Imaging of Renal Cancer

Krishna, Satheesh; Leckie, Ashley; Kielar, Ania Z.; Hartman, Robert P.; Khandelwal, Ashish

doi:10.1053/j.sult.2019.12.004

Cited by 18 publications

(8 citation statements)

References 93 publications

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“…considered valuable in the original classification owing to a tendency to overestimate the Bosniak class and to the inability of conventional grayscale or color Doppler US to reliably help in the evaluation for the presence of blood flow (36). Renal mass protocol CT must include noncontrast images and enhanced images (obtained during the nephrographic phase, 100-120 seconds after injection) with the same acquisition parameters and about 3-mm reconstructed sections to enable accurate comparison of attenuation values (37)(38)(39). The corticomedullary phase (30-40 seconds after injection) and urographic phase (5 minutes after injection) are also important phases in a renal mass protocol, which may assist in detection and characterization of renal masses and relevant anatomy (37)(38)(39).…”

Section: Imaging Techniques For Evaluation Of Cystic Renal Masses General Imaging Techniquementioning

confidence: 99%

“…Renal mass protocol CT must include noncontrast images and enhanced images (obtained during the nephrographic phase, 100-120 seconds after injection) with the same acquisition parameters and about 3-mm reconstructed sections to enable accurate comparison of attenuation values (37)(38)(39). The corticomedullary phase (30-40 seconds after injection) and urographic phase (5 minutes after injection) are also important phases in a renal mass protocol, which may assist in detection and characterization of renal masses and relevant anatomy (37)(38)(39). However, many renal masses visualized at CT are imaged in the portal venous phase (eg, at 70-75 seconds) during examinations performed for unrelated reasons.…”

Section: Imaging Techniques For Evaluation Of Cystic Renal Masses General Imaging Techniquementioning

confidence: 99%

“…It is important to recognize that some RCCs (eg, papillary RCC) may not enhance by using an attenuation change threshold of 20 HU at CT, typically showing indeterminate range enhancement (10-20 HU) and less frequently no enhancement (<10 HU) (16,47). Subtraction images at MRI, which coregister precontrast and postcontrast (obtained after the administration of contrast material) gadolinium-enhanced images, are helpful in the detection (or exclusion) of enhancement (36,37), particularly in the evaluation of masses that are intrinsically T1 hyperintense. Misregistration artifacts can confound interpretation of subtraction images and are important to recognize.…”

Section: Bosniak Classification Version 2019 Definition and Significance Of Enhancementmentioning

confidence: 99%

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Bosniak Classification of Cystic Renal Masses, Version 2019: A Pictorial Guide to Clinical Use

Schieda¹,

Davenport²,

Krishna³

et al. 2021

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Cystic renal masses are commonly encountered in clinical practice. In 2019, the Bosniak classification of cystic renal masses, originally developed for CT, underwent a major revision to incorporate MRI and is referred to as the Bosniak Classification, version 2019. The proposed changes attempt to (a) define renal masses (ie, cystic tumors with less than 25% enhancing tissue) to which the classification should be applied; (b) emphasize specificity for diagnosis of cystic renal cancers, thereby decreasing the number of benign and indolent cystic masses that are unnecessarily treated or imaged further; (c) improve interobserver agreement by defining imaging features, terms, and classes of cystic renal masses; (d) reduce variation in reported malignancy rates for each of the Bosniak classes; (e) incorporate MRI and to some extent US; and (f) be applicable to all cystic renal masses encountered in clinical practice, including those that had been considered indeterminate with the original classification. The authors instruct how, using CT, MRI, and to some extent US, the revised classification can be applied, with representative clinical examples and images. Practical tips, pitfalls to avoid, and decision tree rules are included to help radiologists and other physicians apply the Bosniak Classification, version 2019 and better manage cystic renal masses. An online resource and mobile application are also available for clinical assistance.

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Section: Imaging Techniques For Evaluation Of Cystic Renal Masses General Imaging Techniquementioning

confidence: 99%

Section: Imaging Techniques For Evaluation Of Cystic Renal Masses General Imaging Techniquementioning

confidence: 99%

Section: Bosniak Classification Version 2019 Definition and Significance Of Enhancementmentioning

confidence: 99%

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Bosniak Classification of Cystic Renal Masses, Version 2019: A Pictorial Guide to Clinical Use

Schieda¹,

Davenport²,

Krishna³

et al. 2021

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“…31 Some limitations faced in our study include the following: retrospectively performed procedures make many patients were excluded due to lack of pathological results and not long enough follow-up, and the number of patients with these masses was small. The quality of images was easily affected by the patient body habitus and their ability to hold the breath, 34 in addition to poorer sonic window due to bowel gases, ribs, or mass location. 20 Recently, as the Bosniak classification of CRM by CEUS is hard to widely apply in clinical work, the role of CEUS is not recognized in the frame of the newly published Bosniak classification version.…”

Section: Discussionmentioning

confidence: 99%

Clinical Evaluation of Cystic Renal Masses With Bosniak Classification by Contrast‐Enhanced Ultrasound and Contrast‐Enhanced Computer Tomography

Lan,

Yang,

et al. 2023

J of Ultrasound Medicine

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ObjectivesThe study aims to compare retrospectively three clinically applied methods for the diagnostic performance of cystic renal masses (CRMs) by contrast‐enhanced ultrasound (CEUS) and contrast‐enhanced computer tomography (CECT) with Bosniak classification system.MethodsA total of 52 cases of Bosniak II–IV CRMs in 49 consecutive patients were diagnosed from January 2013 to July 2022 and their data were analyzed. All patients had been subjected to CEUS and CECT simultaneously. Pathological diagnoses and masses stability were used as standard references to determine whether lesions were malignant or benign. Then 49 CRMs only with pathologic results were classified into group 1 and 2.ResultsA total of 52 CRMs in 49 enrolled patients were classified into 8 category II, 16 category IIF, 15 category III, and 13 category IV by CEUS (EFSUMB 2020), 10 category II, 13 category IIF, 16 category III, and 13 category IV by CEUS (V2019), while 15 category II, 9 category IIF, 13 category III, and 15 category IV by CECT (V2019). Pathological results and masses stability longer than 5 years follow‐up performed substantially for CEUS (EFSUMB 2020), CEUS (V2019), and CECT (V2019) (kappa values were 0.696, 0.735, and 0.696, respectively). Among 49 pathologic approving CRMs, wall/septation thickness ≥4 mm, wall/septation thickness, presence of enhancing nodule and the diameter were found to be statistically significant for malignancy. Twenty‐two malignant masses were correctly diagnosed by CEUS (V2019), while 21 malignant masses were both correctly diagnosed by CEUS (EFSUMB 2020) and CECT (V2019), and 1 mass was misdiagnosed.ConclusionsBosniak classification of EFSUMB 2020 version might be as accurate as version 2019 CEUS and version 2019 CECT in diagnosing CRMs, and CEUS is found to have an excellent safety profile in dealing with clinical works.

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“…A multiphasic abdominal CECT was performed according to a standard scanning protocol [17] and included the following essential components: precontract native (NAT) phase images, corticomedullary phase (CMP) performed 20-30 seconds after the bolus, nephrographic phase (NP) executed 100 seconds after the contrast administration and excretory phase (EP) carried out 10 minutes postcontrast. CECT was performed for in-depth topographical characterization of the lesion, including determining the size of the tumor and VTT, its shape and position, the presence of necrotic areas, nodular contrast enhancement, indistinct edges, the presence of cystic components, high vascularization, calci cations, the presence of multicentric growth, invasion into the collecting system/sinus of the kidney, spread to the surrounding tissues, including the adrenal gland, the size and distribution of the tumor thrombus in the renal and vena cava, and the state of regional lymph nodes.…”

Section: Ct Imaging Technique and 3d Texture Analysismentioning

confidence: 99%

Differentiation of solid and friable tumor thrombus in patients with renal cell carcinoma using volumetric analysis of computed tomography radiomic features

Kowal,

Ratajczyk,

Bursiewicz

et al. 2023

Preprint

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Background. Renal cell carcinoma (RCC) has a unique tendency to invade the inferior vena cava through the renal vein, forming a venous tumor thrombus (VTT). Precisely determining the solidity of the VTT before surgery is crucial for appropriate treatment planning and optimal outcomes, as the perioperative spread of friable thrombus can lead to life-threatening complications like pulmonary embolism. The aim of the study was to assess the applicability of CT volumetric analysis to differentiate solid and friable VTT in patients with RCC. Methods. Twenty-eight patients with RCC and VTT were enrolled in the study, in whom nephrectomy and thrombectomy were performed. Preoperative abdominal multiphasic contrast-enhanced CT was executed. Patients were categorized into solid or friable groups according to the consistency of the thrombus. For the volumetric texture analysis, the radiomic first-order features were calculated from the entire thrombus volume separately for each CT phase. Results. A significant association between the percentage of RCC cells in VTT and the radiodensity values of mean, median, 10th percentile of corticomedullary phase (CMP), mean and median of nephrographic phase (NP) was found. The percentage of RCC cells within the tumour thrombus showed a significant correlation with the CMP median (Pearson's r = 0.748), CMP mean (Pearson's r = 0.731), CMP 90th percentile (Pearson's r = 0.638), CMP 10th percentile (Pearson's r = 0.622) and NP median (Pearson's r = 0.450). The highest performance in differentiating between solid and friable VTT demonstrated the CMP median, with an area under the curve (AUC) of 0.934 (95% CI 0.846-1.0), sensitivity of 90% and specificity of 62%. The highest sensitivity and specificity in differentiating between solid and friable VTT showed CMP 90th percentile: 90% and 75%, respectively, AUC 0.928 (95% CI 0.830-1.0). The highest specificity (100%) had CMP mean, while the sensitivity and AUC were 85% and 0.925 (95% CI 0.827-1.0), respectively. Conclusions. Radiomic features of CT images, such as the mean, median and 90th percentile of CMP of the whole-volume VTT, provide an accurate means of distinguishing between solid and friable thrombus consistency in patients with RCC.

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Imaging of Renal Cancer

Cited by 18 publications

References 93 publications

Bosniak Classification of Cystic Renal Masses, Version 2019: A Pictorial Guide to Clinical Use

Bosniak Classification of Cystic Renal Masses, Version 2019: A Pictorial Guide to Clinical Use

Clinical Evaluation of Cystic Renal Masses With Bosniak Classification by Contrast‐Enhanced Ultrasound and Contrast‐Enhanced Computer Tomography

Differentiation of solid and friable tumor thrombus in patients with renal cell carcinoma using volumetric analysis of computed tomography radiomic features

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