) of small renal cancers (≤ 4cm) was performed on non-contrast and portal venous phase abdominal MDCT scans with an ROI drawn at the largest cross-sectional diameter of the tumor using commercially available software. Texture parameters including mean pixel attenuation, the standard deviation (SD) of the pixel distribution histogram, entropy, the mean of positive pixels, the skewness (i.e., asymmetry) of the pixel histogram, kurtosis (i.e., peakness) of the pixel histogram, and the percentage of positive pixels were correlated with pathologic data from surgical resection, including histology and nuclear grade, as well as microarray analysis in a subset (n = 40) including Ki67 index, CRP, and neovascularization (CD105/CD31). RESULTS Portal venous phase images were available in 249 patients (105 women, 144 men; mean age, 56.7 years) with tumors ≤ 4cm (mean, median, range, ± SD; 2.66, 2.60, 0.3-4.0 ± 0.85 cm). CT texture features of standard deviation, mean of the positive pixels, and entropy of the pixel histogram were significantly associated with histologic cell type (clear vs. non-clear; p < 0.001). Entropy and mean of the positive pixels also showed an association with nuclear grade, although not statistically significant. In the microarray analysis subset, kurtosis of the pixel histogram was associated with CD105/CD31 (p = 0.05). SD also showed some association with CD 105 positivity (p = 0.02) and CAIX expression (p = 0.01). Non-contrast CT images were available in 174 patients (72 women, 102 men; mean age, 57.5 years). Although the association with histology was not as strong as on the portal venous phase, in the subset of patients with microarray data, SD was found to correlate with CRP (p = 0.08), kurtosis with CRP (p = 0.004), CD105/CD31 (p = 0.002), and with Ki 67 index (p < 0.001). CONCLUSION CT texture features were significantly associated with important histopathologic features in small renal cancers. These non-invasive measures can be performed retrospectively and may provide useful information when determining follow-up and treatment of small renal cancers.
Collapse
Affiliation(s)
- Andrew T Scrima
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, E3/311 Clinical Sciences Center, 600 Highland Ave, Madison, WI, 53792, USA
| | - Meghan G Lubner
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, E3/311 Clinical Sciences Center, 600 Highland Ave, Madison, WI, 53792, USA.
| | - E Jason Abel
- Department of Urology, University of Wisconsin School of Medicine and Public Health, Madison, USA
| | - Thomas C Havighurst
- Department of Biostatistics, University of Wisconsin School of Medicine and Public Health, Madison, USA
| | - Daniel D Shapiro
- Department of Urology, University of Wisconsin School of Medicine and Public Health, Madison, USA
| | - Wei Huang
- Department of Pathology, University of Wisconsin School of Medicine and Public Health, Madison, USA
| | - Perry J Pickhardt
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, E3/311 Clinical Sciences Center, 600 Highland Ave, Madison, WI, 53792, USA
| |
Collapse
|
15
|
Abstract
OBJECTIVE. Renal masses comprise a heterogeneous group of pathologic conditions, including benign and indolent diseases and aggressive malignancies, complicating management. In this article, we explore the emerging role of imaging to provide a comprehensive noninvasive characterization of a renal mass-so-called "virtual biopsy"-and its potential use in the management of patients with renal tumors. CONCLUSION. Percutaneous renal mass biopsy (RMB) remains a valuable method to provide a presurgical histopathologic diagnosis of renal masses, but it is an invasive procedure and is not always feasible. Accumulating data support the use of imaging features to predict histopathology of renal masses. Imaging may help address some of the inherent limitations of RMB, and in certain settings, a multimodal clinical approach may allow decreasing the need for RMB.
Collapse
|
16
|
|
17
|
Subtype Differentiation of Small (≤ 4 cm) Solid Renal Mass Using Volumetric Histogram Analysis of DWI at 3-T MRI. AJR Am J Roentgenol 2018; 211:614-623. [PMID: 29812980 DOI: 10.2214/ajr.17.19278] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVE The purpose of this article is to evaluate the utility of volumetric histogram analysis of apparent diffusion coefficient (ADC) derived from reduced-FOV DWI for small (≤ 4 cm) solid renal mass subtypes at 3-T MRI. MATERIALS AND METHODS This retrospective study included 38 clear cell renal cell carcinomas (RCCs), 16 papillary RCCs, 18 chromophobe RCCs, 13 minimal fat angiomyolipomas (AMLs), and seven oncocytomas evaluated with preoperative MRI. Volumetric ADC maps were generated using all slices of the reduced-FOV DW images to obtain histogram parameters, including mean, median, 10th percentile, 25th percentile, 75th percentile, 90th percentile, and SD ADC values, as well as skewness, kurtosis, and entropy. Comparisons of these parameters were made by one-way ANOVA, t test, and ROC curves analysis. RESULTS ADC histogram parameters differentiated eight of 10 pairs of renal tumors. Three subtype pairs (clear cell RCC vs papillary RCC, clear cell RCC vs chromophobe RCC, and clear cell RCC vs minimal fat AML) were differentiated by mean ADC. However, five other subtype pairs (clear cell RCC vs oncocytoma, papillary RCC vs minimal fat AML, papillary RCC vs oncocytoma, chromophobe RCC vs minimal fat AML, and chromophobe RCC vs oncocytoma) were differentiated by histogram distribution parameters exclusively (all p < 0.05). Mean ADC, median ADC, 75th and 90th percentile ADC, SD ADC, and entropy of malignant tumors were significantly higher than those of benign tumors (all p < 0.05). Combination of mean ADC with histogram parameters yielded the highest AUC (0.851; sensitivity, 80.0%; specificity, 86.1%). CONCLUSION Quantitative volumetric ADC histogram analysis may help differentiate various subtypes of small solid renal tumors, including benign and malignant lesions.
Collapse
|
18
|
Abstract
PURPOSE OF REVIEW Renal cell carcinoma is a heterogeneous disease with a spectrum of subtypes and clinical behavior. Quantitative and qualitative imaging biomarkers are sought to correlate with genetic and histologic features and complement pathologic analysis. RECENT FINDINGS Texture analysis, radiogenomics, and modality-specific advancements have yielded an array of renal cell carcinoma imaging biomarkers in the research domain. Although many techniques are promising, standardization and validation of these procedures are needed prior to implementation into clinical practice. SUMMARY We introduce novel imaging techniques and analytic methods which have been shown to contribute to characterization of renal cell carcinoma and its subtypes, aggressiveness, and responsiveness to therapy, including associated advantages and limitations.
Collapse
|
19
|
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: 42] [Impact Index Per Article: 5.3] [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.
Collapse
|
20
|
Lopes Vendrami C, Parada Villavicencio C, DeJulio TJ, Chatterjee A, Casalino DD, Horowitz JM, Oberlin DT, Yang GY, Nikolaidis P, Miller FH. Differentiation of Solid Renal Tumors with Multiparametric MR Imaging. Radiographics 2017; 37:2026-2042. [DOI: 10.1148/rg.2017170039] [Citation(s) in RCA: 60] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Affiliation(s)
- Camila Lopes Vendrami
- From the Departments of Radiology (C.L.V., C.P.V., A.C., D.D.C., J.M.H., P.N., F.H.M.), Pathology (T.J.D., G.Y.Y.), and Urology (D.T.O.), Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, 676 N St Clair St, Suite 800, Chicago, IL 60611
| | - Carolina Parada Villavicencio
- From the Departments of Radiology (C.L.V., C.P.V., A.C., D.D.C., J.M.H., P.N., F.H.M.), Pathology (T.J.D., G.Y.Y.), and Urology (D.T.O.), Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, 676 N St Clair St, Suite 800, Chicago, IL 60611
| | - Todd J. DeJulio
- From the Departments of Radiology (C.L.V., C.P.V., A.C., D.D.C., J.M.H., P.N., F.H.M.), Pathology (T.J.D., G.Y.Y.), and Urology (D.T.O.), Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, 676 N St Clair St, Suite 800, Chicago, IL 60611
| | - Argha Chatterjee
- From the Departments of Radiology (C.L.V., C.P.V., A.C., D.D.C., J.M.H., P.N., F.H.M.), Pathology (T.J.D., G.Y.Y.), and Urology (D.T.O.), Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, 676 N St Clair St, Suite 800, Chicago, IL 60611
| | - David D. Casalino
- From the Departments of Radiology (C.L.V., C.P.V., A.C., D.D.C., J.M.H., P.N., F.H.M.), Pathology (T.J.D., G.Y.Y.), and Urology (D.T.O.), Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, 676 N St Clair St, Suite 800, Chicago, IL 60611
| | - Jeanne M. Horowitz
- From the Departments of Radiology (C.L.V., C.P.V., A.C., D.D.C., J.M.H., P.N., F.H.M.), Pathology (T.J.D., G.Y.Y.), and Urology (D.T.O.), Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, 676 N St Clair St, Suite 800, Chicago, IL 60611
| | - Daniel T. Oberlin
- From the Departments of Radiology (C.L.V., C.P.V., A.C., D.D.C., J.M.H., P.N., F.H.M.), Pathology (T.J.D., G.Y.Y.), and Urology (D.T.O.), Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, 676 N St Clair St, Suite 800, Chicago, IL 60611
| | - Guang-Yu Yang
- From the Departments of Radiology (C.L.V., C.P.V., A.C., D.D.C., J.M.H., P.N., F.H.M.), Pathology (T.J.D., G.Y.Y.), and Urology (D.T.O.), Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, 676 N St Clair St, Suite 800, Chicago, IL 60611
| | - Paul Nikolaidis
- From the Departments of Radiology (C.L.V., C.P.V., A.C., D.D.C., J.M.H., P.N., F.H.M.), Pathology (T.J.D., G.Y.Y.), and Urology (D.T.O.), Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, 676 N St Clair St, Suite 800, Chicago, IL 60611
| | - Frank H. Miller
- From the Departments of Radiology (C.L.V., C.P.V., A.C., D.D.C., J.M.H., P.N., F.H.M.), Pathology (T.J.D., G.Y.Y.), and Urology (D.T.O.), Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, 676 N St Clair St, Suite 800, Chicago, IL 60611
| |
Collapse
|
21
|
PET-MRI of the Pancreas and Kidneys. CURRENT RADIOLOGY REPORTS 2017. [DOI: 10.1007/s40134-017-0229-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
|
22
|
Renal clear cell carcinoma: diffusion tensor imaging diagnostic accuracy and correlations with clinical and histopathological factors. Clin Radiol 2017; 72:560-564. [PMID: 28330685 DOI: 10.1016/j.crad.2017.02.016] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Revised: 01/19/2017] [Accepted: 02/13/2017] [Indexed: 12/20/2022]
Abstract
AIM To investigate whether diffusion tensor imaging (DTI) can be used to assess renal clinical histopathology, including the nuclear grade (NG), cell density (CD), and the presence of ki-67. MATERIALS AND METHODS Thirty patients were enrolled in the study and were confirmed at surgical histopathology to have clear cell renal cell carcinoma (CCRCC). For DTI, a coronal echo-planar imaging sequence was performed (1400 ms repetition time, 76 ms echo time, diffusion direction=6, number of excitations=4; b=0 and 800 s/mm2, 6 mm section thickness with no intersection gap). CD and the presence of ki-67 were compared between the different NGs. Correlations between apparent diffusion coefficients (ADCs), E1, fractional anisotropy (FA), CD, and ki-67 were evaluated. RESULTS ADC, E1, and FA values are important tools used to identify NG. The cut-off values were 1.003×10-3 mm2/s, 1.277×10-3 mm2/s, and 0.218 mm2/s, respectively. The difference between high- and low-grade CD was significant (t=-4.50, p<0.05). Similarly, a significant difference between high and low grade was also found in ki-67 (t=-4.03, p<0.05). ADC, E1, and FA values were decreased with increased CD; a significant negative correlation was found (r=-0.796, -0.865, and -0.996, respectively). Significant negative correlations between ADC, E1, and FA values, and ki-67 were found (r=-0.739, -0.826, and -0.876, respectively). CONCLUSIONS DTI can be used to non-invasively assess CCRCC.
Collapse
|
23
|
Woo S, Kim SH. Differentiation of Small, Solid Renal Masses: A Pattern Recognition Approach. Semin Ultrasound CT MR 2017; 38:28-36. [DOI: 10.1053/j.sult.2016.08.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
|
24
|
Abstract
This review article aims to provide an overview on of diffusion-weighted MR imaging (DW-MR imaging) in the urogenital tract. Compared with conventional cross-sectional imaging methods, the additional value of DW-MR imaging in the detection and further characterization of benign and malignant lesions of the kidneys, bladder, prostate, and pelvic lymph nodes is discussed as well as the role of DW-MR imaging in the evaluation of treatment response.
Collapse
Affiliation(s)
- Martin H Maurer
- Department of Radiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 10, Bern 3010, Switzerland
| | - Kirsi Hannele Härmä
- Department of Radiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 10, Bern 3010, Switzerland
| | - Harriet Thoeny
- Department of Radiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 10, Bern 3010, Switzerland.
| |
Collapse
|
25
|
Colagrande S, Inghilesi AL, Aburas S, Taliani GG, Nardi C, Marra F. Challenges of advanced hepatocellular carcinoma. World J Gastroenterol 2016; 22:7645-7659. [PMID: 27678348 PMCID: PMC5016365 DOI: 10.3748/wjg.v22.i34.7645] [Citation(s) in RCA: 128] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2016] [Revised: 07/06/2016] [Accepted: 08/08/2016] [Indexed: 02/06/2023] Open
Abstract
Hepatocellular carcinoma (HCC) is an aggressive malignancy, resulting as the third cause of death by cancer each year. The management of patients with HCC is complex, as both the tumour stage and any underlying liver disease must be considered conjointly. Although surveillance by imaging, clinical and biochemical parameters is routinely performed, a lot of patients suffering from cirrhosis have an advanced stage HCC at the first diagnosis. Advanced stage HCC includes heterogeneous groups of patients with different clinical condition and radiological features and sorafenib is the only approved treatment according to Barcelona Clinic Liver Cancer. Since the introduction of sorafenib in clinical practice, several phase III clinical trials have failed to demonstrate any superiority over sorafenib in the frontline setting. Loco-regional therapies have also been tested as first line treatment, but their role in advanced HCC is still matter of debate. No single agent or combination therapies have been shown to impact outcomes after sorafenib failure. Therefore this review will focus on the range of experimental therapeutics for patients with advanced HCC and highlights the successes and failures of these treatments as well as areas for future development. Specifics such as dose limiting toxicity and safety profile in patients with liver dysfunction related to the underlying chronic liver disease should be considered when developing therapies in HCC. Finally, robust validated and reproducible surrogate end-points as well as predictive biomarkers should be defined in future randomized trials.
Collapse
|
26
|
Abstract
Multiparametric MR imaging (mpMRI) combine different sequences that, properly tailored, can provide qualitative and quantitative information about the tumor microenvironment beyond traditional tumor size measures and/or morphologic assessments. This article focuses on mpMRI in the evaluation of urogenital tract malignancies by first reviewing technical aspects and then discussing its potential clinical role. This includes insight into histologic subtyping and grading of renal cell carcinoma and assessment of tumor response to targeted therapies. The clinical utility of mpMRI in the staging and grading of ureteral and bladder tumors is presented. Finally, the evolving role of mpMRI in prostate cancer is discussed.
Collapse
|
27
|
Ananthakrishnan L, Kapur P, Leyendecker JR. The spectrum of renal cell carcinoma in adults. Abdom Radiol (NY) 2016; 41:1052-65. [PMID: 27108133 DOI: 10.1007/s00261-016-0737-4] [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] [Indexed: 02/06/2023]
Abstract
The spectrum of renal cell carcinoma (RCC) includes many neoplasms with distinct cytogenetics, biologic behaviors, and imaging appearances. The advent of molecular therapies targeting different tumor types, new insights into the relative roles of biopsy and surveillance for small incidental tumors, and a growing array of nephron-sparing interventions have altered management of RCC. Similarly, the role of the radiologist is changing, and it is becoming increasingly important for radiologists to familiarize themselves with the various types of RCC. This article introduces the reader to the common and uncommon recognized types of renal cell carcinoma and discusses how these neoplasms differ in imaging appearance and behavior.
Collapse
|
28
|
Inci MF, Kalayci TO, Tan S, Karasu S, Albayrak E, Cakir V, Ocal I, Ozkan F. Diagnostic value of strain elastography for differentiation between renal cell carcinoma and transitional cell carcinoma of kidney. Abdom Radiol (NY) 2016; 41:1152-9. [PMID: 26880174 DOI: 10.1007/s00261-016-0658-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
PURPOSE The objective of our study was to prospectively evaluate the diagnostic performance of strain elastography for differentiation between renal cell carcinomas (RCCs) and transitional cell carcinomas (TCCs) of kidney. METHODS A total of 99 consecutive patients who were referred to our hospital because of a newly diagnosed solid renal mass suspicious for malignancy on radiological screenings were evaluated with sonography, including strain elastography. Strain elastography was used to compare the stiffness of the renal masses and renal cortex. The ratio of strain in a renal mass and nearby renal cortex was defined as the strain index value. Mean strain index values for RCCs and TCCs were compared, and mean strain index values between histological subtypes of RCC were also compared. RESULTS Although TCCs were smaller than RCCs (p < 0.001), there were no significant differences in gender distribution and mean age of the patients, and mean probe-tumor distance between RCC and TCC. The mean strain index value ±SD for TCC (5.18 ± 1.12) was significantly higher than the value for RCC (4.04 ± 0.72; p < 0.001). Mean strain index value for papillary cell carcinomas (4.09 ± 0.45) was slightly higher than that for clear cell carcinomas (3.85 ± 0.78): however, the difference was not statistically significant (p = 0.51). CONCLUSIONS Strain elastography can be used as a valuable imaging technique for preoperative differentiation between RCC and TCC of kidney.
Collapse
Affiliation(s)
- Mehmet Fatih Inci
- Department of Radiology, Izmir Katip Çelebi University, School of Medicine, Izmir, Turkey.
- Department of Radiology, Atatürk Training and Research Hospital, Izmir Katip Celebi University, Polat Caddesi, Karabaglar, Izmir, 35160, Turkey.
| | - Tugce Ozlem Kalayci
- Department of Radiology, Atatürk Training and Research Hospital, Izmir Katip Celebi University, Polat Caddesi, Karabaglar, Izmir, 35160, Turkey
| | - Sinan Tan
- Department of Radiology, Kırıkkale University, School of Medicine, Kırıkkale, Turkey
| | - Sebnem Karasu
- Department of Radiology, Atatürk Training and Research Hospital, Izmir Katip Celebi University, Polat Caddesi, Karabaglar, Izmir, 35160, Turkey
| | - Eda Albayrak
- Department of Radiology, Gaziosmanpasa University, School of Medicine, Tokat, Turkey
| | - Volkan Cakir
- Department of Radiology, Izmir Katip Çelebi University, School of Medicine, Izmir, Turkey
| | - Irfan Ocal
- Department of Pathology, Izmir Katip Çelebi University, School of Medicine, Izmir, Turkey
| | - Fuat Ozkan
- Department of Radiology, Okmeydanı Education and Research Hospital, Istanbul, Turkey
| |
Collapse
|
29
|
Low G, Huang G, Fu W, Moloo Z, Girgis S. Review of renal cell carcinoma and its common subtypes in radiology. World J Radiol 2016; 8:484-500. [PMID: 27247714 PMCID: PMC4882405 DOI: 10.4329/wjr.v8.i5.484] [Citation(s) in RCA: 115] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2015] [Revised: 01/20/2016] [Accepted: 03/09/2016] [Indexed: 02/06/2023] Open
Abstract
Representing 2%-3% of adult cancers, renal cell carcinoma (RCC) accounts for 90% of renal malignancies and is the most lethal neoplasm of the urologic system. Over the last 65 years, the incidence of RCC has increased at a rate of 2% per year. The increased incidence is at least partly due to improved tumor detection secondary to greater availability of high-resolution cross-sectional imaging modalities over the last few decades. Most RCCs are asymptomatic at discovery and are detected as unexpected findings on imaging performed for unrelated clinical indications. The 2004 World Health Organization Classification of adult renal tumors stratifies RCC into several distinct histologic subtypes of which clear cell, papillary and chromophobe tumors account for 70%, 10%-15%, and 5%, respectively. Knowledge of the RCC subtype is important because the various subtypes are associated with different biologic behavior, prognosis and treatment options. Furthermore, the common RCC subtypes can often be discriminated non-invasively based on gross morphologic imaging appearances, signal intensity on T2-weighted magnetic resonance images, and the degree of tumor enhancement on dynamic contrast-enhanced computed tomography or magnetic resonance imaging examinations. In this article, we review the incidence and survival data, risk factors, clinical and biochemical findings, imaging findings, staging, differential diagnosis, management options and post-treatment follow-up of RCC, with attention focused on the common subtypes.
Collapse
|
30
|
CT Textural Analysis of Large Primary Renal Cell Carcinomas: Pretreatment Tumor Heterogeneity Correlates With Histologic Findings and Clinical Outcomes. AJR Am J Roentgenol 2016; 207:96-105. [PMID: 27145377 DOI: 10.2214/ajr.15.15451] [Citation(s) in RCA: 109] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
OBJECTIVE The purpose of the present study is to determine whether CT texture features of newly diagnosed primary renal cell carcinomas (RCCs) correlate with pathologic features and oncologic outcomes. MATERIALS AND METHODS CT texture analysis was performed on large (> 7 cm; mean size, 9.9 cm) untreated RCCs in 157 patients (52 women and 105 men; mean age, 60.3 years). Measures of tumor heterogeneity, including entropy, kurtosis, skewness, mean, mean of positive pixels, and SD of pixel distribution histogram were derived from multiphasic CT using various filter settings: unfiltered (spatial scaling factor, 0), fine (spatial scaling factor, 2), medium (spatial scaling factor, 3-4), or coarse (spatial scaling factor, 5-6). Texture values were correlated with histologic subtype, nuclear grade, pathologic stage, and clinical outcome. RESULTS When a coarse filter setting (spatial scaling factor, 6) was used, entropy on portal venous phase CT images was positively associated with clear cell histologic findings (odds ratio [OR], 134; 95% CI, 16-1110; p < 0.001) and was negatively associated with non-clear cell subtype findings (papillary spatial scale factor, 6; OR, 0.016; 95% CI, 0.002-0.132; p < 0.001). ROC curve analysis for entropy (on portal venous phase images obtained with a spatial scaling factor of 6) revealed an AUC of 0.943 (95% CI, 0.892-0.993) for clear cell histologic findings, with similar values noted for non-clear cell histologic findings. The mean of positive pixels and the SD of the pixel distribution histogram were statistically significantly associated with histologic cell type in a similar fashion. Entropy, the SD of the pixel distribution histogram, and the mean of positive pixels were associated with nuclear grade, most prominently when fine or medium texture filters were used (p < 0.05). There was a statistically significant association of texture features noted on unenhanced CT, including the SD of the pixel distribution histogram, the mean of positive pixels, and entropy, with the time to disease recurrence and death due to disease (e.g., for entropy noted on unenhanced CT images obtained with a spatial scaling factor of 6, the hazard ratio was 3.49 [95% CI, 1.55-7.84]; p = 0.002). CONCLUSION CT texture features (in particular, entropy, the mean of positive pixels, and the SD of the pixel distribution histogram) are associated with tumor histologic findings, nuclear grade, and outcome measures. The contrast phase does seem to affect heterogeneity measures.
Collapse
|
31
|
Fifty Years of Technological Innovation: Potential and Limitations of Current Technologies in Abdominal Magnetic Resonance Imaging and Computed Tomography. Invest Radiol 2016; 50:584-93. [PMID: 26039773 DOI: 10.1097/rli.0000000000000173] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Magnetic resonance imaging (MRI) has become an important modality for the diagnosis of intra-abdominal pathology. Hardware and pulse sequence developments have made it possible to derive not only morphologic but also functional information related to organ perfusion (dynamic contrast-enhanced MRI), oxygen saturation (blood oxygen level dependent), tissue cellularity (diffusion-weighted imaging), and tissue composition (spectroscopy). These techniques enable a more specific assessment of pathologic lesions and organ functionality. Magnetic resonance imaging has thus transitioned from a purely morphologic examination to a modality from which image-based disease biomarkers can be derived. This fits well with several emerging trends in radiology, such as the need to accurately assess response to costly treatment strategies and the need to improve lesion characterization to potentially avoid biopsy. Meanwhile, the cost-effectiveness, availability, and robustness of computed tomography (CT) ensure its place as the current workhorse for clinical imaging. Although the lower soft tissue contrast of CT relative to MRI is a long-standing limitation, other disadvantages such as ionizing radiation exposure have become a matter of public concern. Nevertheless, recent technical developments such as dual-energy CT or dynamic volume perfusion CT also provide more functional imaging beyond morphology.The aim of this article was to review and discuss the most important recent technical developments in abdominal MRI and state-of-the-art CT, with an eye toward the future, providing examples of their clinical utility for the evaluation of hepatic and renal pathologies.
Collapse
|
32
|
Mahajan A, Goh V, Basu S, Vaish R, Weeks AJ, Thakur MH, Cook GJ. Bench to bedside molecular functional imaging in translational cancer medicine: to image or to imagine? Clin Radiol 2015; 70:1060-1082. [PMID: 26187890 DOI: 10.1016/j.crad.2015.06.082] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2014] [Revised: 06/03/2015] [Accepted: 06/08/2015] [Indexed: 02/05/2023]
Abstract
Ongoing research on malignant and normal cell biology has substantially enhanced the understanding of the biology of cancer and carcinogenesis. This has led to the development of methods to image the evolution of cancer, target specific biological molecules, and study the anti-tumour effects of novel therapeutic agents. At the same time, there has been a paradigm shift in the field of oncological imaging from purely structural or functional imaging to combined multimodal structure-function approaches that enable the assessment of malignancy from all aspects (including molecular and functional level) in a single examination. The evolving molecular functional imaging using specific molecular targets (especially with combined positron-emission tomography [PET] computed tomography [CT] using 2- [(18)F]-fluoro-2-deoxy-D-glucose [FDG] and other novel PET tracers) has great potential in translational research, giving specific quantitative information with regard to tumour activity, and has been of pivotal importance in diagnoses and therapy tailoring. Furthermore, molecular functional imaging has taken a key place in the present era of translational cancer research, producing an important tool to study and evolve newer receptor-targeted therapies, gene therapies, and in cancer stem cell research, which could form the basis to translate these agents into clinical practice, popularly termed "theranostics". Targeted molecular imaging needs to be developed in close association with biotechnology, information technology, and basic translational scientists for its best utility. This article reviews the current role of molecular functional imaging as one of the main pillars of translational research.
Collapse
Affiliation(s)
- A Mahajan
- Division of Imaging Sciences and Biomedical Engineering, King's College London, UK; Department of Radiodiagnosis, Tata Memorial Centre, Mumbai, 400012, India.
| | - V Goh
- Division of Imaging Sciences and Biomedical Engineering, King's College London, UK
| | - S Basu
- Radiation Medicine Centre, Bhabha Atomic Research Centre, Tata Memorial Hospital Annexe, Mumbai, 400 012, India
| | - R Vaish
- Department of Head and Neck Surgical Oncology, Tata Memorial Centre, Mumbai, 400012, India
| | - A J Weeks
- Division of Imaging Sciences and Biomedical Engineering, King's College London, UK
| | - M H Thakur
- Department of Radiodiagnosis, Tata Memorial Centre, Mumbai, 400012, India
| | - G J Cook
- Division of Imaging Sciences and Biomedical Engineering, King's College London, UK; Department of Nuclear Medicine, Guy's and St Thomas NHS Foundation Trust Hospital, London, UK
| |
Collapse
|
33
|
Ding J, Chen J, Jiang Z, Zhou H, Di J, Xing S, Xing W. Is low b-factors-based apparent diffusion coefficient helpful in assessing renal dysfunction? Radiol Med 2015; 121:6-11. [PMID: 26280633 DOI: 10.1007/s11547-015-0577-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2015] [Accepted: 07/30/2015] [Indexed: 01/14/2023]
Abstract
PURPOSE To investigate whether low b-factors-based apparent diffusion coefficient (ADC) is helpful in assessing renal dysfunction. MATERIALS AND METHODS Forty-four subjects were recruited, and classified as having severe renal injury group (sRI) or not (non-sRI) according to a threshold of estimated glomerular filtration rate (eGFR) = 30 ml/min/1.73 m(2). A free-breathing DWI with 7 b-factors (0, 20, 40, 80, 200, 400, and 800 s/mm(2)) was performed. After choosing an anatomical section that covered the largest part of right kidney, the regions of interest covered the renal parenchyma. For each subject, two apparent diffusion coefficients based on all b-factors less than 400 s/mm(2) (ADC0-400) and 800 s/mm(2) (ADC0-800) were calculated by fitting the signal intensity at different b-factors to a mono-exponential decay, respectively. It was found that the examination time of the free-breathing DWI sequence in this study can be reduced from 3.27 to 2.55 min if the b-factor (800 s/mm(2)) is removed. RESULTS ADC0-400 was larger than ADC0-800 in each group (P < 0.05). Both ADC0-400 and ADC0-800 were smaller in the sRI group than those in the non-sRI group (P < 0.01), and they were linearly related with eGFR (P < 0.05). While a significant difference was not found between the two coefficients to differentiate sRI from non-sRI participants (P > 0.05), a strong correlation was present between ADC0-400 and ADC0-800 (r = 0.856, P < 0.001). CONCLUSION The low b-factors-based ADC was an economical option for reducing the examination time without sacrificing its diagnostic performance.
Collapse
Affiliation(s)
- Jiule Ding
- Department of Radiology, Third Affiliated Hospital of Suzhou University, Changzhou, 213003, Jiangsu, China
| | - Jie Chen
- Department of Radiology, Third Affiliated Hospital of Suzhou University, Changzhou, 213003, Jiangsu, China
| | - Zhenxing Jiang
- Department of Radiology, Third Affiliated Hospital of Suzhou University, Changzhou, 213003, Jiangsu, China
| | - Hua Zhou
- Department of Nephrology, Third Affiliated Hospital of Suzhou University, Changzhou, 213003, Jiangsu, China
| | - Jia Di
- Department of Nephrology, Third Affiliated Hospital of Suzhou University, Changzhou, 213003, Jiangsu, China
| | - Shijun Xing
- Department of Radiology, Third Affiliated Hospital of Suzhou University, Changzhou, 213003, Jiangsu, China
| | - Wei Xing
- Department of Radiology, Third Affiliated Hospital of Suzhou University, Changzhou, 213003, Jiangsu, China.
| |
Collapse
|
34
|
DWI for Renal Mass Characterization: Systematic Review and Meta-Analysis of Diagnostic Test Performance. AJR Am J Roentgenol 2015. [DOI: 10.2214/ajr.14.13930] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
|
35
|
Comparison of Utility of Histogram Apparent Diffusion Coefficient and R2* for Differentiation of Low-Grade From High-Grade Clear Cell Renal Cell Carcinoma. AJR Am J Roentgenol 2015. [PMID: 26204307 DOI: 10.2214/ajr.14.13802] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
|
36
|
Sulkowska K, Palczewski P, Duda-Zysk A, Szeszkowski W, Wojcik D, Kownacka-Piotrowska D, Gołebiowski M. Diffusion-weighted MRI of kidneys in healthy volunteers and living kidney donors. Clin Radiol 2015; 70:1122-7. [PMID: 26149258 DOI: 10.1016/j.crad.2015.05.016] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2015] [Revised: 04/09/2015] [Accepted: 05/29/2015] [Indexed: 12/13/2022]
Abstract
AIM To establish the normal apparent diffusion coefficient (ADC) values in healthy kidneys, comparing them with the literature, and assessing the correlation between ADC values, creatinine blood level, and glomerular filtration rate (GFR). MATERIALS AND METHODS Twenty-four healthy volunteers and 26 living kidney donors were examined on a 1.5 T magnetic resonance imaging (MRI) unit. Two diffusion-weighted imaging (DWI) sequences were included in the study protocol (protocol 1 with 16 b-values, protocol 2 with 10 b-values) before the examination blood and urine samples were collected. The GFR was calculated using Cockcroft & Gault and MDRD (Modification of Diet In Renal Disease) formulas and the ADC values were measured separately for the cortex and medulla of each kidney by two independent observers. All statistical analyses were performed using the STATISTICA (version 10.0) software package. Data were analysed using an unpaired t-test; p < 0.05 indicated a statistically significant difference. RESULTS The average ADC value for protocol 1 for the cortex was 2.26 × 10(-3) mm(2)/s, for the medulla 2.21 × 10(-3) mm(2)/s. In protocol 2, the respective values were 2.13 × 10(-3) mm(2)/s and 2.06 × 10(-3) mm(2)/s. Neither statistically significant interobserver differences nor correlation between ADC values, GFR, and creatinine serum level were observed. CONCLUSION The reference ADC values were established. The measurements show high interobserver consistency. The differences in ADC values reported in the literature suggest dependence on the equipment and methodology and point to the necessity of obtaining ADC norms for each MRI unit.
Collapse
Affiliation(s)
- K Sulkowska
- I Department of Clinical Radiology, Warsaw Medical University, Chalubinskiego 5, 02-004 Warsaw, Poland.
| | - P Palczewski
- I Department of Clinical Radiology, Warsaw Medical University, Chalubinskiego 5, 02-004 Warsaw, Poland
| | - A Duda-Zysk
- I Department of Clinical Radiology, Warsaw Medical University, Chalubinskiego 5, 02-004 Warsaw, Poland
| | - W Szeszkowski
- II Department of Clinical Radiology, Warsaw Medical University, Banacha 1a, 02-097 Warsaw, Poland
| | - D Wojcik
- I Department of Clinical Radiology, Warsaw Medical University, Chalubinskiego 5, 02-004 Warsaw, Poland
| | - D Kownacka-Piotrowska
- I Department of Clinical Radiology, Warsaw Medical University, Chalubinskiego 5, 02-004 Warsaw, Poland
| | - M Gołebiowski
- I Department of Clinical Radiology, Warsaw Medical University, Chalubinskiego 5, 02-004 Warsaw, Poland
| |
Collapse
|
37
|
Wu GY, Suo ST, Lu Q, Zhang J, Zhu WQ, Xu JR. The value of blood oxygenation level-dependent (BOLD) MR imaging in differentiation of renal solid mass and grading of renal cell carcinoma (RCC): analysis based on the largest cross-sectional area versus the entire whole tumour. PLoS One 2015; 10:e0123431. [PMID: 25875306 PMCID: PMC4398373 DOI: 10.1371/journal.pone.0123431] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2014] [Accepted: 03/03/2015] [Indexed: 12/04/2022] Open
Abstract
Objectives To study the value of assessing renal masses using different methods in parameter approaches and to determine whether BOLD MRI is helpful in differentiating RCC from benign renal masses, differentiating clear-cell RCC from renal masses other than clear-cell RCC and determining the tumour grade. Methods Ninety-five patients with 139 renal masses (93 malignant and 46 benign) who underwent abdominal BOLD MRI were enrolled. R2* values were derived from the largest cross-section (R2*largest) and from the whole tumour (R2*whole). Intra-observer and inter-observer agreements were analysed based on two measurements by the same observer and the first measurement from each observer, respectively, and these agreements are reported with intra-class correlation coefficients and 95% confidence intervals. The diagnostic value of the R2* value in the evaluation was assessed with receiver-operating characteristic analysis. Results The intra-observer agreement was very good for R2*largest and R2*whole (all > 0.8). The inter-observer agreement of R2*whole (0.75, 95% confidence interval: 0.69~0.79) was good and was significantly improved compared with the R2*largest (0.61, 95% confidence interval: 0.52~0.68), as there was no overlap in the 95% confidence interval of the intra-class correlation coefficients. The diagnostic value in differentiating renal cell carcinoma from benign lesions with R2*whole (AUC=0.79/0.78[observer1/observer2]) and R2*largest (AUC=0.75[observer1]) was good and significantly higher (p=0.01 for R2*largest[observer2] vs R2*whole[observer2], p<0.01 for R2*whole[observer1] vs R2*largest[observer2]) than R2*largest for observer 2 (AUC=0.64). For the grading of clear-cell RCC, both R2*whole and R2*largest were good (all > 0.7) and were not significantly different (p=0.89/0.93 for R2*largest vs R2*whole[observer1/observer2], 0.96 for R2*whole[observer1] vs R2*largest[observer2] and 0.96 for R2*whole [observer2] vs R2*largest[observer1]). Conclusions BOLD MRI could provide a feasible parameter for differentiating renal cell carcinoma from benign renal masses and for predicting clear-cell renal cell carcinoma grading. Compared with the largest cross-section, assessing the whole tumour provides better inter-observer agreement in parameter measurement for differentiating renal cell carcinoma from benign renal masses.
Collapse
Affiliation(s)
- Guang-yu Wu
- Department of Radiology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Pudong, Shanghai, China
| | - Shi-teng Suo
- Department of Radiology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Pudong, Shanghai, China
| | - Qing Lu
- Department of Radiology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Pudong, Shanghai, China
| | - Jin Zhang
- Department of Urology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Pudong, Shanghai, China
| | - Wan-qiu Zhu
- Department of Radiology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Pudong, Shanghai, China
| | - Jian-rong Xu
- Department of Radiology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Pudong, Shanghai, China
- * E-mail:
| |
Collapse
|