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ABSTRACT: Renal cell carcinoma (RCC) in patients with von Hippel Lindau (VHL) disease tends to be multifocal, bilateral, and recur or develop new tumors after removal. These characteristics make treating hereditary RCCs difficult for urologists or radiologists compared to treating a sporadic RCC. Radiofrequency ablation (RFA) is a minimally-invasive treatment for small hereditary RCCs associated with a low complication rate and a minimal decrease in renal function.No RFA guidelines have been established about what to treat and when and how to ablate RCCs in patients with VHL disease. Besides, reports on complications and treatment outcomes in this patient group are rare. The purpose of this review is to discuss the indications, techniques, complications, and outcomes of RFA in treating RCC in patients with VHL disease.
Acta Radiologica 02/2013; · 1.37 Impact Factor
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ABSTRACT: Purpose:To determine the diagnostic performance of dual-energy computed tomography (CT) by using virtual unenhanced CT to characterize adrenal masses.Materials and Methods:This study is retrospective, HIPAA-compliant, and approved by the institutional review board. Between December 2009 and June 2010, 49 patients with 49 adrenal masses underwent 120-kVp unenhanced CT and 80-kVp and 140-kVp early and delayed contrast agent-enhanced dual-energy CT. Early virtual unenhanced (EVU) and delayed virtual unenhanced (DVU) CT images were composed of data sets of early and delayed contrast-enhanced CT, respectively. Adenomas were divided into lipid-rich adenoma and lipid-poor adenoma on the basis of lesion attenuation values measured according to unenhanced CT and percentage loss of enhancement. Absolute percentage loss of enhancement was calculated with the following equation: (CT(EE) - CT(DE)) × 100/(CT(EE) - CT(UE)), where CT(UE), CT(EE), and CT(DE) are adrenal mass attenuation values at unenhanced CT, early contrast-enhanced CT, and delayed contrast-enhanced CT, respectively. The sensitivity of adrenal protocol adenoma with delayed contrast-enhanced CT was obtained with a reference standard of unenhanced CT, pathologic examination, or size stability on follow-up examination findings. Lesion attenuation values measured on unenhanced CT, EVU CT, and DVU CT images were compared by using repeated measures analysis of variance with post hoc test.Results:Of 49 masses, 33 were adenomas and 16 were nonadenomas. Adenoma group was 18 lipid-rich adenomas and 15 lipid-poor adenomas. Mean attenuation values of the lipid-rich adenomas on EVU CT images (11.7 HU ± 9.5) were significantly greater than those on unenhanced CT images (0.7 HU ± 7.2) (P = .001) and DVU CT images (6.6 HU ± 8.4) (P = .01). The sensitivities of EVU CT and DVU CT for lipid-rich adenoma were 39% (seven of 18) and 61% (11 of 18), respectively. The sensitivity for adenoma with percentage loss of enhancement values calculated from virtual unenhanced CT and early and delayed contrast-enhanced CT was 100% (33 of 33).Conclusion:Although adrenal protocol with dual-energy CT by using virtual unenhanced CT and washout rate can help diagnose all lipid-poor adenomas, it may miss lipid-rich adenomas that can be diagnosed on unenhanced CT images.© RSNA, 2013.
Radiology 01/2013; · 5.73 Impact Factor
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ABSTRACT: To retrospectively determine the optimal b value of diffusion-weighted imaging (DWI) for predicting the presence of localized prostate cancer, and to evaluate the utility of DWI under different b values in differentiating between cancers and benign prostatic tissues.
Eighty patients with suspected prostate cancer underwent MRI including DWI at 3T, followed by radical prostatectomy. DWI was examined under different b values. Apparent diffusion coefficient (ADC) maps were generated by using b = 0, and other b values of 300, 700, 1000 or 2000 s/mm(2). For predicting the presence of cancers, four different ADC maps were analyzed independently by two blinded readers. ADCs were measured in benign and malignant tissues.
For predicting the presence of 110 prostate cancers, the sensitivity and area under the curve (AUC) for an experienced reader was significantly greater at b = 1000 (85% and 0.91) than b = 300, 700 or 2000 s/mm(2) (p < 0.01). For a less-experienced reader, the AUC was significantly greater at b = 700, 1000 or 2000 than b = 300 s/mm(2) (p < 0.01). Mean ADCs of the cancers in sequence from b = 300 to 2000 s/mm(2) were 1.33, 1.03, 0.88 and 0.68 × 10(-3) mm(2)/s, which were significantly lower than those of benign tissues (p < 0.001).
The optimal b value for 3T DWI for predicting the presence of prostate cancer may be 1000 s/mm(2).
Korean journal of radiology: official journal of the Korean Radiological Society 01/2013; 14(1):61-9. · 1.32 Impact Factor
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ABSTRACT: PURPOSE: To evaluate the feasibility and complications of ultrasound (US)-guided biopsy of small renal masses (SRMs) and to determine factors that contribute to nondiagnostic biopsy specimens. MATERIALS AND METHODS: Between June 2004 and May 2011, 58 consecutive patients underwent US-guided core biopsy of a SRM (>1 cm and≤4 cm) using an 18-gauge core biopsy device. The diagnostic rate, histologic diagnosis, and complications of US-guided core biopsy were assessed. Mann-Whitney U and Fisher exact tests were used to compare diagnostic and nondiagnostic biopsy specimens. Univariate analysis was performed to determine the predictive factors for nondiagnostic biopsy specimens. RESULTS: There were 59 biopsies of SRMs performed, and the diagnostic rate was 81% (48 of 59). The mass size of diagnostic and nondiagnostic biopsy specimens ranged from 1.2-3.9 cm (2.4 cm±0.7) for diagnostic specimens and from 1.1-3.5 cm (1.9 cm±0.7) for nondiagnostic specimens (P= .024). Of the diagnostic biopsy specimens, 77% (37 of 48) were malignant, and 23% (11 of 48) were benign. Minor complications developed in 20.3% (12 of 59) of biopsies. The lesion size or core number threshold for decreasing diagnostic rate was 2 cm or three cores. A cystic mass, fewer cores (three or fewer cores), an upper pole mass, and a small mass (≤2 cm) significantly predicted a nondiagnostic biopsy specimen (P= .007-.046). CONCLUSIONS: US-guided core biopsy is a feasible and safe procedure for histologic diagnosis of a SRM. However, nondiagnostic rates may increase when a cystic mass is biopsied, a mass is located in an upper pole mass, a mass is 2 cm or less, and three cores or fewer are sampled.
Journal of vascular and interventional radiology: JVIR 11/2012; · 1.81 Impact Factor
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ABSTRACT: Purpose:To retrospectively compare absolute and relative washout of adrenal metastases in patients with renal cell carcinoma (RCC) and hepatocellular carcinoma (HCC) to that of adrenal adenoma.Materials and Methods:Between November 1994 and August 2011, in this institutional review board-approved study (with waiver of informed consent), 16 patients with 19 adrenal metastases (16 in 13 RCC patients, three in three HCC patients) and 20 patients with 21 adrenal adenomas (16 in 15 RCC patients, five in five HCC patients) underwent dedicated adrenal protocol consisting of unenhanced, 1-minute contrast material-enhanced, and 15-minute delayed contrast-enhanced computed tomography (CT). The attenuation values and percentage enhancement washout, including absolute percentage washout (APW) and relative percentage washout (RPW), were calculated. If available, histologic findings and the change in the size of adrenal lesions were assessed. Statistical analyses were performed by using generalized estimating equation and coefficient of variation.Results:The mean APW of the metastases (observer 1, 67% ± 11 [standard deviation]; observer 2, 63% ± 12) was not significantly different from that of adenomas (observer 1, 73% ± 9; observer 2, 72% ± 12) for observer 1 (P = .143) and was significantly different for observer 2 (P = .029). The mean RPW of the metastases (observer 1, 46% ± 11; observer 2, 43% ± 12) was significantly lower than that of adenomas (observer 1, 62% ± 19; observer 2, 60% ± 17) (all P < .001 for each observer). With a threshold of 60% for APW or 40% for RPW, 95% (18 of 19) and 89% (17 of 19), respectively, of the metastases were falsely diagnosed as lipid-poor adenomas by each observer. All nine metastases that were followed up at CT had a substantial growth in size.Conclusion:In patients with RCC and HCC who undergo dedicated adrenal CT imaging for known adrenal lesions, the percentage enhancement washout of adrenal metastases is similar to that of lipid-poor adrenal adenomas. Careful imaging follow-up or pathologic tissue confirmation is needed.© RSNA, 2012Supplemental material: http://radiology.rsna.org/lookup/suppl/doi:10.1148/radiol.12120110/-/DC1.
Radiology 11/2012; · 5.73 Impact Factor
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ABSTRACT: PURPOSE: To prospectively assess the usefulness of diffusion-weighted magnetic resonance imaging (MRI) with background body signal suppression (DWIBS) at 3T for the preoperative evaluation of endometrial cancer. MATERIALS AND METHODS: Fifty-two consecutive patients with biopsy-proven endometrial cancer were examined with a 3T MR scanner, followed by a hysterectomy. MR examinations included T2-weighted (T2WI), DWIBS, and dynamic contrast-enhanced T1-weighted imaging (DCEI). The apparent diffusion coefficient (ADC) was calculated in the tumor and normal myometrium. According to tumor grade, the mean ADC of the tumor was analyzed. The depth of myometrial invasion was independently assessed by two radiologists for three MRI datasets on a five-point scale. RESULTS: The mean ADC of the tumors was significantly lower than that of normal myometrium (P < 0.001). The mean ADC of grades 2 or 3 was significantly lower than grade 1 (P < 0.01). For predicting myometrial invasion, the specificity, accuracy, and area under the curve of combined T2WI and DWIBS in both readers were similar to DCEI (P > 0.05). Interreader agreement in all MRI datasets was excellent. CONCLUSION: DWIBS at 3T has potential for being an effective method for the preoperative evaluation of endometrial cancer. J. Magn. Reson. Imaging 2012;. © 2012 Wiley Periodicals, Inc.
Journal of Magnetic Resonance Imaging 11/2012; · 2.70 Impact Factor
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ABSTRACT: Because of its minimally invasive nature, thermal ablation is increasingly performed in patients with renal cell carcinoma (RCC) who are poor surgical candidates. Thermal ablation has been associated with excellent outcomes, and thus has been regarded as a viable alternative to nephron-sparing surgery. Many papers report minimal to no reduction in renal function after ablation therapies. However, in order to achieve good local control, normal renal tissue must be sacrificed, subsequently leading to reduced renal function. The amount of normal renal tissue to be ablated depends on the size, location, and number of RCCs, as well as the type of thermal ablation applied. However, there are few reports about what reduces renal function following thermal ablation therapies. The purpose of this review was to discuss factors that affect reduction in renal function and to assess the relationship between local tumour control and renal function.
International Journal of Hyperthermia 11/2012; · 1.92 Impact Factor
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ABSTRACT: PURPOSE: To investigate the changes in apparent diffusion coefficients (ADCs) in cervical cancer patients receiving concurrent chemoradiotherapy (CCRT), and to assess the relationship between tumor ADCs or changes in tumor ADCs and final tumor responses to therapy. MATERIALS AND METHODS: Twenty-four patients with cervical cancer who received CCRT were examined with 3 Tesla (T) MRI including diffusion-weighted imaging (DWI). All patients had three serial MR examinations: before therapy (pre-Tx); at 4 weeks of therapy (mid-Tx); and 1 month after completion of therapy (post-Tx). At each examination, ADC was measured in tumors and normal gluteus muscles. Final tumor response as determined by change in tumor size or volume using MRI was correlated with tumor ADCs at each therapeutic time or changes in tumor ADCs at mid-Tx. RESULTS: From pre-Tx to post-Tx, mean tumor ADCs were 0.88, 1.30, and 1.47 × 10(-3) mm(2) /s in sequence (P < 0.001), while those of normal gluteus muscles were 1.24, 1.29, and 1.21 × 10(-3) mm(2) /s in sequence (P > 0.05). At mid-Tx, tumor ADCs and changes in tumor ADCs had a significant correlation with final tumor size responses (P = 0.029 and 0.025, respectively). However, the tumor ADC values at pre-Tx were not associated with the final tumor size response (P = 0.47). The final tumor volume response was not associated with tumor ADC at pre-Tx or mid-Tx (P > 0.05) or changes in tumor ADCs at mid-Tx (P > 0.05). CONCLUSION: DWI may have potentials in evaluating the therapeutic response to CCRT in patients with cervical cancer. J. Magn. Reson. Imaging 2012;. © 2012 Wiley Periodicals, Inc.
Journal of Magnetic Resonance Imaging 09/2012; · 2.70 Impact Factor
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ABSTRACT: Renal lymphangioma typically manifests as a unilocular or multilocular cystic mass in the parapelvic or perirenal spaces. A solid mass-like lymphangioma rarely occurs and thus is hard to differentiate from a renal cell carcinoma. We encountered a case of a solid mass-like renal lymphangioma that was confirmed using percutaneous biopsy. The purpose of our case report was to describe magnetic resonance imaging features, to show the differential diagnoses, and to discuss the role of percutaneous renal mass biopsy.
Clinical imaging 07/2012; 36(4):398-401. · 0.73 Impact Factor
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ABSTRACT: To investigate the changes of dynamic contrast-enhanced MR imaging (DCE-MRI) parameters at 3 T in cervical cancer patients before and after concurrent chemoradiotherapy (CCRT), and to correlate the parameters with final tumour response to therapy.
Thirty-five patients with cervical cancer underwent DCE-MRI before CCRT, 4 weeks after starting therapy and at 1 month after the end of therapy. DCE-MRI parameters were calculated in the tumour and normal gluteus muscle. Final response to treatment as determined by changes in tumour size and volume was correlated with pre-treatment DCE-MRI parameters.
DCE-MRI parameters (i.e. K (trans), v (e) and k (ep)) in the tumours showed significant changes in response to CCRT (P < 0.05) and in particular K (trans) and v (e) demonstrated early significant increase (P < 0.01), but those in normal muscle did not show a significant difference (P > 0.05). Before therapy, the mean values of K (trans), k (ep), v (e) and v (p) in the tumours were significantly greater than those in muscle (P < 0.05). DCE-MRI parameters of the tumours at pre-treatment were not statistically associated with final tumour size or volume change.
DCE-MRI parameters may help evaluate early changes of cervical cancer to CCRT, but larger, more definitive studies are needed. KEY POINTS : • DCE-MRI offers new insights into tumour behaviour. • Changes in tumour size lag behind biomarkers which improve quickly in responders. • DCE-MRI is a non-invasive imaging technique that can characterize tumour vasculature. • DCE-MRI of cervical cancer may be useful in monitoring changes with therapy.
European Radiology 06/2012; 22(11):2533-9. · 3.22 Impact Factor
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ABSTRACT: The objective of our study was to investigate the feasibility and reproducibility of blood oxygenation level-dependent (BOLD) MRI using different gradient echoes at 3 T in patients with renal allografts and healthy volunteers and to evaluate whether BOLD MRI can be used to distinguish between cases of acute allograft rejection and normally functioning allografts.
BOLD MRI at 3 T was performed of eight patients with normal allografts, four patients with acute allograft rejection, and 10 healthy volunteers. Multiple fast-field echo sequences were performed at gradient echoes of 8, 16, and 20 to obtain T2(*)-weighted images. The reproducibility of BOLD MRI was evaluated in patients with normal allografts.
Cortical and medullary R2(*) values were not significantly different between healthy volunteers and patients with normal allografts, but medullary R2(*) values were significantly greater than cortical R2(*) values in both groups for all three protocols (p < 0.01). Medullary R2(*) values were significantly lower in cases of acute allograft rejection than in normal allografts for all three protocols (p < 0.001). The mean difference in cortical or medullary R2(*) values was 3.8% or less in all protocols.
BOLD MRI performed using different gradient echoes at 3 T is feasible and reproducible in patients with renal allografts and can show significant changes in medullary oxygenation in patients with acute rejection.
American Journal of Roentgenology 05/2012; 198(5):1108-14. · 2.78 Impact Factor
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ABSTRACT: To evaluate the feasibility of 18F-fluorodeoxyglucose (FDG) positron emission tomography (PET)/computed tomography (CT)-guided conformal brachytherapy treatment planning in patients with cervical cancer.
Pretreatment FDG-PET/CT was performed for 12 patients with cervical cancer. Brachytherapy simulation was performed after an external-beam radiation therapy median dose of 4140 cGy. Patients underwent FDG-PET/CT scans with placement of tandem and ovoid applicators. The gross tumor volume (GTV) was determined by adjusting the window and level to a reasonable value and outlining the edge of the enhancing area, which was done in consultation with a nuclear medicine physician. A standardized uptake value profile of the tumor margin was taken for each patient relative to the maximum uptake value of each tumor and analyzed. The plan was designed to deliver 400 cGy to point A (point A plan) or to cover the clinical target volume (CTV) (PET/CT plan).
The median dose that encompassed 95% of the target volume (D95) of the CTV was 323.0 cGy for the point A plan vs 399.0 cGy for the PET/CT plan (P=.001). The maximum standardized uptake values (SUV(max)) of the tumors were reduced by a median of 57% (range, 13%-80%). All but 1 patient presented with discernable residual uptake within the tumors. The median value of the thresholds of the tumors contoured by simple visual analysis was 41% (range, 23%-71%).
In this study, the PET/CT plan was better than the conventional point A plan in terms of target coverage without increasing the dose to the normal tissue, making optimized 3-dimensional brachytherapy treatment planning possible. In comparison with the previously reported study with PET or CT alone, we found that visual target localization was facilitated by PET fusion on indeterminate CT masses. Further studies are needed to characterize the metabolic activity detected during radiation therapy for more reliable targeting.
International journal of radiation oncology, biology, physics 04/2012; 84(1):e29-34. · 4.59 Impact Factor
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ABSTRACT: To compare percutaneous radiofrequency ablation (RFA) and open partial nephrectomy (OPN) for the treatment of renal cell carcinoma (RCC) with respect to renal function and mid-term oncological outcome.
From January 2006 to December 2008, 40 (RFA group) and 110 (OPN group) patients underwent RFA and OPN for sporadic RCC, respectively. The sizes and locations of RCCs were matched between the two groups. To determine the lesion size, the maximum transverse diameter was measured. Estimated glomerular filtration rates (eGFR) before and after treatment and overall three-year recurrence-free survival rates were calculated and compared.
Tumours in the RFA and OPN groups ranged from 9-76 mm (24.4 ± 13.1 mm) and from 6-60 mm (22.3 ± 10.2 mm), respectively (p = 0.962). The locations of RCCs were not significantly different (p = 0.101-0.508). The mean reductions of eGFR in the RFA and OPN groups were 2.3 ± 8.6 mL/min/1.73 m² (range, -23 to +17.5 mL/min/1.73 m²) and 7.4 ± 10.9 mL/min/1.73 m² (-23.6 to +42.8 mL/min/1.73 m², respectively (p = 0.013). Overall three-year recurrence-free survival rates in the RFA and OPN groups were 94.7% and 98.9%, respectively (p = 0.266).
For treating size- and location-matched RCCs, RFA is superior to OPN with respect to the preservation of renal function. Furthermore, RFA can achieve excellent mid-term outcomes that are equivalent to those of OPN.
International Journal of Hyperthermia 01/2012; 28(3):227-34. · 1.92 Impact Factor
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ABSTRACT: To investigate the feasibility of diffusion-weighted MRI (DWI) as an early and reproducible change indicator in patients receiving radiotherapy for prostate cancer (PC).
Eight consecutive patients with biopsy-proven PC underwent DWI at 3T. All patients who received external-beam radiotherapy had four serial MR scans, as follows: before therapy (PreTx); after 1 week of therapy (PostT1); after 3 weeks of therapy (PostT2); and 1 month after the completion of therapy (PostT3). At each time, the apparent diffusion coefficient (ADC) was measured in tumors and normal tissues. For reproducibility of the ADC measurement, five patients also had two separate pretreatment DWI scans at an interval of <2 weeks. Serum prostate-specific antigen (PSA) levels were evaluated at the same time as MR scans.
Thirteen tumors (peripheral zone = 10; transition zone = 3) were found. The mean ADC values for the tumors from PreTx to PostT3 were 0.86, 1.03, 1.15, and 1.26 × 10(-3) mm(2)/s in sequence, respectively. Compared with PreTx, PostT1 (p = 0.005), PostT2 (p = 0.003), and PostT3 (p < 0.001) showed a significant increase in ADC values. The mean ADC values of the benign tissues from PreTx to PostT3 were 1.60, 1.58, 1.47, and 1.46 × 10(-3) mm(2)/s in sequence, respectively. Reproducibility of ADC measurements was confirmed with a mean difference in ADC of -0.04 in peripheral zone and -0.017 in transition zone between two separate pretreatment MR scans. The mean PSA levels from PreTx to PostT3 were 9.05, 9.18, 9.25, and 4.11 ng/mL in sequence, respectively.
DWI, as a reproducible biomarker, has the potential to evaluate the early therapeutic changes of PC to radiotherapy.
International journal of radiation oncology, biology, physics 12/2011; 83(2):749-55. · 4.59 Impact Factor
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ABSTRACT: The objective of our study was to assess the utility of dual-energy CT for characterizing renal masses using iodine overlay techniques and virtual unenhanced images and to measure the potential radiation dose reduction for two-phase kidney CT compared with a standard three-phase protocol.
Sixty patients with suspected renal masses underwent dual-energy CT including true unenhanced, dual-energy corticomedullary, and dual-energy late nephrographic phase imaging. Iodine overlay and virtual unenhanced images were derived from the corticomedullary and late nephrographic phases, respectively. The CT numbers of renal masses were calculated using the iodine overlay images superimposed on the virtual unenhanced images. The overall imaging quality of the true unenhanced images and of the virtual unenhanced images was also evaluated. The effective radiation doses for dual-energy CT and for true unenhanced imaging were calculated.
For overlay or enhancement values on iodine overlay images, 36 simple cysts and 10 hemorrhagic cysts had an attenuation value of less than 20 HU, whereas 21 renal cell carcinomas showed an attenuation value of 20 HU or greater. Eleven angiomyolipomas contained macroscopic fat tissue. All renal masses were accurately classified on the basis of dual-energy CT. The imaging quality of the virtual unenhanced images from the corticomedullary and late nephrographic phases was inferior to the image quality of the true unenhanced images (p < 0.01). The mean effective doses for the three-phase protocol and for true unenhanced images were 12.6 and 2.4 mSv, respectively.
Our results show that dual-energy CT using iodine overlay techniques and virtual unenhanced images may be useful for characterizing renal masses.
American Journal of Roentgenology 12/2011; 197(6):W1076-82. · 2.78 Impact Factor
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ABSTRACT: The purpose of our study was to prospectively evaluate whether MRI before an initial transrectal ultrasound-guided biopsy contributed to detection of prostate cancer in patients with high prostate-specific antigen (PSA) level and no previous biopsy.
Men with an abnormal digital rectal examination or high PSA level were enrolled in this prospective randomized study. Participants were randomly allocated into two groups; the MRI group underwent 3-T MRI and then a transrectal ultrasound-guided biopsy with knowledge of the cancer location. The non-MRI group did not undergo MRI before transrectal ultrasound-guided biopsy. The cancer detection rate and positive core rate were obtained to compare the MRI and non-MRI groups.
The MRI and non-MRI groups contained 44 and 41 patients, respectively. There was no significant difference between the two groups with respect to age, PSA, and prostate volume. The MRI group (13/44, 29.5%) had a significantly higher cancer detection rate than the non-MRI group (4/41, 9.8%) (p = 0.03). The MRI group (52/527, 9.9%) had a significantly higher positive core rate than the non-MRI group (11/432, 2.5%) (p = 0.00). Regarding cancer detection rate and positive core rate, odds ratios were 3.9 (95% CI, 1.1-13.1) and 4.2 (95% CI, 2.2-8.1), respectively.
In patients with PSA level and no previous biopsy, 3-T MRI that is performed before transrectal ultrasound-guided biopsy may contribute to the detection of prostate cancer.
American Journal of Roentgenology 11/2011; 197(5):W876-81. · 2.78 Impact Factor
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ABSTRACT: Magnetic resonance imaging (MRI) has been frequently used to determine a preoperative treatment plan for gynecologic cancers. However, the MR accuracy for staging an endometrial cancer is not satisfactory based on the old FIGO staging system.
To evaluate MR accuracy for staging endometrial cancer using the new FIGO staging system.
Between January 2005 and May 2009, 199 women underwent surgery due to endometrial cancer. In each patient, an endometrial cancer was staged using MR findings based on the old FIGO staging system and then repeated according to the new FIGO staging system for comparison. Histopathologic findings were used as a standard of reference.
The accuracy of MRI in the staging of endometrial carcinoma stage I, II, III, and IV using the old FIGO staging system were 80% (159/199), 89% (178/199), 90% (179/199), and 99% (198/199), respectively, compared to 87% (174/199), 97% (193/199), 90% (179/199), and 99% (198/199), respectively, when using the new FIGO staging criteria. The overall MR accuracy of the old and new staging systems were 51% (101/199) and 81% (161/199), respectively.
MRI has become a more useful tool in the preoperative staging of endometrial cancers using the new FIGO staging system compared to the old one with increased accuracy.
Acta Radiologica 09/2011; 52(7):818-24. · 1.37 Impact Factor
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ABSTRACT: The purpose of this article is to prospectively determine the feasibility of using blood oxygenation level-dependent (BOLD) MRI at 3 T in differentiating various renal lesions.
Seventy-one patients (mean age, 53.8 years; range, 22-80 years) underwent kidney MRI, including BOLD MRI at 3 T. BOLD MRI was performed using a multiple fast-field echo (FFE) sequence to acquire 20 T2(*)-weighted images within a single breath-hold. The rate of spin dephasing (R2(*)) values of solid and benign cystic renal lesions were compared, and the results of four subgroups--simple cysts, renal cell carcinomas (RCCs), hemorrhagic cysts, and angiomyolipomas (AMLs)--were analyzed. The degree of overall imaging quality in BOLD MRI was also assessed.
One hundred three renal lesions were detected in the 71 patients. The mean (± SD) R2(*) values of 45 solid lesions (30.6 ± 19.4 1/s) were significantly higher than those of 58 benign cystic lesions (4.5 ± 4.8 1/s; p < 0.001). The mean R2(*) values of simple cysts, RCCs, hemorrhagic cysts, and AMLs were 1.7 ± 1.7, 22.6 ± 12.6, 10.7 ± 3.7, and 48.0 ± 25.5 1/s, respectively (p < 0.001). The degree of overall imaging quality in all patients was satisfactory or better.
Renal BOLD MRI at 3 T is a feasible technique and may be useful for differentiating various renal lesions.
American Journal of Roentgenology 09/2011; 197(3):W489-94. · 2.78 Impact Factor
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ABSTRACT: Radiofrequency ablation (RFA) is accepted as a minimally invasive treatment of renal cell carcinoma (RCC). However, RFA is not fully evaluated for treating RCC in patients with von Hippel Lindau (VHL) disease who cannot undergo surgery due to serious postoperative morbidity or mortality.
To evaluate the role of RFA of RCC in patients with VHL disease previously undergoing renal surgery.
Percutaneous RFA was performed for treating 14 RCCs in six patients who had undergone radical nephrectomy (n = 3) or repeated nephron-sparing surgery (n = 3). Treatment feasibility, complications, outcome, and the change of renal function were evaluated.
To completely ablate 14 RCCs, 23 ablations during 12 sessions were necessary. Of 14 RCCs, nine were in proximity (<5 mm) to one or more following organs: bowel (n = 4), ureteropelvic junction or pelvis (n = 2), psoas muscle (n = 2), vascular pedicle (n = 1), and pancreas (n = 1). Of 12 sessions, one major complication (pneumothorax) developed in one session (8%). No residual or recurrent tumors were identified at the ablation areas. However, new three solid tumors less than 1 cm in diameter developed during the follow-up period but ablation was withheld until these tumors had grown to more than 1 cm in size. The mean level of serum creatinine increased with 6.4% and the mean estimated glomerular filtration rate decreased by 12.8% after the last ablation compared to those before the initial ablation (P < 0.05).
Despite technical difficulties, percutaneous RFA is a promising treatment for VHL patients who cannot undergo surgery because of excellent treatment outcome and minimal change of renal function.
Acta Radiologica 04/2011; 52(6):680-5. · 1.37 Impact Factor
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ABSTRACT: incidental detection of solid renal masses has been increasing since the multidetector computed tomography (MDCT) scanner was introduced.
to evaluate the clinico-radio-pathologic features of a solitary solid renal mass at MDCT examination.
a total of 466 non-fatty solid renal masses in 466 patients undergoing nephrectomy were evaluated by MDCT examination. MDCT was performed before and after intravenous injection of contrast material. We obtained the incidences of benign tumors versus malignant tumors, renal cell carcinoma (RCC) versus non-RCC, and asymptomatic RCCs versus symptomatic RCCs. MDCT accuracy for detection of RCC was obtained with a threshold of more than 20 HU tumor attenuation difference between unenhanced and contrast-enhanced CT images. Nuclear grade was also compared between small RCCs (≤4 cm) and large RCCs (>4 cm).
of 466 tumors, 443 (95%) were malignant and 23 (5%) were benign. Of 443 malignant tumors, 437 (99%) were RCC and 6 (1%) were non-RCC. Of 437 RCCs, 324 (74%) were asymptomatic and 113 (26%) were symptomatic. Asymptomatic RCCs (n=183, 56%) were more frequently pT1a than symptomatic RCCs (n=28, 25%) (P<0.05). MDCT accuracy for detection of RCC was 94% (437/466). Of 220 RCCs ≤4 cm, low grade RCC (53%) was more common than high grade RCC (47%).
most solitary solid renal masses are early stage RCCs and can be diagnosed preoperatively at MDCT examination.
Acta Radiologica 12/2010; 51(10):1143-8. · 1.37 Impact Factor
