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  1. Article ; Online: Renal cell carcinoma: dynamic contrast-enhanced MR imaging for differentiation of tumor subtypes--correlation with pathologic findings.

    Sun, Maryellen R M / Ngo, Long / Genega, Elizabeth M / Atkins, Michael B / Finn, Myra E / Rofsky, Neil M / Pedrosa, Ivan

    Radiology

    2009  Volume 250, Issue 3, Page(s) 793–802

    Abstract: Purpose: To retrospectively evaluate whether the enhancement patterns of pathologically proved clear cell, papillary, and chromophobe renal cell carcinomas (RCCs) measured on clinical dynamic contrast agent-enhanced magnetic resonance (MR) images permit ...

    Abstract Purpose: To retrospectively evaluate whether the enhancement patterns of pathologically proved clear cell, papillary, and chromophobe renal cell carcinomas (RCCs) measured on clinical dynamic contrast agent-enhanced magnetic resonance (MR) images permit accurate diagnosis of RCC subtype.
    Materials and methods: This study was Institutional Review Board approved and HIPAA compliant; informed consent was waived. One hundred twelve patients (76 men, 36 women; age range, 25-88 years; mean age, 58.1 years) underwent MR imaging of 113 renal masses (mean diameter, 5.4 cm) with pathologic diagnoses of clear cell (n = 75), papillary (n = 28), or chromophobe (n = 10) RCC. A 1.5-T clinical MR protocol was used before and after (corticomedullary and nephrographic phases) intravenous administration of contrast agent. Region-of-interest measurements within tumor and uninvolved renal cortex were used to calculate percentage signal intensity change and tumor-to-cortex enhancement index. Subtype groups were compared by using linear mixed-effects models. Receiver operating characteristic (ROC) curve analysis was performed for the comparison of clear cell and papillary RCCs.
    Results: On both the corticomedullary and nephrographic phase images, clear cell RCCs showed greater signal intensity change (205.6% and 247.1%, respectively) than did papillary RCCs (32.1% and 96.6%, respectively) (P < .001). Chromophobe RCCs showed intermediate change (109.9% and 192.5%, respectively). The tumor-to-cortex enhancement indexes at corticomedullary and nephrographic phases were largest for clear cell RCCs (1.4 and 1.2, respectively), smallest for papillary RCCs (0.2 and 0.4, respectively), and intermediate for chromophobe RCCs (0.6 and 0.8, respectively). Signal intensity changes on corticomedullary phase images were the most effective parameter for distinguishing clear cell and papillary RCC (area under ROC curve, 0.99); a threshold value of 84% permitted distinction with 93% sensitivity and 96% specificity.
    Conclusion: Clear cell, papillary, and chromophobe RCCs demonstrate different patterns of enhancement on two-time point clinical dynamic contrast-enhanced MR images, allowing their differentiation with high sensitivity and specificity.
    MeSH term(s) Adult ; Aged ; Aged, 80 and over ; Carcinoma, Renal Cell/pathology ; Contrast Media ; Female ; Gadolinium ; Humans ; Kidney Neoplasms/pathology ; Magnetic Resonance Imaging/methods ; Male ; Middle Aged ; Reproducibility of Results ; Sensitivity and Specificity ; Statistics as Topic
    Chemical Substances Contrast Media ; Gadolinium (AU0V1LM3JT)
    Language English
    Publishing date 2009-03
    Publishing country United States
    Document type Journal Article
    ZDB-ID 80324-8
    ISSN 1527-1315 ; 0033-8419
    ISSN (online) 1527-1315
    ISSN 0033-8419
    DOI 10.1148/radiol.2503080995
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  2. Article ; Online: Differentiating pancreatic cystic neoplasms from pancreatic pseudocysts at MR imaging: value of perceived internal debris.

    Macari, Michael / Finn, Myra E / Bennett, Genevieve L / Cho, Kyunghee C / Newman, Elliot / Hajdu, Cristina H / Babb, James S

    Radiology

    2009  Volume 251, Issue 1, Page(s) 77–84

    Abstract: Purpose: To retrospectively evaluate the sensitivity and specificity of several morphologic findings that may be seen with cystic pancreatic lesions, in the diagnosis of pseudocyst at magnetic resonance (MR) imaging.: Materials and methods: This ... ...

    Abstract Purpose: To retrospectively evaluate the sensitivity and specificity of several morphologic findings that may be seen with cystic pancreatic lesions, in the diagnosis of pseudocyst at magnetic resonance (MR) imaging.
    Materials and methods: This study was institutional review board approved and HIPAA compliant. From January 1, 2005, to December 31, 2007, electronic radiology and pathology databases were searched to identify patients with pancreatic cystic neoplasms or pseudocysts who underwent pancreatic MR imaging. Twenty-two patients with cystic pancreatic neoplasms that were confirmed at surgical resection (n = 12) or endoscopic ultrasonography (US) with cystic fluid analysis (n = 10) were identified. Of 20 patients with pancreatic pseudocysts, seven had pseudocysts that were identified at pathologic resection and 13 had a clinical history of pancreatitis, with initial computed tomography (CT) revealing no pancreatic cyst and subsequent follow-up MR imaging depicting cystic lesions. Two abdominal radiologists independently and randomly evaluated each case for presence or absence of septa and internal dependent debris and for external cyst morphology on axial and coronal T2-weighted images and three-dimensional gradient-echo T1-weighted images obtained before and after intravenous contrast agent administration. Logistic regression for correlated data was used to assess the usefulness of internal debris, external morphology, and septa for differentiating cystic neoplasms from pseudocysts.
    Results: The readers' assessments of the presence or absence of cystic debris were concordant for 40 (95%) of the 42 patients, with a kappa coefficient of 0.889, which indicated nearly perfect agreement. Thirteen (93%) of 14 lesions found to have debris by either or both readers were pseudocysts, and only one (4%) of the 22 cystic neoplasms had debris. Both readers were more likely to identify septa within cystic neoplasms than within pseudocysts; however, the difference was not significant for either reader. The readers were more likely to observe microlobulated morphology in cystic neoplasms than in pseudocysts, with the difference between these lesion types, in terms of prevalence of microlobulated morphology, exhibiting a trend toward-but not reaching-statistical significance (P = .0627).
    Conclusion: Presence of internal dependent debris appears to be a highly specific MR finding for the diagnosis of pancreatic pseudocyst.
    MeSH term(s) Adult ; Aged ; Aged, 80 and over ; Algorithms ; Diagnosis, Differential ; Female ; Humans ; Image Enhancement/methods ; Image Interpretation, Computer-Assisted/methods ; Male ; Middle Aged ; Pancreatic Cyst/diagnosis ; Pancreatic Neoplasms/diagnosis ; Pancreatitis ; Reproducibility of Results ; Retrospective Studies ; Sensitivity and Specificity
    Language English
    Publishing date 2009-04
    Publishing country United States
    Document type Evaluation Studies ; Journal Article
    ZDB-ID 80324-8
    ISSN 1527-1315 ; 0033-8419
    ISSN (online) 1527-1315
    ISSN 0033-8419
    DOI 10.1148/radiol.2511081286
    Database MEDical Literature Analysis and Retrieval System OnLINE

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    In stock of ZB MED Cologne/Königswinter

    Ue I Zs.106: Show issues Location:
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  3. Article ; Online: Dual-energy CT in patients suspected of having renal masses: can virtual nonenhanced images replace true nonenhanced images?

    Graser, Anno / Johnson, Thorsten R C / Hecht, Elizabeth M / Becker, Christoph R / Leidecker, Christianne / Staehler, Michael / Stief, Christian G / Hildebrandt, Henriette / Godoy, Myrna C B / Finn, Myra E / Stepansky, Flora / Reiser, Maximilian F / Macari, Michael

    Radiology

    2009  Volume 252, Issue 2, Page(s) 433–440

    Abstract: Purpose: To qualitatively and quantitatively compare virtual nonenhanced (VNE) data sets derived from dual-energy (DE) computed tomography (CT) with true nonenhanced (TNE) data sets in the same patients and to calculate potential radiation dose ... ...

    Abstract Purpose: To qualitatively and quantitatively compare virtual nonenhanced (VNE) data sets derived from dual-energy (DE) computed tomography (CT) with true nonenhanced (TNE) data sets in the same patients and to calculate potential radiation dose reductions for a dual-phase renal multidetector CT compared with a standard triple-phase protocol.
    Materials and methods: This prospective study was approved by the institutional review board; all patients provided written informed consent. Seventy one men (age range, 30-88 years) and 39 women (age range, 22-87 years) underwent preoperative DE CT that included unenhanced, DE nephrographic, and delayed phases. DE CT parameters were 80 and 140 kV, 96 mAs (effective). Collimation was 14 x 1.2 mm. CT numbers were measured in renal parenchyma and tumor, liver, aorta, and psoas muscle. Image noise was measured on TNE and VNE images. Exclusion of relevant anatomy with the 26-cm field of view detector was quantified with a five-point scale (0 = none, 4 = >75%). Image quality and noise (1 = none, 5 = severe) and acceptability for VNE and TNE images were rated. Effective radiation doses for DE CT and TNE images were calculated. Differences were tested with a Student t test for paired samples.
    Results: Mean CT numbers (+/- standard deviation) on TNE and VNE images, respectively, for renal parenchyma were 30.8 HU +/- 4.0 and 31.6 HU +/- 7.1, P = .29; liver, 55.8 HU +/- 8.6 and 57.8 HU +/- 10.1, P = .11; aorta, 42.1 HU +/- 4.1 and 43.0 HU +/- 8.8, P = .16; psoas, 47.3 HU +/- 5.6 and 48.1 HU +/- 9.3 HU, P = .38. No exclusion of the contralateral kidney was seen in 50 patients, less than 25% was seen in 43, 25%-50% was seen in 13, and 50%-75% was seen in four. Mean image noise was 1.71 +/- 0.71 for VNE and 1.22 +/- 0.45 for TNE (P < .001); image quality was 1.70 HU +/- 0.72 for VNE and 1.15 HU +/- 0.36 for TNE (P < .0001). In all but three patients radiologists accepted VNE images as replacement for TNE images. Mean effective dose for DE CT scans of the abdomen was 5.21 mSv +/- 1.86 and that for nonenhanced scans was 4.97 mSv +/- 1.43. Mean dose reduction by omitting the TNE scan was 35.05%.
    Conclusion: In patients with renal masses, DE CT can provide high-quality VNE data sets, which are a reasonable approximation of TNE data sets. Integration of DE scanning into a renal mass protocol will lower radiation exposure by 35%.
    MeSH term(s) Adult ; Aged ; Aged, 80 and over ; Body Burden ; Female ; Humans ; Kidney Neoplasms/diagnostic imaging ; Male ; Middle Aged ; Radiation Dosage ; Radiographic Image Enhancement ; Radiographic Image Interpretation, Computer-Assisted/methods ; Reproducibility of Results ; Sensitivity and Specificity ; Tomography, X-Ray Computed/methods ; Young Adult
    Language English
    Publishing date 2009-08
    Publishing country United States
    Document type Journal Article
    ZDB-ID 80324-8
    ISSN 1527-1315 ; 0033-8419
    ISSN (online) 1527-1315
    ISSN 0033-8419
    DOI 10.1148/radiol.2522080557
    Database MEDical Literature Analysis and Retrieval System OnLINE

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    In stock of ZB MED Cologne/Königswinter

    Ue I Zs.106: Show issues Location:
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    bis Jg. 2021: Bestellungen von Artikeln über das Online-Bestellformular
    ab Jg. 2022: Lesesaal (EG)

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