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Journal of Magnetic Resonance Imaging :... May 2024Clear cell likelihood score (ccLS) is reliable for diagnosing small renal masses (SRMs). However, the diagnostic value of Clear cell likelihood score version 1.0 (ccLS...
BACKGROUND
Clear cell likelihood score (ccLS) is reliable for diagnosing small renal masses (SRMs). However, the diagnostic value of Clear cell likelihood score version 1.0 (ccLS v1.0) and v2.0 for common subtypes of SRMs might be a potential score extension.
PURPOSE
To compare the diagnostic performance and interobserver agreement of ccLS v1.0 and v2.0 for characterizing five common subtypes of SRMs.
STUDY TYPE
Retrospective.
POPULATION
797 patients (563 males, 234 females; mean age, 53 ± 12 years) with 867 histologically proven renal masses.
FIELD STRENGTH/SEQUENCES
3.0 and 1.5 T/T2 weighted imaging, T1 weighted imaging, diffusion-weighted imaging, a dual-echo chemical shift (in- and opposed-phase) T1 weighted imaging, multiphase dynamic contrast-enhanced imaging.
ASSESSMENT
Six abdominal radiologists were trained in the ccLS algorithm and independently scored each SRM using ccLS v1.0 and v2.0, respectively. All SRMs had definite pathological results. The pooled area under curve (AUC), accuracy, sensitivity, and specificity were calculated to evaluate the diagnostic performance of ccLS v1.0 and v2.0 for characterizing common subtypes of SRMs. The average κ values were calculated to evaluate the interobserver agreement of the two scoring versions.
STATISTICAL TESTS
Random-effects logistic regression; Receiver operating characteristic analysis; DeLong test; Weighted Kappa test; Z test. The statistical significance level was P < 0.05.
RESULTS
The pooled AUCs of clear cell likelihood score version 2.0 (ccLS v2.0) were statistically superior to those of ccLS v1.0 for diagnosing clear cell renal cell carcinoma (ccRCC) (0.907 vs. 0.851), papillary renal cell carcinoma (pRCC) (0.926 vs. 0.888), renal oncocytoma (RO) (0.745 vs. 0.679), and angiomyolipoma without visible fat (AMLwvf) (0.826 vs. 0.766). Interobserver agreement for SRMs between ccLS v1.0 and v2.0 is comparable and was not statistically significant (P = 0.993).
CONCLUSION
The diagnostic performance of ccLS v2.0 surpasses that of ccLS v1.0 for characterizing ccRCC, pRCC, RO, and AMLwvf. Especially, the standardized algorithm has optimal performance for ccRCC and pRCC. ccLS has potential as a supportive clinical tool.
EVIDENCE LEVEL
4.
TECHNICAL EFFICACY
Stage 2.
PubMed: 38738786
DOI: 10.1002/jmri.29392 -
The Journal of the Association of... Mar 2024To study the utility of chemical shift imaging (CSI) and diffusion-weighted images (DWI)/apparent diffusion coefficient (ADC) maps for the evaluation of solid renal...
OBJECTIVES
To study the utility of chemical shift imaging (CSI) and diffusion-weighted images (DWI)/apparent diffusion coefficient (ADC) maps for the evaluation of solid renal tumors.
METHODS
Magnetic resonance imaging (MRI) has an equivalent application as computerized tomography (CT) in the characterization of renal masses. It offers a radiation-free imaging technique and has a better soft tissue contrast than CT. Also, MRI is favored in patients with chronic kidney disease. MRI is useful when findings on CT are equivocal. The role of DWI in characterizing solid renal lesions as malignant is encouraging, and DWI can be particularly useful when gadolinium is contraindicated. CSI is useful in differentiating angiomyolipoma (AML) from clear cell (cc) renal cell carcinoma (RCC). We did a cross-sectional study on 24 patients with solid renal masses. MRI of the upper abdomen (from the dome of the diaphragm to the iliac crest) will be done on an MRI machine in our department (1.5T, ACHIEVA, Phillips medical system) using the torso coil.
RESULT
There was no significant association seen in terms of ADC values and histological subtypes (χ = 11.222, = 0.082). In our study, 50% (one out of two) of AML showed a signal drop, whereas 40% of cases (6 out of 15) of ccRCC and 66% (two out of three) of papillary RCC showed a signal drop.
CONCLUSION
In this article, we concluded CSI, although a useful tool to look for microscopic fat, can't be used as a reliable marker to rule in cc-carcinoma as both AML and papillary cell carcinoma have microscopic fat. Further, no histological classification can be done on the basis of DWI/ADC images.
Topics: Humans; Kidney Neoplasms; Diffusion Magnetic Resonance Imaging; Cross-Sectional Studies; Carcinoma, Renal Cell; Female; Angiomyolipoma; Male; Middle Aged; Adult; Aged
PubMed: 38736111
DOI: 10.59556/japi.72.0368 -
Frontiers in Surgery 2024A limiting factor in expanding the kidney donor pool is donor kidneys with renal tumors or cysts. Partial nephrectomy (PN) to remove these lesions prior to...
BACKGROUND
A limiting factor in expanding the kidney donor pool is donor kidneys with renal tumors or cysts. Partial nephrectomy (PN) to remove these lesions prior to transplantation may help optimize organ usage without recurrence of malignancy or increased risk of complications.
METHODS
We retrospectively analyzed all recipients of a living or deceased donor graft between February 2009 and October 2022 in which a PN was performed prior to transplant due to the presence of one or more concerning growths. Donor and recipient demographics, perioperative data, donor allograft pathology, and recipient outcomes were obtained.
RESULTS
Thirty-six recipients received a graft in which a PN was performed to remove suspicious masses or cysts prior to transplant. Majority of pathologies turned out to be a simple renal cyst (65%), followed by renal cell carcinoma (15%), benign multilocular cystic renal neoplasm (7.5%), angiomyolipoma (5%), benign renal tissue (5%), and papillary adenoma (2.5%). No renal malignancy recurrences were observed during the study period (median follow-up: 67.2 months). Fourteen complications occurred among 11 patients (30.6% overall) during the first 6mo post-transplant. Mean eGFR (± standard error) at 36 months post-transplant was 51.9 ± 4.2 ml/min/1.73 m ( = 23). Three death-censored graft losses and four deaths with a functioning graft and were observed.
CONCLUSION
PN of renal grafts with suspicious looking masses or cysts is a safe option to optimize organ usage and decrease the kidney non-use rate, with no observed recurrence of malignancy or increased risk of complications.
PubMed: 38726469
DOI: 10.3389/fsurg.2024.1391971 -
Malaysian Family Physician : the... 2024Benign renal lesions are relatively rare. Angiomyolipoma (AML) is the most commonly encountered benign renal lesion. One of the complications of AML is rupture, which...
Benign renal lesions are relatively rare. Angiomyolipoma (AML) is the most commonly encountered benign renal lesion. One of the complications of AML is rupture, which results in retroperitoneal haemorrhage with a mortality rate of up to 20%. Pregnancy poses a major risk for the rupture of AML. This is attributed to its hormonal effect, which causes the tumour to grow rapidly during pregnancy. The possibility of AML rupture should be considered when encountering pregnant patients with hypovolemic shock but with normal initial obstetric ultrasound findings. We present a case of a pregnant patient who was admitted with hypovolemic shock and CT scan confirmed rupture of AML.
PubMed: 38725613
DOI: 10.51866/cr.399 -
Saudi Journal of Kidney Diseases and... Nov 2023Renal angiomyolipomas (AMLs) and pulmonary lymphangioleiomyomatosis (LAM) are two major presentations of tuberous sclerosis (TS), an autosomal dominant multisystem...
Renal angiomyolipomas (AMLs) and pulmonary lymphangioleiomyomatosis (LAM) are two major presentations of tuberous sclerosis (TS), an autosomal dominant multisystem disorder. Renal AMLs can lead to life-threatening complications like hemorrhage and cause progressive renal failure requiring dialysis and kidney transplant. mTOR inhibitors showed promising results in TS patients with renal AMLs, LAM, and subependymal giant cell astrocytomas. This case report is a follow-up of a patient we reported in 2010 with giant AMLs and LAM who required an emergency nephrectomy for massive hemorrhage from giant left-sided AMLs.
Topics: Humans; Kidney Neoplasms; Angiomyolipoma; Lymphangioleiomyomatosis; Lung Neoplasms; Female; Nephrectomy; Tuberous Sclerosis; Adult; Treatment Outcome; Hemorrhage; Time Factors; Tumor Burden; Tomography, X-Ray Computed
PubMed: 38725217
DOI: 10.4103/sjkdt.sjkdt_324_21 -
International Journal of Critical... 2024Wunderlich syndrome is characterized by the presence of abdominal pain, hematuria, and hypovolemic shock. We report a rare case of a 25-year-old pregnant woman, who came...
Wunderlich syndrome is characterized by the presence of abdominal pain, hematuria, and hypovolemic shock. We report a rare case of a 25-year-old pregnant woman, who came to the emergency department due to the sudden onset of low back pain and diaphoresis. The patient, during medical evaluation, experienced an altered state of consciousness. Diagnosed with hypovolemic shock, she was admitted to the operating room, where examination of the abdominal cavity revealed a left retroperitoneal hematoma. Damage control surgery was performed, but given the postoperative clinical deterioration, computerized tomography angiography of the abdomen was performed, showing a mass-like lesion arising from the upper pole of the left kidney, consistent with Wunderlich syndrome. Left nephrectomy was the definitive treatment for the 10-cm renal angiomyolipoma. Since Wunderlich syndrome is a potentially lethal entity, CT is usually the preferred diagnostic approach, and supra-selective vascular embolization is the first-line treatment.
PubMed: 38715755
DOI: 10.4103/ijciis.ijciis_45_23 -
BMC Urology May 2024Renal sinus angiomyolipoma (RSAML) is a rare and typically complex renal tumor. The objective is to present our single-center experience with a modified technique of...
BACKGROUND
Renal sinus angiomyolipoma (RSAML) is a rare and typically complex renal tumor. The objective is to present our single-center experience with a modified technique of robotic nephron-sparing surgery (NSS) for treating RSAML.
METHODS
We retrospectively evaluated 15 patients with RSAMLs who were treated with robotic NSS at the Department of Urology of Tongji hospital, ranging from November 2018 to September 2022. Renal vessels and ureter were dissected. The outer part of RSAML was resected. The rest of tumor was removed by bluntly grasp, curettage and suction. Absorbable gelatin sponges were filled in the renal sinus. The preoperative parameters, operative measures and postoperative outcomes were all collected. Follow-up was performed by ultrasonography and estimated glomerular filtration rate (eGFR).
RESULTS
Robotic NSS was successfully performed in all the patients, without any conversion to open surgery or nephrectomy. The mean operation time was 134.13 ± 40.56 min. The mean warm ischemia time was 25.73 ± 3.28 min. The median estimated blood loss was 100 [50, 270] ml and 1 patient required blood transfusion. The mean drainage duration was 5.77 ± 1.98 days. The median postoperative hospital stay was 6.90 [5.80, 8.70] days. Two patients experienced postoperative urinary tract infection (Clavien-Dindo Grade II). During the median follow-up of 25.53 ± 15.28 months, patients received 91.18% renal function preservation. No local recurrence occurred in all the patients.
CONCLUSIONS
Robotic NSS for RSAML is a complicated procedure that demands technical expertise and a well-designed strategy is critical in the operation. Treating RSAML with modified robotic NSS is safe, effective and feasible.
Topics: Humans; Robotic Surgical Procedures; Kidney Neoplasms; Female; Retrospective Studies; Adult; Male; Middle Aged; Organ Sparing Treatments; Angiomyolipoma; Nephrons; Nephrectomy
PubMed: 38715034
DOI: 10.1186/s12894-024-01492-x -
The Aging Male : the Official Journal... Dec 2024To assess various management options for renal angiomyolipoma (AML) to guide clinical practice.
OBJECTIVE
To assess various management options for renal angiomyolipoma (AML) to guide clinical practice.
METHODS
A single center retrospectively reviewed an AML series from 2002 to 2022. The image reports and chart reviews of patients who received two abdominal scans at least 6 months between the first and last scans were assessed.
RESULTS
A total of 203 patients with 209 tumors were identified and followed up for a median of 42.6 months. Active surveillance (AS) was the most frequently selected option (70.9% of cases). Interventions were required for 59 AMLs, of which 20 were treated with embolization, 29 with partial nephrectomy, 9 with radical nephrectomy, and 1 with radiofrequency (RF) ablation. The median size of the lesions at intervention was 5 cm. The average growth rate of the lesions was 0.12 cm/year, and there was a significant difference in the average growth rate of lesions ≤4 cm and those >4 cm (0.11 0.24 cm/year; = 0.0046).
CONCLUSION
This series on AMLs confirms that lesions >4 cm do not require early intervention based on size alone. Appropriately selected cases of renal AML can be managed by AS.KEYWORDS: Angiomyolipoma; active surveillance; embolization; nephrectomy; nephron-sparing surgery.
Topics: Humans; Angiomyolipoma; Kidney Neoplasms; Retrospective Studies; Nephrectomy; Middle Aged; Female; Male; Adult; Embolization, Therapeutic; Watchful Waiting; Aged; Radiofrequency Ablation
PubMed: 38709235
DOI: 10.1080/13685538.2024.2346308 -
Pathology Apr 2024
PubMed: 38705799
DOI: 10.1016/j.pathol.2024.02.007 -
Journal of Medical Imaging and... May 2024The purpose of this study is to evaluate the patient selection methods, treatment outcomes, complications, clinical and radiological follow-up after renal angiomyolipoma...
INTRODUCTION
The purpose of this study is to evaluate the patient selection methods, treatment outcomes, complications, clinical and radiological follow-up after renal angiomyolipoma (AML) treatment with selective arterial embolization (SAE) in an Australian metropolitan tertiary centre.
METHODS
This study presents a retrospective single-centre review of patients' medical records who underwent SAE for renal AML during the period of 1st January 2012 and 1st January 2023.
RESULTS
A total of 32 SAE procedures for renal AML occurred during the study period. Three episodes were classified as emergency cases [9.38%] and the remaining 29 were treated electively. Mean AML size pre-treatment was 69.45 mm (range = 33-177; SD = 31.69). All AMLs demonstrated hyper-vascularity on contrast-enhanced cross-sectional imaging (arterial-phase enhancement characteristics and/or prominent tortuous feeding vessels) [n = 32; 100%] or an intralesional aneurysm or pseudoaneurysm [n = 12; 42.85%]. Periprocedural complications [n = 3; 9.38%] included: one intralesional haemorrhage after embolization, one vascular access site complication, and one lipiduria-associated urinary tract infection. No patients suffered a life-threatening complication, non-target embolization, deterioration in renal function or death following SAE. Re-treatment with SAE was performed in only three patients [10.71%]. Hospital mean length of stay was 1.58 days. Median durations of clinical and radiological follow-up post-treatment were 493 days (range = 104-1645) and 501 days (range = 35-1774), respectively. Follow-up imaging revealed AML total size reduction in all cases [mean = -17.17 mm; -26.51%] and 50% had obliteration of lesion hyper-vascularity after one episode of SAE. Outpatient clinical follow-up signifies that none of the patients included in the study have re-presented with lesion haemorrhage after successful SAE.
CONCLUSION
In this study, renal AMLs were treated safely with a high degree of success by using SAE, and there were very low rates of periprocedural complications. Follow-up of patients after SAE treatment of renal AML should include both radiological (assessment for reduction in lesion vascularity and size) and clinical review in an outpatient clinic setting (either by an interventional radiologist or urologist).
PubMed: 38698609
DOI: 10.1111/1754-9485.13665