1
|
Keskin Z, Keskin S. Shear wave elastography in the characterization of renal cell carcinoma and angiomyolipoma. Acta Radiol 2023; 64:1272-1279. [PMID: 35938612 DOI: 10.1177/02841851221118473] [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] [Indexed: 11/17/2022]
Abstract
BACKGROUND Detection and characterization of renal lesions are common in daily clinical practice. PURPOSE To investigate the effectiveness of shear wave elastography (SWE), a novel radiological examination technique, in the characterization of renal masses. MATERIAL AND METHODS The study included a total of 68 patients (33 men, 35 women; mean age = 57.71 ± 12.08 years; age range = 19-83 years) who underwent SWE. SWE measurements were obtained at depths of 2-8 cm from the probe surface in two different positions from an analysis window of approximately 0.5 × 1.0 cm on ultrasound. The cutoff SWE was calculated for the differentiation of renal cell carcinoma (RCC) and angiomyolipoma (AML) by receiver operating characteristic (ROC) analysis. When the result was statistically significant, the sensitivity, specificity, accuracy, and positive and negative predictive values of the test were calculated. RESULTS Mass-to-parenchyma SWE ratios of RCCs were significantly higher than those of AMLs (P = 0.003). In ROC curve analysis, the SWE cutoff was 1.215 m/s to differentiate RCCs from AMLs. The area under the ROC curve was calculated as 0.74 (95% CI = 0.610-0.871, sensitivity = 70.7%, specificity = 70.6%, positive predictive value = 87.8%, negative predictive value = 44.4%). CONCLUSION The SWE technique is increasingly used and may be useful in distinguishing RCC and AML lesions, and especially clear cell and non-clear cell RCCs.
Collapse
Affiliation(s)
- Zeynep Keskin
- Department of Radiology, 591703Konya City Hospital, Konya, Turkey
| | - Suat Keskin
- Department of Radiology, Karatay School of Medicine, Medicana Hospital, Konya, Turkey
| |
Collapse
|
2
|
Elastography in the Urological Practice: Urinary and Male Genital Tract, Prostate Excluded—Review. Diagnostics (Basel) 2022; 12:diagnostics12071727. [PMID: 35885631 PMCID: PMC9320571 DOI: 10.3390/diagnostics12071727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2022] [Revised: 07/08/2022] [Accepted: 07/12/2022] [Indexed: 11/16/2022] Open
Abstract
The aim of this article is to review the utility of elastography in the day-to-day clinical practice of the urologist. An electronic database search was performed on PubMed and Cochrane Library with a date range between January 2000 and December 2021. The search yielded 94 articles that passed the inclusion and exclusion criteria. The articles were reviewed and discussed by organ, pathology and according to the physical principle underlying the elastographic method. Elastography was used in the study of normal organs, tumoral masses, chronic upper and lower urinary tract obstructive diseases, dysfunctions of the lower urinary tract and the male reproductive system, and as a pre- and post-treatment monitoring tool. Elastography has numerous applications in urology, but due to a lack of standardization in the methodology and equipment, further studies are required.
Collapse
|
3
|
Aggarwal A, Das CJ, Sharma S. Recent advances in imaging techniques of renal masses. World J Radiol 2022; 14:137-150. [PMID: 35978979 PMCID: PMC9258310 DOI: 10.4329/wjr.v14.i6.137] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 03/04/2022] [Accepted: 06/17/2022] [Indexed: 02/06/2023] Open
Abstract
Multiphasic multidetector computed tomography (CT) forms the mainstay for the characterization of renal masses whereas magnetic resonance imaging (MRI) acts as a problem-solving tool in some cases. However, a few of the renal masses remain indeterminate even after evaluation by conventional imaging methods. To overcome the deficiency in current imaging techniques, advanced imaging methods have been devised and are being tested. This review will cover the role of contrast-enhanced ultrasonography, shear wave elastography, dual-energy CT, perfusion CT, MR perfusion, diffusion-weighted MRI, blood oxygen level-dependent MRI, MR spectroscopy, positron emission tomography (PET)/prostate-specific membrane antigen-PET in the characterization of renal masses.
Collapse
Affiliation(s)
- Ankita Aggarwal
- Department of Radiology, Vardhman Mahavir Medical College& Safdarjung Hospital, Delhi 110029, India
| | - Chandan J Das
- Department of Radiodiagnosis and Interventional Radiology, All India Institute of Medical Sciences, Delhi 110029, India
| | - Sanjay Sharma
- Department of Radiology (RPC), All India Institute of Medical Sciences, New Delhi 110029, India
| |
Collapse
|
4
|
Roussel E, Campi R, Amparore D, Bertolo R, Carbonara U, Erdem S, Ingels A, Kara Ö, Marandino L, Marchioni M, Muselaers S, Pavan N, Pecoraro A, Beuselinck B, Pedrosa I, Fetzer D, Albersen M. Expanding the Role of Ultrasound for the Characterization of Renal Masses. J Clin Med 2022; 11:jcm11041112. [PMID: 35207384 PMCID: PMC8876198 DOI: 10.3390/jcm11041112] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Revised: 02/16/2022] [Accepted: 02/17/2022] [Indexed: 02/01/2023] Open
Abstract
The incidental detection of renal masses has been steadily rising. As a significant proportion of renal masses that are surgically treated are benign or indolent in nature, there is a clear need for better presurgical characterization of renal masses to minimize unnecessary harm. Ultrasound is a widely available and relatively inexpensive real-time imaging technique, and novel ultrasound-based applications can potentially aid in the non-invasive characterization of renal masses. Evidence acquisition: We performed a narrative review on novel ultrasound-based techniques that can aid in the non-invasive characterization of renal masses. Evidence synthesis: Contrast-enhanced ultrasound (CEUS) adds significant diagnostic value, particularly for cystic renal masses, by improving the characterization of fine septations and small nodules, with a sensitivity and specificity comparable to magnetic resonance imaging (MRI). Additionally, the performance of CEUS for the classification of benign versus malignant renal masses is comparable to that of computed tomography (CT) and MRI, although the imaging features of different tumor subtypes overlap significantly. Ultrasound molecular imaging with targeted contrast agents is being investigated in preclinical research as an addition to CEUS. Elastography for the assessment of tissue stiffness and micro-Doppler imaging for the improved detection of intratumoral blood flow without the need for contrast are both being investigated for the characterization of renal masses, though few studies have been conducted and validation is lacking. Conclusions: Several novel ultrasound-based techniques have been investigated for the non-invasive characterization of renal masses. CEUS has several advantages over traditional grayscale ultrasound, including the improved characterization of cystic renal masses and the potential to differentiate benign from malignant renal masses to some extent. Ultrasound molecular imaging offers promise for serial disease monitoring and the longitudinal assessment of treatment response, though this remains in the preclinical stages of development. While elastography and emerging micro-Doppler techniques have shown some encouraging applications, they are currently not ready for widespread clinical use.
Collapse
Affiliation(s)
- Eduard Roussel
- Department of Urology, University Hospitals Leuven, 3000 Leuven, Belgium;
- Correspondence:
| | - Riccardo Campi
- Unit of Urological Robotic Surgery and Renal Transplantation, Careggi Hospital, University of Florence, 50134 Firenze, Italy;
| | - Daniele Amparore
- Department of Urology, San Luigi Gonzaga Hospital, University of Turin, 10043 Orbassano, Italy; (D.A.); (A.P.)
| | - Riccardo Bertolo
- Department of Urology, San Carlo Di Nancy Hospital, 00165 Rome, Italy;
| | - Umberto Carbonara
- Department of Emergency and Organ Transplantation-Urology, Andrology and Kidney Transplantation Unit, University of Bari, 70121 Bari, Italy;
| | - Selcuk Erdem
- Division of Urologic Oncology, Department of Urology, Istanbul University Istanbul Faculty of Medicine, 34093 Istanbul, Turkey;
| | - Alexandre Ingels
- Department of Urology, University Hospital Henri Mondor, 94000 Créteil, France;
| | - Önder Kara
- Department of Urology, Kocaeli University School of Medicine, 41001 Kocaeli, Turkey;
| | - Laura Marandino
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133 Milan, Italy;
| | - Michele Marchioni
- Department of Medical, Oral and Biotechnological Sciences, G. d’Annunzio University of Chieti, 66100 Chieti, Italy;
| | - Stijn Muselaers
- Department of Urology, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands;
| | - Nicola Pavan
- Urology Clinic, Department of Medical, Surgical and Health Science, University of Trieste, 34127 Trieste, Italy;
| | - Angela Pecoraro
- Department of Urology, San Luigi Gonzaga Hospital, University of Turin, 10043 Orbassano, Italy; (D.A.); (A.P.)
| | - Benoit Beuselinck
- Department of General Medical Oncology, University Hospitals Leuven, 3000 Leuven, Belgium;
| | - Ivan Pedrosa
- Department of Radiology, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA; (I.P.); (D.F.)
- Advanced Imaging Research Center, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA
| | - David Fetzer
- Department of Radiology, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA; (I.P.); (D.F.)
| | - Maarten Albersen
- Department of Urology, University Hospitals Leuven, 3000 Leuven, Belgium;
| | | |
Collapse
|
5
|
Sagreiya H, Akhbardeh A, Li D, Sigrist R, Chung BI, Sonn GA, Tian L, Rubin DL, Willmann JK. Point Shear Wave Elastography Using Machine Learning to Differentiate Renal Cell Carcinoma and Angiomyolipoma. ULTRASOUND IN MEDICINE & BIOLOGY 2019; 45:1944-1954. [PMID: 31133445 PMCID: PMC6689386 DOI: 10.1016/j.ultrasmedbio.2019.04.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Revised: 03/31/2019] [Accepted: 04/03/2019] [Indexed: 05/09/2023]
Abstract
The question of whether ultrasound point shear wave elastography can differentiate renal cell carcinoma (RCC) from angiomyolipoma (AML) is controversial. This study prospectively enrolled 51 patients with 52 renal tumors (42 RCCs, 10 AMLs). We obtained 10 measurements of shear wave velocity (SWV) in the renal tumor, cortex and medulla. Median SWV was first used to classify RCC versus AML. Next, the prediction accuracy of 4 machine learning algorithms-logistic regression, naïve Bayes, quadratic discriminant analysis and support vector machines (SVMs)-was evaluated, using statistical inputs from the tumor, cortex and combined statistical inputs from tumor, cortex and medulla. After leave-one-out cross validation, models were evaluated using the area under the receiver operating characteristic (ROC) curve (AUC). Tumor median SWV performed poorly (AUC = 0.62; p = 0.23). Except logistic regression, all machine learning algorithms reached statistical significance using combined statistical inputs (AUC = 0.78-0.98; p < 7.1 × 10-3). SVMs demonstrated 94% accuracy (AUC = 0.98; p = 3.13 × 10-6) and clearly outperformed median SWV in differentiating RCC from AML (p = 2.8 × 10-4).
Collapse
Affiliation(s)
- Hersh Sagreiya
- Department of Radiology, Stanford University School of Medicine, Stanford, CA, USA
| | - Alireza Akhbardeh
- Department of Radiology, Stanford University School of Medicine, Stanford, CA, USA
| | - Dandan Li
- Department of Radiology, Stanford University School of Medicine, Stanford, CA, USA
| | - Rosa Sigrist
- Department of Radiology, Stanford University School of Medicine, Stanford, CA, USA
| | - Benjamin I Chung
- Department of Urology, Stanford University School of Medicine, Stanford, CA, USA
| | - Geoffrey A Sonn
- Department of Radiology, Stanford University School of Medicine, Stanford, CA, USA; Department of Urology, Stanford University School of Medicine, Stanford, CA, USA
| | - Lu Tian
- Department of Health, Research & Policy, Stanford University, Stanford, CA, USA
| | - Daniel L Rubin
- Department of Radiology, Stanford University School of Medicine, Stanford, CA, USA; Department of Biomedical Data Science, Stanford University, Stanford, CA, USA; Department of Medicine (Biomedical Informatics Research), Stanford University, Stanford, CA, USA.
| | - Jürgen K Willmann
- Department of Radiology, Stanford University School of Medicine, Stanford, CA, USA
| |
Collapse
|
6
|
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: 1.0] [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
|