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Sah A, Gupta A, Garg S, Yadav N, Khan MA, Das CJ. Can quantitative perfusion CT-based biomarkers predict renal cell carcinoma subtypes? Abdom Radiol (NY) 2025; 50:2586-2594. [PMID: 39688674 DOI: 10.1007/s00261-024-04746-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2024] [Revised: 12/01/2024] [Accepted: 12/03/2024] [Indexed: 12/18/2024]
Abstract
PURPOSE To assess diagnostic accuracy of perfusion CT (pCT) based biomarkers in differentiating clear-cell renal cell carcinoma (ccRCC) from non-ccRCC. MATERIALS AND METHOD This retrospective study comprised 95 patients with RCCs (70 ccRCCs and 25 non-ccRCCs) who had perfusion CT (pCT) before surgery between January 2017 and December 2022. Two readers independently recorded PCT parameters [blood flow (BF), blood volume (BV), mean transit time (MTT), and time to peak (TTP)] by drawing a circular ROI on the tumor. The open-source program "Labelme" was used to create a polygonal bounding box to outline tumor borders. The intraclass correlation coefficient (ICC) was used to determine interreader agreement. The pCT model was evaluated using multivariable logistic regression analysis with the STATA 18 program to determine the importance of each of these characteristics in predicting the type of tumor. RESULTS Clear cell RCC had significantly greater MIP and lower TTP values than non-clear cell RCC (p < 0.05). RCCs showed considerably higher TTP, MTT, and lower MIP values than the normal renal cortex (p < 0.05). At a threshold of 129 HU, MIP had an AUC of 0.78, sensitivity and specificity of 80% and 70%, respectively, according to ROC analysis. CONCLUSIONS pCT has a high diagnostic accuracy in distinguishing between ccRCC and non-ccRCC tumors; Clinical relevance: A non-invasive, accurate, reliable, and reproducible imaging biomarker for RCC subtype prediction is possible on pCT, which may be significant for evaluating the response to antiangiogenic therapy.
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Affiliation(s)
- Anjali Sah
- All India Institute of Medical Sciences, Ansari Nagar East, New Delhi, 110029, India
| | - Amit Gupta
- All India Institute of Medical Sciences, Ansari Nagar East, New Delhi, 110029, India
| | - Sanil Garg
- All India Institute of Medical Sciences, Ansari Nagar East, New Delhi, 110029, India
| | - Neel Yadav
- All India Institute of Medical Sciences, Ansari Nagar East, New Delhi, 110029, India
| | - Maroof Ahmad Khan
- All India Institute of Medical Sciences, Ansari Nagar East, New Delhi, 110029, India
| | - Chandan J Das
- All India Institute of Medical Sciences, Ansari Nagar East, New Delhi, 110029, India.
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Xing X, Cheng SP, Huang JB. Predicting angiogenesis in adrenal pheochromocytoma: the role of modified parameters from contrast-enhanced CT. Discov Oncol 2024; 15:497. [PMID: 39331234 PMCID: PMC11436525 DOI: 10.1007/s12672-024-01343-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2024] [Accepted: 09/12/2024] [Indexed: 09/28/2024] Open
Abstract
OBJECTIVE The aim of this study is to investigate the value of modified parameters derived from dual-phase contrast-enhanced computed tomography (CT) in predicting angiogenesis within pheochromocytoma. METHOD A total of 31 patients with pathologically confirmed pheochromocytoma underwent preoperative dual-phase contrast-enhanced CT scanning, wherein modified CT enhancement parameters, namely maximum enhancement difference (∆H) and maximum enhancement velocity (V), were quantified. Subsequently, postoperative specimens were evaluated by pathological section, while microvessel density (MVD) and vascular endothelial growth factor (VEGF) levels were counted. We conducted comparative analyses to assess disparities in maximum enhancement difference and enhancement velocity between groups characterized by high and low VEGF expression. Furthermore, correlations between maximum enhancement difference, enhancement velocity, and MVD were examined, along with an assessment of the association between maximum enhancement difference, VEGF expression, and MVD at the point of maximal enhancement difference occurrence. RESULTS In the study group, unilateral pheochromocytoma was observed in 31 cases, with 19 cases of arterial phase enhancement and 12 cases displaying venous phase enhancement. The range of maximum enhancement difference (ΔH) spanned from 24 to 102 HU, while the range of maximum enhancement velocity (V) extended from 0.40 HU/s to 4.08 HU/s. Analysis revealed a significant elevation in MVD value within the arterial phase enhancement group compared to the venous phase enhancement group. Additionally, a positive correlation was discerned between the maximum enhancement difference, V, and MVD. Notably, both ∆H and V exhibited statistically significant elevations in the high VEGF expression group relative to the low VEGF expression group. Furthermore, a positive correlation was observed between both ΔH and V and VEGF expression levels. CONCLUSION Increased values of ∆H and V are indicative of heightened MVD and VEGF expression. Consequently, the modified parameters derived from dual-phase contrast-enhanced CT scanning serve as predictive markers for angiogenesis in adrenal pheochromocytoma.
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Affiliation(s)
- Xing Xing
- Department of Urology, The First Affiliated Hospital of Yangtze University Jingzhou, No. 8 of HangKong Road, ShaShi District, Jingzhou, 434000, Hubei, People's Republic of China
| | - Shao-Ping Cheng
- Department of Urology, The First Affiliated Hospital of Yangtze University Jingzhou, No. 8 of HangKong Road, ShaShi District, Jingzhou, 434000, Hubei, People's Republic of China.
| | - Jin-Bai Huang
- Department of Radiology, The First Affiliated Hospital of Yangtze University Jingzhou, Jingzhou, 434000, Hubei, People's Republic of China
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Pathak N, Ganpule A, Patel D, Singh A, Shete N, Sabnis R, Desai M. Outcomes and predictors of clinical T1 renal mass (cT1) upstaged to pathological T3a (pT3a) after partial nephrectomy: A single-center experience. Int J Urol 2024; 31:252-257. [PMID: 38124339 DOI: 10.1111/iju.15344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 11/06/2023] [Indexed: 12/23/2023]
Abstract
OBJECTIVES Clinical T1 (cT1) renal mass treated surgically has a good prognosis, but there is an upstaging risk that potentially threatens oncological outcomes after partial nephrectomy (PN). We aim to analyze and study the incidence, predictors, perioperative morbidity, and oncological outcomes of pT3a upstaging. METHODOLOGY A retrospective study of 313 patients who underwent PN for cT1 renal mass at a single center from a single tertiary referral center between 2000 and 2021 was done. Demographic, perioperative, pathological, and outcome variables were reviewed. We compared these parameters between upstaged and non-upstaged groups. Multivariate logistic regression analysis was used to study preoperative variables associated with upstaging. RESULTS Nineteen patients were upstaged to pT3a. Making an incidence of 6.1%. Upstaged tumors were bigger (5.02 cm vs. 4.08 cm, p = 0.004), had higher clinical stage T1b (84.2 vs. 40.5%, p < 0.001), had more tumors which were central location (21 vs. 3.4%, p < 0.001), had more endophytic and mesophytic tumors (15.8 vs. 5.8% and 52.6 vs. 9.5%, p < 0.001), and had higher R.E.N.A.L Nephrometry score (8.05 vs. 6, p < 0.001). Upstaged tumors had more operative times (227 vs. 203 min, p = 0.01), more postoperative complications (68.4 vs. 13.1%, p < 0.001), more major complications of Clavien Dindo Grade 3 and above (15.8 vs. 4.4%, p < 0.001). Age (OR 1.035, p = 0.034), Radiological tumor dimension (OR 1.578, p = 0.003), Radiological or Clinical stage (T1b) (9.19, p = 0.008), Higher Nephrometry score (Intermediate and High) (OR 6.184, p = 0.004) were preoperative predictors of upstaging. Oncological outcomes were comparable. CONCLUSION Tumor upstaging was uncommon with more perioperative morbidity. Higher age, larger tumor size, higher tumor stage, and higher nephrometry scores were preoperative predictors of upstaging.
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Affiliation(s)
- Niramya Pathak
- Urology Department, Muljibhai Patel Urological Hospital, Nadiad, Gujarat, India
| | - Arvind Ganpule
- Urology Department, Muljibhai Patel Urological Hospital, Nadiad, Gujarat, India
| | - Dhruv Patel
- Urology Department, Muljibhai Patel Urological Hospital, Nadiad, Gujarat, India
| | - Abhishek Singh
- Urology Department, Muljibhai Patel Urological Hospital, Nadiad, Gujarat, India
| | - Nitiraj Shete
- Urology Department, Muljibhai Patel Urological Hospital, Nadiad, Gujarat, India
| | - Ravindra Sabnis
- Urology Department, Muljibhai Patel Urological Hospital, Nadiad, Gujarat, India
| | - Mahesh Desai
- Urology Department, Muljibhai Patel Urological Hospital, Nadiad, Gujarat, India
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Zhou Z, Qian X, Hu J, Geng C, Zhang Y, Dou X, Che T, Zhu J, Dai Y. Multi-phase-combined CECT radiomics models for Fuhrman grade prediction of clear cell renal cell carcinoma. Front Oncol 2023; 13:1167328. [PMID: 37692840 PMCID: PMC10485140 DOI: 10.3389/fonc.2023.1167328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 07/24/2023] [Indexed: 09/12/2023] Open
Abstract
Objective This study aimed to evaluate the effectiveness of multi-phase-combined contrast-enhanced CT (CECT) radiomics methods for noninvasive Fuhrman grade prediction of clear cell renal cell carcinoma (ccRCC). Methods A total of 187 patients with four-phase CECT images were retrospectively enrolled and then were categorized into training cohort (n=126) and testing cohort (n=61). All patients were confirmed as ccRCC by histopathological reports. A total of 110 3D classical radiomics features were extracted from each phase of CECT for individual ccRCC lesion, and contrast-enhanced variation features were also calculated as derived radiomics features. These features were concatenated together, and redundant features were removed by Pearson correlation analysis. The discriminative features were selected by minimum redundancy maximum relevance method (mRMR) and then input into a C-support vector classifier to build multi-phase-combined CECT radiomics models. The prediction performance was evaluated by the area under the curve (AUC) of receiver operating characteristic (ROC). Results The multi-phase-combined CECT radiomics model showed the best prediction performance (AUC=0.777) than the single-phase CECT radiomics model (AUC=0.711) in the testing cohort (p value=0.039). Conclusion The multi-phase-combined CECT radiomics model is a potential effective way to noninvasively predict Fuhrman grade of ccRCC. The concatenation of first-order features and texture features extracted from corticomedullary phase and nephrographic phase are discriminative feature representations.
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Affiliation(s)
- Zhiyong Zhou
- Suzhou Institute of Biomedical Engineering and Technology, Chinese Academy of Sciences, Suzhou, Jiangsu, China
| | - Xusheng Qian
- Suzhou Institute of Biomedical Engineering and Technology, Chinese Academy of Sciences, Suzhou, Jiangsu, China
- School of Biomedical Engineering (Suzhou), Division of Life Sciences and Medicine, University of Science and Technology of China, Suzhou, Jiangsu, China
| | - Jisu Hu
- Suzhou Institute of Biomedical Engineering and Technology, Chinese Academy of Sciences, Suzhou, Jiangsu, China
- School of Biomedical Engineering (Suzhou), Division of Life Sciences and Medicine, University of Science and Technology of China, Suzhou, Jiangsu, China
| | - Chen Geng
- Suzhou Institute of Biomedical Engineering and Technology, Chinese Academy of Sciences, Suzhou, Jiangsu, China
| | - Yongsheng Zhang
- Department of Pathology, Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Xin Dou
- Department of Radiology, Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Tuanjie Che
- Key Laboratory of Functional Genomic and Molecular Diagnosis of Gansu Province, Lanzhou, Gansu, China
- Suzhou Science & Technology Town Hospital, Gusu School, Nanjing Medical University, Suzhou, Jiangsu, China
| | - Jianbing Zhu
- Suzhou Science & Technology Town Hospital, Gusu School, Nanjing Medical University, Suzhou, Jiangsu, China
| | - Yakang Dai
- Suzhou Institute of Biomedical Engineering and Technology, Chinese Academy of Sciences, Suzhou, Jiangsu, China
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Sanders JL, Biliroglu AO, Newsome IG, Adelegan OJ, Yamaner FY, Dayton PA, Oralkan O. A Handheld Imaging Probe for Acoustic Angiography With an Ultrawideband Capacitive Micromachined Ultrasonic Transducer (CMUT) Array. IEEE TRANSACTIONS ON ULTRASONICS, FERROELECTRICS, AND FREQUENCY CONTROL 2022; 69:2318-2330. [PMID: 35522635 PMCID: PMC9716577 DOI: 10.1109/tuffc.2022.3172566] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
This article presents an imaging probe with a 256-element ultrawideband (UWB) 1-D capacitive micromachined ultrasonic transducer (CMUT) array designed for acoustic angiography (AA). This array was fabricated on a borosilicate glass wafer with a reduced bottom electrode and an additional central plate mass to achieve the broad bandwidth. A custom 256-channel handheld probe was designed and implemented with integrated low-noise amplifiers and supporting power circuitry. This probe was used to characterize the UWB CMUT, which has a functional 3-dB frequency band from 3.5 to 23.5 MHz. A mechanical index (MI) of 0.33 was achieved at 3.5 MHz at a depth of 11 mm. These promising measurements are then combined to demonstrate AA. The use of alternate amplitude modulation (aAM) combined with a frequency analysis of the measured transmit signal demonstrates the suitability of the UWB CMUT for AA. This is achieved by measuring only a low level of unwanted high-frequency harmonics in both the transmit signal and the reconstructed image in the areas other than the contrast bubbles.
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Newsome IG, Dayton PA. Acoustic Angiography: Superharmonic Contrast-Enhanced Ultrasound Imaging for Noninvasive Visualization of Microvasculature. Methods Mol Biol 2022; 2393:641-655. [PMID: 34837204 DOI: 10.1007/978-1-0716-1803-5_34] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Acoustic angiography is a contrast-enhanced ultrasound technique that relies on superharmonic imaging to form high-resolution, three-dimensional maps of the microvasculature. In order to obtain signal separation between tissue and contrast, acoustic angiography has been performed with dual-frequency transducers with nonoverlapping bandwidths. This enables a high contrast-to-tissue ratio, and the choice of a high frequency receiving element provides high resolution. In this chapter, we describe the technology behind acoustic angiography as well as the step-by-step implementation of this contrast enhanced microvascular imaging technique.
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Affiliation(s)
- Isabel G Newsome
- Joint Department of Biomedical Engineering, University of North Carolina at Chapel Hill and North Carolina State University, Raleigh, NC, USA
| | - Paul A Dayton
- Joint Department of Biomedical Engineering, University of North Carolina at Chapel Hill and North Carolina State University, Raleigh, NC, USA.
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Spek A, Graser A, Casuscelli J, Szabados B, Rodler S, Marcon J, Stief C, Staehler M. Dynamic contrast-enhanced CT-derived blood flow measurements enable early prediction of long term outcome in metastatic renal cell cancer patients on antiangiogenic treatment. Urol Oncol 2021; 40:13.e1-13.e8. [PMID: 34535355 DOI: 10.1016/j.urolonc.2021.08.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Revised: 07/11/2021] [Accepted: 08/13/2021] [Indexed: 11/18/2022]
Abstract
PURPOSE To evaluate the role of dynamic contrast-enhanced CT (DCE-CT) as an independent non-invasive biomarker in predicting long term outcome in patients with metastatic renal cell carcinoma (mRCC) on antiangiogenic treatment. MATERIAL AND METHODS Eighty two mRCC patients were prospectively enrolled from 09/2011 to 04/2015, out of which 71 were included in the final data analysis; the population was observed until 12/2020 to obtain complete overall survival data. DCE-CT imaging was performed at baseline and 10 to 12 weeks after start of treatment with targeted therapy. DCE-CT included a dynamic acquisition after injection of 50 ml of nonionic contrast agent at 6 ml/s using a 4D spiral mode (10 cm z-axis coverage, acquisition time 43 sec, 100 kVp (abdomen), 80 kVp (chest), 80-100 mAs) on a dual source scanner (Definition FLASH, Siemens). Blood flow (BF) was calculated for target tumor volumes using a deconvolution model. Progression free survival (PFS) and overall survival (OS) were analyzed using Kaplan-Meier statistics (SPSS version 24). RESULTS Patients were treated with either sunitinib, pazopanib, sorafenib, tivozanib, axitinib, or cabozantinib. A cut-off value of 50% blood flow reduction at follow-up allowed for identification of patients with favorable long-term outcome: Median OS in n = 42 patients with an average blood flow reduction of >50% (mean, 79%) was 34 (range, 14-54) months, while n = 21 patients with an average reduction of less than 50% (mean, 28%) showed a median OS of 12 (range, 6-18) months, and n = 8 patients with an increase in blood flow survived for a median of 7 (range, 3-11) months. CONCLUSION Blood flow in metastases measured with DCE-CT at first follow-up is a strong predictor of overall survival in mRCC patients on antiangiogenic treatment.
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Affiliation(s)
- Annabel Spek
- Department of Urology, University Hospital, LMU Munich, Munich, Germany.
| | | | | | | | - Severin Rodler
- Department of Urology, University Hospital, LMU Munich, Munich, Germany
| | - Julian Marcon
- Department of Urology, University Hospital, LMU Munich, Munich, Germany
| | - Christian Stief
- Department of Urology, University Hospital, LMU Munich, Munich, Germany
| | - Michael Staehler
- Department of Urology, University Hospital, LMU Munich, Munich, Germany
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Assessment of the embolization effect of temperature-sensitive p(N-isopropylacrylamide-co-butyl methylacrylate) nanogels in the rabbit renal artery by CT perfusion and confirmed by macroscopic examination. Sci Rep 2021; 11:4826. [PMID: 33649484 PMCID: PMC7921428 DOI: 10.1038/s41598-021-84372-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 02/15/2021] [Indexed: 11/29/2022] Open
Abstract
Transcatheter embolization is an important treatment method in clinical therapy, and vascular embolization material plays a key role in embolization. The temperature-sensitive p(N-isopropylacrylamide-co-butyl methylacrylate) (PIB) nanogel is a novel embolic agent. To evaluate the feasibility of the nanogel as a blood vessel embolization agent, we aimed to assess the effect of embolization with PIB nanogels in the rabbit renal artery by non-invasive computed tomography (CT) perfusion, macroscopic and histological examination. Ten healthy adult Japanese rabbits were used to implement RAE of PIB nanogels in their right kidneys. CT perfusion scans were performed pre- and post-treatment at various time-points (1, 4, 8, and 12 weeks). Two rabbits were euthanized and histologically examined at each time-point, and the remaining rabbits were euthanized at 12 weeks after embolization. The RAE efficacy of the nanogels was further confirmed by macroscopic and histological examination. The renal volume and renal blood flow (BF) of the right kidney were significantly decreased post-treatment compared with those pre-treatment (volume: pre, 9278 ± 1736 mm3; post 1 week, 5155 ± 979 mm3, P < 0.0001; post 4 weeks, 3952 ± 846 mm3, P < 0.0001; post 8 weeks, 3226 ± 556 mm3, P < 0.0001; post 12 weeks, 2064 ± 507 mm3, P < 0.0001. BF: pre, 530.81 ± 51.50 ml/min/100 ml; post 1 week, 0 ml/min/100 ml, P < 0.0001; post 4 weeks, 0 ml/min/100 ml, P < 0.0001; post 8 weeks, 0 ml/min/100 ml, P < 0.0001; post 12 weeks, 0 ml/min/100 ml, P < 0.0001). No revascularization or collateral circulation was observed on histological examination during this period, and PIB nanogels were dispersed in all levels of the renal arteries. Twelve weeks after embolization, CT perfusion showed no BF in the right renal artery and renal tissue, a finding that was consistent with histological examination showing complete embolization of the right renal artery with a lack of formation of collateral vessels. The effect of embolization on PIB was adequate, with good dispersion and permanency, and could be evaluated by non-invasive and quantitative CT perfusion.
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Kalarakis G, Brehmer K, Svensson A, Axelsson R, Brismar TB, Tzortzakakis A. Combining contrast-enhanced ultrasound, CT perfusion and 99mTc-Sestamibi SPECT/CT to guide diagnosis in a case of solid renal tumour. BJR Case Rep 2021; 7:20200115. [PMID: 33614118 PMCID: PMC7869121 DOI: 10.1259/bjrcr.20200115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 08/24/2020] [Accepted: 08/25/2020] [Indexed: 11/11/2022] Open
Abstract
Definitive, pre-operative differentiation of solid renal lesions by ultrasound, contrast-enhanced multiphasic CT or MRI examinations is often not possible. An increasing amount of literature indicates the added value of 99mTc-Sestamibi SPECT/CT, CT perfusion and contrast-enhanced ultrasound in the pre-operative characterisation of solid renal tumours. This case report presents the diagnostic approach of a solid renal tumour that turned out to be a hybrid oncocytic chromophobe tumour in a patient with Stage 3 renal failure by combining the three aforementioned modern examination techniques.
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Affiliation(s)
- Georgios Kalarakis
- Department of Radiology, Karolinska University Hospital, Huddinge, Stockholm, Sweden
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Normalized Dual-Energy Iodine Ratio Best Differentiates Renal Cell Carcinoma Subtypes Among Quantitative Imaging Biomarkers From Perfusion CT and Dual-Energy CT. AJR Am J Roentgenol 2020; 215:1389-1397. [PMID: 33052738 DOI: 10.2214/ajr.19.22612] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE. The objective of our study was to assess and compare the diagnostic accuracy of perfusion CT (PCT) and dual-energy CT (DECT) in differentiating clear cell renal cell carcinoma (ccRCC) from non-ccRCC. MATERIALS AND METHODS. This retrospective study included 51 patients with 52 renal cell carcinomas (RCCs) (36 ccRCCs and 16 non-ccRCCs) who underwent both PCT and DECT before surgery or biopsy between January 2014 and December 2018. Three independent readers measured blood flow, blood volume (BV), and permeability using PCT and iodine concentration (IC) and iodine ratio using DECT. Interreader agreement was calculated using the intraclass correlation coefficient (ICC). Multivariable logistic regression analysis was performed to assess PCT and DECT models. Size-specific dose estimates of the two methods were compared. RESULTS. BV (ICC, 0.93) and iodine ratio (ICC, 0.85) were the most reproducible parameters. Both PCT and DECT were significant models (p < 0.05, all readers) for differentiating ccRCC from non-ccRCC. There was no significant difference in diagnostic accuracy between PCT and DECT (p > 0.05). BV and iodine ratio were independent predictors of nonccRCC (p < 0.05). However, the mean size-specific dose estimate was 16 times lower with DECT than with PCT (p < 0.001). The AUC of iodine ratio was 0.95, and sensitivity, specificity, and accuracy with an iodine ratio cutoff of 63.72% was 0.90, 0.86, and 0.87, respectively. CONCLUSION. PCT and DECT had comparable and high diagnostic accuracy in differentiating RCC subtypes; however, because of the significantly lower radiation dose of DECT, iodine ratio may be used as the best independent predictor.
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Newsome IG, Dayton PA. Visualization of Microvascular Angiogenesis Using Dual-Frequency Contrast-Enhanced Acoustic Angiography: A Review. ULTRASOUND IN MEDICINE & BIOLOGY 2020; 46:2625-2635. [PMID: 32703659 PMCID: PMC7608693 DOI: 10.1016/j.ultrasmedbio.2020.06.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Revised: 05/25/2020] [Accepted: 06/14/2020] [Indexed: 05/07/2023]
Abstract
Cancerous tumor growth is associated with the development of tortuous, chaotic microvasculature, and this aberrant microvascular morphology can act as a biomarker of malignant disease. Acoustic angiography is a contrast-enhanced ultrasound technique that relies on superharmonic imaging to form high-resolution 3-D maps of the microvasculature. To date, acoustic angiography has been performed with dual-element transducers that can achieve high contrast-to-tissue ratio and resolution in pre-clinical small animal models. In this review, we first describe the development of acoustic angiography, including the principle, transducer design, and optimization of superharmonic imaging techniques. We then detail several preclinical applications of this microvascular imaging method, as well as the current and future development of acoustic angiography as a pre-clinical and clinical diagnostic tool.
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Affiliation(s)
- Isabel G Newsome
- Joint Department of Biomedical Engineering, University of North Carolina at Chapel Hill and North Carolina State University, Chapel Hill, North Carolina, USA
| | - Paul A Dayton
- Joint Department of Biomedical Engineering, University of North Carolina at Chapel Hill and North Carolina State University, Chapel Hill, North Carolina, USA.
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Association of tumor grade, enhancement on multiphasic CT and microvessel density in patients with clear cell renal cell carcinoma. Abdom Radiol (NY) 2020; 45:3184-3192. [PMID: 31650375 DOI: 10.1007/s00261-019-02271-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
PURPOSE Clear cell renal cell carcinoma (ccRCC) comprises nearly 90% of all diagnosed RCC subtypes and has the worst prognosis and highest metastatic potential. The strongest prognostic factors for patients with ccRCC include histological subtype and Fuhrman grade, which are incorporated into prognostic models. Since ccRCC is a highly vascularized tumor, there may be differences in enhancement patterns on multidetector CT (MDCT) due to the hemodynamics and microvessel density (MVD) of the lesions. This may provide a noninvasive method to characterize incidentally detected low- and high-grade ccRCCs on MDCT. The purpose of our study was to determine the correlation between MDCT enhancement parameters, ccRCC MVD, and Fuhrman grade to determine its utility and value in assessing tumor vascularity and grade in vivo. METHODS In this retrospective, HIPAA-compliant, institutional review board-approved study with waiver of informed consent, 127 consecutive patients with 89 low-grade (LG), and 43 high-grade (HG) ccRCCs underwent preoperative four-phase MDCT. A 3D volume of interest (VOI) was obtained for every tumor and absolute enhancement and the wash-in/wash-out of enhancement for each phase was assessed. Immunohistochemistry on resected specimens was used to quantify MVD. Linear regression and Pearson correlation were used to investigate the strength of the association between 3D VOI enhancement and MVD. Stepwise logistic regression analysis determined independent predictors of HG ccRCC. Cut-off values and odds Ratio (OR) with 95% CIs were reported. The clinical, radiomic, and pathologic features with the highest performance in the stepwise logistic regression analysis were evaluated using receiver operator characteristics (ROC) and area under the curve (AUC). RESULTS Absolute enhancement in the nephrographic phase < 52.1 Hounsfield Units (HU) (HR 0.979, 95% CI 0.964-0.994, p value = 0.006), lesion size > 4.3 cm (HR 1.450, 95% CI 1.211-1.738, p value < 0.001), and an intratumoral MVD < 15% (HR 0.932, 95% CI 0.867-1.002, p value = 0.058) were independent predictors of HG ccRCC with an AUC of 0.818 (95% CI 0.725-0.911). HG ccRCCs had a significant association between 3D VOI enhancement and MVD in each post-contrast phase (r2 = 0.238 to 0.455, p < 0.05). CONCLUSIONS Absolute enhancement of the entire lesion obtained from a 3D VOI in the nephrographic phase on preoperative MDCT can provide quantitative data that are a significant, independent predictor of a high-grade clear cell RCC and can be used to assess tumor vascularity and grade in vivo.
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Beyer T, Bidaut L, Dickson J, Kachelriess M, Kiessling F, Leitgeb R, Ma J, Shiyam Sundar LK, Theek B, Mawlawi O. What scans we will read: imaging instrumentation trends in clinical oncology. Cancer Imaging 2020; 20:38. [PMID: 32517801 PMCID: PMC7285725 DOI: 10.1186/s40644-020-00312-3] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Accepted: 04/17/2020] [Indexed: 12/16/2022] Open
Abstract
Oncological diseases account for a significant portion of the burden on public healthcare systems with associated costs driven primarily by complex and long-lasting therapies. Through the visualization of patient-specific morphology and functional-molecular pathways, cancerous tissue can be detected and characterized non-invasively, so as to provide referring oncologists with essential information to support therapy management decisions. Following the onset of stand-alone anatomical and functional imaging, we witness a push towards integrating molecular image information through various methods, including anato-metabolic imaging (e.g., PET/CT), advanced MRI, optical or ultrasound imaging.This perspective paper highlights a number of key technological and methodological advances in imaging instrumentation related to anatomical, functional, molecular medicine and hybrid imaging, that is understood as the hardware-based combination of complementary anatomical and molecular imaging. These include novel detector technologies for ionizing radiation used in CT and nuclear medicine imaging, and novel system developments in MRI and optical as well as opto-acoustic imaging. We will also highlight new data processing methods for improved non-invasive tissue characterization. Following a general introduction to the role of imaging in oncology patient management we introduce imaging methods with well-defined clinical applications and potential for clinical translation. For each modality, we report first on the status quo and, then point to perceived technological and methodological advances in a subsequent status go section. Considering the breadth and dynamics of these developments, this perspective ends with a critical reflection on where the authors, with the majority of them being imaging experts with a background in physics and engineering, believe imaging methods will be in a few years from now.Overall, methodological and technological medical imaging advances are geared towards increased image contrast, the derivation of reproducible quantitative parameters, an increase in volume sensitivity and a reduction in overall examination time. To ensure full translation to the clinic, this progress in technologies and instrumentation is complemented by advances in relevant acquisition and image-processing protocols and improved data analysis. To this end, we should accept diagnostic images as "data", and - through the wider adoption of advanced analysis, including machine learning approaches and a "big data" concept - move to the next stage of non-invasive tumour phenotyping. The scans we will be reading in 10 years from now will likely be composed of highly diverse multi-dimensional data from multiple sources, which mandate the use of advanced and interactive visualization and analysis platforms powered by Artificial Intelligence (AI) for real-time data handling by cross-specialty clinical experts with a domain knowledge that will need to go beyond that of plain imaging.
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Affiliation(s)
- Thomas Beyer
- QIMP Team, Centre for Medical Physics and Biomedical Engineering, Medical University Vienna, Währinger Gürtel 18-20/4L, 1090, Vienna, Austria.
| | - Luc Bidaut
- College of Science, University of Lincoln, Lincoln, UK
| | - John Dickson
- Institute of Nuclear Medicine, University College London Hospital, London, UK
| | - Marc Kachelriess
- Division of X-ray imaging and CT, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, 69120, Heidelberg, DE, Germany
| | - Fabian Kiessling
- Institute for Experimental Molecular Imaging, University Clinic and Helmholtz Institute for Biomedical Engineering, RWTH Aachen University, Pauwelsstrasse 20, 52074, Aachen, DE, Germany
- Fraunhofer Institute for Digital Medicine MEVIS, Am Fallturm 1, 28359, Bremen, DE, Germany
| | - Rainer Leitgeb
- Centre for Medical Physics and Biomedical Engineering, Medical University Vienna, Vienna, AT, Austria
| | - Jingfei Ma
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Lalith Kumar Shiyam Sundar
- QIMP Team, Centre for Medical Physics and Biomedical Engineering, Medical University Vienna, Währinger Gürtel 18-20/4L, 1090, Vienna, Austria
| | - Benjamin Theek
- Institute for Experimental Molecular Imaging, University Clinic and Helmholtz Institute for Biomedical Engineering, RWTH Aachen University, Pauwelsstrasse 20, 52074, Aachen, DE, Germany
- Fraunhofer Institute for Digital Medicine MEVIS, Am Fallturm 1, 28359, Bremen, DE, Germany
| | - Osama Mawlawi
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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Upstaging to pT3a disease in patients undergoing robotic partial nephrectomy for cT1 kidney cancer: Outcomes and predictors from a multi-institutional dataset. Urol Oncol 2020; 38:286-292. [DOI: 10.1016/j.urolonc.2019.12.024] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Revised: 12/03/2019] [Accepted: 12/24/2019] [Indexed: 12/19/2022]
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Iodine Parameters in Triple-Bolus Dual-Energy CT Correlate With Perfusion CT Biomarkers of Angiogenesis in Renal Cell Carcinoma. AJR Am J Roentgenol 2020; 214:808-816. [PMID: 32069083 DOI: 10.2214/ajr.19.21969] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
OBJECTIVE. The purpose of this study is to determine the degree of the relationship between perfusion CT (PCT) parameters and iodine concentration metrics derived from triple-bolus dual-energy CT (DECT) and to compare the radiation dose delivered. SUBJECTS AND METHODS. This single-center prospective study was conducted from October 2015 to September 2017. Twenty-three consenting adults (15 men and eight women; mean [± SD] age, 56 ± 13 years [range, 25-78 years]) with renal cell carcinomas underwent consecutive PCT and triple-bolus DECT examinations. Triple-bolus DECT consisted of synchronous corticomedullary, nephrographic, and delayed phase scans acquired using a dual-source DECT scanner. Two readers independently analyzed blood flow, blood volume, and permeability, as measured by PCT, and iodine density and iodine ratio, as measured by triple-bolus DECT. Size-specific dose estimates were calculated for both groups. RESULTS. Interreader agreement was good for permeability (intraclass correlation coefficient [ICC] =.812) and blood flow (ICC = 0.849) and excellent for blood volume (ICC = 0.956), iodine density (ICC = 0.961), and iodine ratio (ICC = 0.956). Very strong positive correlations were found between blood volume and iodine density (p < 0.001) and between blood volume and iodine ratio (p < 0.001). Strong positive correlations were found between blood flow and iodine density (p < 0.001) and between blood flow and iodine ratio (p < 0.001). The correlations between permeability and iodine density (p = 0.01) and between permeability and iodine ratio (p = 0.02) were moderate. The mean size-specific dose estimate of triple-bolus DECT was approximately 15 times lower than that of PCT (p < 0.001). CONCLUSION. Quantitative iodine metrics derived from triple-bolus DECT showed significant correlation with CT parameters in renal cell carcinoma, with a significantly lower radiation dose.
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Baseline perfusion CT parameters as potential biomarkers in predicting long-term prognosis of localized clear cell renal cell carcinoma. Abdom Radiol (NY) 2019; 44:3370-3376. [PMID: 31399787 DOI: 10.1007/s00261-019-02087-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
PURPOSE We aimed to explore the relationship among baseline perfusion CT parameters, clinical, and pathological factors with post-nephrectomy long-term progression-free survival in localized clear cell renal cell carcinoma. MATERIALS AND METHODS This study retrospectively collected 127 patients from March 2005 to May 2007 who undertook perfusion CT. 61 patients were confirmed of pT1N0M0 or pT2N0M0 ccRCC. The mean follow-up time is 118.8 months (± 13.1 m, range 72-135 m). We compared clinical, pathological factors (gender, T stage, age, Fuhrmann grade, VEGF level, and MVD), and perfusion parameters before treatment [blood flow (BF), blood volume, mean transition time, and permeability surface-area product] between groups with post-nephrectomy metastasis and without metastasis. Association between covariates and progression-free survival (PFS) were analyzed using Cox proportional regression. RESULTS Among 61 patients, 11 developed distant metastasis (10 in the lung, one in the bone). BF in metastatic group [429.1 (233.8, 570.1) ml/min/100 g] was significantly higher than non-metastatic group [214.3 (153.3, 376.5) ml/min/100 g] (p = 0.011). Metastatic group also had more patients with higher Fuhrmann grade. Multi-covariant Cox regression demonstrated T staging, Fuhrmann grade, and BF were significantly associated with PFS [hazard ratio (HR) 3.35, 3.08, and 1.006]. In another model, BF > 230 ml/min/100 g was associated with PFS (HR 12.90), along with T staging and Fuhrmann grade (HR 4.73, 3.69). CONCLUSION Baseline tumor BF is a potential biomarker in prediction long-term metastasis of localized ccRCC and may help screening for higher risk localized ccRCC patients who need personalized surveillance strategy after nephrectomy.
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Fan AC, Sundaram V, Kino A, Schmiedeskamp H, Metzner TJ, Kamaya A. Early Changes in CT Perfusion Parameters: Primary Renal Carcinoma Versus Metastases After Treatment with Targeted Therapy. Cancers (Basel) 2019; 11:cancers11050608. [PMID: 31052289 PMCID: PMC6562747 DOI: 10.3390/cancers11050608] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Revised: 04/25/2019] [Accepted: 04/26/2019] [Indexed: 12/28/2022] Open
Abstract
Computed tomography (CT) perfusion is a novel imaging method to determine tumor perfusion using a low-dose CT technique to measure iodine concentration at multiple time points. We determined if early changes in perfusion differ between primary renal tumors and metastatic tumor sites in patients with renal cell carcinoma (RCC) receiving targeted anti-angiogenic therapy. A total of 10 patients with advanced RCC underwent a CT perfusion scan at treatment baseline and at one week after initiating treatment. Perfusion measurements included blood volume (BV), blood flow (BF), and flow extraction product (FEP) in a total of 13 lesions (six primary RCC tumors, seven RCC metastases). Changes between baseline and week 1 were compared between tumor locations: primary kidney tumors vs metastases. Metastatic lesions had a greater decrease in BF (average BF difference ± standard deviation (SD): −75.0 mL/100 mL/min ± 81) compared to primary kidney masses (−25.5 mL/100 mL/min ± 35). Metastatic tumors had a wider variation of change in BF, BV and FEP measures compared to primary renal tumors. Tumor diameters showed little change after one week, but early perfusion changes are evident, especially in metastatic lesions compared to primary lesions. Future studies are needed to determine if these changes can predict which patients are benefiting from targeted therapy.
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Affiliation(s)
- Alice C Fan
- Division of Oncology, Department of Medicine, Stanford University School of Medicine, Stanford, CA 94305, USA
- Stanford Cancer Institute, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Vandana Sundaram
- Quantitative Sciences Unit, Department of Medicine, Stanford University School of Medicine, Stanford, CA 94304, USA
| | - Aya Kino
- Department of Radiology, Stanford University School of Medicine, Stanford, CA 94305, USA
| | | | - Thomas J Metzner
- Department of Urology, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Aya Kamaya
- Stanford Cancer Institute, Stanford University School of Medicine, Stanford, CA 94305, USA
- Department of Radiology, Stanford University School of Medicine, Stanford, CA 94305, USA.
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Gunn AJ, Mullenbach BJ, Poundstone MM, Gordetsky JB, Underwood ES, Rais-Bahrami S. Transarterial embolization of renal cell carcinoma as an adjunctive therapy prior to cryoablation: a propensity score matching analysis. ACTA ACUST UNITED AC 2019; 24:357-363. [PMID: 30373723 DOI: 10.5152/dir.2018.18090] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
PURPOSE We aimed to assess the safety and effectiveness of transarterial embolization (TAE) prior to percutaneous cryoablation (PCA) in the management of renal cell carcinoma (RCC) compared with PCA alone using a propensity score matching analysis to minimize confounding factors. METHODS A retrospective review of all PCAs performed for renal masses identified 9 patients who underwent TAE prior to PCA. These patients were matched in a 2:1 ratio with patients who underwent PCA only using age, gender, and tumor size to create the propensity score model for matching. Other demographic, clinical, and outcomes data were collected. RESULTS The TAE+PCA group included 5 males and 4 females with a mean age of 67.9 years and mean tumor diameter of 51.7 mm. The PCA only group included 11 males and 7 females with a mean age of 66.8 years and mean tumor diameter of 46.2 mm. No significant differences in these propensity score matched characteristics were identified. Further, the groups had no significant differences in tumor geometry (P = 0.831), R.E.N.A.L. nephrometry scores (P = 0.144), or comorbidity indices (P = 0.392). TAE was technically successful and without complication in all cases. PCA was technically successful in 8 of 9 patients in the TAE+PCA group and in 14 of 18 patients in the PCA only group (P = 0.483). No significant differences in the rate of complications (P = 0.483), change in eGFR (P = 0.691), or change in hematocrit (P = 0.152) were identified between the two groups. CONCLUSION TAE of RCC prior to PCA is safe and technically feasible; however, no objective benefits over PCA alone were identified by propensity score matching analysis. Due to small sample size and limitations of the study, no definite conclusions should be drawn. Larger, prospective studies of this therapeutic approach are warranted.
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Affiliation(s)
- Andrew J Gunn
- Division of Interventional Radiology, Department of Radiology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Benjamin J Mullenbach
- Division of Interventional Radiology, Department of Radiology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - May M Poundstone
- Division of Interventional Radiology, Department of Radiology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Jennifer B Gordetsky
- Department of Pathology University of Alabama at Birmingham, Birmingham, AL, USA
| | - Edgar S Underwood
- Division of Interventional Radiology, Department of Radiology, University of Alabama at Birmingham, Birmingham, AL, USA
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Coy H, Young JR, Douek ML, Pantuck A, Brown MS, Sayre J, Raman SS. Association of qualitative and quantitative imaging features on multiphasic multidetector CT with tumor grade in clear cell renal cell carcinoma. Abdom Radiol (NY) 2019; 44:180-189. [PMID: 29987358 DOI: 10.1007/s00261-018-1688-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
PURPOSE The purpose of the study was to determine if enhancement features and qualitative imaging features on multiphasic multidetector computed tomography (MDCT) were associated with tumor grade in patients with clear cell renal cell carcinoma (ccRCC). METHODS In this retrospective, IRB approved, HIPAA-compliant, institutional review board-approved study with waiver of informed consent, 127 consecutive patients with 89 low grade (LG) and 43 high grade (HG) ccRCCs underwent preoperative four-phase MDCT in unenhanced (UN), corticomedullary (CM), nephrographic (NP), and excretory (EX) phases. Previously published quantitative (absolute peak lesion enhancement, absolute peak lesion enhancement relative to normal enhancing renal cortex, 3D whole lesion enhancement and the wash-in/wash-out of enhancement within the 3D whole lesion ROI) and qualitative (enhancement pattern; presence of necrosis; pattern of; tumor margin; tumor-parenchymal interface, tumor-parenchymal interaction; intratumoral vascularity; collecting system infiltration; renal vein invasion; and calcification) assessments were obtained for each lesion independently by two fellowship-trained genitourinary radiologists. Comparisons between variables included χ2, ANOVA, and student t test. p values less than 0.05 were considered to be significant. Inter-reader agreement was obtained with the Gwet agreement coefficient (AC1) and standard error (SE) was reported. RESULTS No significant differences were observed between the LG and HG ccRCC cohorts with respect to absolute peak lesion enhancement and relative lesion enhancement ratio. There was a significant inverse correlation between low and high grade ccRCC and tumor enhancement the NP (71 HU vs. 54 HU, p < 0.001) and EX (52 HU vs. 39 HU, p < 0.001) phases using the 3D whole lesion ROI method. The percent wash-in of 3D enhancement from the UN to the CM phase was also significantly different between LG and HG ccRCCs (352% vs. 255%, p = 0.003). HG lesions showed significantly more calcification, necrosis, collecting system infiltration and ill-defined tumor margins (p < 0.05). Overall agreement between the two readers had a mean AC1 of 0.8172 (SE 0.0235). CONCLUSIONS Quantitatively, high grade ccRCC had significantly lower whole lesion enhancement in the NP and EX phases on MDCT. Qualitatively, high grade ccRCC were significantly more likely to be associated with calcifications, necrosis, collecting system infiltration, and an ill-defined tumor margin.
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Affiliation(s)
- Heidi Coy
- Department of Radiological Sciences, David Geffen School of Medicine at UCLA, Ronald Reagan-UCLA Medical Center, 924 Westwood Boulevard, Suite 650, Los Angeles, CA, 90024, USA.
| | - Jonathan R Young
- Department of Radiology, University of California, Davis, 4860 Y Street, Suite 3100, Sacramento, CA, 95817, USA
| | - Michael L Douek
- Department of Radiological Sciences, David Geffen School of Medicine at UCLA, Ronald Reagan-UCLA Medical Center, 924 Westwood Boulevard, Suite 650, Los Angeles, CA, 90024, USA
| | - Alan Pantuck
- Department of Urology, David Geffen School of Medicine at UCLA, Ronald Reagan-UCLA Medical Center, Clark Urology Center-Westwood, 200 Medical Plaza, Suite 140, Los Angeles, CA, 90095, USA
| | - Matthew S Brown
- Department of Radiological Sciences, David Geffen School of Medicine at UCLA, Ronald Reagan-UCLA Medical Center, 924 Westwood Boulevard, Suite 650, Los Angeles, CA, 90024, USA
| | - James Sayre
- Department of Biostatistics, UCLA School of Public Heath, Room 51-253A, Los Angeles, CA, 90095, USA
| | - Steven S Raman
- UCLA Department of Radiological Sciences, Ronald Reagan UCLA Medical Center, 757 Westwood Plaza, RRUMC 1621H, Box 957437, Los Angeles, CA, 90095, USA
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Chen C, Kang Q, Xu B, Shi Z, Guo H, Wei Q, Lu Y, Wu X. Fat poor angiomyolipoma differentiation from renal cell carcinoma at 320-slice dynamic volume CT perfusion. Abdom Radiol (NY) 2018; 43:1223-1230. [PMID: 28828638 DOI: 10.1007/s00261-017-1286-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
PURPOSE To compare various CT perfusion features of fat poor angiomyolipoma (AML) with those of size-matched renal cell carcinoma (RCC). METHODS One hundred and seventy-four patients [16 with fat poor AML (mean diameter, 3.1 cm; range, 1.5-5.5 cm) and 158 with RCC (mean diameter, 3.2 cm; range, 2.4-5.4 cm)] who had undergone 320-slice dynamic volume CT perfusion were evaluated. Equivalent blood volume (BV Equiv), permeability surface-area product (PS), and blood flow (BF) of tumor were measured and analyzed. Fat poor AML was compared with each subtype of RCC (132 clear cell, 9 papillary, and 17 chromophobe). Receiver operating characteristic (ROC) curve analysis was performed for the comparison of fat poor AML and RCC. ROC curve analysis was not performed for the papillary RCC subtype because of the small number of masses of this subtype. RESULTS BV Equiv and BF were significantly lower in fat poor AML than in clear cell RCC (P < 0.05 for both). Fat poor AML had higher BV Equiv, PS, and BF than papillary RCC (P < 0.05 for all). PS and BF in fat poor AML significantly exceeded those in chromophobe RCC (P < 0.05 for both). For differentiating fat poor AML from clear cell RCC, area under the ROC curve (AUC) of BV Equiv and BF were 0.82 and 0.69. Using the optimal threshold value, the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were 0.82, 0.81, 0.35, 0.97 for BV Equiv and 0.71, 0.75, 0.24, 0.96 for BF, respectively. For differentiating fat poor AML from chromophobe RCC, AUC of PS and BF were 0.77 and 0.79, respectively. The optimal sensitivity, specificity, PPV, and NPV were 0.77, 0.75, 0.75, 0.76 for PS and 0.71, 0.81, 0.72, 0.80 for BF, respectively. CONCLUSIONS Fat poor AML and subtypes of RCCs demonstrate different perfusion features at 320-slice dynamic volume CT, allowing their differentiations with BV Equiv, PS, and BF being valuable perfusion parameters.
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Wei J, Zhao J, Zhang X, Wang D, Zhang W, Wang Z, Zhou J. Analysis of dual energy spectral CT and pathological grading of clear cell renal cell carcinoma (ccRCC). PLoS One 2018; 13:e0195699. [PMID: 29715308 PMCID: PMC5929552 DOI: 10.1371/journal.pone.0195699] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Accepted: 02/26/2018] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To discuss the dual energy spectral computer tomography (CT) imaging features of the pathological grading of clear cell renal cell carcinoma (ccRCC) and the correlation between spectral CT imaging features and pathology. MATERIALS AND METHODS We performed analyses of 62 patients with confirmed diagnosis of ccRCC. All patients underwent non-enhanced CT and dual-phase (cortex phase, CP and parenchyma phase, PP) contrast-enhanced CT with dual energy spectral mode. The subjects were pathologically divided into two groups: low-grade group (Fuhrman 1/2) and high-grade group (Fuhrman 3/4). The CT value of each lesion was measured on the monochromatic image at 70 keV. The normalized iodine concentrations (NIC) and the slope of the spectrum curve were calculated. The qualitative morphological parameters, including tumor shape, calcification, pseudocapsule, necrosis, and enhancement mode, were compared between the two groups. The quantitative data were compared using Student's t-test, and the enumeration data were analyzed using the chi-square test between low-grade and high-grade ccRCC.Receiver operating characteristic curve was used to determine the sensitivity and specificity of the quantitative parameters in two groups. RESULTS The CT value, NIC, and mean slope of the low-grade group were increased compared with the high-grade group during CP (P = 0.001, P = 0.043, and P<0.001, respectively). The CT did not differ significantly during PP (P = 0.134); however, the NIC and mean slope varied considerably in the low grade compared with the high-grade group (P = 0.048, P = 0.017, respectively). The CT threshold value, NIC, and slope had high sensitivity and specificity in differentiating low-grade ccRCC from high-grade ccRCC. The tumor shape, pseudocapsule, and necrosis differed significantly between the two groups (P<0.05). CONCLUSIONS Dual energy spectral CT with the quantitative analysis of iodine concentration and qualitative analysis of morphological characteristics increases the accuracy of diagnosing the pathological grade of ccRCC.
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Affiliation(s)
- Jinyan Wei
- Department of Radiology, Lanzhou University Second Hospital, Lanzhou, PR China
| | - Jianhong Zhao
- Department of Radiology, Lanzhou University Second Hospital, Lanzhou, PR China
| | - Xueling Zhang
- Department of Radiology, Lanzhou University Second Hospital, Lanzhou, PR China
| | - Dan Wang
- Department of Radiology, Lanzhou University Second Hospital, Lanzhou, PR China
| | - Wenjuan Zhang
- Department of Radiology, Lanzhou University Second Hospital, Lanzhou, PR China
| | - Zhiping Wang
- Institute of Urology, Lanzhou University Second Hospital, Key Laboratory of Gansu Province for Urological Diseases, Clinical Center of Gansu Province for Nephrourology, Lanzhou, PR China
| | - Junlin Zhou
- Department of Radiology, Lanzhou University Second Hospital, Lanzhou, PR China
- * E-mail:
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Shelton SE, Lindsey BD, Dayton PA, Lee YZ. First-in-Human Study of Acoustic Angiography in the Breast and Peripheral Vasculature. ULTRASOUND IN MEDICINE & BIOLOGY 2017; 43:2939-2946. [PMID: 28982628 PMCID: PMC6267932 DOI: 10.1016/j.ultrasmedbio.2017.08.1881] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Revised: 08/20/2017] [Accepted: 08/21/2017] [Indexed: 05/07/2023]
Abstract
Screening with mammography has been found to increase breast cancer survival rates by about 20%. However, the current system in which mammography is used to direct patients toward biopsy or surgical excision also results in relatively high rates of unnecessary biopsy, as 66.8% of biopsies are benign. A non-ionizing radiation imaging approach with increased specificity might reduce the rate of unnecessary biopsies. Quantifying the vascular characteristics within and surrounding lesions represents one potential target for assessing likelihood of malignancy via imaging. In this clinical note, we describe the translation of a contrast-enhanced ultrasound technique, acoustic angiography, to human imaging. We illustrate the feasibility of this technique with initial studies in imaging the hand, wrist and breast using Definity microbubble contrast agent and a mechanically steered prototype dual-frequency transducer in healthy volunteers. Finally, this approach was used to image pre-biopsy Breast Imaging Reporting and Data System (BI-RADS) 4 and 5 lesions <2 cm in depth in 11 patients. Results indicate that sensitivity and spatial resolution are sufficient to image vessels as small as 0.2 mm in diameter at depths of ~15 mm in the human breast. Challenges observed include motion artifacts, as well as limited depth of field and sensitivity, which could be improved by correction algorithms and improved transducer technologies.
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Affiliation(s)
- Sarah E Shelton
- Joint Department of Biomedical Engineering, University of North Carolina-Chapel Hill and North Carolina State University, Raleigh, North Carolina, USA
| | - Brooks D Lindsey
- Joint Department of Biomedical Engineering, University of North Carolina-Chapel Hill and North Carolina State University, Raleigh, North Carolina, USA
| | - Paul A Dayton
- Joint Department of Biomedical Engineering, University of North Carolina-Chapel Hill and North Carolina State University, Raleigh, North Carolina, USA; Biomedical Research Imaging Center, University of North Carolina-Chapel Hill, Chapel Hill, North Carolina, USA.
| | - Yueh Z Lee
- Biomedical Research Imaging Center, University of North Carolina-Chapel Hill, Chapel Hill, North Carolina, USA; Department of Radiology, University of North Carolina-Chapel Hill, Chapel Hill, North Carolina, USA
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Chen C, Kang Q, Xu B, Guo H, Wei Q, Wang T, Ye H, Wu X. Differentiation of low- and high-grade clear cell renal cell carcinoma: Tumor size versus CT perfusion parameters. Clin Imaging 2017; 46:14-19. [PMID: 28686936 DOI: 10.1016/j.clinimag.2017.06.010] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2017] [Revised: 06/11/2017] [Accepted: 06/28/2017] [Indexed: 01/20/2023]
Abstract
PURPOSE To compare the utility of tumor size and CT perfusion parameters for differentiation of low- and high-grade clear cell renal cell carcinoma (RCC). MATERIALS AND METHODS Tumor size, Equivalent blood volume (Equiv BV), permeability surface-area product (PS), blood flow (BF), and Fuhrman pathological grading of clear cell RCC were retrospectively analyzed. RESULTS High-grade clear cell RCC had significantly higher tumor size and lower PS than low grade. Tumor size positively correlated with Fuhrman grade, but PS negatively did. CONCLUSIONS Tumor size and PS were significantly independent indexes for differentiating high-grade from low-grade clear cell RCC.
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Affiliation(s)
- Chao Chen
- Department of Radiology, PLA Army General Hospital, Beijing 100700, China
| | - Qinqin Kang
- Department of Radiology, Changhai Hospital of Shanghai, The second Military Medical University, Shanghai 200433, China
| | - Bing Xu
- Department of Radiology, Changhai Hospital of Shanghai, The second Military Medical University, Shanghai 200433, China
| | - Hairuo Guo
- Affiliated Bayi Brain Hospital, PLA Army General Hospital, Beijing 100700, China
| | - Qiang Wei
- Department of Orthopaedics, Changhai Hospital of Shanghai, The second Military Medical University, Shanghai 200433, China
| | - Tiegong Wang
- Department of Radiology, Changhai Hospital of Shanghai, The second Military Medical University, Shanghai 200433, China
| | - Hui Ye
- Hunan Tumor Hospital, PET-CT Center, Changsha 410013, China
| | - Xinhuai Wu
- Department of Radiology, PLA Army General Hospital, Beijing 100700, China.
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Pisana F, Henzler T, Schönberg S, Klotz E, Schmidt B, Kachelrieß M. Noise reduction and functional maps image quality improvement in dynamic CT perfusion using a new k-means clustering guided bilateral filter (KMGB). Med Phys 2017; 44:3464-3482. [DOI: 10.1002/mp.12297] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Revised: 03/07/2017] [Accepted: 03/10/2017] [Indexed: 12/11/2022] Open
Affiliation(s)
- Francesco Pisana
- Medical Physics in Radiology; German Cancer Research Center (DKFZ); Heidelberg 69120 Germany
- CT Clinical Applications Predevelopment; Siemens Healthcare GmbH; Forchheim 91301 Germany
| | - Thomas Henzler
- Radiology and Nuclear Medicine Department; University Hospital of Mannheim; Mannheim 68167 Germany
| | - Stefan Schönberg
- Radiology and Nuclear Medicine Department; University Hospital of Mannheim; Mannheim 68167 Germany
| | - Ernst Klotz
- CT Clinical Applications Predevelopment; Siemens Healthcare GmbH; Forchheim 91301 Germany
| | - Bernhard Schmidt
- CT Clinical Applications Predevelopment; Siemens Healthcare GmbH; Forchheim 91301 Germany
| | - Marc Kachelrieß
- Medical Physics in Radiology; German Cancer Research Center (DKFZ); Heidelberg 69120 Germany
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Correlation between CT perfusion parameters and Fuhrman grade in pTlb renal cell carcinoma. Abdom Radiol (NY) 2017; 42:1464-1471. [PMID: 27999886 DOI: 10.1007/s00261-016-1009-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
PURPOSE To evaluate the correlation of CT perfusion parameters with the Fuhrman grade in pT1b (4-7 cm) renal cell carcinoma (RCC). METHODS CT perfusion imaging and Fuhrman pathological grading of pT1b RCC were performed in 48 patients (10 grade 1, 27 grade 2, 9 grade 3, and 2 grade 4). Equivalent blood volume (BV Equiv), permeability surface area product (PS), and blood flow (BF) of tumors were measured. Grade 1 and 2 were defined as low-grade group (n = 37), meanwhile high-grade group (n = 11) included grade 3 and 4. Comparisons of CT perfusion parameters and tumor size of the two different groups were performed. Correlations between CT perfusion parameters, Fuhrman grade (grade 1, 2, 3, and 4), and tumor size were assessed. RESULTS PS was significantly lower in high grade than in low-grade pT1b RCC (P = 0.004). However, no significant differences were found in BV Equiv and BF between the two groups (P > 0.05 for both). The optimal threshold value, sensitivity, specificity, and the area under the ROC curve for distinguishing the two groups using PS were 68.8 mL/100 g/min, 0.7, 0.8, and 0.8, respectively. Negative significant correlation was observed between PS and Fuhrman grade (r = -0.338, P = 0.019). CONCLUSIONS The PS of pT1b RCC had negative significant correlation with Fuhrman grade. CT perfusion appeared to be a non-invasive means to predict high Fuhrman grade of pT1b RCC preoperatively and guide the optimal treatment for the patient.
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Lindsey BD, Shelton SE, Martin KH, Ozgun KA, Rojas JD, Foster FS, Dayton PA. High Resolution Ultrasound Superharmonic Perfusion Imaging: In Vivo Feasibility and Quantification of Dynamic Contrast-Enhanced Acoustic Angiography. Ann Biomed Eng 2016; 45:939-948. [PMID: 27832421 DOI: 10.1007/s10439-016-1753-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Accepted: 10/26/2016] [Indexed: 12/13/2022]
Abstract
Mapping blood perfusion quantitatively allows localization of abnormal physiology and can improve understanding of disease progression. Dynamic contrast-enhanced ultrasound is a low-cost, real-time technique for imaging perfusion dynamics with microbubble contrast agents. Previously, we have demonstrated another contrast agent-specific ultrasound imaging technique, acoustic angiography, which forms static anatomical images of the superharmonic signal produced by microbubbles. In this work, we seek to determine whether acoustic angiography can be utilized for high resolution perfusion imaging in vivo by examining the effect of acquisition rate on superharmonic imaging at low flow rates and demonstrating the feasibility of dynamic contrast-enhanced superharmonic perfusion imaging for the first time. Results in the chorioallantoic membrane model indicate that frame rate and frame averaging do not affect the measured diameter of individual vessels observed, but that frame rate does influence the detection of vessels near and below the resolution limit. The highest number of resolvable vessels was observed at an intermediate frame rate of 3 Hz using a mechanically-steered prototype transducer. We also demonstrate the feasibility of quantitatively mapping perfusion rate in 2D in a mouse model with spatial resolution of ~100 μm. This type of imaging could provide non-invasive, high resolution quantification of microvascular function at penetration depths of several centimeters.
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Affiliation(s)
- Brooks D Lindsey
- Joint Department of Biomedical Engineering, University of North Carolina at Chapel Hill and North Carolina State University, Raleigh, NC, USA
| | - Sarah E Shelton
- Joint Department of Biomedical Engineering, University of North Carolina at Chapel Hill and North Carolina State University, Raleigh, NC, USA
| | - K Heath Martin
- Joint Department of Biomedical Engineering, University of North Carolina at Chapel Hill and North Carolina State University, Raleigh, NC, USA
| | - Kathryn A Ozgun
- Joint Department of Biomedical Engineering, University of North Carolina at Chapel Hill and North Carolina State University, Raleigh, NC, USA
| | - Juan D Rojas
- Joint Department of Biomedical Engineering, University of North Carolina at Chapel Hill and North Carolina State University, Raleigh, NC, USA
| | | | - Paul A Dayton
- Joint Department of Biomedical Engineering, University of North Carolina at Chapel Hill and North Carolina State University, Raleigh, NC, USA. .,Biomedical Research Imaging Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
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Turco S, Wijkstra H, Mischi M. Mathematical Models of Contrast Transport Kinetics for Cancer Diagnostic Imaging: A Review. IEEE Rev Biomed Eng 2016; 9:121-47. [PMID: 27337725 DOI: 10.1109/rbme.2016.2583541] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Angiogenesis plays a fundamental role in cancer growth and the formation of metastasis. Novel cancer therapies aimed at inhibiting angiogenic processes and/or disrupting angiogenic tumor vasculature are currently being developed and clinically tested. The need for earlier and improved cancer diagnosis, and for early evaluation and monitoring of therapeutic response to angiogenic treatment, have led to the development of several imaging methods for in vivo noninvasive assessment of angiogenesis. The combination of dynamic contrast-enhanced imaging with mathematical modeling of the contrast agent kinetics enables quantitative assessment of the structural and functional changes in the microvasculature that are associated with tumor angiogenesis. In this paper, we review quantitative imaging of angiogenesis with dynamic contrast-enhanced magnetic resonance imaging, computed tomography, and ultrasound.
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Low G, Huang G, Fu W, Moloo Z, Girgis S. Review of renal cell carcinoma and its common subtypes in radiology. World J Radiol 2016; 8:484-500. [PMID: 27247714 PMCID: PMC4882405 DOI: 10.4329/wjr.v8.i5.484] [Citation(s) in RCA: 111] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2015] [Revised: 01/20/2016] [Accepted: 03/09/2016] [Indexed: 02/06/2023] Open
Abstract
Representing 2%-3% of adult cancers, renal cell carcinoma (RCC) accounts for 90% of renal malignancies and is the most lethal neoplasm of the urologic system. Over the last 65 years, the incidence of RCC has increased at a rate of 2% per year. The increased incidence is at least partly due to improved tumor detection secondary to greater availability of high-resolution cross-sectional imaging modalities over the last few decades. Most RCCs are asymptomatic at discovery and are detected as unexpected findings on imaging performed for unrelated clinical indications. The 2004 World Health Organization Classification of adult renal tumors stratifies RCC into several distinct histologic subtypes of which clear cell, papillary and chromophobe tumors account for 70%, 10%-15%, and 5%, respectively. Knowledge of the RCC subtype is important because the various subtypes are associated with different biologic behavior, prognosis and treatment options. Furthermore, the common RCC subtypes can often be discriminated non-invasively based on gross morphologic imaging appearances, signal intensity on T2-weighted magnetic resonance images, and the degree of tumor enhancement on dynamic contrast-enhanced computed tomography or magnetic resonance imaging examinations. In this article, we review the incidence and survival data, risk factors, clinical and biochemical findings, imaging findings, staging, differential diagnosis, management options and post-treatment follow-up of RCC, with attention focused on the common subtypes.
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Fifty Years of Technological Innovation: Potential and Limitations of Current Technologies in Abdominal Magnetic Resonance Imaging and Computed Tomography. Invest Radiol 2016; 50:584-93. [PMID: 26039773 DOI: 10.1097/rli.0000000000000173] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Magnetic resonance imaging (MRI) has become an important modality for the diagnosis of intra-abdominal pathology. Hardware and pulse sequence developments have made it possible to derive not only morphologic but also functional information related to organ perfusion (dynamic contrast-enhanced MRI), oxygen saturation (blood oxygen level dependent), tissue cellularity (diffusion-weighted imaging), and tissue composition (spectroscopy). These techniques enable a more specific assessment of pathologic lesions and organ functionality. Magnetic resonance imaging has thus transitioned from a purely morphologic examination to a modality from which image-based disease biomarkers can be derived. This fits well with several emerging trends in radiology, such as the need to accurately assess response to costly treatment strategies and the need to improve lesion characterization to potentially avoid biopsy. Meanwhile, the cost-effectiveness, availability, and robustness of computed tomography (CT) ensure its place as the current workhorse for clinical imaging. Although the lower soft tissue contrast of CT relative to MRI is a long-standing limitation, other disadvantages such as ionizing radiation exposure have become a matter of public concern. Nevertheless, recent technical developments such as dual-energy CT or dynamic volume perfusion CT also provide more functional imaging beyond morphology.The aim of this article was to review and discuss the most important recent technical developments in abdominal MRI and state-of-the-art CT, with an eye toward the future, providing examples of their clinical utility for the evaluation of hepatic and renal pathologies.
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Wang J, Tang Z, Wang S, Zeng W, Qian W, Wu L, Wang W, Luo J. Differential diagnostic value of computed tomography perfusion combined with vascular endothelial growth factor expression in head and neck lesions. Oncol Lett 2016; 11:3342-3348. [PMID: 27123114 PMCID: PMC4840932 DOI: 10.3892/ol.2016.4413] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2015] [Accepted: 03/08/2016] [Indexed: 12/22/2022] Open
Abstract
There are numerous types of head and neck lesions (HNLs), and conventional computed tomography (CT) has low specificity and sensitivity in the definitive and differential diagnosis of HNLs. The aim of the present study was to evaluate the value of perfusion CT (CTP) combined with vascular endothelial growth factor (VEGF) expression in the differentiation between malignant and benign HNLs. In total, 41 HNLs, which were pathologically confirmed, underwent CTP and VEGF expression analysis. All lesions were divided into three groups: Group A, benign hypovascular lesions; Group B, benign hypervascular lesions; and Group C, malignant lesions. Time density curve (TDC) and CTP parameters [maximum intensity projection (MIP), blood volume (BV), blood flow (BF), mean transit time and capillary permeability] were analyzed. The association between perfusion measurements and VEGF was assessed using Pearson's correlation. TDCs were classified into three types, and type I was more frequently identified in benign tumors (Groups A and B) compared with malignant tumors (Group C) (P=0.003). Malignant tumors primarily had a TDC of type II and III. MIP, BF and BV were all significantly higher in Groups B and C compared to Group A (P<0.01). VEGF expression of malignant tumors was significantly higher than benign tumors (P=0.007). No correlation was identified between VEGF and any CTP parameter. The present findings suggest that CTP combined with VEGF may differentiate between malignant and benign HNLs, and between benign hypovascular and hypervascular lesions.
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Affiliation(s)
- Jie Wang
- Department of Radiology, Eye Ear Nose and Throat Hospital, Fudan University, Shanghai 200031, P.R. China
| | - Zuohua Tang
- Department of Radiology, Eye Ear Nose and Throat Hospital, Fudan University, Shanghai 200031, P.R. China
| | - Shuyi Wang
- Department of Pathology, Eye Ear Nose and Throat Hospital, Fudan University, Shanghai 200031, P.R. China
| | - Wenjiao Zeng
- Department of Pathology, Shanghai Medical School of Fudan University, Shanghai 200032, P.R. China
| | - Wen Qian
- Department of Radiology, Eye Ear Nose and Throat Hospital, Fudan University, Shanghai 200031, P.R. China
| | - Lingjie Wu
- Department of Radiology, Eye Ear Nose and Throat Hospital, Fudan University, Shanghai 200031, P.R. China
| | - Wenzhong Wang
- Department of Radiology, Eye Ear Nose and Throat Hospital, Fudan University, Shanghai 200031, P.R. China
| | - Jianfeng Luo
- Department of Health Statistics and Social Medicine, School of Public Health, Fudan University, Shanghai 200032, P.R. China
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Jiang Y, Li J, Wang J, Xiao H, Li T, Liu H, Liu W. Assessment of Vascularity in Hepatic Alveolar Echinococcosis: Comparison of Quantified Dual-Energy CT with Histopathologic Parameters. PLoS One 2016; 11:e0149440. [PMID: 26901164 PMCID: PMC4762698 DOI: 10.1371/journal.pone.0149440] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2015] [Accepted: 01/31/2016] [Indexed: 02/07/2023] Open
Abstract
Purpose To investigate whether dual-energy computer tomography(DECT) could determine the angiographic vascularity of alveolar echinococcosis lesions by comparing the quantitative iodine concentration (IC) with the microvascular density (MVD). Material and Methods Twenty-five patients (16 men, 9 women; mean age, 40.9 ± 13.8 years) with confirmed hepatic alveolar echinococcosis (HAE) underwent DECT of the abdomen, consisting of arterial phase (AP), portal venous phase (PVP), and delayed phase (DP) scanning, in dual-source mode (100 kV/140 kV). Image data were processed with a DECT software algorithm that was designed for the evaluation of iodine distribution in the different layers (marginal zone, solid and cystic) of the lesions. The CT patterns of HAE lesions were classified into three types: solid type, pseudocystic type and ‘geographic map’ (mixed) type. The IC measurements in different layers and different types of lesions were statistically compared. MVD was examined using CD34 immunohistochemical staining of the resected HAE tissue and scored based on the percentage of positively stained cells and their intensity. Pearson’s correlation analysis was used to evaluate the potential correlation between DECT parameters and MVD. Results A total of 27 HAE lesions were evaluated, of which 9 were solid type, 3 were pseudocystic type and 15 were mixed type. The mean lesion size was 100.7 ± 47.3 mm. There was a significant difference in the IC measurements between different layers of HAE lesions during each scan phase (p < 0.001). The IC in the marginal zone was significantly higher than in the solid and cystic components in AP (2.15 mg/mL vs. 0.17 or 0.01 mg/mL), PVP (3.08 mg/mL vs. 0.1 or 0.02 mg/mL), and DP (2.93 mg/mL vs. 0.04 or 0.02 mg/mL). No significant difference was found among the different CT patterns of HAE lesions. Positive expression of CD34 in the marginal zones surrounding HAE lesions was found in 92.5% (25/27) of lesions, of which 18.5% (5/27) were strongly positive, 62.7% (17/27) were moderately positive, and 11.1% (3/27) were weakly positive. In contrast, 7.4% (2/27) of the lesions were negative for CD34. There was a positive correlation between IC measurements and MVD in the marginal zone of HAE lesions (r = 0.73, p < 0.05). Conclusions The DECT quantitative iodine concentration was significantly correlated with MVD in the marginal zones surrounding HAE lesions. Dual-energy CT using a quantitative analytic methodology can be used to evaluate the vascularity of AE.
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Affiliation(s)
- Yi Jiang
- Imaging Center, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China
| | - Jiaqi Li
- Imaging Center, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China
| | - Jing Wang
- Imaging Center, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China
| | - Hu Xiao
- Imaging Center, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China
| | - Tingting Li
- Imaging Center, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China
| | - Hui Liu
- Imaging Center, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China
| | - Wenya Liu
- Imaging Center, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China
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Gordic S, Puippe GD, Krauss B, Klotz E, Desbiolles L, Lesurtel M, Müllhaupt B, Pfammatter T, Alkadhi H. Correlation between Dual-Energy and Perfusion CT in Patients with Hepatocellular Carcinoma. Radiology 2016; 280:78-87. [PMID: 26824712 DOI: 10.1148/radiol.2015151560] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Purpose To develop a dual-energy contrast media-enhanced computed tomographic (CT) protocol by using time-attenuation curves from previously acquired perfusion CT data and to evaluate prospectively the relationship between iodine enhancement metrics at dual-energy CT and perfusion CT parameters in patients with hepatocellular carcinoma (HCC). Materials and Methods Institutional review board and local ethics committee approval and written informed consent were obtained. The retrospective part of this study included the development of a dual-energy CT contrast-enhanced protocol to evaluate peak arterial enhancement of HCC in the liver on the basis of time-attenuation curves from previously acquired perfusion CT data in 20 patients. The prospective part of the study consisted of an intraindividual comparison of dual-energy CT and perfusion CT data in another 20 consecutive patients with HCC. Iodine density and iodine ratio (iodine attenuation of the lesion divided by iodine attenuation in the aorta) from dual-energy CT and arterial perfusion (AP), portal venous perfusion, and total perfusion (TP) from perfusion CT were compared. Pearson R and linear correlation coefficients were calculated for AP and iodine density, AP and iodine ratio, TP and iodine density, and TP and iodine ratio. Results The dual-energy CT protocol consisted of bolus tracking in the abdominal aorta (threshold, 150 HU; scan delay, 9 seconds). The strongest intraindividual correlations in HCCs were found between iodine density and AP (r = 0.75, P = .0001). Moderate correlations were found between iodine ratio and AP (r = 0.50, P = .023) and between iodine density and TP (r = 0.56, P = .011). No further significant correlations were found. The volume CT dose index (11.4 mGy) and dose-length product (228.0 mGy · cm) of dual-energy CT was lower than those of the arterial phase of perfusion CT (36.1 mGy and 682.3 mGy · cm, respectively). Conclusion A contrast-enhanced dual-energy CT protocol developed by using time-attenuation curves from previously acquired perfusion CT data sets in patients with HCC could show good correlation between iodine density from dual-energy CT with AP from perfusion CT. (©) RSNA, 2016.
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Affiliation(s)
- Sonja Gordic
- From the Institute of Diagnostic and Interventional Radiology (S.G., G.P., T.P., H.A.), Department of Surgery, Swiss Hepato-Pancreatico-Biliary and Transplantation Center (M.L.), and Department of Hepatology and Gastroenterology (B.M.), University Hospital Zurich, University of Zurich, Raemistrasse 100, Zurich 8091, Switzerland; Computed Tomography Division, Siemens Healthcare, Forchheim, Germany (B.K., E.K.); and Division of Radiology and Nuclear Medicine, Kantonsspital St. Gallen, St. Gallen, Switzerland (L.D.)
| | - Gilbert D Puippe
- From the Institute of Diagnostic and Interventional Radiology (S.G., G.P., T.P., H.A.), Department of Surgery, Swiss Hepato-Pancreatico-Biliary and Transplantation Center (M.L.), and Department of Hepatology and Gastroenterology (B.M.), University Hospital Zurich, University of Zurich, Raemistrasse 100, Zurich 8091, Switzerland; Computed Tomography Division, Siemens Healthcare, Forchheim, Germany (B.K., E.K.); and Division of Radiology and Nuclear Medicine, Kantonsspital St. Gallen, St. Gallen, Switzerland (L.D.)
| | - Bernhard Krauss
- From the Institute of Diagnostic and Interventional Radiology (S.G., G.P., T.P., H.A.), Department of Surgery, Swiss Hepato-Pancreatico-Biliary and Transplantation Center (M.L.), and Department of Hepatology and Gastroenterology (B.M.), University Hospital Zurich, University of Zurich, Raemistrasse 100, Zurich 8091, Switzerland; Computed Tomography Division, Siemens Healthcare, Forchheim, Germany (B.K., E.K.); and Division of Radiology and Nuclear Medicine, Kantonsspital St. Gallen, St. Gallen, Switzerland (L.D.)
| | - Ernst Klotz
- From the Institute of Diagnostic and Interventional Radiology (S.G., G.P., T.P., H.A.), Department of Surgery, Swiss Hepato-Pancreatico-Biliary and Transplantation Center (M.L.), and Department of Hepatology and Gastroenterology (B.M.), University Hospital Zurich, University of Zurich, Raemistrasse 100, Zurich 8091, Switzerland; Computed Tomography Division, Siemens Healthcare, Forchheim, Germany (B.K., E.K.); and Division of Radiology and Nuclear Medicine, Kantonsspital St. Gallen, St. Gallen, Switzerland (L.D.)
| | - Lotus Desbiolles
- From the Institute of Diagnostic and Interventional Radiology (S.G., G.P., T.P., H.A.), Department of Surgery, Swiss Hepato-Pancreatico-Biliary and Transplantation Center (M.L.), and Department of Hepatology and Gastroenterology (B.M.), University Hospital Zurich, University of Zurich, Raemistrasse 100, Zurich 8091, Switzerland; Computed Tomography Division, Siemens Healthcare, Forchheim, Germany (B.K., E.K.); and Division of Radiology and Nuclear Medicine, Kantonsspital St. Gallen, St. Gallen, Switzerland (L.D.)
| | - Mickaël Lesurtel
- From the Institute of Diagnostic and Interventional Radiology (S.G., G.P., T.P., H.A.), Department of Surgery, Swiss Hepato-Pancreatico-Biliary and Transplantation Center (M.L.), and Department of Hepatology and Gastroenterology (B.M.), University Hospital Zurich, University of Zurich, Raemistrasse 100, Zurich 8091, Switzerland; Computed Tomography Division, Siemens Healthcare, Forchheim, Germany (B.K., E.K.); and Division of Radiology and Nuclear Medicine, Kantonsspital St. Gallen, St. Gallen, Switzerland (L.D.)
| | - Beat Müllhaupt
- From the Institute of Diagnostic and Interventional Radiology (S.G., G.P., T.P., H.A.), Department of Surgery, Swiss Hepato-Pancreatico-Biliary and Transplantation Center (M.L.), and Department of Hepatology and Gastroenterology (B.M.), University Hospital Zurich, University of Zurich, Raemistrasse 100, Zurich 8091, Switzerland; Computed Tomography Division, Siemens Healthcare, Forchheim, Germany (B.K., E.K.); and Division of Radiology and Nuclear Medicine, Kantonsspital St. Gallen, St. Gallen, Switzerland (L.D.)
| | - Thomas Pfammatter
- From the Institute of Diagnostic and Interventional Radiology (S.G., G.P., T.P., H.A.), Department of Surgery, Swiss Hepato-Pancreatico-Biliary and Transplantation Center (M.L.), and Department of Hepatology and Gastroenterology (B.M.), University Hospital Zurich, University of Zurich, Raemistrasse 100, Zurich 8091, Switzerland; Computed Tomography Division, Siemens Healthcare, Forchheim, Germany (B.K., E.K.); and Division of Radiology and Nuclear Medicine, Kantonsspital St. Gallen, St. Gallen, Switzerland (L.D.)
| | - Hatem Alkadhi
- From the Institute of Diagnostic and Interventional Radiology (S.G., G.P., T.P., H.A.), Department of Surgery, Swiss Hepato-Pancreatico-Biliary and Transplantation Center (M.L.), and Department of Hepatology and Gastroenterology (B.M.), University Hospital Zurich, University of Zurich, Raemistrasse 100, Zurich 8091, Switzerland; Computed Tomography Division, Siemens Healthcare, Forchheim, Germany (B.K., E.K.); and Division of Radiology and Nuclear Medicine, Kantonsspital St. Gallen, St. Gallen, Switzerland (L.D.)
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Thaiss WM, Sauter AW, Bongers M, Horger M, Nikolaou K. Clinical applications for dual energy CT versus dynamic contrast enhanced CT in oncology. Eur J Radiol 2015; 84:2368-79. [DOI: 10.1016/j.ejrad.2015.06.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2015] [Accepted: 06/02/2015] [Indexed: 12/12/2022]
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Contrast-enhanced CT in 100 clear cell renal cell cancers — an analysis of enhancement, tumour size, and survival. Clin Radiol 2015; 70:1357-61. [DOI: 10.1016/j.crad.2015.07.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2015] [Revised: 04/27/2015] [Accepted: 07/24/2015] [Indexed: 12/19/2022]
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García-Figueiras R, Padhani AR, Beer AJ, Baleato-González S, Vilanova JC, Luna A, Oleaga L, Gómez-Caamaño A, Koh DM. Imaging of Tumor Angiogenesis for Radiologists—Part 1: Biological and Technical Basis. Curr Probl Diagn Radiol 2015; 44:407-24. [DOI: 10.1067/j.cpradiol.2015.02.010] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2014] [Revised: 02/24/2015] [Accepted: 02/28/2015] [Indexed: 01/09/2023]
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Tian F, Hayano K, Kambadakone AR, Sahani DV. Response assessment to neoadjuvant therapy in soft tissue sarcomas: using CT texture analysis in comparison to tumor size, density, and perfusion. ABDOMINAL IMAGING 2015; 40:1705-1712. [PMID: 25526682 DOI: 10.1007/s00261-014-0318-3] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
PURPOSE To evaluate the role of computed tomography (CT) texture analysis in assessing response of soft tissue sarcoma (STS) treated with neoadjuvant bevacizumab (BVZ) plus radiotherapy in comparison to tumor size, density, and perfusion. METHODS In the phase II clinical trial, 20 patients with STSs received BVZ alone for 2 weeks followed by BVZ plus radiotherapy for 6 weeks prior to surgery. All patients received CT perfusion at baseline, 2 and 8 weeks after the therapy, and tumor blood flow (BF) was measured. In contrast enhanced CT image at the arterial peak enhancement time, mean of positive pixels (MPP) was measured as a texture parameter using texture analysis software, and tumor size and density were also measured. The percent changes of these parameters were compared with pathological response on surgical specimen. RESULTS After 2 weeks of the therapy, MPP and BF decreased by 10.42% and 20.08%, while changes of tumor size and density were not obvious. After 8 weeks, MPP, BF, and density decreased by 29.2% (p = 0.03), 53.2% (p = 0.001), and 30.41% (p = 0.005), respectively, without a significant change in size. The percent change of MPP after 8 weeks had a significant correlation with tumor necrosis in surgical specimen (r = -0.801, p < 0.001), whereas those of size, density, and BF did not. The receiver-operating characteristic analysis demonstrated that the percent change of MPP < -35.36% was an optimal cut-off value to differentiate pathological responders. CONCLUSION The change of MPP is the best biomarker for the treatment response in STS.
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Affiliation(s)
- Fang Tian
- Division of Abdominal Imaging and Intervention, Harvard Medical School and Massachusetts General Hospital, 55 Fruit St White 270, Boston, MA, 02114, USA
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Das CJ, Thingujam U, Panda A, Sharma S, Gupta AK. Perfusion computed tomography in renal cell carcinoma. World J Radiol 2015; 7:170-179. [PMID: 26217456 PMCID: PMC4506935 DOI: 10.4329/wjr.v7.i7.170] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2014] [Revised: 03/30/2015] [Accepted: 06/08/2015] [Indexed: 02/06/2023] Open
Abstract
Various imaging modalities are available for the diagnosis, staging and response evaluation of patients with renal cell carcinoma (RCC). While contrast enhanced computed tomography (CT) is used as the standard of imaging for size, morphological evaluation and response assessment in RCC, a new functional imaging technique like perfusion CT (pCT), goes down to the molecular level and provides new perspectives in imaging of RCC. pCT depicts regional tumor perfusion and vascular permeability which are indirect parameters of tumor angiogenesis and thereby provides vital information regarding tumor microenvironment. Also response evaluation using pCT may predate the size criteria used in Response Evaluation Criteria in Solid Tumors, as changes in the perfusion occurs earlier following tissue kinase inhibitors before any actual change in size. This may potentially help in predicting prognosis, better selection of therapy and more accurate and better response evaluation in patients with RCC. This article describes the techniques and role of pCT in staging and response assessment in patients with RCCs.
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Dynamic contrast-enhanced magnetic resonance imaging assessment of kidney function and renal masses: single slice versus whole organ/tumor. Invest Radiol 2015; 49:720-7. [PMID: 24901546 DOI: 10.1097/rli.0000000000000075] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
OBJECTIVES The aim of this study was to compare single-slice and 3-dimensional (3D) analysis for magnetic resonance renography (plasma flow [FP], plasma volume [VP], and glomerular filtration rate [GFR]) and for dynamic contrast-enhanced magnetic resonance imaging (MRI) of renal tumors (FP, VP, permeability-surface area product), respectively. MATERIAL AND METHODS We prospectively included 22 patients (43 kidneys with 22 suspicious renal lesions) and performed preoperative and postoperative imaging before and after partial nephrectomy, respectively. Of the 22 renal lesions, 15 turned out to be renal cell carcinoma and were included in the tumor analysis, altogether leading to 86 renal and 15 tumor MRI scans, respectively. Dynamic contrast-enhanced MRI was performed with a time-resolved angiography with stochastic trajectories sequence (spatial resolution, 2.6 × 2.6 × 2.6 mm3; temporal resolution, 2.5 seconds) at 3 T (Magnetom Verio; Siemens Healthcare Sector) after injection of 0.05 mmol/kg body weight Gadobutrol (Bayer Healthcare Pharmaceuticals). Analysis was performed using regions of interest encompassing a single central slice and the whole kidney/tumor, respectively. A 2-compartment model yielding FP, VP, GFR, or tumor permeability-surface area product was used for kinetic modelling. Modelling was performed based on relative contrast enhancement to account for coil-related inhomogeneity. Significance in difference, agreement, and goodness of fit of the data to the curve was assessed with paired t tests, Bland-Altman plots, and χ2 test, respectively. RESULTS Bland-Altman analysis revealed a good agreement between both types of measurement for kidneys and tumors, respectively. Results between single-slice and whole-kidney regions of interest showed significant differences for Fp (single slice, 256.1 ± 104.1 mL/100 mL/min; whole kidney, 217.2 ± 92.5 mL/100 mL/min; P < 0.01). Regarding VP and GFR, no significant differences were observed. The χ2 test showed a significantly better goodness of fit of the data to the curve for whole kidneys (0.30% ± 0.18%) than for single slices (0.43% ± 0.26%) (P < 0.01). In contrast to renal assessment, tumor analysis showed no significant differences regarding functional parameters and χ test, respectively. CONCLUSION In dynamic contrast-enhanced MRI of the kidney, both 3D whole-organ/tumor and single-slice analyses provide roughly comparable values in functional analysis. However, 3D assessment is considerably more precise and should be preferred if available.
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Dynamic contrast-enhanced computed tomography as a potential biomarker in patients with metastatic renal cell carcinoma: preliminary results from the Danish Renal Cancer Group Study-1. Invest Radiol 2015; 49:601-7. [PMID: 24691140 DOI: 10.1097/rli.0000000000000058] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVES The aim of this study was to explore the impact of dynamic contrast-enhanced (DCE) computer tomography (CT) as a biomarker in metastatic renal cell carcinoma (mRCC). MATERIALS AND METHODS Twelve patients with favorable or intermediate Memorial Sloan Kettering Cancer Center risk group and clear cell mRCC participating in an ongoing prospective randomized phase II trial comprising interleukin-2-based immunotherapy and bevacizumab were included in this preliminary analysis. All patients had a follow-up time of at least 2 years. Interpretation of DCE-CT (max slope method) was performed blinded to treatment group. The DCE-CT scans were performed at baseline, at weeks 5 and 10, and thereafter every third month. Blood flow (BF; mL/min/100 mL), peak enhancement (Hounsfield units), time to peak (seconds), and blood volume (BV; mL/100 g) were calculated. Parameters for DCE-CT were correlated with sum of diameters (defined by Response Evaluation Criteria in Solid Tumors 1.1), progression-free survival (PFS), and overall survival (OS) using Wilcoxon, Man-Whitney, Kaplan-Meier, and log rank statistics, as appropriate. RESULTS Blood flow at baseline ranged from 4.9 to 148.1 mL/min/100 mL (median, 62.2; 25th percentile, 25.8; 75th percentile, 110.0). Patients with high baseline BF (using quartiles as cutoffs) had significantly longer OS (not reached vs 5.2 months, P = 0.011) and longer PFS (not reached vs 3.9 months, P = 0.026). Blood volume at baseline ranged from 8.8 to 74.1 mL/100 g tissue (median, 21.5), and at week 5, from 4.9 to 34.7 mL/100 g (median, 17.2). Relative changes in BV between baseline and week 5 ranged from -64% to +68% (median, -16%; 25th percentile, -41%; 75th percentile, +2%) and were significantly associated with OS using quartiles as cutoffs (5.2 months vs not reached, P = 0.038) and PFS using the median as cutoff (5.3 months vs not reached, P = 0.009), with larger reductions associated with longer survival. Using medians as cutoffs, relative changes in both BF and BV between baseline and week 10 were significantly associated with OS (for both, 8.6 months vs not reached, P = 0.031). CONCLUSIONS Dynamic contrast-enhanced CT is a potential biomarker in patients with mRCC. High baseline BF and reductions in BF and BV during early treatment are associated with improved outcome. Large-scale studies are required.
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Choi SM, Choi DK, Kim TH, Jeong BC, Seo SI, Jeon SS, Lee HM, Choi HY, Jeon HG. A comparison of radiologic tumor volume and pathologic tumor volume in renal cell carcinoma (RCC). PLoS One 2015; 10:e0122019. [PMID: 25799553 PMCID: PMC4370411 DOI: 10.1371/journal.pone.0122019] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2014] [Accepted: 02/09/2015] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To investigate the difference between preoperative radiologic tumor volume (RTV) and postoperative pathologic tumor volume (PTV) in patients who received nephrectomy for renal cell carcinoma (RCC). MATERIALS AND METHODS We reviewed 482 patients who underwent preoperative computed tomography (CT) within 4 weeks before radical or partial nephrectomy for renal cell carcinoma. RTV measured by a three dimensional rendering program was compared with PTV (π/6 x height x length x width) measured in surgical specimen according to pathologic tumor size and histologic subtype. Correlation of the inter-quartile range (IQR) of the RTV and Fuhrman nuclear grade was also investigated. RESULTS There was a significant positive linear correlation between RTV and PTV (p < 0.001, r = 0.911), and the mean RTV and mean PTV were not significantly different (79.0 vs 76.9 cm3, p = 0.393). For pathologic tumor size (PTS) < 4 cm, the mean RTV was larger than the mean PTV (10.9 vs 7.1 cm3, p < 0.001). For a PTS of 4-7 cm, the mean RTV was larger than the mean PTV (56.0 vs 44.7 cm3, p < 0.001). However, for a PTS ≥ 7 cm, there was no statistical difference between RTV and PTV (p > 0.05). Among patients with clear cell RCC, the mean RTV was significantly larger than the mean PTV (p = 0.042), not for non-clear cell group (p = 0.055). As the quartile of the RTV increased, the Fuhrman grade also increased (p < 0.001). CONCLUSIONS RTV was correlated with PTV and pathologic grade. RTV was larger than the PTV for a tumor size 7 cm or less or in clear cell RCC. RTV may be useful to measure tumor burden preoperatively.
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Affiliation(s)
- See Min Choi
- Department of Urology, Gyeongsang National University Hospital, Gyeongsang National University School of medicine, Jinju, Korea
| | - Don Kyoung Choi
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Tae Heon Kim
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Byong Chang Jeong
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Seong Il Seo
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Seong Soo Jeon
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hyun Moo Lee
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Han-Yong Choi
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hwang Gyun Jeon
- Department of Urology, Samsung Medical Center, Samsung Biomedical Research Institute, Sungkyunkwan University School of Medicine, Seoul, Korea
- * E-mail:
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Recent Technological Advances in Computed Tomography and the Clinical Impact Therein. Invest Radiol 2015; 50:119-27. [DOI: 10.1097/rli.0000000000000125] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Dynamic contrast-enhanced micro-computed tomography correlates with 3-dimensional fluorescence ultramicroscopy in antiangiogenic therapy of breast cancer xenografts. Invest Radiol 2015; 49:445-56. [PMID: 24598441 DOI: 10.1097/rli.0000000000000038] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVES Dynamic contrast-enhanced (DCE) micro-computed tomography (micro-CT) has emerged as a valuable imaging tool to noninvasively obtain quantitative physiological biomarkers of drug effect in preclinical studies of antiangiogenic compounds. In this study, we explored the ability of DCE micro-CT to assess the antiangiogenic treatment response in breast cancer xenografts and correlated the results to the structural vessel response obtained from 3-dimensional (3D) fluorescence ultramicroscopy (UM). MATERIAL AND METHODS Two groups of tumor-bearing mice (KPL-4) underwent DCE micro-CT imaging using a fast preclinical dual-source micro-CT system (TomoScope Synergy Twin, CT Imaging GmbH, Erlangen, Germany). Mice were treated with either a monoclonal antibody against the vascular endothelial growth factor or an unspecific control antibody. Changes in vascular physiology were assessed measuring the mean value of the relative blood volume (rBV) and the permeability-surface area product (PS) in different tumor regions of interest (tumor center, tumor periphery, and total tumor tissue). Parametric maps of rBV were calculated of the tumor volume to assess the intratumoral vascular heterogeneity. Isotropic 3D UM vessel scans were performed from excised tumor tissue, and automated 3D segmentation algorithms were used to determine the microvessel density (MVD), relative vessel volume, and vessel diameters. In addition, the accumulation of coinjected fluorescence-labeled trastuzumab was quantified in the UM tissue scans to obtain an indirect measure of vessel permeability. Results of the DCE micro-CT were compared with corresponding results obtained by ex vivo UM. For validation, DCE micro-CT and UM parameters were compared with conventional histology and tumor volume. RESULTS Examination of the parametric rBV maps revealed significantly different patterns of intratumoral blood supply between treated and control tumors. Whereas control tumors showed a characteristic vascular rim pattern with considerably elevated rBV values in the tumor periphery, treated tumors showed a widely homogeneous blood supply. Compared with UM, the physiological rBV maps showed excellent agreement with the spatial morphology of the intratumoral vascular architecture. Regional assessment of mean physiological values exhibited a significant decrease in rBV (P < 0.01) and PS (P < 0.05) in the tumor periphery after anti-vascular endothelial growth factor treatment. Structural validation with UM showed a significant reduction in reduction of relative vessel volume (rVV) (P < 0.01) and MVD (P < 0.01) in the corresponding tumor region. The reduction in rBV correlated well with the rVV (R = 0.73 for single values and R = 0.95 for mean values). Spatial maps of antibody penetration showed a significantly reduced antibody accumulation (P < 0.01) in the tumor tissue after treatment and agreed well with the physiological change of PS. Examination of vessel diameters revealed a size-dependent antiangiogenic treatment effect, which showed a significant reduction in MVD (P < 0.001) for vessels with diameters smaller than 25 μm. No treatment effect was observed by tumor volume. CONCLUSIONS Noninvasive DCE micro-CT provides valuable physiological information of antiangiogenic drug effect in the intact animal and correlates with ex vivo structural analysis of 3D UM. The combined use of DCE micro-CT with UM constitutes a complementary imaging toolset that can help to enhance our understanding of antiangiogenic drug mechanisms of action in preclinical drug research.
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Assessment of Prostate Cancer With Dynamic Contrast-Enhanced Computed Tomography Using an En Bloc Approach. Invest Radiol 2014; 49:571-8. [DOI: 10.1097/rli.0000000000000055] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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CT perfusion in the characterisation of renal lesions: an added value to multiphasic CT. BIOMED RESEARCH INTERNATIONAL 2014; 2014:135013. [PMID: 25184133 PMCID: PMC4145536 DOI: 10.1155/2014/135013] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/25/2014] [Accepted: 06/16/2014] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To prospectively evaluate if computed tomography perfusion (CTp) could be a useful tool in addition to multiphasic CT in renal lesion characterisation. MATERIALS AND METHODS Fifty-eight patients that were scheduled for surgical resection of a renal mass with a suspicion of renal cell carcinoma (RCC) were enrolled. Forty-one out of 58 patients underwent total or partial nephrectomy after CTp examination, and a pathological analysis was obtained for a total of 49 renal lesions. Perfusion parameters and attenuation values at multiphasic CT for both lesion and normal cortex were analysed. All the results were compared with the histological data obtained following surgery. RESULTS PS and MTT values were significantly lower in malignant lesions than in the normal cortex (P < 0.001 and P = 0.011, resp.); PS, MTT, and BF values were also statistically different between oncocytomas and malignant lesions. According to ROC analysis, the accuracy, sensitivity, and specificity to predict RCC were 95.92%, 100%, and 66.7%, respectively, for CTp whereas they were 89.80%, 93.35%, and 50%, respectively, for multiphasic CT. CONCLUSION A significant difference between renal cortex and tumour CTp parameter values may suggest a malignant renal lesion. CTp could represent an added value to multiphasic CT in differentiating renal cells carcinoma from oncocytoma.
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Pathuri G, Madka V, Hedrick AF, Lightfoot S, Awasthi V, Cowley BD, Rao CV, Gali H. Evaluation of (99m)Tc-probestin SPECT as a novel technique for noninvasive imaging of kidney aminopeptidase N expression. Mol Pharm 2014; 11:2948-53. [PMID: 24988047 PMCID: PMC4144757 DOI: 10.1021/mp5002872] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2014] [Revised: 05/23/2014] [Accepted: 07/02/2014] [Indexed: 01/04/2023]
Abstract
Aminopeptidase N (APN; CD13; EC 3.4.11.2) is a zinc-dependent membrane-bound exopeptidase that catalyzes the removal of N-terminal amino acids from peptides. APN is known to be highly expressed on renal cortical proximal tubules. APN expression levels are markedly decreased under the influence of nephrotoxins and in the tumor regions of renal cancers. Thus, molecular imaging of kidney APN expression could provide pathophysiological information about kidneys noninvasively. Probestin is a potent APN inhibitor and binds to APN. Abdominal SPECT imaging was conducted at 1 h postinjection of (99m)Tc-probestin in a group of 12 UPII-SV40T transgenic and wild-type mice. UPII-SV40T mice spontaneously develop urothelial carcinoma in situ and invasive transitional cell carcinoma (TCC) that invade kidneys. Histopathology and immunohistochemistry analysis were used to confirm the presence of tumor and to evaluate APN expression in kidney. Radioactivity in normal tissue regions of renal cortex was clearly visible in SPECT images, whereas tumor regions of renal cortex displayed significantly lower or no radioactivity uptake. Histopathological analysis of kidney sections showed normal morphology for both renal pelvic and cortical regions in wild-type mice and abnormal morphology in some transgenic mice. Proliferating cell nuclear antigen staining confirmed the presence of tumor in those abnormal regions. Immunohistochemical analysis of kidney sections using anti-CD13 antibody showed significantly lower APN expression in tumor regions compared to normal regions. Results obtained in this study demonstrate the potential use of (99m)Tc-probestin SPECT as a novel technique for noninvasive imaging of kidney APN expression.
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Affiliation(s)
- Gopal Pathuri
- Department
of Pharmaceutical Sciences, College of Pharmacy, Center for Cancer
Prevention and Drug Development, Hematology/Oncology Section, Department
of Medicine, PCS Oklahoma Cancer Center, and Nephrology Section, Department of Medicine,
College of Medicine, The University of Oklahoma
Health Sciences Center, Oklahoma
City, Oklahoma 73117, United States
| | - Venkateshwar Madka
- Department
of Pharmaceutical Sciences, College of Pharmacy, Center for Cancer
Prevention and Drug Development, Hematology/Oncology Section, Department
of Medicine, PCS Oklahoma Cancer Center, and Nephrology Section, Department of Medicine,
College of Medicine, The University of Oklahoma
Health Sciences Center, Oklahoma
City, Oklahoma 73117, United States
| | - Andria F. Hedrick
- Department
of Pharmaceutical Sciences, College of Pharmacy, Center for Cancer
Prevention and Drug Development, Hematology/Oncology Section, Department
of Medicine, PCS Oklahoma Cancer Center, and Nephrology Section, Department of Medicine,
College of Medicine, The University of Oklahoma
Health Sciences Center, Oklahoma
City, Oklahoma 73117, United States
| | - Stanley
A. Lightfoot
- Department
of Pharmaceutical Sciences, College of Pharmacy, Center for Cancer
Prevention and Drug Development, Hematology/Oncology Section, Department
of Medicine, PCS Oklahoma Cancer Center, and Nephrology Section, Department of Medicine,
College of Medicine, The University of Oklahoma
Health Sciences Center, Oklahoma
City, Oklahoma 73117, United States
| | - Vibhudutta Awasthi
- Department
of Pharmaceutical Sciences, College of Pharmacy, Center for Cancer
Prevention and Drug Development, Hematology/Oncology Section, Department
of Medicine, PCS Oklahoma Cancer Center, and Nephrology Section, Department of Medicine,
College of Medicine, The University of Oklahoma
Health Sciences Center, Oklahoma
City, Oklahoma 73117, United States
| | - Benjamin D. Cowley
- Department
of Pharmaceutical Sciences, College of Pharmacy, Center for Cancer
Prevention and Drug Development, Hematology/Oncology Section, Department
of Medicine, PCS Oklahoma Cancer Center, and Nephrology Section, Department of Medicine,
College of Medicine, The University of Oklahoma
Health Sciences Center, Oklahoma
City, Oklahoma 73117, United States
| | - Chinthalapally V. Rao
- Department
of Pharmaceutical Sciences, College of Pharmacy, Center for Cancer
Prevention and Drug Development, Hematology/Oncology Section, Department
of Medicine, PCS Oklahoma Cancer Center, and Nephrology Section, Department of Medicine,
College of Medicine, The University of Oklahoma
Health Sciences Center, Oklahoma
City, Oklahoma 73117, United States
| | - Hariprasad Gali
- Department
of Pharmaceutical Sciences, College of Pharmacy, Center for Cancer
Prevention and Drug Development, Hematology/Oncology Section, Department
of Medicine, PCS Oklahoma Cancer Center, and Nephrology Section, Department of Medicine,
College of Medicine, The University of Oklahoma
Health Sciences Center, Oklahoma
City, Oklahoma 73117, United States
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Computed tomographic perfusion imaging for the prediction of response and survival to transarterial radioembolization of liver metastases. Invest Radiol 2014; 48:787-94. [PMID: 23748229 DOI: 10.1097/rli.0b013e31829810f7] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
PURPOSE The purpose of this study was to evaluate prospectively, in patients with liver metastases, the ability of computed tomographic (CT) perfusion to predict the morphologic response and survival after transarterial radioembolization (TARE). METHODS Thirty-eight patients (22 men; mean [SD] age, 63 [12] years) with otherwise therapy-refractory liver metastases underwent dynamic, contrast-enhanced CT perfusion within 1 hour before treatment planning catheter angiography, for calculation of the arterial perfusion (AP) of liver metastases, 20 days before TARE with Yttrium-90 microspheres. Treatment response was evaluated morphologically on follow-up imaging (mean, 114 days) on the basis of the Response Evaluation Criteria in Solid Tumors criteria (version 1.1). Pretreatment CT perfusion was compared between responders and nonresponders. One-year survival was calculated including all 38 patients using the Kaplan-Meier curves; the Cox proportional hazard model was used for calculating predictors of survival. RESULTS Follow-up imaging was not available in 11 patients because of rapidly deteriorating health or death. From the remaining 27, a total of 9 patients (33%) were classified as responders and 18 patients (67%) were classified as nonresponders. A significant difference in AP was found on pretreatment CT perfusion between the responders and the nonresponders to the TARE (P < 0.001). Change in tumor size on the follow-up imaging correlated significantly and negatively with AP before the TARE (r = -0.60; P = 0.001). Receiver operating characteristics analysis of AP in relation to treatment response revealed an area under the curve of 0.969 (95% confidence interval, 0.911-1.000; P < 0.001). A cutoff AP of 16 mL per 100 mL/min was associated with a sensitivity of 100% (9/9) (95% CI, 70%-100%) and a specificity of 89% (16/18) (95% CI, 62%-96%) for predicting therapy response. A significantly higher 1-year survival after the TARE was found in the patients with a pretreatment AP of 16 mL per 100 mL/min or greater (P = 0.028), being a significant, independent predictor of survival (hazard ratio, 0.101; P = 0.015). CONCLUSIONS Arterial perfusion of liver metastases, as determined by pretreatment CT perfusion imaging, enables prediction of short-term morphologic response and 1-year survival to TARE.
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