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Ng J, Loukogeorgakis S, Sanna E, Derwig I, Yu C, Paramasivam G, Lees C, Farrugia MK. Postnatal outcome of prenatally-detected "simple" renal cysts: Are they really simple? Early Hum Dev 2021; 157:105382. [PMID: 33964640 DOI: 10.1016/j.earlhumdev.2021.105382] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 04/12/2021] [Accepted: 04/26/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND The majority of simple renal cysts diagnosed postnatally are asymptomatic and rarely require treatment unless they become symptomatic or complex. We hypothesised that prenatally-detected simple renal cysts would have a similar harmless outcome. AIMS To establish the natural history and postnatal outcome of prenatally-diagnosed simple renal cysts. STUDY DESIGN Single-centre retrospective case-series review (12-year period). SUBJECTS All patients with prenatally-diagnosed simple renal cysts (defined as a solitary, non-septated, non-communicating cyst in an otherwise normal kidney). OUTCOME MEASURES Prenatal and postnatal changes to cyst size, persistence, resolution or modification of diagnosis. Data is presented as the proportion of patients or median (range). RESULTS 30 cysts were detected (2 bilateral, 26 unilateral) in 28 fetuses (median gestational age of 23 [20-36] weeks). Median maximum diameter was 15 (4-35) mm at initial diagnosis and 17.5 (4-100) mm across all prenatal scans. On follow-up scans diagnosis was modified in 16 (53%) to: multicystic dysplastic kidney (MCDK), dilated duplex kidney, hydronephrosis, urinoma, renal agenesis and adrenal mass. 12 (40%) cysts resolved. 2 (7%) asymptomatic cysts persisted at one year postnatally. Cyst maximum diameter in the modified diagnosis group (21.5 [10-100] mm) was significantly larger than the simple cyst group (12 [4-20] mm) (P = 0.03). CONCLUSIONS Our study revealed the challenges of prenatal ultrasound imaging, with modified diagnoses in over half the cases. Kidneys with solitary cysts could evolve into multicystic kidneys or involute completely, which suggests a true alteration in morphology rather than sonographic error. Persistent simple cysts in an otherwise normal kidney, however, resolved spontaneously or remained asymptomatic. Prenatally-detected simple cysts should be monitored with serial imaging.
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Affiliation(s)
- Jessica Ng
- Department of Paediatric Surgery and Urology, Chelsea and Westminster Hospital NHS Foundation Trust, 369 Fulham Road, London SW10 9NH, UK.
| | - Stavros Loukogeorgakis
- Department of Paediatric Surgery and Urology, Chelsea and Westminster Hospital NHS Foundation Trust, 369 Fulham Road, London SW10 9NH, UK.
| | - Elisabetta Sanna
- Centre for Fetal Care, Queen Charlotte's and Chelsea Hospital, Imperial College Healthcare NHS Trust, Du Cane Road, London W12 0HS, UK.
| | - Iris Derwig
- Centre for Fetal Care, Queen Charlotte's and Chelsea Hospital, Imperial College Healthcare NHS Trust, Du Cane Road, London W12 0HS, UK.
| | - Christina Yu
- Centre for Fetal Care, Queen Charlotte's and Chelsea Hospital, Imperial College Healthcare NHS Trust, Du Cane Road, London W12 0HS, UK.
| | - Gowri Paramasivam
- Centre for Fetal Care, Queen Charlotte's and Chelsea Hospital, Imperial College Healthcare NHS Trust, Du Cane Road, London W12 0HS, UK.
| | - Christoph Lees
- Centre for Fetal Care, Queen Charlotte's and Chelsea Hospital, Imperial College Healthcare NHS Trust, Du Cane Road, London W12 0HS, UK; Department of Developmental Biology, Faculty of Medicine, Imperial College London, South Kensington, London SW7 2AZ, UK.
| | - Marie-Klaire Farrugia
- Department of Paediatric Surgery and Urology, Chelsea and Westminster Hospital NHS Foundation Trust, 369 Fulham Road, London SW10 9NH, UK; Centre for Fetal Care, Queen Charlotte's and Chelsea Hospital, Imperial College Healthcare NHS Trust, Du Cane Road, London W12 0HS, UK.
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Ercolani G, Capuani S, Antonelli A, Camilli A, Ciulla S, Petrillo R, Satta S, Grimm R, Giancotti A, Ricci P, Catalano C, Manganaro L. IntraVoxel Incoherent Motion (IVIM) MRI of fetal lung and kidney: Can the perfusion fraction be a marker of normal pulmonary and renal maturation? Eur J Radiol 2021; 139:109726. [PMID: 33895624 DOI: 10.1016/j.ejrad.2021.109726] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 03/30/2021] [Accepted: 04/14/2021] [Indexed: 12/29/2022]
Abstract
PURPOSE To investigate the use of IntraVoxel Incoherent Motion (IVIM) MRI in the study of microstructural tissue changes occurring in fetal lung and kidney during gestation. METHODS 34 normal pregnancies were enrolled. Patients were divided into two groups based on gestational age (GA): group A (21-29 weeks) and group B (30-39 weeks). MR examinations were performed at 1.5T, with a standard fetal MR protocol including a Diffusion-Weighted Echo-Planar Imaging sequence with 10 different b-values (0, 10, 30, 50, 75, 100, 200, 400, 700, 1000s/mm2). For each fetus, two bilateral ROIs were manually placed in lung and renal parenchyma. Mean values of perfusion fraction f, pseudo-diffusion coefficient D* and diffusion coefficient D were obtained. The correlation between IVIM parameters and GA was investigated. RESULTS In renal ROIs a positive correlation between fkidney and GA (p < 0.005) was found; similarly flung showed a statistically significant correlation with GA (p < 0.001). F mean values were significantly higher in group B compared to group A in both renal (p = 0.0002) and lung (p = 0.018) ROIs. No correlation was found in D and D* as a function of GA. CONCLUSIONS The IVIM perfusion fraction f may be considered as a potential marker of pulmonary and renal maturation in relation to hemodynamic changes described in intrauterine life. Our results highlight that IVIM model is useful as an additional prenatal diagnostic tool to study lung and renal development.
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Affiliation(s)
- Giada Ercolani
- Department of Radiological, Oncological and Pathological Sciences, Umberto I Hospital, "Sapienza" University of Rome, Italy
| | - Silvia Capuani
- CNR ISC, Physics Department, "Sapienza" University of Rome, Italy
| | - Amanda Antonelli
- Department of Radiological, Oncological and Pathological Sciences, Umberto I Hospital, "Sapienza" University of Rome, Italy
| | - Arianna Camilli
- Department of Radiological, Oncological and Pathological Sciences, Umberto I Hospital, "Sapienza" University of Rome, Italy
| | - Sandra Ciulla
- Department of Radiological, Oncological and Pathological Sciences, Umberto I Hospital, "Sapienza" University of Rome, Italy
| | - Roberta Petrillo
- Department of Radiological, Oncological and Pathological Sciences, Umberto I Hospital, "Sapienza" University of Rome, Italy
| | - Serena Satta
- Department of Radiological, Oncological and Pathological Sciences, Umberto I Hospital, "Sapienza" University of Rome, Italy
| | | | - Antonella Giancotti
- Department of Gynecological-Obstetrical and Urological Sciences, Umberto I Hospital, "Sapienza" University of Rome, Italy
| | - Paolo Ricci
- Department of Radiological, Oncological and Pathological Sciences, Umberto I Hospital, "Sapienza" University of Rome, Italy
| | - Carlo Catalano
- Department of Radiological, Oncological and Pathological Sciences, Umberto I Hospital, "Sapienza" University of Rome, Italy
| | - Lucia Manganaro
- Department of Radiological, Oncological and Pathological Sciences, Umberto I Hospital, "Sapienza" University of Rome, Italy.
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Barbosa RM, Souza RT, Silveira C, Andrade KC, Almeida CM, Bortoleto AG, Oliveira PF, Cecatti JG. Reference ranges for ultrasound measurements of fetal kidneys in a cohort of low-risk pregnant women. Arch Gynecol Obstet 2019; 299:585-591. [PMID: 30607595 DOI: 10.1007/s00404-018-5032-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 05/20/2018] [Accepted: 12/14/2018] [Indexed: 11/24/2022]
Abstract
PURPOSE Alterations in renal dimensions may be an early manifestation of deviation from normality, with possible repercussions beyond intrauterine life. The objective of this study was to establish reference curves for fetal kidney dimensions and volume from 14 to 40 weeks of gestation. METHODS This is a prospective longitudinal study of 115 Brazilian participants in the "WHO multicentre study for the development of growth standards from fetal life to childhood: the fetal component". Pregnant women with clinical and sociodemographic characteristics allowing the full potential fetal growth were followed up from the first trimester until delivery. These women underwent serial sonographic evaluation of fetal kidneys. The longitudinal, anteroposterior and transverse diameters of both fetal kidneys were measured, in addition to calculation of kidney volume. By quantile regression analysis, reference curves of renal measurements related to gestational age were built. RESULTS Standard normal sonographic values of renal biometry were defined during pregnancy. Reference values for the 10th, 50th and 90th centiles of different fetal kidney measurements (longitudinal, anteroposterior, transverse and volume) from the 14th to the 40th week of gestation were fitted. CONCLUSION The reference curves presented should be of the utmost importance for screening and diagnosis of alterations in renal development during the intrauterine period.
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Affiliation(s)
- Ricardo M Barbosa
- Department of Gynecology and Obstetrics, School of Medicine, University of Campinas, Alexander Fleming Street 101, Campinas, SP, 13083-891, Brazil
| | - Renato T Souza
- Department of Gynecology and Obstetrics, School of Medicine, University of Campinas, Alexander Fleming Street 101, Campinas, SP, 13083-891, Brazil
| | - Carla Silveira
- Department of Gynecology and Obstetrics, School of Medicine, University of Campinas, Alexander Fleming Street 101, Campinas, SP, 13083-891, Brazil
| | - Kleber C Andrade
- Department of Gynecology and Obstetrics, School of Medicine, University of Campinas, Alexander Fleming Street 101, Campinas, SP, 13083-891, Brazil
| | - Cristiane M Almeida
- Department of Gynecology and Obstetrics, School of Medicine, University of Campinas, Alexander Fleming Street 101, Campinas, SP, 13083-891, Brazil
| | - Ana G Bortoleto
- Department of Gynecology and Obstetrics, School of Medicine, University of Campinas, Alexander Fleming Street 101, Campinas, SP, 13083-891, Brazil
| | - Paulo F Oliveira
- Statistics Unit, School of Medical Sciences, University of Campinas, Campinas, Brazil
| | - Jose G Cecatti
- Department of Gynecology and Obstetrics, School of Medicine, University of Campinas, Alexander Fleming Street 101, Campinas, SP, 13083-891, Brazil.
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Seravalli V, Miller JL, Block-Abraham D, McShane C, Millard S, Baschat A. The Relationship between the Fetal Volume-Corrected Renal Artery Pulsatility Index and Amniotic Fluid Volume. Fetal Diagn Ther 2018; 46:97-102. [PMID: 30300895 DOI: 10.1159/000491749] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 01/10/2018] [Accepted: 07/02/2018] [Indexed: 11/19/2022]
Abstract
INTRODUCTION To evaluate if the volume-corrected renal artery pulsatility index (vcRA-PI) is more closely related to the amniotic fluid level than the uncorrected or the gestational age (GA)-adjusted RA-PI. METHODS RA-PI and kidney volume were measured in low- and high-risk pregnancies at 17-38 weeks. Fetal anomalies associated with nonrenal causes of abnormal amniotic fluid volume were excluded. The vcRA-PI was calculated by dividing the RA-PI by the renal volume. The RA-PI was adjusted for GA, to obtain the GA-adjusted RA-PI. The uncorrected, GA-adjusted, and the vcRA-PI were related to the amniotic fluid level using nonparametric tests and receiver operating characteristic (ROC) curve analyses. RESULTS 146 examinations from 59 pregnancies were reviewed. Of these, 16 had oligo- and 15 had polyhydramnios. A higher vcRA-PI was associated with oligohydramnios (OR 2.54, 95% CI 1.67-3.86, p < 0.001), while the uncorrected RA-PI and GA-adjusted RA-PI were not able to predict oligohydramnios. ROC curve analysis showed a high predictive accuracy of the vcRA-PI for oligohydramnios (AUC 0.84, 95% CI 0.72-0.94). On the other hand, the uncorrected RA-PI and GA-adjusted RA-PI significantly predicted polyhydramnios (p = 0.04 and 0.02, respectively), while the vcRA-PI did not. CONCLUSION The vcRA-PI is superior to the uncorrected and the GA-adjusted RA-PI in predicting oligohydramnios.
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Affiliation(s)
- Viola Seravalli
- Center for Fetal Therapy, Department of Gynecology and Obstetrics, Johns Hopkins Hospital, Baltimore, Maryland, USA, .,Department of Health Sciences, University of Florence, Florence, Italy,
| | - Jena L Miller
- Center for Fetal Therapy, Department of Gynecology and Obstetrics, Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Dana Block-Abraham
- Inova Fairfax Hospital, Falls Church, Virginia, USA.,Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA
| | - Cyrethia McShane
- Center for Fetal Therapy, Department of Gynecology and Obstetrics, Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Sarah Millard
- Center for Fetal Therapy, Department of Gynecology and Obstetrics, Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Ahmet Baschat
- Center for Fetal Therapy, Department of Gynecology and Obstetrics, Johns Hopkins Hospital, Baltimore, Maryland, USA
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Brennan S, Watson D, Rudd D, Schneider M, Kandasamy Y. Evaluation of fetal kidney growth using ultrasound: A systematic review. Eur J Radiol 2017; 96:55-64. [PMID: 29103476 DOI: 10.1016/j.ejrad.2017.09.017] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Revised: 08/06/2017] [Accepted: 09/22/2017] [Indexed: 01/24/2023]
Abstract
PURPOSE To determine the role of ultrasound imaging in evaluating fetal kidney growth. METHODS MEDLINE, CINAHL and EMBASE databases were electronically searched for studies between 1996 and January 2017 and limited to English language. Studies were included if they reported on an ultrasound technique to assess fetal kidney growth and they were not a case report or case series. There was independent selection of studies by two reviewers in consensus with one other reviewer. Data were extracted by one reviewer in consensus with two other reviewers. RESULTS A total of 1785 articles were identified. The full text of 39 of these were assessed for eligibility for inclusion. Twenty-eight studies were then included in the review. Standard two dimensional (2D) fetal renal measurements are easy to perform, however, this review identified that most studies had some methodological limitations. The disadvantage with 2D and three dimensional (3D) fetal renal volumes are that they include the entire kidney and good reproducibility of 3D volumes has not yet been demonstrated. Currently there is limited research on fetal kidney growth in the setting of abnormal fetal growth. Research focussing directly on fetal kidney parenchyma and blood flow is scarce. CONCLUSIONS Some nomograms of 2D and 3D fetal kidney size and volume have been developed. Kidney length is the most popular single fetal kidney measurement; however, it does not seem to be a good indicator of growth. In IUGR fetuses, kidney length remained similar to appropriately grown fetuses whereas AP and TS dimensions were significantly decreased. New ultrasound techniques focusing on the parenchyma of the kidney and perfusion to the kidney should be explored as they may provide more meaningful information on kidney development in the fetus and future kidney function.
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Affiliation(s)
- Sonja Brennan
- Ultrasound Department, The Townsville Hospital, IMB 47 P.O. Box 670, Douglas, Townsville, Queensland, 4810, Australia; College of Public Health, Medical and Veterinary Sciences, James Cook University, 1 James Cook Drive, Townsville, Queensland 4811, Australia.
| | - David Watson
- Department of Obstetrics and Gynaecology, The Townsville Hospital, IMB 85 P.O. Box 670, Townsville, Queensland 4810, Australia
| | - Donna Rudd
- College of Public Health, Medical and Veterinary Sciences, James Cook University, 1 James Cook Drive, Townsville, Queensland 4811, Australia
| | - Michal Schneider
- Department of Medical Imaging and Radiation Sciences, School of Primary And Allied Health Care, 10 Chancellors Way, Monash University, Clayton, Victoria 3800, Australia
| | - Yogavijayan Kandasamy
- College of Public Health, Medical and Veterinary Sciences, James Cook University, 1 James Cook Drive, Townsville, Queensland 4811, Australia; Department of Neonatology, The Townsville Hospital, IMB 51 P.O. Box 670, Townsville, Queensland 4810, Australia; Mothers and Babies Research Centre, Hunter Medical Research Institute, John Hunter Hospital, The University of Newcastle,University Drive, Callaghan, NSW 2308, Australia
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