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Eldihimi F, Walsh C, Hibbert RM, Nasibi KA, Pickovsky JS, Schieda N. Evaluation of a multiparametric renal CT algorithm for diagnosis of clear-cell renal cell carcinoma among small (≤ 4 cm) solid renal masses. Eur Radiol 2023:10.1007/s00330-023-10434-4. [PMID: 37968475 DOI: 10.1007/s00330-023-10434-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 08/11/2023] [Accepted: 09/13/2023] [Indexed: 11/17/2023]
Abstract
OBJECTIVE To evaluate a recently proposed CT-based algorithm for diagnosis of clear-cell renal cell carcinoma (ccRCC) among small (≤ 4 cm) solid renal masses diagnosed by renal mass biopsy. METHODS This retrospective study included 51 small renal masses in 51 patients with renal-mass CT and biopsy between 2014 and 2021. Three radiologists independently evaluated corticomedullary phase CT for the following: heterogeneity and attenuation ratio (mass:renal cortex), which were used to inform the CT score (1-5). CT score ≥ 4 was considered positive for ccRCC. Diagnostic accuracy was calculated for each reader and overall using fixed effects logistic regression modelling. RESULTS There were 51% (26/51) ccRCC and 49% (25/51) other masses. For diagnosis of ccRCC, area under curve (AUC), sensitivity, specificity, and positive predictive value (PPV) were 0.69 (95% confidence interval 0.61-0.76), 78% (68-86%), 59% (46-71%), and 67% (54-79%), respectively. CT score ≤ 2 had a negative predictive value 97% (92-99%) to exclude diagnosis of ccRCC. For diagnosis of papillary renal cell carcinoma (pRCC), CT score ≤ 2, AUC, sensitivity, specificity, and PPV were 0.89 (0.81-0.98), 81% (58-94%), 98% (93-99%), and 85% (62-97%), respectively. Pooled inter-observer agreement for CT scoring was moderate (Fleiss weighted kappa = 0.52). CONCLUSION The CT scoring system for prediction of ccRCC was sensitive with a high negative predictive value and moderate agreement. The CT score is highly specific for diagnosis of pRCC. CLINICAL RELEVANCE STATEMENT The CT score algorithm may help guide renal mass biopsy decisions in clinical practice, with high sensitivity to identify clear-cell tumors for biopsy to establish diagnosis and grade and high specificity to avoid biopsy in papillary tumors. KEY POINTS • A CT score ≥ 4 had high sensitivity and negative predictive value for diagnosis of clear-cell renal cell carcinoma (RCC) among solid ≤ 4-cm renal masses. • A CT score ≤ 2 was highly specific for diagnosis of papillary RCC among solid ≤ 4-cm renal masses. • Inter-observer agreement for CT score was moderate.
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Affiliation(s)
- Fatma Eldihimi
- Department of Medical Imaging, The Ottawa Hospital, 1053 Carling Avenue, Room C159, Ottawa, ON, K1Y 4E9, Canada
| | - Cynthia Walsh
- Department of Medical Imaging, The Ottawa Hospital, 1053 Carling Avenue, Room C159, Ottawa, ON, K1Y 4E9, Canada
| | - Rebecca M Hibbert
- Department of Medical Imaging, The Ottawa Hospital, 1053 Carling Avenue, Room C159, Ottawa, ON, K1Y 4E9, Canada
| | - Khalid Al Nasibi
- Department of Medical Imaging, The Ottawa Hospital, 1053 Carling Avenue, Room C159, Ottawa, ON, K1Y 4E9, Canada
| | - Jana Sheinis Pickovsky
- Department of Medical Imaging, The Ottawa Hospital, 1053 Carling Avenue, Room C159, Ottawa, ON, K1Y 4E9, Canada
| | - Nicola Schieda
- Department of Medical Imaging, The Ottawa Hospital, 1053 Carling Avenue, Room C159, Ottawa, ON, K1Y 4E9, Canada.
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Schieda N, Davenport MS, Silverman SG, Bagga B, Barkmeier D, Blank Z, Curci NE, Doshi AM, Downey RT, Edney E, Granader E, Gujrathi I, Hibbert RM, Hindman N, Walsh C, Ramsay T, Shinagare AB, Pedrosa I. Multicenter Evaluation of Multiparametric MRI Clear Cell Likelihood Scores in Solid Indeterminate Small Renal Masses. Radiology 2023; 306:e239001. [PMID: 36803006 DOI: 10.1148/radiol.239001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
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Schieda N, Davenport MS, Silverman SG, Bagga B, Barkmeier D, Blank Z, Curci NE, Doshi A, Downey R, Edney E, Granader E, Gujrathi I, Hibbert RM, Hindman N, Walsh C, Ramsay T, Shinagare AB, Pedrosa I. Multicenter Evaluation of Multiparametric MRI Clear Cell Likelihood Scores in Solid Indeterminate Small Renal Masses. Radiology 2022; 303:590-599. [PMID: 35289659 PMCID: PMC9794383 DOI: 10.1148/radiol.211680] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Background Solid small renal masses (SRMs) (≤4 cm) represent benign and malignant tumors. Among SRMs, clear cell renal cell carcinoma (ccRCC) is frequently aggressive. When compared with invasive percutaneous biopsies, the objective of the proposed clear cell likelihood score (ccLS) is to classify ccRCC noninvasively by using multiparametric MRI, but it lacks external validation. Purpose To evaluate the performance of and interobserver agreement for ccLS to diagnose ccRCC among solid SRMs. Materials and Methods This retrospective multicenter cross-sectional study included patients with consecutive solid (≥25% approximate volume enhancement) SRMs undergoing multiparametric MRI between December 2012 and December 2019 at five academic medical centers with histologic confirmation of diagnosis. Masses with macroscopic fat were excluded. After a 1.5-hour training session, two abdominal radiologists per center independently rendered a ccLS for 50 masses. The diagnostic performance for ccRCC was calculated using random-effects logistic regression modeling. The distribution of ccRCC by ccLS was tabulated. Interobserver agreement for ccLS was evaluated with the Fleiss κ statistic. Results A total of 241 patients (mean age, 60 years ± 13 [SD]; 174 men) with 250 solid SRMs were evaluated. The mean size was 25 mm ± 8 (range, 10-39 mm). Of the 250 SRMs, 119 (48%) were ccRCC. The sensitivity, specificity, and positive predictive value for the diagnosis of ccRCC when ccLS was 4 or higher were 75% (95% CI: 68, 81), 78% (72, 84), and 76% (69, 81), respectively. The negative predictive value of a ccLS of 2 or lower was 88% (95% CI: 81, 93). The percentages of ccRCC according to the ccLS were 6% (range, 0%-18%), 38% (range, 0%-100%), 32% (range, 60%-83%), 72% (range, 40%-88%), and 81% (range, 73%-100%) for ccLSs of 1-5, respectively. The mean interobserver agreement was moderate (κ = 0.58; 95% CI: 0.42, 0.75). Conclusion The clear cell likelihood score applied to multiparametric MRI had moderate interobserver agreement and differentiated clear cell renal cell carcinoma from other solid renal masses, with a negative predictive value of 88%. © RSNA, 2022 Online supplemental material is available for this article. See also the editorial by Mileto and Potretzke in this issue.
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Affiliation(s)
- Nicola Schieda
- Department of Medical Imaging, The Ottawa Hospital, University of Ottawa. Ottawa, Ontario, Canada
| | | | - Stuart G. Silverman
- Department of Radiology, Brigham and Women’s Hospital. Harvard Medical School Boston, MA
| | - Barun Bagga
- Department of Radiology, NYU Langone Medical Center. New York, NY, USA
| | - Daniel Barkmeier
- Department of Radiology, University of Michigan. Ann Arbor, MI, USA
| | - Zane Blank
- Department of Radiology. University of Nebraska Medical Center. Omaha, Nebraska
| | - Nicole E Curci
- Department of Radiology, University of Michigan. Ann Arbor, MI, USA
| | - Ankur Doshi
- Department of Radiology. NYU Langone Medical Center. New York, NY, USA
| | - Ryan Downey
- Department of Radiology. University of Nebraska Medical Center. Omaha, Nebraska
| | - Elizabeth Edney
- Department of Radiology. University of Nebraska Medical Center. Omaha, Nebraska
| | - Elon Granader
- Department of Radiology. University of Nebraska Medical Center. Omaha, Nebraska
| | - Isha Gujrathi
- Department of Radiology, Brigham and Women’s Hospital. Harvard Medical School Boston, MA
| | - Rebecca M. Hibbert
- Department of Medical Imaging, The Ottawa Hospital, University of Ottawa. Ottawa, Ontario, Canada
| | - Nicole Hindman
- Department of Radiology. NYU Langone Medical Center, New York, NY, USA
| | - Cynthia Walsh
- Department of Medical Imaging, The Ottawa Hospital, University of Ottawa. Ottawa, Ontario, Canada
| | - Tim Ramsay
- Ottawa Hospital Research Institute. Ottawa, Ontario, Canada
| | - Atul B. Shinagare
- Department of Radiology, Brigham and Women’s Hospital. Harvard Medical School Boston, MA
| | - Ivan Pedrosa
- University of Texas Southwestern Medical Center. Dallas, TX
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Haroon M, Sathiadoss P, Hibbert RM, Jeyaraj SK, Lim C, Schieda N. Imaging considerations for thermal and radiotherapy ablation of primary and metastatic renal cell carcinoma. Abdom Radiol (NY) 2021; 46:5386-5407. [PMID: 34245341 DOI: 10.1007/s00261-021-03178-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 06/09/2021] [Accepted: 06/10/2021] [Indexed: 10/20/2022]
Abstract
Ablative (percutaneous and stereotactic) thermal and radiotherapy procedures for management of both primary and metastatic renal cell carcinoma are increasing in popularity in clinical practice. Data suggest comparable efficacy with lower cost and morbidity compared to nephrectomy. Ablative therapies may be used alone or in conjunction with surgery or chemotherapy for treatment of primary tumor and metastatic disease. Imaging plays a crucial role in pre-treatment selection and planning of ablation, intra-procedural guidance, evaluation for complications, short- and long-term post-procedural surveillance of disease, and treatment response. Treatment response and disease recurrence may differ considerably after ablation, particularly for stereotactic radiotherapy, when compared to conventional surgical and chemotherapies. This article reviews the current and emerging role of imaging for ablative therapy of renal cell carcinoma.
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Jibri ZA, Hibbert RM, Rakhra KS. Cadaveric Simulation Training Improves Residents' Knowledge and Confidence in Performing Fluoroscopic Guided Joint Injections. Acad Radiol 2021; 28:877-882. [PMID: 32739075 DOI: 10.1016/j.acra.2020.07.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 07/09/2020] [Accepted: 07/11/2020] [Indexed: 10/23/2022]
Abstract
RATIONALE AND OBJECTIVE Simulation training has been strongly encouraged to enhance radiology trainees' procedural competency. We aimed to assess whether a cadaveric simulation training session was effective in improving radiology residents' subjective technical ability, knowledge and confidence in performing fluoroscopic-guided joint injections. METHODS As part of the residency program's procedural training curriculum, first year radiology resident participated in a cadaveric, musculoskeletal injection training session including a didactic lecture followed by a practical hands-on component. Trainees performed fluoroscopic guided hip and shoulder injections on fresh cadavers, supervised by two fellowship-trained musculoskeletal radiologists. Trainees' knowledge on indications, contraindications, preprocedural care, complications, and technical ability in performing the procedures, as well as their rating of overall session experience were evaluated with pre- and post-session questionnaires (5 point Likert-scale). The mean residents' scores for pre- and post-session questionnaire items were calculated and compared using paired t-test. The magnitude of difference between mean pre- and post-session scores was compared between the items using analysis of variance. RESULTS Results Over a 5-year period, 27 trainees participated in the joint injection simulation session. The mean pre- and post-session scores were significantly higher in the post session questionnaire for all five items pertaining to knowledge of indications, contraindications, preprocedural care, complications, and technical ability (all p < 0.0001). The magnitude of improvement was not different between the items (p = 0.45). Most of the participants rated the training facilities, contents, hands-on experience, teaching quality, and session organization as very good or excellent. CONCLUSIONS Cadaveric joint injection simulation training significantly improved trainees' subjective knowledge, confidence, and technical ability in performing joint injections.
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Miao TL, Kielar AZ, Hibbert RM, Schieda N. Utility of T1-weighted MRI as a predictor of liver lesion visibility on ultrasound: A clinical tool to determine feasibility of ultrasound-guided percutaneous interventions. Eur J Radiol 2017; 90:256-261. [PMID: 28583643 DOI: 10.1016/j.ejrad.2017.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2016] [Revised: 03/03/2017] [Accepted: 03/12/2017] [Indexed: 10/19/2022]
Abstract
PURPOSE To determine the utility of fat-suppressed T1-weighted gradient recalled echo (FS-T1W-GRE) MRI to predict visibility of focal liver lesions (FLL) on abdominal ultrasound (US). MATERIALS AND METHODS With IRB approval, between 2010 and 2013, 109 patients (28.4% females, age 66.9±10.9years) with 177 FLL (hepatocellular carcinoma=132, metastases=44, other=1) underwent MRI and prospective, radiologist-performed treatment-planning US (to determine eligibility for US-guided ablation). MRI examinations were reviewed by a blinded radiologist who assessed: a) size and location of FLL, b) presence of hepatic steatosis on dual-echo T1W-GRE, and c) quantitative signal intensity of FLL relative to liver on FS-T1W-GRE. Associations between MR imaging findings and visibility on US were assessed using independent t-tests and the chi-squares test. RESULTS 69.5% (123/177) FLL were identified with US and 30.5% (54/177) were not visible. Size of FLL on MRI was associated with visibility on US (p<0.0001) with no association between FLL visibility on US and segmental or subcapsular location (p=0.29 and p=0.25, respectively). 20.2% (22/109) patients had hepatic steatosis on MRI, which was not associated with non-visibility of FLL on US (p=0.67). 38.4% (68/177) FLL were isointense to liver on FS-T1W-GRE which was associated with non-visibility on US (p=0.036) particularly in non-steatotic livers (p=0.014). CONCLUSION FLL size and isointensity of FLL to liver parenchyma on FS-T1W-GRE MRI are associated with non-visibility on US, particularly in non-steatotic livers. These results have implications when planning US-guided percutaneous interventions of FLL detected with MRI.
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Affiliation(s)
- Timothy L Miao
- Faculty of Medicine, University of Ottawa, 451 Smyth Road, Ottawa, ON, K1H 8M5, Canada
| | - Ania Z Kielar
- Department of Medical Imaging, The Ottawa Hospital-Civic Campus, C1, 1053 Carling Avenue, Ottawa, ON, K1R 4E9, Canada; Ottawa Hospital Research Institute, 725 Parkdale Avenue, Ottawa, ON, K1Y 4E9, Canada.
| | - Rebecca M Hibbert
- Department of Medical Imaging, The Ottawa Hospital-Civic Campus, C1, 1053 Carling Avenue, Ottawa, ON, K1R 4E9, Canada
| | - Nicola Schieda
- Department of Medical Imaging, The Ottawa Hospital-Civic Campus, C1, 1053 Carling Avenue, Ottawa, ON, K1R 4E9, Canada; Ottawa Hospital Research Institute, 725 Parkdale Avenue, Ottawa, ON, K1Y 4E9, Canada
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McInnes MDF, Hibbert RM, Inácio JR, Schieda N. Focal Nodular Hyperplasia and Hepatocellular Adenoma: Accuracy of Gadoxetic Acid–enhanced MR Imaging—A Systematic Review. Radiology 2015; 277:927. [DOI: 10.1148/radiol.2015154033] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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McInnes MDF, Hibbert RM, Inácio JR, Schieda N. Focal Nodular Hyperplasia and Hepatocellular Adenoma: Accuracy of Gadoxetic Acid-enhanced MR Imaging--A Systematic Review. Radiology 2015; 277:413-23. [PMID: 26020440 DOI: 10.1148/radiol.2015142986] [Citation(s) in RCA: 65] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
PURPOSE To perform a systematic review to evaluate the diagnostic accuracy of hepatobiliary (HPB) phase gadoxetic acid-enhanced MR imaging of the liver in the diagnosis of focal nodular hyperplasia (FNH) versus hepatocellular adenoma (HCA) and to identify the rate of (a) reported HCAs that are iso- or hyperintense to liver and (b) reported FNHs that are hypointense to liver on HPB phase MR images. MATERIALS AND METHODS The institutional review board granted a waiver for this study type, and multiple databases were searched for studies in which researchers distinguished between FNH and HCA with gadoxetic acid-enhanced MR imaging. Studies to evaluate diagnostic accuracy were included; case reports and series were included to analyze the rate of iso- or hyperintense HCAs on HPB phase MR images. Risk of bias was assessed by using the Quality Assessment Tool for Diagnostic Accuracy Studies-2. Sensitivity and specificity were plotted with a forest plot; pooling was not performed because a small number of heterogeneous studies were included. Rate of iso- or hyperintense HCA on HPB phase gadoxetic acid-enhanced MR images was evaluated. RESULTS Six studies (309 patients; 164 with HCA, 233 with FNH) were included for diagnostic accuracy assessment. Twelve case series (129 patients; 81 with HCA, 70 with FNH) were included (studies with insufficient 2 × 2 table data for diagnostic accuracy assessment). Sensitivity was high (range, 0.91-1.00; lower margin of the 95% confidence interval: 0.77). Specificity was high (range, 0.87-1.00; lower margin of the 95% confidence interval: 0.54). Specificity was lowest among studies in which molecular subtyping of HCA was performed. Rate of iso-or hyperintensity of HCA on HPB phase MR images was variable (range, 0%-67%) and occurred more frequently in the inflammatory subtype. High risk of bias was identified in the domains of patient selection and reference standard. CONCLUSION The reported diagnostic accuracy of HPB phase gadoxetic acid-enhanced MR imaging in the diagnosis of HCA versus FNH is high; however, studies are few, heterogeneous, and at high risk for bias, indicating that diagnostic accuracy may be overestimated.
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Affiliation(s)
- Matthew D F McInnes
- From the Department of Radiology, Clinical Epidemiology Program, University of Ottawa, Ottawa Hospital Research Institute, 1053 Carling Ave, Ottawa Hospital Civic Campus, Room c159, Ottawa ON, Canada K1Y 4E9
| | - Rebecca M Hibbert
- From the Department of Radiology, Clinical Epidemiology Program, University of Ottawa, Ottawa Hospital Research Institute, 1053 Carling Ave, Ottawa Hospital Civic Campus, Room c159, Ottawa ON, Canada K1Y 4E9
| | - João R Inácio
- From the Department of Radiology, Clinical Epidemiology Program, University of Ottawa, Ottawa Hospital Research Institute, 1053 Carling Ave, Ottawa Hospital Civic Campus, Room c159, Ottawa ON, Canada K1Y 4E9
| | - Nicola Schieda
- From the Department of Radiology, Clinical Epidemiology Program, University of Ottawa, Ottawa Hospital Research Institute, 1053 Carling Ave, Ottawa Hospital Civic Campus, Room c159, Ottawa ON, Canada K1Y 4E9
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Affiliation(s)
- Ania Z Kielar
- Department of Radiology, University of Ottawa, Ottawa, Ontario, Canada
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Hibbert RM, Atwell TD, Lekah A, Patel MD, Carter RE, McDonald JS, Rabatin JT. Safety of Ultrasound-Guided Thoracentesis in Patients With Abnormal Preprocedural Coagulation Parameters. Chest 2013; 144:456-463. [DOI: 10.1378/chest.12-2374] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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