Value of intravoxel incoherent motion for differential diagnosis of renal tumors

2018 ◽  
Vol 60 (3) ◽  
pp. 382-387 ◽  
Author(s):  
Qingqiang Zhu ◽  
Wenrong Zhu ◽  
Jing Ye ◽  
Jingtao Wu ◽  
Wenxin Chen ◽  
...  
Keyword(s):  
Renal Cell ◽  
Clear Cell ◽  
Threshold Value ◽  
Intravoxel Incoherent Motion ◽  
Renal Tumors ◽  
Threshold Values ◽  
Renal Cell Carcinomas ◽  
Perfusion Fraction ◽  
D Values ◽  
Tumor Types

Background Few studies have reported on the use of intravoxel incoherent motion (IVIM) for renal tumors. Purpose To investigate the value of IVIM for distinguishing renal tumors. Material and Methods Thirty-one patients with clear cell renal cell carcinomas (CCRCCs), 13 patients with renal angiomyolipomas with minimal fat (RAMFs), eight patients with chromophobe renal cell carcinomas (ChRCCs), and ten patients with papillary renal cell carcinomas (PRCCs) were examined. The tissue diffusivity (D), pseudodiffusivity (D*), and perfusion fraction (f) were calculated. Results The D and f values were highest for CCRCCs, lowest for PRCCs, and intermediate for ChRCCs and RAMFs ( P < 0.05). The D values of CCRCCs differed significantly from those of ChRCCs and PRCCs ( P < 0.05). The D* values were highest for RAMFs, lowest for ChRCCs, and intermediate for CCRCCs and PRCCs ( P < 0.05). Statistically significant differences were observed between the D* values of CCRCCs and RAMFs ( P < 0.05). The D* values of the CCRCCs differed significantly from the D* values of the ChRCCs ( P < 0.05). Using the D and f values of 1.10 and 0.41, respectively, as the threshold values for differentiating CCRCCs from RAMFs, ChRCCs, and PRCCs, the best results had sensitivities of 81.0% and 66.8% and specificities of 85.7% and 81.0%, respectively. Using the D* value of 0.038 as the threshold value for differentiating RAMFs from CCRCCs, ChRCCs, and PRCCs, the best result obtained had a sensitivity of 90.5% and specificity of 76.2%. Conclusion IVIM may provide information for differentiating renal tumor types.

The Diagnostic Accuracy of Percutaneous Renal Needle Core Biopsy and Its Potential Impact on the Clinical Management of Renal Cortical Neoplasms

2014 ◽  
Vol 138 (12) ◽  
pp. 1673-1679 ◽  
Author(s):  
Lan L. Gellert ◽  
Rohit Mehra ◽  
Ying-Bei Chen ◽  
Anuradha Gopalan ◽  
Samson W. Fine ◽  
...  
Keyword(s):  
Clinical Management ◽  
Renal Cell ◽  
Core Biopsy ◽  
Clear Cell ◽  
Renal Tumors ◽  
Low Grade ◽  
Renal Cell Carcinomas ◽  
Biopsy Diagnosis ◽  
Potential Impact ◽  
Renal Cortical Neoplasms

Context While biopsies are now increasingly being performed for the diagnosis of renal cortical neoplasms, the influence of the rendered pathological diagnoses on the clinical management is only rarely documented. Objectives To report our experience with consecutively performed renal biopsies and the potential impact of the diagnosis on subsequent clinical management. Design Material from needle biopsies performed consecutively at our institution between 2006 and 2011 was reviewed. The influence of the reported pathology results on the clinical management was determined from patient follow-up medical record review. Results In total, 218 percutaneous biopsies for renal masses were performed during this period. Among them, 181 (83%) yielded neoplastic tissue, including 81 clear cell renal cell carcinomas, 29 low-grade oncocytic neoplasms, 7 papillary renal cell carcinomas, 5 clear cell papillary renal cell carcinomas, 5 angiomyolipomas, and 14 urothelial carcinomas. Fourteen additional cases (6%) contained lesional material from clinically known nonneoplastic processes, for a total diagnostic yield of 89%. Twenty-three (11%) were nonrepresentative of lesional tissue. In 10 of these, repeat biopsies or resections established the diagnosis of renal tumors. Biopsy diagnosis was confirmed in 29 of 30 cases (97%) on subsequent nephrectomy. Following the biopsy diagnosis, there were significant differences in the clinical management; overall, 79% of clear cell renal cell carcinomas received therapeutic interventions, and 17% were put on active surveillance. In contrast, 77% of the benign or low-grade lesions were put on active surveillance. Conclusions Accurate and specific diagnosis can be rendered on renal core biopsy in most renal tumors, and the biopsy diagnosis can have a definitive role in their clinical management.

Subtype differentiation of small renal cell carcinomas on three-phase MDCT: usefulness of the measurement of degree and heterogeneity of enhancement

2012 ◽  
Vol 53 (1) ◽  
pp. 112-118 ◽  
Author(s):  
Seung Chai Jung ◽  
Jeong Yeon Cho ◽  
Seung Hyup Kim
Keyword(s):  
Renal Cell ◽  
Clear Cell ◽  
Cell Types ◽  
Renal Tumors ◽  
Imaging Features ◽  
Renal Cell Carcinomas ◽  
Three Phase ◽  
Significant Difference ◽  
Subtype Differentiation ◽  
Papillary Type

Background Subtype differentiation of small renal cell carcinomas (RCCs) can provide more information to surgeons and patients and get more useful information about imaging features of small renal tumors. Purpose To evaluate the usefulness of the measurement of degree and heterogeneity of enhancement in subtype differentiation of small renal cell carcinomas (RCCs) by three-phase multidetector-row CT (MDCT). Material and Methods We reviewed 149 pathologically confirmed small (<4cm) RCCs in 143 patients: 114 (clear cell), 17 (chromophobe), and 18 papillary (8 papillary type 1 and 10 papillary type 2). Scans in pre-contrast, corticomedullary, and nephrographic phases were obtained. We assessed the mean and standard deviation of the Hounsfield units (HU) in a region of interest (ROI) for the degree of enhancement and the heterogeneity of enhancement, respectively. We compared the attenuation values, and the degree and heterogeneity of enhancement among the subtypes. Results The clear cell type showed the highest enhancement and heterogeneity of enhancement followed by chromophobe and papillary types. There was a significant difference in enhancement between the clear cell and papillary types in the corticomedullary phase ( P < 0.01), and between clear and non-clear cell types in the nephrographic phase ( P < 0.05). Heterogeneity of enhancement showed a significant difference between clear cell and non-clear cell types in the corticomedullary phase ( P < 0.05). Conclusion The measurement of degree and heterogeneity of enhancement on contrast-enhanced MDCT may be a simple and useful method to differentiate between the different types of small RCCs.

scholarly journals Multiple and Bilateral Sporadic Renal Cell Carcinomas: A Surgical Challenge

2018 ◽  
Vol 2018 ◽  
pp. 1-4
Author(s):  
Antonios Katsimantas ◽  
Spyridon Paparidis ◽  
Konstantinos Bouropoulos ◽  
Nikolaos Ferakis
Keyword(s):  
Renal Cell Carcinoma ◽  
Cell Carcinoma ◽  
Renal Cell ◽  
Clear Cell ◽  
Renal Tumors ◽  
High Grade ◽  
Lower Pole ◽  
Renal Cell Carcinomas ◽  
Cell Renal Cell Carcinoma ◽  
The Right

Sporadic, synchronous, bilateral, or unilateral Renal Cell Carcinomas constitute a rare clinical entity. We report the case of a 68-year-old male patient who presented in our department due to incidentally discovered multiple, bilateral renal tumors. Magnetic Resonance Imaging demonstrated cT1b renal tumors at the lower pole of each kidney and a cT1a renal tumor at the upper pole of the right kidney. The patient underwent transperitoneal, laparoscopic left partial nephrectomy with renal artery occlusion, histology revealed high-grade, pT1b, clear-cell renal cell carcinoma; however we observed decline of patient’s estimated glomerular filtration rate postoperatively. Forty days postoperatively, he underwent open partial nephrectomy for the right sided tumors with manual compression of the renal parenchyma and no use of ischemia. Histology revealed high-grade, pT1a, clear-cell renal cell carcinoma at the upper pole of the right kidney and low-grade, pT1b, clear-cell renal cell carcinoma at the lower pole of the right kidney. There was no additional decline in the serum creatinine value postoperatively. The patient avoided permanent or temporary dialysis and 6 months postoperatively he demonstrated no recurrence on imaging and his renal function remained stable.

scholarly journals Clinical Utility of Chromosome Genomic Array Testing for Unclassified and Advanced-Stage Renal Cell Carcinomas

2018 ◽  
Vol 143 (4) ◽  
pp. 494-504 ◽  
Author(s):  
Nicole K. Andeen ◽  
Xiaoyu Qu ◽  
Tatjana Antic ◽  
Scott S. Tykodi ◽  
Min Fang ◽  
...  
Keyword(s):  
Renal Cell ◽  
Clinical Utility ◽  
Clear Cell ◽  
Renal Tumors ◽  
Renal Cell Carcinomas ◽  
Duct Carcinoma ◽  
Clinical Scenarios ◽  
Genomic Array ◽  
Clear Cell Rcc ◽  
Array Testing

Context.— Cytogenomic analysis provides a useful adjunct to traditional pathology in the categorization of renal cell carcinomas (RCCs), particularly in morphologically ambiguous cases, but it has disadvantages, including cost. Objective.— To define the clinical scenarios in which this technology has direct clinical applications. Design.— DNA was isolated from paraffin-embedded tissue from 40 selected cases of RCC. Chromosome genomic array testing was performed using the OncoScan. Results.— Of 23 cases of unclassified renal tumors, 19 (83%) were reclassified with incorporation of cytogenetic and histologic features, including 10 as clear cell RCC, 2 as collecting duct carcinoma, 2 as papillary RCC, and 1 as novel TFEB-amplified tumor lacking TFEB translocation. Of 5 tumors with “hybrid” oncocytic features, 3 were reclassified as an eosinophilic variant of chromophobe RCC and 1 as oncocytoma. Appropriate staging in 2 patients was determined by identifying distinct, nonshared cytogenetic profiles. Of 11 cases of metastatic clear cell RCC, 7 (63%) had cytogenetic features associated with a poor prognosis. Conclusions.— We identified 5 scenarios in which chromosome genomic array testing has direct clinical utility: (1) to investigate unclassified RCCs, (2) to understand tumors with “hybrid” features and “collision” tumors, (3) to determine appropriate staging in questions of bilateral tumors and/or metastases, (4) to identify chromosomal aberrations in metastatic clear cell RCCs associated with a worse prognosis, and (5) to identify new entities. This has practical value in our institution, where a molecular profile diagnostically separating morphologically difficult to classify clear cell, papillary, chromophobe, and unclassified RCC influences treatment recommendations and clinical trial eligibility.

Value of intravoxel incoherent motion in assessment of pathological grade of clear cell renal cell carcinoma

2017 ◽  
Vol 59 (1) ◽  
pp. 121-127 ◽  
Author(s):  
Qingqiang Zhu ◽  
Jing Ye ◽  
Wenrong Zhu ◽  
Jingtao Wu ◽  
Wenxin Chen
Keyword(s):  
Renal Cell Carcinoma ◽  
Cell Carcinoma ◽  
Renal Cell ◽  
Clear Cell ◽  
Roc Curves ◽  
Tissue Perfusion ◽  
Intravoxel Incoherent Motion ◽  
Exponential Fitting ◽  
Cell Renal Cell Carcinoma ◽  
D Values

Background Intravoxel incoherent motion (IVIM) can provide a unique view of tissue perfusion without the use of exogenous contrast agents. Purpose To investigate the value of IVIM in assessing grades of clear cell renal cell carcinoma (CRCC). Material and Methods A total of 107 patients with pathologically proven CRCC were included, 26 with grade I, 27 with grade II, 25 with grade III, and 29 with grade IV. These tumors were divided into low (I + II) and high grades (III + IV). Nine b values (0, 30, 50, 80, 150, 300, 500, 800, and 1500 s/mm2) were used in diffusion-weighted imaging (DWI). The tissue diffusivity (D), pseudodiffusivity (D*), and perfusion fraction (f) were calculated using bi-exponential fitting of the diffusion data. Results The D values of the four groups were 1.83 ± 0.38, 1.23 ± 0.19, 1.07 ± 0.26, and 0.37 ± 0.11 × 10–3 mm2/s ( P < 0.05). The D* values of the four groups were 0.079 ± 0.021, 0.053 ± 0.019, 0.047 ± 0.022, and 0.033 ± 0.017 ( P < 0.05). The f values of the four groups were 0.208 ± 0.09, 0.341 ± 0.12, 0.373 ± 0.15, and 0.461 ± 0.17 ( P < 0.05). Both the D and D* values correlated negatively with CRCC grading ( r = –0.677 and –0.693, P < 0.05). The f values correlated positively with CRCC grading (r = 0.699, P < 0.05). The areas of the D, D*, and f values under the ROC curves to diagnose low and high CRCC grades were 0.934, 0.837, and 0.793, respectively. The cutoff values of D, D*, and f were 1.13, 0.056, and 0.376, respectively; the diagnostic performance for low and high CRCC grading had a sensitivity of 82.0%, 80.7%, and 83.2% and a specificity of 90.8%, 86.3%, and 82.6%. Conclusion IVIM may provide information for differentiating CRCC grades.

scholarly journals FLUORESCENT IN SITU HYBRIDIZATION AND IMMUNOHISTOCHEMISTRY FOR SUBTYPING “NON-CLASSIFIABLE” RENAL CELL CARCINOMAS

2019 ◽  
Vol 31 (4) ◽  
pp. 921-924
Author(s):  
Atanas Ivanov ◽  
Vili Stoyanova
Keyword(s):  
In Situ Hybridization ◽  
Genetic Analysis ◽  
Renal Cell ◽  
Clear Cell ◽  
Renal Tumors ◽  
Renal Cell Carcinomas ◽  
Trisomy 7 ◽  
Papillary Rcc ◽  
Clear Cell Rcc

Renal tumors account for about 3% of the malignancies in adults. Clear cell subtype renal cell carcinoma (RCC) and papillary RCC are the most common renal tubular epithelial carcinomas and their differentiation is important because they have a different prognosis and are associated with different treatment protocols. In most cases, histological features allow accurate diagnosis of renal cell carcinomas. There are also overlapping morphological findings between certain kidney neoplasms that make their subtyping extremely difficult. Some of them display papillary architecture but also have a clear cell component and it is not clear whether they should be classified as clear cell RCC or papillary RCC. In our study we performed an immunohistochemical and genetic analysis of 24 cases of RCC classified as non-classifiable with mixed papillary and clear cell components treated at Clinic of Urology in University Hospital "St. George "-Plovdiv. The mean age of patients was 54.5 years, and gender distribution: 60% male and 40% female. Based on the results of immunohistochemistry and fluorescence in situ hybridization (FISH), patients were stratified in 2 groups. The first group included 16 of the cases where strong immunoreactivity was found for alfa-methyl coenzyme A racemase (AMACR), with cytokeratin 7 (CK7) being present in 15 of these. In all cases in this group, FISH proved trisomy 7 and 17, in 4-9p deletion, and in 2- 3p deletion. The remaining 8 cases were stratified in the second group - all negative for CK7 and only one positive for AMACR. Genetic analysis showed a lack of trisomy 7 and 17 in all cases, as well as a deletion of 3p and 9p in 7 of them. The combination of immunohistochemical and genetic analyzes allows with a high accuracy to differentiate cases of papillary RCC from those with clear cell RCC.

scholarly journals CT-based multi-phase Radiomic models for differentiating clear cell renal cell carcinoma

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Menglin Chen ◽  
Fu Yin ◽  
Yuanmeng Yu ◽  
Haijie Zhang ◽  
Ge Wen
Keyword(s):  
Renal Cell ◽  
Clear Cell ◽  
Characteristic Curve ◽  
Treatment Options ◽  
Texture Features ◽  
Diagnostic Value ◽  
Renal Tumors ◽  
Diagnostic Model ◽  
Renal Cell Carcinomas ◽  
Cell Renal Cell Carcinoma

Abstract Background The aim of the study is to compare the diagnostic value of models that based on a set of CT texture and non-texture features for differentiating clear cell renal cell carcinomas(ccRCCs) from non-clear cell renal cell carcinomas(non-ccRCCs). Methods A total of 197 pathologically proven renal tumors were divided into ccRCC(n = 143) and non-ccRCC (n = 54) groups. The 43 non-texture features and 296 texture features that extracted from the 3D volume tumor tissue were assessed for each tumor at both Non-contrast Phase, NCP; Corticomedullary Phase, CMP; Nephrographic Phase, NP and Excretory Phase, EP. Texture-score were calculated by the Least Absolute Shrinkage and Selection Operator (LASSO) to screen the most valuable texture features. Model 1 contains the three most distinctive non-texture features with p < 0.001, Model 2 contains texture scores, and Model 3 contains the above two types of features. Results The three models shown good discrimination of the ccRCC from non-ccRCC in NCP, CMP, NP, and EP. The area under receiver operating characteristic curve (AUC)values of the Model 1, Model 2, and Model 3 in differentiating the two groups were 0.748–0.823, 0.776–0.887 and 0.864–0.900, respectively. The difference in AUC between every two of the three Models was statistically significant (p < 0.001). Conclusions The predictive efficacy of ccRCC was significantly improved by combining non-texture features and texture features to construct a combined diagnostic model, which could provide a reliable basis for clinical treatment options.

scholarly journals PD14-07 DIFFERENTIATION BETWEEN CLEAR CELL RENAL CELL CARCINOMAS AND ONCOCYTOMAS USING TEXTURE ANALYSIS OF CT IMAGES

2016 ◽  
Vol 195 (4S) ◽  
Author(s):  
Vinay Duddalwar ◽  
Xuejun Zhang ◽  
Darryl Hwang ◽  
Steven Cen ◽  
Felix Yap ◽  
...  
Keyword(s):  
Texture Analysis ◽  
Renal Cell ◽  
Clear Cell ◽  
Ct Images ◽  
Renal Cell Carcinomas
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