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Alhussaini AJ, Steele JD, Jawli A, Nabi G. Radiomics Machine Learning Analysis of Clear Cell Renal Cell Carcinoma for Tumour Grade Prediction Based on Intra-Tumoural Sub-Region Heterogeneity. Cancers (Basel) 2024; 16:1454. [PMID: 38672536 PMCID: PMC11048006 DOI: 10.3390/cancers16081454] [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: 02/06/2024] [Revised: 03/22/2024] [Accepted: 04/03/2024] [Indexed: 04/28/2024] Open
Abstract
BACKGROUND Renal cancers are among the top ten causes of cancer-specific mortality, of which the ccRCC subtype is responsible for most cases. The grading of ccRCC is important in determining tumour aggressiveness and clinical management. OBJECTIVES The objectives of this research were to predict the WHO/ISUP grade of ccRCC pre-operatively and characterise the heterogeneity of tumour sub-regions using radiomics and ML models, including comparison with pre-operative biopsy-determined grading in a sub-group. METHODS Data were obtained from multiple institutions across two countries, including 391 patients with pathologically proven ccRCC. For analysis, the data were separated into four cohorts. Cohorts 1 and 2 included data from the respective institutions from the two countries, cohort 3 was the combined data from both cohort 1 and 2, and cohort 4 was a subset of cohort 1, for which both the biopsy and subsequent histology from resection (partial or total nephrectomy) were available. 3D image segmentation was carried out to derive a voxel of interest (VOI) mask. Radiomics features were then extracted from the contrast-enhanced images, and the data were normalised. The Pearson correlation coefficient and the XGBoost model were used to reduce the dimensionality of the features. Thereafter, 11 ML algorithms were implemented for the purpose of predicting the ccRCC grade and characterising the heterogeneity of sub-regions in the tumours. RESULTS For cohort 1, the 50% tumour core and 25% tumour periphery exhibited the best performance, with an average AUC of 77.9% and 78.6%, respectively. The 50% tumour core presented the highest performance in cohorts 2 and 3, with average AUC values of 87.6% and 76.9%, respectively. With the 25% periphery, cohort 4 showed AUC values of 95.0% and 80.0% for grade prediction when using internal and external validation, respectively, while biopsy histology had an AUC of 31.0% for the classification with the final grade of resection histology as a reference standard. The CatBoost classifier was the best for each of the four cohorts with an average AUC of 80.0%, 86.5%, 77.0% and 90.3% for cohorts 1, 2, 3 and 4 respectively. CONCLUSIONS Radiomics signatures combined with ML have the potential to predict the WHO/ISUP grade of ccRCC with superior performance, when compared to pre-operative biopsy. Moreover, tumour sub-regions contain useful information that should be analysed independently when determining the tumour grade. Therefore, it is possible to distinguish the grade of ccRCC pre-operatively to improve patient care and management.
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Affiliation(s)
- Abeer J. Alhussaini
- Division of Imaging Sciences and Technology, School of Medicine, Ninewells Hospital, University of Dundee, Dundee DD1 9SY, UK
- Department of Clinical Radiology, Al-Amiri Hospital, Ministry of Health, Sulaibikhat 1300, Kuwait
| | - J. Douglas Steele
- Division of Imaging Sciences and Technology, School of Medicine, Ninewells Hospital, University of Dundee, Dundee DD1 9SY, UK
| | - Adel Jawli
- Division of Imaging Sciences and Technology, School of Medicine, Ninewells Hospital, University of Dundee, Dundee DD1 9SY, UK
- Department of Clinical Radiology, Sheikh Jaber Al-Ahmad Al-Sabah Hospital, Ministry of Health, Sulaibikhat 1300, Kuwait
| | - Ghulam Nabi
- Division of Imaging Sciences and Technology, School of Medicine, Ninewells Hospital, University of Dundee, Dundee DD1 9SY, UK
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2
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Iorio L, Pizzi M, Cecchin D, Davanzo F, Ghirardello A, Dei Tos AP, Doria A, Padoan R. Cutting-Edge Strategies for Renal Tumour-like Lesions in Granulomatosis with Polyangiitis: A Systematic Review. Diagnostics (Basel) 2024; 14:566. [PMID: 38473038 DOI: 10.3390/diagnostics14050566] [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: 02/06/2024] [Revised: 03/03/2024] [Accepted: 03/04/2024] [Indexed: 03/14/2024] Open
Abstract
BACKGROUND Granulomatosis with polyangiitis (GPA) is characterised by granulomatous inflammation and small-to-medium vessel necrotising vasculitis, mainly affecting respiratory tract and kidneys. Renal involvement presenting as tumour-like lesions poses diagnostic and treatment challenges. METHODS Following the observation of a GPA patient presenting with multiple renal tumour-like lesions, we conducted a systematic literature review on MEDLINE/PubMed, EMBASE, and Cochrane databases. Data gathered from the literature were analysed to summarise the diagnostic approach, management, and outcome of renal GPA-related tumour-like lesions. RESULTS a 49-year-old female presented with persistent constitutional symptoms and multiple bilateral renal lesions. Renal biopsy showed chronic interstitial inflammation with necrotising granulomas. Laboratory tests disclosed positive anti-proteinase 3 (PR3) anti-neutrophil cytoplasmic antibody (ANCA) leading to a final diagnosis of GPA. She was effectively treated with high-dose glucocorticoids and rituximab. Literature search yielded 41 articles, concerning 42 GPA patients with renal masses, presenting bilaterally in 23.8% of the cases. Positive PR3-ANCA was observed in 86.5% of the cases. Half of 42 patients showed kidney abnormalities. Treatment with glucocorticoids (83.3%) and immunosuppressive agents (80.9%) resulted in an overall good remission rate and favourable prognosis. CONCLUSIONS GPA should be considered in the differential diagnoses of kidney tumour-like lesions. The diagnosis is challenging, and histological examination greatly contributes to the diagnostic work-up.
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Affiliation(s)
- Luca Iorio
- Rheumatology Unit, Department of Medicine DIMED, University of Padua, 35121 Padua, Italy
| | - Marco Pizzi
- Surgical Pathology and Cytopathology Unit, Department of Medicine DIMED, University of Padua, 35121 Padua, Italy
| | - Diego Cecchin
- Nuclear Medicine Unit, Department of Medicine DIMED, University of Padua, 35121 Padua, Italy
| | - Federica Davanzo
- Rheumatology Unit, Department of Medicine DIMED, University of Padua, 35121 Padua, Italy
| | - Anna Ghirardello
- Rheumatology Unit, Department of Medicine DIMED, University of Padua, 35121 Padua, Italy
| | - Angelo Paolo Dei Tos
- Surgical Pathology and Cytopathology Unit, Department of Medicine DIMED, University of Padua, 35121 Padua, Italy
| | - Andrea Doria
- Rheumatology Unit, Department of Medicine DIMED, University of Padua, 35121 Padua, Italy
| | - Roberto Padoan
- Rheumatology Unit, Department of Medicine DIMED, University of Padua, 35121 Padua, Italy
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Elgendi K, Zarli M, Ahmed S, Szell N. Inferior Vena Cava Thrombus Associated With Renal Cell Carcinoma With an Atypical Radiological Presentation: A Case Report. Cureus 2023; 15:e45193. [PMID: 37842479 PMCID: PMC10576161 DOI: 10.7759/cureus.45193] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/13/2023] [Indexed: 10/17/2023] Open
Abstract
Renal cell carcinoma (RCC) is characterized by the development of kidney masses, which can lead to various long-term complications. Among the extrarenal manifestations associated with RCC, the formation of a thrombus within the inferior vena cava (IVC) is particularly prevalent due to the substantial tumor burden imposed by the kidneys. In this report, we present an exceptional case involving an 80-year-old male patient who presented with an intravascular thrombus within the inferior vena cava (IVC), which originated from RCC. The diagnosis of RCC was conclusively established through core needle biopsy and subsequent tumor marker staining. Remarkably, despite the confirmation of RCC within the IVC thrombus through biopsy and tumor marker analysis, radiological assessments failed to reveal any discernible renal cell masses within the kidneys. The patient subsequently received treatment for RCC with a combination regimen of cabozantinib and nivolumab, which resulted in a noteworthy improvement in his clinical condition. The presentation of RCC in this report is notably atypical, given that the biopsy of the thrombus yielded definitive evidence of RCC while radiological investigations did not yield any indications of renal masses or a tumor burden within the kidneys that would typically be associated with RCC.
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Affiliation(s)
- Kareem Elgendi
- Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Clearwater, USA
| | - Mohamadhusni Zarli
- Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, USA
| | - Sohaib Ahmed
- Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Clearwater, USA
| | - Nicole Szell
- Urology, Advanced Urology Institute, Clearwater, USA
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Anıl H, Yıldız A, Güzel A, Akdemir S, Karamık K, Arslan M. Comparison of Posterior and Antero-Lateral Renal Tumors in Retroperitoneal Laparoscopic Partial Nephrectomy: A Propensity Score Matching Analysis. J Kidney Cancer VHL 2023; 10:9-16. [PMID: 37457633 PMCID: PMC10338714 DOI: 10.15586/jkcvhl.v10i3.273] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 06/19/2023] [Indexed: 07/18/2023] Open
Abstract
This study aimed to compare the antero-lateral and posterior localized renal masses in laparoscopic partial nephrectomy with the retroperitoneal approach in terms of operative, functional, and oncological outcomes. Patients who underwent retroperitoneal laparoscopic partial nephrectomy by a single surgeon between January 2013 and January 2021 were included in the study. A one-to-one propensity score matching (PSM) analysis was conducted to obtain two balanced groups. The patients were divided into two groups as posterior and antero-lateral according to the localization of the mass. A total of 239 patients were included in the PSM analysis, with 65 patients allocated to each group. The mean operative time was 79.2 ± 11.2 min in the posterior group, while it was 90.0 ± 11.6 min in the antero-lateral group (P < 0.001). Warm ischemia time was 15.9 ± 2.4 min in the posterior group and 18.6 ± 2.7 min in the antero-lateral group (P < 0.001). The median decrease in eGFR at 1 year was 4.8 (IQR, 2.9-6.9) mL/min in the posterior group and 5.0 (IQR, 2.8-11) mL/min in the antero-lateral group (P = 0.219). The warm ischemia time and clamping technique were found to be significant factors for predicting eGFR change after surgery (β:0.693, 95% CI: 0.39-0.99, P < 0.001; β:6.43, 95% CI: 1.1-11.7, P = 0.017, respectively). We report that retroperitoneal laparoscopic partial nephrectomy provided longer warm -ischemia and operative time for antero-lateral renal masses than posterior masses. However, long-term oncological and functional results were similar for both localizations.
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Affiliation(s)
- Hakan Anıl
- Department of Urology, Adana Seyhan State Hospital, Adana, Turkey
| | - Ali Yıldız
- Department of Urology, Faculty of Medicine, Okan University Hospital, Istanbul, Turkey
| | - Ahmet Güzel
- Department of Urology, Aydın State Hospital, Aydın, Turkey
| | - Serkan Akdemir
- Department of Urology, Private Tınaztepe Hospital, İzmir, Turkey
| | - Kaan Karamık
- Department of Urology, Korkuteli State Hospital, Antalya, Turkey
| | - Murat Arslan
- Department of Urology, Faculty of Medicine, Okan University Hospital, Istanbul, Turkey
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Sharafeldeen M, Shaaban M, Afif AH, Elsaqa M, Naguib N, Elnaggar S, Beltagy A. Role of Angular Interface Sign in Characterizing Small Exophytic Renal Masses in Computed Tomography; Prospective Study. J Kidney Cancer VHL 2023; 10:33-39. [PMID: 37404672 PMCID: PMC10315668 DOI: 10.15586/jkcvhl.v10i2.262] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2022] [Accepted: 06/18/2023] [Indexed: 07/06/2023] Open
Abstract
The widespread use of computed tomography (CT) has increased the incidence of small renal cell masses. We aimed to evaluate the usefulness of the angular interface sign (ice cream cone sign) to differentiate a broad spectrum of small renal masses using CT. The prospective study included CT images of patients with exophytic renal masses ≤ 4 cm in maximal dimension. The presence or absence of an angular interface of the renal parenchyma with the deep part of the renal mass was assessed. Correlation with the final pathological diagnosis was performed. The study included 116 patients with renal parenchymal masses of a mean (± SD) diameter of 28 (± 8.8) mm and a mean age of 47.7 (±12.8) years. The final diagnosis showed 101 neoplastic masses [66 renal cell carcinomas (RCC), 29 angiomyolipomas (AML), 3 lymphomas, and 3 oncocytomas] and 15 non-neoplastic masses [11 small abscesses, 2 complicated renal cysts, and 2 granulomas]. Angular interface sign was statistically comparable in neoplastic versus non-neoplastic lesions (37.6% versus 13.3%, respectively, P = 0.065). There was a statistically higher incidence of the sign when comparing benign versus malignant neoplastic masses (56.25 vs. 29%, respectively, P = 0.009). Also, comparing the sign in AML versus RCC was statistically significant (52% of AML versus 29% of RCC, P = 0.032). The angular interface sign seems beneficial in predicting the nature of small renal masses. The sign suggests benign rather than malignant small renal masses.
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Affiliation(s)
- Mohamed Sharafeldeen
- Department of Urology, Faculty of Medicine, Alexandria University. Alexandria Governorate, Egypt
| | - Mohamed Shaaban
- Department of Radiology, Faculty of Medicine, Alexandria University, Alexandria Governorate, Egypt
| | - Ahmed Hafez Afif
- Department of Radiology, Faculty of Medicine, Alexandria University, Alexandria Governorate, Egypt
| | - Mohamed Elsaqa
- Department of Urology, Faculty of Medicine, Alexandria University. Alexandria Governorate, Egypt
| | - Nagy Naguib
- Department of Radiology, Faculty of Medicine, Alexandria University, Alexandria Governorate, Egypt
| | - Sara Elnaggar
- Faculty of Medicine, Alexandria University, Alexandria Governorate, Egypt
| | - Ahmad Beltagy
- Department of Urology, Faculty of Medicine, Alexandria University. Alexandria Governorate, Egypt
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Artunduaga M, Eklund M, van der Beek JN, Hammer M, Littooij AS, Sandberg JK, Schenk JP, Servaes S, Singh S, Smith EA, Srinavasan A, Khanna G. Imaging of pediatric renal tumors: A COG Diagnostic Imaging Committee/SPR Oncology Committee White Paper focused on Wilms tumor and nephrogenic rests. Pediatr Blood Cancer 2023; 70 Suppl 4:e30004. [PMID: 36308415 PMCID: PMC10641878 DOI: 10.1002/pbc.30004] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Revised: 09/19/2022] [Accepted: 09/01/2022] [Indexed: 11/08/2022]
Abstract
Malignant renal tumors account for approximately 6% of pediatric malignancies, with Wilms tumor (WT) representing approximately 90% of pediatric renal tumors. This paper provides consensus-based imaging guidelines for the initial evaluation of a child with suspected WT and follow-up during and after therapy co-developed by the Children's Oncology Group (COG) Diagnostic Imaging and Society for Pediatric Radiology (SPR) oncology committees. The guidelines for Wilms Tumor Imaging in the Society of International Pediatric Oncology (SIOP) are briefly discussed to highlight some of the differences in imaging approach.
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Affiliation(s)
- Maddy Artunduaga
- Pediatric Radiology Division, Department of Radiology, University of Texas Southwestern Medical Center, Dallas, TX, USA
- Children’s Health Medical Center, Dallas, TX, USA
| | - Meryle Eklund
- Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, USA
| | - Justine N. van der Beek
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht/Wilhelmina Children’s Hospital, Utrecht University, Utrecht, The Netherlands
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Matthew Hammer
- Pediatric Radiology Division, Department of Radiology, University of Texas Southwestern Medical Center, Dallas, TX, USA
- Children’s Health Medical Center, Dallas, TX, USA
| | - Annemieke S. Littooij
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht/Wilhelmina Children’s Hospital, Utrecht University, Utrecht, The Netherlands
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Jesse K. Sandberg
- Department of Radiology, Stanford University School of Medicine, Stanford, CA, USA
| | - Jens-Peter Schenk
- Clinic of Diagnostic and Interventional Radiology, Division of Pediatric Radiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Sabah Servaes
- Department of Radiology, West Virginia University Children’s Hospital, Morgantown, WV, USA
| | - Sudha Singh
- Department of Radiology, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Ethan A. Smith
- Department of Radiology, Cincinnati Children’s Hospital, Cincinnati, OH, USA
- Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Abhay Srinavasan
- Department of Radiology, Children’s Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Geetika Khanna
- Department of Radiology & Imaging Sciences, Emory University, Children’s Healthcare of Atlanta, Atlanta, GA, USA
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Hojat SA, Ravish NA, Azabdaftari G, Yang Z. Rapid on-site evaluation in percutaneous core needle biopsies of renal masses: Cytologic-histologic concordance and diagnostic challenges. Diagn Cytopathol 2023. [PMID: 37096957 DOI: 10.1002/dc.25147] [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: 01/05/2023] [Revised: 04/05/2023] [Accepted: 04/14/2023] [Indexed: 04/26/2023]
Abstract
BACKGROUND Image-guided fine needle aspirations (FNAs) and core needle biopsies (CNBs) play the critical role in diagnosis of renal lesions. Rapid on-site evaluation (ROSE) can potentially increase the adequacy rate and improve diagnostic yield, while providing additional information for rapid clinical decisions. The aim of this study is to evaluate the diagnostic utility of ROSE in obtaining adequate tissue for diagnosis of renal lesions in our institution. METHODS We retrospectively reviewed all percutaneous renal CNB cases with available ROSE interpretations for a 11-year period. The ROSE interpretations and CNB diagnoses was compared and the concordance rate was calculated accordingly. The discrepant cases were re-reviewed and the possible causes for discrepancy were analyzed. RESULTS A total of 189 cases were identified. Definitive diagnoses were rendered in 164 (87%) cases on the final CNBs, including primary renal lesions in 151 cases and metastatic malignancies in 13 cases. At the time of ROSE, samples were deemed to be adequate in the majority of cases (83%). The calculated concordance rate between ROSE interpretations and CNB final diagnoses was 84.6%. Sampling issue and scant tumor cells were the main causes for the discordance between ROSE interpretations and CNB diagnoses. CONCLUSION Our study showed a relatively high-concordance rate of 84.6% between ROSE interpretations and CNB final diagnoses, suggesting that ROSE is a valuable tool for procurement of adequate renal CNB samples for diagnosis.
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Affiliation(s)
- Seyed Amin Hojat
- Department of Pathology, Roswell Park Comprehensive Cancer Center, Buffalo, New York, USA
| | - Nakul A Ravish
- Department of Pathology, Jacobs School of Medicine and Biomedical Sciences, University of Buffalo, Buffalo, New York, USA
| | - Gissou Azabdaftari
- Department of Pathology, Roswell Park Comprehensive Cancer Center, Buffalo, New York, USA
| | - Zhongbo Yang
- Department of Pathology, Roswell Park Comprehensive Cancer Center, Buffalo, New York, USA
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Tufano A, Leonardo C, Di Bella C, Lucarelli G, Dolcetti V, Dipinto P, Proietti F, Flammia RS, Anceschi U, Perdonà S, Franco G, Sciarra A, Di Pierro GB, Cantisani V. Qualitative Assessment of Contrast-Enhanced Ultrasound in Differentiating Clear Cell Renal Cell Carcinoma and Oncocytoma. J Clin Med 2023; 12:jcm12093070. [PMID: 37176510 PMCID: PMC10179124 DOI: 10.3390/jcm12093070] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [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: 02/09/2023] [Revised: 03/01/2023] [Accepted: 04/21/2023] [Indexed: 05/15/2023] Open
Abstract
BACKGROUND We aimed to assess whether clear cell renal cell carcinoma (ccRCC) can be differentiated from renal oncocytoma (RO) on a contrast-enhanced ultrasound (CEUS). METHODS Between January 2021 and October 2022, we retrospectively queried and analyzed our prospectively maintained dataset. Renal mass features were scrutinized with conventional ultrasound imaging (CUS) and CEUS. All lesions were confirmed by histopathologic diagnoses after nephron-sparing surgery (NSS). A multivariable analysis was performed to identify the potential predictors of ccRCC. The area under the curve (AUC) was depicted in order to assess the diagnostic accuracy of the multivariable model. RESULTS A total of 126 renal masses, including 103 (81.7%) ccRCC and 23 (18.3%) RO, matched our inclusion criteria. Among these two groups, we found significant differences in terms of enhancement (homogeneous vs. heterogeneous) (p < 0.001), wash-in (fast vs. synchronous/slow) (p = 0.004), wash-out (fast vs. synchronous/slow) (p = 0.001), and rim-like enhancement (p < 0.001). On the multivariate logistic regression, heterogeneous enhancement (OR: 19.37; p = <0.001) and rim-like enhancement (OR: 3.73; p = 0.049) were independent predictors of ccRCC. Finally, these two variables had an AUC of 82.5% and 75.3%, respectively. CONCLUSIONS Diagnostic imaging for presurgical planning is crucial in the choice of either conservative or radical management. CEUS, with its unique features, revealed its usefulness in differentiating ccRCC from RO.
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Affiliation(s)
- Antonio Tufano
- Department of Maternal-Child and Urological Sciences, Policlinico Umberto I Hospital, Sapienza University of Rome, 00162 Rome, Italy
| | - Costantino Leonardo
- Department of Maternal-Child and Urological Sciences, Policlinico Umberto I Hospital, Sapienza University of Rome, 00162 Rome, Italy
| | - Chiara Di Bella
- Department of Radiological Sciences, Oncology and Pathology, Sapienza University of Rome, 00162 Rome, Italy
| | - Giuseppe Lucarelli
- Department of Radiological Sciences, Oncology and Pathology, Sapienza University of Rome, 00162 Rome, Italy
| | - Vincenzo Dolcetti
- Department of Radiological Sciences, Oncology and Pathology, Sapienza University of Rome, 00162 Rome, Italy
| | - Piervito Dipinto
- Department of Maternal-Child and Urological Sciences, Policlinico Umberto I Hospital, Sapienza University of Rome, 00162 Rome, Italy
| | - Flavia Proietti
- Department of Maternal-Child and Urological Sciences, Policlinico Umberto I Hospital, Sapienza University of Rome, 00162 Rome, Italy
| | - Rocco Simone Flammia
- Department of Maternal-Child and Urological Sciences, Policlinico Umberto I Hospital, Sapienza University of Rome, 00162 Rome, Italy
| | - Umberto Anceschi
- Department of Urology, IRCCS "Regina Elena" National Cancer Institute, 00144 Rome, Italy
| | | | - Giorgio Franco
- Department of Maternal-Child and Urological Sciences, Policlinico Umberto I Hospital, Sapienza University of Rome, 00162 Rome, Italy
| | - Alessandro Sciarra
- Department of Maternal-Child and Urological Sciences, Policlinico Umberto I Hospital, Sapienza University of Rome, 00162 Rome, Italy
| | - Giovanni Battista Di Pierro
- Department of Maternal-Child and Urological Sciences, Policlinico Umberto I Hospital, Sapienza University of Rome, 00162 Rome, Italy
| | - Vito Cantisani
- Department of Radiological Sciences, Oncology and Pathology, Sapienza University of Rome, 00162 Rome, Italy
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Anush A, Rohini G, Nicola S, WalaaEldin EM, Eranga U. Deep-learning-based ensemble method for fully automated detection of renal masses on magnetic resonance images. J Med Imaging (Bellingham) 2023; 10:024501. [PMID: 36950139 PMCID: PMC10026851 DOI: 10.1117/1.jmi.10.2.024501] [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: 05/18/2022] [Accepted: 02/22/2023] [Indexed: 03/24/2023] Open
Abstract
Purpose Accurate detection of small renal masses (SRM) is a fundamental step for automated classification of benign and malignant or indolent and aggressive renal tumors. Magnetic resonance image (MRI) may outperform computed tomography (CT) for SRM subtype differentiation due to improved tissue characterization, but is less explored compared to CT. The objective of this study is to autonomously detect SRM on contrast-enhanced magnetic resonance images (CE-MRI). Approach In this paper, we described a novel, fully automated methodology for accurate detection and localization of SRM on CE-MRI. We first determine the kidney boundaries using a U-Net convolutional neural network. We then search for SRM within the localized kidney regions using a mixture-of-experts ensemble model based on the U-Net architecture. Our dataset contained CE-MRI scans of 118 patients with different solid kidney tumor subtypes including renal cell carcinomas, oncocytomas, and fat-poor renal angiomyolipoma. We evaluated the proposed model on the entire CE-MRI dataset using 5-fold cross validation. Results The developed algorithm reported a Dice similarity coefficient of 91.20 ± 5.41 % (mean ± standard deviation) for kidney segmentation from 118 volumes consisting of 25,025 slices. Our proposed ensemble model for SRM detection yielded a recall and precision of 86.2% and 83.3% on the entire CE-MRI dataset, respectively. Conclusions We described a deep-learning-based method for fully automated SRM detection using CE-MR images, which has not been studied previously. The results are clinically important as SRM localization is a pre-step for fully automated diagnosis of SRM subtypes.
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Affiliation(s)
- Agarwal Anush
- University of Guelph, School of Engineering, Guelph, Ontario, Canada
| | - Gaikar Rohini
- University of Guelph, School of Engineering, Guelph, Ontario, Canada
| | - Schieda Nicola
- University of Ottawa, Department of Radiology, Ottawa, Ontario, Canada
| | | | - Ukwatta Eranga
- University of Guelph, School of Engineering, Guelph, Ontario, Canada
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Tufano A, Antonelli L, Di Pierro GB, Flammia RS, Minelli R, Anceschi U, Leonardo C, Franco G, Drudi FM, Cantisani V. Diagnostic Performance of Contrast-Enhanced Ultrasound in the Evaluation of Small Renal Masses: A Systematic Review and Meta-Analysis. Diagnostics (Basel) 2022; 12:diagnostics12102310. [PMID: 36291999 PMCID: PMC9600471 DOI: 10.3390/diagnostics12102310] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 09/21/2022] [Accepted: 09/21/2022] [Indexed: 12/02/2022] Open
Abstract
Ultrasound (US) is a highly sensitive imaging tool in the detection of renal masses. However, the detection rate of small renal masses (SRMs) (<4 cm) is still limited. In this scenario, contrast-enhanced ultrasound (CEUS) is a relatively novel, but increasingly utilized, diagnostic modality which aims to increase the overall diagnostic ability in the identification of SRMs. In consequence, we performed a systematic review (SR) and pooled meta-analysis to investigate the diagnostic performance of CEUS in the evaluation of SRMs confirmed by pathology. A SR up to April 2022 was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. The diagnostic performance of CEUS was evaluated basing on malignant vs. benign SMRs. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) from eligible studies were pooled, and summary receiver operating characteristic (SROC) curves were constructed for each endpoint. Overall, five qualified studies were deemed suitable for this meta-analysis. Finally, diagnostic performance of CEUS showed an accuracy of 0.93 in detecting malignant masses (sensitivity of 0.94, PPV of 0.95, specificity of 0.78, and NPV of 0.73). Taken together, CEUS may represent a promising minimally invasive diagnostic tool for characterization of SMRs, since it allows clinicians to identify malignant lesions.
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Affiliation(s)
- Antonio Tufano
- Department of Maternal-Infant and Urological Sciences, “Sapienza” Rome University, Policlinico Umberto I Hospital, 00185 Rome, Italy
- Correspondence: (A.T.); (V.C.)
| | - Luca Antonelli
- Department of Maternal-Infant and Urological Sciences, “Sapienza” Rome University, Policlinico Umberto I Hospital, 00185 Rome, Italy
| | - Giovanni Battista Di Pierro
- Department of Maternal-Infant and Urological Sciences, “Sapienza” Rome University, Policlinico Umberto I Hospital, 00185 Rome, Italy
| | - Rocco Simone Flammia
- Department of Maternal-Infant and Urological Sciences, “Sapienza” Rome University, Policlinico Umberto I Hospital, 00185 Rome, Italy
| | - Rocco Minelli
- Department Life and Health “V. Tiberio”, University of Molise, Francesco De Sanctis 1, 86100 Campobasso, Italy
| | - Umberto Anceschi
- Department of Urology, IRCCS “Regina Elena” National Cancer Institute, Via Elio Chianesi 53, 00144 Rome, Italy
| | - Costantino Leonardo
- Department of Maternal-Infant and Urological Sciences, “Sapienza” Rome University, Policlinico Umberto I Hospital, 00185 Rome, Italy
| | - Giorgio Franco
- Department of Maternal-Infant and Urological Sciences, “Sapienza” Rome University, Policlinico Umberto I Hospital, 00185 Rome, Italy
| | - Francesco Maria Drudi
- Department of Radiological, Oncological and Pathobiological Sciences, Sapienza University of Rome, 00144 Rome, Italy
| | - Vito Cantisani
- Department of Radiological, Oncological and Pathobiological Sciences, Sapienza University of Rome, 00144 Rome, Italy
- Correspondence: (A.T.); (V.C.)
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Alhussaini AJ, Steele JD, Nabi G. Comparative Analysis for the Distinction of Chromophobe Renal Cell Carcinoma from Renal Oncocytoma in Computed Tomography Imaging Using Machine Learning Radiomics Analysis. Cancers (Basel) 2022; 14:3609. [PMID: 35892868 DOI: 10.3390/cancers14153609] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 07/13/2022] [Accepted: 07/19/2022] [Indexed: 02/04/2023] Open
Abstract
Background: ChRCC and RO are two types of rarely occurring renal tumors that are difficult to distinguish from one another based on morphological features alone. They differ in prognosis, with ChRCC capable of progressing and metastasizing, but RO is benign. This means discrimination of the two tumors is of crucial importance. Objectives: The purpose of this research was to develop and comprehensively evaluate predictive models that can discriminate between ChRCC and RO tumors using Computed Tomography (CT) scans and ML-Radiomics texture analysis methods. Methods: Data were obtained from 78 pathologically confirmed renal masses, scanned at two institutions. Data from the two institutions were combined to form a third set resulting in three data cohorts, i.e., cohort 1, 2 and combined. Contrast-enhanced scans were used and the axial cross-sectional slices of each tumor were extracted from the 3D data using a semi-automatic segmentation technique for both 2D and 3D scans. Radiomics features were extracted before and after applying filters and the dimensions of the radiomic features reduced using the least absolute shrinkage and selection operator (LASSO) method. Synthetic minority oversampling technique (SMOTE) was applied to avoid class imbalance. Five ML algorithms were used to train models for predictive classification and evaluated using 5-fold cross-validation. Results: The number of selected features with good model performance was 20, 40 and 6 for cohorts 1, 2 and combined, respectively. The best model performance in cohorts 1, 2 and combined had an excellent Area Under the Curve (AUC) of 1.00 ± 0.000, 1.00 ± 0.000 and 0.87 ± 0.073, respectively. Conclusions: ML-based radiomics signatures are potentially useful for distinguishing ChRCC and RO tumors, with a reliable level of performance for both 2D and 3D scanning.
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Scott ER, Singh A, Quinn A, Boyd K, Lallas CD. How I Do It: Cost-effective 3D printed models for renal masses. Can J Urol 2021; 28:10874-10877. [PMID: 34657662] [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] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
3D printing has been growing in many surgical fields including Urology. The primary use has been to print kidneys with tumors to better understand anatomy and to assist with surgical planning and education. Previous studies that utilized 3D printing of kidneys for partial nephrectomies have been limited by the cost and complexity of model creation, rendering them highly impractical to be used on a routine basis. Using a simpler and more cost-effective design and materials allow the 3D kidney models to be used in a wider range and number of patients. We describe our streamlined process to create 3D kidney models costing $30 on average and we believe this process can be repeated by others.
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Affiliation(s)
- E Reilly Scott
- Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Abhay Singh
- Department of Urology, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Andrea Quinn
- Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Kaitlyn Boyd
- Health Design Lab of Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Costas D Lallas
- Department of Urology, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
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Abstract
With the ever increasing trend of using cross-section imaging in today's era, incidental detection of small solid renal masses has dramatically multiplied. Coincidentally, the number of asymptomatic benign lesions being detected has also increased. The role of radiologists is not only to identify these lesions, but also go a one step further and accurately characterize various renal masses. Earlier detection of small renal cell carcinomas means identifying at the initial stage which has an impact on prognosis, patient management and healthcare costs. In this review article we share our experience with the typical and atypical solid renal masses encountered in adults in routine daily practice.
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Affiliation(s)
- Mahesh Kumar Mittal
- Department of Radiodiagnosis, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Binit Sureka
- Department of Radiology, Institute of Liver and Biliary Sciences, New Delhi, India
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14
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Klatte T, Berni A, Serni S, Campi R. Intermediate- and long-term oncological outcomes of active surveillance for localized renal masses: a systematic review and quantitative analysis. BJU Int 2021; 128:131-143. [PMID: 34060192 DOI: 10.1111/bju.15435] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To evaluate intermediate- and long-term oncological outcomes of active surveillance (AS) for localized renal masses (LRMs). METHODS This systematic literature review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement and registered on PROSPERO (CRD42021230416). Studies on AS for LRMs with at least 3 years' follow-up were eligible. Two review authors independently screened the literature, extracted data, and assessed risk of bias. The primary outcomes were metastasis rate, renal cell carcinoma (RCC)-specific mortality (RCC-SM) and all-cause mortality (ACM). Pooled estimates were obtained from random-effects models. Subgroup analyses were performed for small renal masses (SRMs; ≤4 cm) and non-SRMs (>4 cm). RESULTS We analysed 18 unique cohorts comprising 2066 patients. The pooled initial maximum tumour size was 2.8 cm (95% confidence interval [CI] 2.7-3.0) and the percutaneous biopsy rate was 28%. The pooled mean annual growth rate was 2.8 mm (95% CI 2.1-3.4). Within a pooled mean follow-up of 53 months, 2.1% (95% CI 1.0-3.6) of patients developed metastatic disease, 1.0% (95% CI 0.3-2.1) died from RCC and 22.6% (95% CI 15.8-30.2) died from any cause. For patients with SRMs (nine studies, n = 987), the pooled metastasis rate was 1.8% (95% CI 0.5-3.7), RCC-SM was 0.6% (95% CI 0-2.1), and ACM was 28.5% (95% CI 17.4-41.4). Across five studies reporting on outcomes of 239 patients with non-SRMs, the pooled metastasis rate was 5.1% (95% CI 0-17.3), RCC-SM was 2.1% (95% CI 0-8.9) and ACM was 29.1% (95% CI 13.6-47.3). This review is limited by non-standardized inclusion criteria, definitions and follow-up, data heterogeneity, limited patient numbers in sub-analyses and absence of high-quality studies. CONCLUSIONS Active surveillance is a safe intermediate- and long-term management option for well-selected patients with LRMs, especially those with SRMs. Limited data are available for non-SRMs, but current evidence would support further evaluation of this approach in selected patients. It is not possible to draw definitive conclusions until more high-quality data become available.
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Affiliation(s)
- Tobias Klatte
- Department of Urology, Royal Bournemouth Hospital, Dorset University Hospitals NHS Foundation Trust, Bournemouth, UK.,Department of Surgery, University of Cambridge, Cambridge, UK
| | - Alessandro Berni
- Unit of Urological Robotic Surgery and Renal Transplantation, Careggi Hospital, University of Florence, Florence, Italy
| | - Sergio Serni
- Unit of Urological Robotic Surgery and Renal Transplantation, Careggi Hospital, University of Florence, Florence, Italy.,Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Riccardo Campi
- Unit of Urological Robotic Surgery and Renal Transplantation, Careggi Hospital, University of Florence, Florence, Italy.,Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy.,European Association of Urology Young Academic Urologists Renal Cancer Working Group, Arnhem, The Netherlands
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Eisenbrey JR, Kamaya A, Gummadi S, Bird K, Burrowes D, Arias D, Lallas CD, Trabulsi EJ, Lyshchik A. Effects of Contrast-Enhanced Ultrasound of Indeterminate Renal Masses on Patient Clinical Management: Retrospective Analysis From 2 Institutions. J Ultrasound Med 2021; 40:131-139. [PMID: 32657452 DOI: 10.1002/jum.15383] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 05/28/2020] [Accepted: 06/02/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVES To investigate the long-term impact of contrast-enhanced ultrasound (CEUS) on the treatment of patients with indeterminate renal masses. METHODS In this retrospective study, consecutive charts of all patients receiving renal CEUS at 1 of 2 academic medical centers between January 1, 2014, and December 31, 2018, were reviewed. Patients were included in the study if they had documented chronic renal disease (estimated glomerular filtration rate < 60 mL/min/1.73 m2 ) or prior nephrectomy and received CEUS for a previously untreated renal mass. RESULTS A total of 215 lesions in 157 patients were used for analysis. Contrast-enhanced ultrasound provided a final treatment recommendation in 71.6% of lesions (154 of 215). Of these 154 lesions, 7.8% (12 of 154) were lost to follow-up despite CEUS suggesting malignancy; 15.6% (24 of 154) went directly for surgical intervention, with malignancy confirmed by pathologic results in 87.5% (21 of 24) of these cases; and the remaining 76.6% (118 of 154) were deemed benign and required no additional follow-up. Of the 118 lesions diagnosed by CEUS as benign and requiring no follow-up, none showed evidence of later renal cell carcinoma development and, only 5.1% (6 of 118) of the total population was referred for further cross-sectional imaging of the mass in question. In 28.4% of all lesions (61 of 215), CEUS resulted in a recommendation for surveillance imaging at a 6- to 12-month interval, and less than 10% (6 of 61) of these underwent additional cross-sectional imaging within the recommended 6 months after CEUS. CONCLUSIONS These findings highlight the impact of CEUS on clinical treatment of indeterminate renal masses, including reducing the use of the potentially nephrotoxic contrast agents and providing a direct pathway to transplant.
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Affiliation(s)
- John R Eisenbrey
- Department of Radiology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Aya Kamaya
- Department of Radiology, Stanford University, Stanford, California, USA
| | - Sriharsha Gummadi
- Department of Radiology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Kristen Bird
- Department of Radiology, Stanford University, Stanford, California, USA
| | - David Burrowes
- Department of Radiology, Stanford University, Stanford, California, USA
| | - Diego Arias
- Department of Radiology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Costas D Lallas
- Department of Urology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Edouard J Trabulsi
- Department of Urology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Andrej Lyshchik
- Department of Radiology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
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Wu JF, Ge LJ, Ye XB, Sun Y, Wang YL, Wang ZP. Can acoustic radiation force impulse imaging (ARFI) accurately diagnose renal masses?: A protocol of systematic review and meta-analysis. Medicine (Baltimore) 2020; 99:e21500. [PMID: 32756185 PMCID: PMC7402870 DOI: 10.1097/md.0000000000021500] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Renal masses are increasingly being discovered because of the wide accessibility of modern high resolution imaging procedures. Previous clinical studies have reported that acoustic radiation force impulse imaging (ARFI) is used for diagnosis of renal masses. However, no study has investigated this topic systematically. Therefore, this study will evaluate the diagnostic value of ARFI for the diagnosis of renal masses. METHODS A systematic search using the databases of Cochrane Library, EMBASE, Pubmed, WANGFANG, and China National Knowledge Infrastructure will be performed to identify studies in which patients with renal masses are assessed by ARFI. Two investigators will independently screen the literature and extract the data. Any discrepancies will be resolved via discussion with the senior author. Study quality will be assessed by the Quality Assessment of Diagnostic Accuracy Studies 2 tool, and pooled sensitivity and specificity of various ARFI findings for the diagnosis of renal masses will be determined. Summary receiver operating characteristic curve will be used to assess the overall performance of ARFI. RESULTS This study will evaluate the diagnostic value of ARFI for the diagnosis of renal masses through sensitivity, specificity, positive and negative likelihood ratio, and diagnostic odds ratio. CONCLUSION This study will summarize the most recent evidence that focusing on the diagnosis of ARFI for renal masses. STUDY REGISTRATION INPLASY202060105.
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Varghese BA, Chen F, Hwang DH, Cen SY, Desai B, Gill IS, Duddalwar VA. Differentiation of Predominantly Solid Enhancing Lipid-Poor Renal Cell Masses by Use of Contrast-Enhanced CT: Evaluating the Role of Texture in Tumor Subtyping. AJR Am J Roentgenol 2018; 211:W288-96. [PMID: 30240299 DOI: 10.2214/AJR.18.19551] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVE The purpose of this study was to assess the accuracy of a panel of texture features extracted from clinical CT in differentiating benign from malignant solid enhancing lipid-poor renal masses. MATERIALS AND METHODS In a retrospective case-control study of 174 patients with predominantly solid nonmacroscopic fat-containing enhancing renal masses, 129 cases of malignant renal cell carcinoma were found, including clear cell, papillary, and chromophobe subtypes. Benign renal masses-oncocytoma and lipid-poor angiomyolipoma-were found in 45 patients. Whole-lesion ROIs were manually segmented and coregistered from the standard-of-care multiphase contrast-enhanced CT (CECT) scans of these patients. Pathologic diagnosis of all tumors was obtained after surgical resection. CECT images of the renal masses were used as inputs to a CECT texture analysis panel comprising 31 texture metrics derived with six texture methods. Stepwise logistic regression analysis was used to select the best predictor among all candidate predictors from each of the texture methods, and their performance was quantified by AUC. RESULTS Among the texture predictors aiding renal mass subtyping were entropy, entropy of fast-Fourier transform magnitude, mean, uniformity, information measure of correlation 2, and sum of averages. These metrics had AUC values ranging from good (0.80) to excellent (0.98) across the various subtype comparisons. The overall CECT-based tumor texture model had an AUC of 0.87 (p < 0.05) for differentiating benign from malignant renal masses. CONCLUSION The CT texture statistical model studied was accurate for differentiating benign from malignant solid enhancing lipid-poor renal masses.
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Mudoni A, Cornacchiari M, Liccardo A, Di Nicolo' P, Di Lullo L, Guastoni C, Mereghetti M. [Management of the incidental renal masses]. G Ital Nefrol 2018; 35:35-2018-7. [PMID: 30035446] [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] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
The diagnosis of renal masses has increased in the last decades owing to the widespread use of imaging (ultrasound, computed tomography and magnetic resonance). Majority of the renal masses are detected incidentally on routine ultrasound examination. Solid masses detected on ultrasound require further imaging evaluation with CT and/or MRI for suitable characterization. US-guided renal biopsy is a safe, effective and accurate method for evaluating the small renal masses with ambiguous radiologic findings. Navigation technology and multimodality image fusion represent an important development in interventional radiology, especially for performing difficult percutaneous biopsies and ablations of small renal masses. Multidisciplinary approach is required which results from experience and knowledge and in hard cases the use of serial imaging can be helpful.
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Affiliation(s)
- Anna Mudoni
- Unità Operativa di Nefrologia e Dialisi Ospedale Cardinale G Panico Tricase, Lecce
| | | | - Amelia Liccardo
- Unità Operativa di Nefrologia e Dialisi Multimedica Presidio di Castellanza, Varese
| | | | - Luca Di Lullo
- Unità Operativa Complessa di Nefrologia e Dialisi, Ospedale L. Parodi - Delfino, Colleferro, Roma
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Liu AL, Mikheev A, Rusinek H, Huang WC, Wysock JS, Babb JS, Feiweier T, Stoffel D, Chandarana H, Sigmund EE. REnal Flow and Microstructure AnisotroPy (REFMAP) MRI in Normal and Peritumoral Renal Tissue. J Magn Reson Imaging 2018; 48:188-197. [PMID: 29331053 DOI: 10.1002/jmri.25940] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [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: 09/13/2017] [Accepted: 12/14/2017] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Diffusion-weighted imaging (DWI) provides insight into the pathophysiology underlying renal dysfunction. Variants of DWI include intravoxel incoherent motion (IVIM), which differentiates between microstructural diffusion and vascular or tubular flow, and diffusion tensor imaging (DTI), which quantifies diffusion directionality. PURPOSE To investigate the reproducibility of joint IVIM-DTI and compare controls to presurgical renal mass patients. STUDY TYPE Prospective cross-sectional. SUBJECTS Thirteen healthy controls and ten presurgical renal mass patients were scanned. Ten controls were scanned twice to investigate reproducibility. FIELD STRENGTH/SEQUENCE Subjects were scanned on a 3T system using 10 b-values and 20 diffusion directions for IVIM-DTI in a study approved by the local Institutional Review Board. ASSESSMENT Retrospective coregistration and measurement of joint IVIM-DTI parameters were performed. STATISTICAL ANALYSIS Parameter reproducibility was defined as intraclass correlation coefficient (ICC) >0.7 and coefficient of variation (CV) <30%. Patient data were stratified by lesion side (contralateral/ipsilateral) for comparison with controls. Corticomedullary differentiation was evaluated. RESULTS In controls, the reproducible subset of REnal Flow and Microstructure AnisotroPy (REFMAP) parameters had average ICC = 0.82 and CV = 7.5%. In renal mass patients, medullary fractional anisotropy (FA) was significantly lower than in controls (0.227 ± 0.072 vs. 0.291 ± 0.044, P = 0.016 for the kidney contralateral to the mass and 0.228 ± 0.070 vs. 0.291 ± 0.044, P = 0.018 for the kidney ipsilateral). In the kidney ipsilateral to the mass, cortical Dp,radial was significantly higher than in controls (P = 0.012). Conversely, medullary Dp,axial was significantly lower in contralateral than ipsilateral kidneys (P = 0.027) and normal controls (P = 0.044). DATA CONCLUSION REFMAP-MRI parameters provide unique information regarding renal dysfunction. In presurgical renal mass patients, directional flow changes were noted that were not identified with IVIM analysis alone. Both contralateral and ipsilateral kidneys in patients show reductions in structural diffusivities and anisotropy, while flow metrics showed opposing changes in contralateral vs. ipsilateral kidneys. LEVEL OF EVIDENCE 2 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2018.
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Affiliation(s)
- Andrea L Liu
- New York University School of Medicine, New York, New York, USA
| | - Artem Mikheev
- Bernard and Irene Schwartz Center for Biomedical Imaging, Department of Radiology, New York University School of Medicine, New York, New York, USA.,Center for Advanced Imaging and Innovation (CAI2R), New York University School of Medicine, New York, New York, USA
| | - Henry Rusinek
- Bernard and Irene Schwartz Center for Biomedical Imaging, Department of Radiology, New York University School of Medicine, New York, New York, USA.,Center for Advanced Imaging and Innovation (CAI2R), New York University School of Medicine, New York, New York, USA
| | - William C Huang
- Department of Urology, New York University School of Medicine, New York, New York, USA
| | - James S Wysock
- Department of Urology, New York University School of Medicine, New York, New York, USA
| | - James S Babb
- Bernard and Irene Schwartz Center for Biomedical Imaging, Department of Radiology, New York University School of Medicine, New York, New York, USA.,Center for Advanced Imaging and Innovation (CAI2R), New York University School of Medicine, New York, New York, USA
| | | | - David Stoffel
- Bernard and Irene Schwartz Center for Biomedical Imaging, Department of Radiology, New York University School of Medicine, New York, New York, USA.,Center for Advanced Imaging and Innovation (CAI2R), New York University School of Medicine, New York, New York, USA
| | - Hersh Chandarana
- Bernard and Irene Schwartz Center for Biomedical Imaging, Department of Radiology, New York University School of Medicine, New York, New York, USA.,Center for Advanced Imaging and Innovation (CAI2R), New York University School of Medicine, New York, New York, USA
| | - Eric E Sigmund
- Bernard and Irene Schwartz Center for Biomedical Imaging, Department of Radiology, New York University School of Medicine, New York, New York, USA.,Center for Advanced Imaging and Innovation (CAI2R), New York University School of Medicine, New York, New York, USA
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Sun MR, Brook A, Powell MF, Kaliannan K, Wagner AA, Kaplan ID, Pedrosa I. Effect of Stereotactic Body Radiotherapy on the Growth Kinetics and Enhancement Pattern of Primary Renal Tumors. AJR Am J Roentgenol 2016; 206:544-53. [PMID: 26901010 DOI: 10.2214/AJR.14.14099] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVE The objective of our study was to assess the growth rate and enhancement of renal masses before and after treatment with stereotactic body radiotherapy (SBRT). MATERIALS AND METHODS This retrospective study included all patients with renal masses who underwent SBRT during a 5-year period. Orthogonal measurements of renal masses were obtained on pre- and posttreatment CT or MRI. Pre- and posttreatment growth rates were compared for renal mass diameter and volume using the t test. Pre- and posttreatment tumor enhancement values were compared for tumors that underwent multiphasic contrast-enhanced MRI. RESULTS Forty patients underwent SBRT for the treatment of 41 renal tumors: clear cell renal cell carcinomas (RCCs) (n = 16), papillary RCCs (n = 6), oncocytic neoplasms (n = 8), unclassified RCCs (n = 2), urothelial carcinoma (n = 1), and no pathologic diagnosis (n = 8). The mean maximum tumor diameter before treatment was 3.9 cm (range, 1.6-8.3 cm). Three hundred thirty-eight pre- and posttreatment imaging studies were analyzed: 214 MRI studies and 124 CT studies. The mean pre- and posttreatment lengths of observation were 416 days (range, 2-1800 days) and 561 days (83-1366 days), respectively. The mean pretreatment tumor growth rate of 0.68 cm/y decreased to -0.37 cm/y post treatment (p < 0.0001), and the mean tumor volume growth rate of 21.2 cm(3)/y before treatment decreased to -5.35 cm(3)/y after treatment (p = 0.002). Local control-defined as less than 5 mm of growth-was achieved in 38 of 41 (92.7%) tumors. The Response Evaluation Criteria in Solid Tumors (RECIST) 1.1 showed progression in one tumor (2.4%), stability in 31 tumors (75.6%), partial response in eight tumors (19.5%), and complete response in one tumor (2.4%). No statistically significant change in tumor enhancement was shown (mean follow-up, 142 days; range, 7-581 days). CONCLUSION Renal tumors treated with SBRT show statistically significant reductions in growth rate and tumor size after treatment but do not show statistically significant differences in enhancement in the initial (mean, 142 days) posttreatment period.
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Matsuki M, Kunishima Y, Wanifuchi A, Inoue R, Takei F, Hisataki T. CLINICAL FEATURES OF 15 PATIENTS UNDER SURVEILLANCE FOR RENAL MASSES. Nihon Hinyokika Gakkai Zasshi 2016; 107:149-54. [PMID: 28740045 DOI: 10.5980/jpnjurol.107.149] [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] [Indexed: 11/08/2022]
Abstract
(Objective) We investigated the clinical features of patients under surveillance for localized renal masses. (Methods) This study was a retrospective analysis of 15 patients who were diagnosed as having clinically localized renal cell carcinoma and were placed under surveillance and 68 patients who underwent immediate radical operation for renal masses. (Results) The age at diagnosis in the surveillance group was significantly higher than in the immediate operation group (median, 81 vs. 65 years, respectively, P<0.01). The Charlson Comorbidity Index in the surveillance group was significantly higher than in the immediate operation group (median, 5 vs. 2, respectively, P<0.01) and 10 patients (67%) had complications, which was one of the reasons for surveillance. The median initial tumor size in the surveillance group was 2.5 cm (1.5-10.1). There was no significant difference in the tumor size between the two groups. During a median follow-up of 19 months (6-55) the median tumor growth rate was 0.29 cm per year (-0.19-0.65) in the surveillance group. Of the 15 patients with computed tomography follow-up, four underwent surgical resection of the renal masses after surveillance. The histological diagnosis was clear cell renal cell carcinoma in all four. During follow-up, two patients died of other causes and one patient had bone metastasis but there was no death related to the renal masses in the surveillance group. (Conclusions) The appropriateness of the surveillance should be considered when we initiate surveillance for patients with renal masses because metastasis was detected in one patient in this study. On the other hand, surveillance may be an acceptable management method for elderly or severely comorbid patients because there were two deaths from other causes in the surveillance group.
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Baldari D, Capece S, Mainenti PP, Tucci AG, Klain M, Cozzolino I, Salvatore M, Maurea S. Comparison between computed tomography multislice and high-field magnetic resonance in the diagnostic evaluation of patients with renal masses. Quant Imaging Med Surg 2015; 5:691-9. [PMID: 26682139 DOI: 10.3978/j.issn.2223-4292.2015.07.03] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
BACKGROUND Renal masses are a common finding in diagnostic imaging; these lesions usually are solid or cystic, benign or malignant, and the correct diagnosis may be difficult. The aim of our study was the comparison of multi-slice computed tomography (MSCT) and high-field magnetic resonance (MR) in the diagnostic evaluation of renal masses. METHODS We studied 29 patients, 16 men and 13 women aged 8-85 years (mean 61±17 years) with histo-cytological diagnosis of renal masses (n=31), of which the majority (74%; n=23) was represented by malignant lesions [renal cell carcinoma (Ca) =16, chromophobe renal cell Ca =2, squamous cell Ca =1, urothelial Ca =2, lymphoma =1, Wilms tumor =1]; the remaining 8 masses (26%) were benign (pyelonephritis =2, simple cyst =1, hematic cyst =1, lipoma =1 and oncocytoma =3). All patients underwent MSCT and MR (3.0 Tesla) before and after contrast injection; the images were evaluated in double-blind by two expert radiologists. The results of the images were then compared with the histo-cytological data to calculate the values of diagnostic accuracy for both methods in the identification and characterization of renal masses. The benign or malignant nature of the lesions was established according to the regularity of the margins, presence or absence of significant contrast enhancement, infiltration of perirenal fat and vascular invasion. The concordance of the results of the two imaging techniques was then calculated using the coefficient Kappa Cohen. RESULTS For both identification and characterization of renal masses, MSCT and MR showed comparable values of diagnostic accuracy with a significant concordance (k=1); in particular, the diagnostic accuracy of MSCT/MR was 100%/100% for lesion identification, 90%/90% for lesion characterization in terms of benign or malignant nature, 97%/97% for the evaluation of lesion edges, 90%/90% for the assessment of lesion contrast enhancement, 93%/93% for the evaluation of peri-renal fat infiltration and 96%/96% for the evaluation of vascular infiltration. Only in three cases of oncocytoma the two imaging methods were both inaccurate for diagnosis of benignity classifying the lesions as probably malignant on the basis of the absence of central scar and of dynamic contrast enhancement pattern. CONCLUSIONS The results of our study show comparable diagnostic accuracy of computed tomography (CT) and MR for the identification and characterization of expansive renal lesions. High-field MR is, therefore, a valid alternative to MSCT in the evaluation of renal masses avoiding exposure to ionizing radiation.
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Affiliation(s)
- Diana Baldari
- 1 Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy ; 2 Istituto di Biostrutture e Bioimmagini (IBB), Consiglio Nazionale delle Ricerche (CNR), Naples, Italy ; 3 IRCCS SDN, Naples, Italy
| | - Sergio Capece
- 1 Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy ; 2 Istituto di Biostrutture e Bioimmagini (IBB), Consiglio Nazionale delle Ricerche (CNR), Naples, Italy ; 3 IRCCS SDN, Naples, Italy
| | - Pier Paolo Mainenti
- 1 Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy ; 2 Istituto di Biostrutture e Bioimmagini (IBB), Consiglio Nazionale delle Ricerche (CNR), Naples, Italy ; 3 IRCCS SDN, Naples, Italy
| | - Anna Giacoma Tucci
- 1 Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy ; 2 Istituto di Biostrutture e Bioimmagini (IBB), Consiglio Nazionale delle Ricerche (CNR), Naples, Italy ; 3 IRCCS SDN, Naples, Italy
| | - Michele Klain
- 1 Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy ; 2 Istituto di Biostrutture e Bioimmagini (IBB), Consiglio Nazionale delle Ricerche (CNR), Naples, Italy ; 3 IRCCS SDN, Naples, Italy
| | - Immacolata Cozzolino
- 1 Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy ; 2 Istituto di Biostrutture e Bioimmagini (IBB), Consiglio Nazionale delle Ricerche (CNR), Naples, Italy ; 3 IRCCS SDN, Naples, Italy
| | - Marco Salvatore
- 1 Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy ; 2 Istituto di Biostrutture e Bioimmagini (IBB), Consiglio Nazionale delle Ricerche (CNR), Naples, Italy ; 3 IRCCS SDN, Naples, Italy
| | - Simone Maurea
- 1 Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy ; 2 Istituto di Biostrutture e Bioimmagini (IBB), Consiglio Nazionale delle Ricerche (CNR), Naples, Italy ; 3 IRCCS SDN, Naples, Italy
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Hwang DH, Ma K, Yepes F, Nadamuni M, Nayyar M, Liu B, Duddalwar V, Lepore N. Multidimensional Interactive Radiology Report and Analysis: Standardization of workflow and reporting for renal mass tracking and quantification. Proc SPIE Int Soc Opt Eng 2015; 9681:96810C. [PMID: 31178621 PMCID: PMC6554203 DOI: 10.1117/12.2211526] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
A conventional radiology report primarily consists of a large amount of unstructured text, and lacks clear, concise, consistent and content-rich information. Hence, an area of unmet clinical need consists of developing better ways to communicate radiology findings and information specific to each patient. Here, we design a new workflow and reporting system that combines and integrates advances in engineering technology with those from the medical sciences, the Multidimensional Interactive Radiology Report and Analysis (MIRRA). Until recently, clinical standards have primarily relied on 2D images for the purpose of measurement, but with the advent of 3D processing, many of the manually measured metrics can be automated, leading to better reproducibility and less subjective measurement placement. Hence, we make use this newly available 3D processing in our workflow. Our pipeline is used here to standardize the labeling, tracking, and quantifying of metrics for renal masses.
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Affiliation(s)
- Darryl H Hwang
- USC 4D Quantitative Imaging Lab, Dept. of Radiology, Univ. of Southern California, Los Angeles, CA, USA 90033
| | - Kevin Ma
- Dept. of Biomedical Engineering, Univ. of Southern California, Los Angeles, CA, USA 90089
| | - Fernando Yepes
- CIBORG Laboratory, Dept. of Radiology, Children's Hospital Los Angeles, CA, USA 90027
| | - Mridula Nadamuni
- Dept. of Radiology, Univ. of Southern California, Los Angeles, CA, USA 90033
| | - Megha Nayyar
- Dept. of Radiology, Univ. of Southern California, Los Angeles, CA, USA 90033
| | - Brent Liu
- Dept. of Biomedical Engineering, Univ. of Southern California, Los Angeles, CA, USA 90089
| | - Vinay Duddalwar
- Dept. of Radiology, Univ. of Southern California, Los Angeles, CA, USA 90033
| | - Natasha Lepore
- CIBORG Laboratory, Dept. of Radiology, Children's Hospital Los Angeles, CA, USA 90027
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24
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Bertolotto M, Cicero C, Perrone R, Degrassi F, Cacciato F, Cova MA. Renal Masses With Equivocal Enhancement at CT: Characterization With Contrast-Enhanced Ultrasound. AJR Am J Roentgenol. 2015;204:W557-W565. [PMID: 25905962 DOI: 10.2214/ajr.14.13375] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVE The purpose of this article is to retrospectively investigate in two radiology centers the role of contrast-enhanced ultrasound in the characterization of renal masses with equivocal enhancement at CT (i.e., with a density increase of 10-20 HU between unenhanced and contrast-enhanced scans) not characterized with conventional ultrasound modes. MATERIALS AND METHODS Forty-seven renal lesions (range, 0.8-7.7 cm; average, 2.6 cm) with equivocal enhancement at CT underwent contrast-enhanced ultrasound using sulfur hexafluoride-filled microbubbles. Examinations were digitally recorded for retrospective blinded evaluation by two radiologists with 20 and 10 years' experience in urologic imaging. Histologic results were available for 30 of 47 (64%) lesions (25 primary malignant tumors, two metastases, and three primary benign lesions). Two lesions increased in size and complexity during the follow-up and were considered malignant. One Bosniak category III and 14 category IIF cysts were stable after a follow-up of at least 3 years and were considered benign. ROC curve analysis was used to assess the capability of contrast-enhanced ultrasound to differentiate benign from malignant lesions. RESULTS Twelve likely complex cystic lesions at gray-scale ultrasound were cystic also on contrast-enhanced ultrasound and reference procedures. Eleven of 34 lesions that appeared solid at gray-scale ultrasound were cystic on contrast-enhanced ultrasound and reference procedures. One lesion considered likely solid by one radiologist and possibly cystic by the other was a solid tumor at contrast-enhanced ultrasound and histologic analysis. The diagnostic performance of contrast-enhanced ultrasound to characterize the lesions as benign or malignant was high for both readers (AUC, 0.958 and 0.966, respectively). CONCLUSION Contrast-enhanced ultrasound is effective for characterizing renal lesions presenting with equivocal enhancement at CT.
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25
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Chen Y, Wu N, Xue T, Hao Y, Dai J. Comparison of contrast-enhanced sonography with MRI in the diagnosis of complex cystic renal masses. J Clin Ultrasound 2015; 43:203-209. [PMID: 25179487 DOI: 10.1002/jcu.22232] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/10/2013] [Revised: 02/11/2014] [Accepted: 07/26/2014] [Indexed: 06/03/2023]
Abstract
PURPOSE To compare the diagnostic performance of contrast-enhanced ultrasound (CEUS) with MRI for complex cystic renal masses. METHODS The study received approval from our Ethics Committee, and all subjects provided informed consent. Seventy-one complex cystic renal masses were assessed using CEUS and MRI in 59 patients (44 men and 15 women; age range, 21-78 years; mean age, 49.6 years). The masses were classified as malignant or benign based on the Bosniak classification system (benign, categories II and IIF; malignant, categories III and IV). The diagnostic performances of CEUS and MRI for complex cystic renal masses were compared with the final diagnosis in each case obtained by histopathology (n = 43) or imaging follow-up (n = 28). RESULTS Among 71 complex cystic renal masses, 35 were benign and 36 were malignant. The sensitivity, specificity, and overall accuracy of CEUS in assessing the masses were 97.2%, 71.4%, and 84.5% versus 80.6%, 77.1%, and 78.9% for MRI; the areas below the receiver operating characteristic curves of CEUS and MRI were 0.84 and 0.79, respectively. The agreement between the classification using CEUS and the final diagnoses was fair to good (κ = 0.70), and the agreement between MRI and the final diagnoses was also fair to good (κ = 0.58). CONCLUSIONS CEUS has higher diagnostic sensitivity and accuracy but lower specificity than MRI for classifying complex cystic renal masses. © 2014 Wiley Periodicals, Inc. J Clin Ultrasound 43:203-209, 2015.
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Affiliation(s)
- Yu Chen
- Department of Diagnostic Radiology, Cancer Institute and Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, No. 17 Panjiayuannanli Chaoyang District, Beijing, 100021, China
| | - Ning Wu
- Department of Diagnostic Radiology, Cancer Institute and Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, No. 17 Panjiayuannanli Chaoyang District, Beijing, 100021, China
| | - Tie Xue
- Department of Ultrasound, Jinzhou Petrochemical Worker Hospital, No. 100 Jingyebeili Guta District, Jinzhou, 121001, China
| | - Yuzhi Hao
- Department of Diagnostic Radiology, Cancer Institute and Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, No. 17 Panjiayuannanli Chaoyang District, Beijing, 100021, China
| | - Jingrui Dai
- Department of Diagnostic Radiology, Cancer Institute and Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, No. 17 Panjiayuannanli Chaoyang District, Beijing, 100021, China
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Abstract
In light of evidence linking radical nephrectomy and consequent suboptimal renal function to adverse cardiovascular events and increased mortality, research into nephron-sparing techniques for renal masses widely expanded in the past two decades. The American Urological Association (AUA) guidelines now explicitly list partial nephrectomy as the standard of care for the management of T1a renal tumors. Because of the increasing utilization of cross-sectional imaging, up to 70% of newly detected renal masses are stage T1a, making them more amenable to minimally invasive nephron-sparing therapies including laparoscopic and robotic partial nephrectomy and ablative therapies. Cryosurgery has emerged as a leading option for renal ablation, and compared with surgical techniques it offers benefits in preserving renal function with fewer complications, shorter hospitalization times, and allows for quicker convalescence. A mature dataset exists at this time, with intermediate and long-term follow-up data available. Cryosurgical recommendations as a first-line therapy are made at this time in limited populations, including elderly patients, patients with multiple comorbidities, and those with a solitary kidney. As more data emerge on oncologic efficacy, and technical experience and the technology continue to improve, the application of this modality will likely be extended in future treatment guidelines.
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Affiliation(s)
- Marc Schiffman
- Department of Radiology, NYP-Weill Cornell Medical College, New York, New York
| | - Amiel Moshfegh
- Department of Radiology, NYP-Weill Cornell Medical College, New York, New York
| | - Adam Talenfeld
- Department of Radiology, NYP-Weill Cornell Medical College, New York, New York
| | - Joseph J Del Pizzo
- Department of Radiology, NYP-Weill Cornell Medical College, New York, New York
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27
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Abstract
The review summarises the technological advances in the application of high-intensity focused ultrasound for small renal masses presumed to be cancer including the systematic review of its clinical application. Current progress in the area of magnetic resonance image guided ultrasound ablation is also appraised. Specifically, organ tracking and real time monitoring of temperature changes during the treatment are discussed. Finally, areas of future research interest are outlined.
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Affiliation(s)
- G Nabi
- Department of Urology, University of Dundee, Scotland, DD1 9SY, UK
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