Assessment of quantitative microflow Vascular Index in testicular cancer.

PURPOSE: Ultrasound (US) is the primary imaging modality when a testicular tumor is suspected. Superb microvascular imaging (SMI) is a novel, highly sensitive Doppler technique that allows quantification of flow signals by determination of the Vascular Index (VI). The aim of the present study is to investigate the diagnostic significance of the SMI-derived VI in normal testicular tissue and testicular cancer. METHODS: This retrospective analysis included patients who underwent testicular US in our department from 2018 to 2022. Inclusion criteria were: i) sufficient image quality of the stored images, ii) US with standardized SMI-default setting (colour gain of 44 ± 5), iii) patient age ≥ 18 years, and iv) normal testicular findings or testicular tumor with histopathological workup. US examinations were performed as part of clinical routine using a high-end ultrasound system (Aplio i800/i900, Canon Medical Systems Corporation, Tochigi, Japan). Statistical analysis included Chi-square test and Mann-Whitney U tests and receiver operating characteristic (ROC) curve analysis. RESULTS: A total of 62 patients (31 each with normal findings and testicular tumors) were included. The VI differed statistically significantly (p < 0.001) between normal testis (median 2.5 %) and testicular tumors (median 17.4 %). Like vascular patterns (p < 0.001), the VI (p = 0.030) was shown to distinguish seminomas (median 14.8 %), non-seminomas (median 17.6 %) and lymphomas (median 34.5 %). CONCLUSIONS: In conclusion, our study has shown the VI to be a quantitative tool that can add information for differentiating testicular tumor entities. While further confirmation in larger study populations is desirable, our results suggest that the VI may be a useful quantitative parameter.

Cost-effectiveness analysis of multiple imaging modalities in diagnosis and follow-up of intermediate complex cystic renal lesions.

OBJECTIVES: To compare health-economic aspects of multiple imaging modalities used to monitor renal cysts, the present study evaluates costs and outcomes of patients with Bosniak IIF and III renal cysts detected and followed-up by either contrast-enhanced computed tomography (ceCT), contrast-enhanced magnetic resonance imaging (ceMRI), or contrast-enhanced ultrasonography (CEUS). PATIENTS AND METHODS: A simulation using Markov models was implemented and performed with 10 cycles of 1 year each. Proportionate cohorts were allocated to Markov models by a decision tree processing specific incidences of malignancy and levels of diagnostic performance. Costs of imaging and surgical treatment were investigated using internal data of a European university hospital. Multivariate probabilistic sensitivity analysis was performed to confirm results considering input value uncertainties. Patient outcomes were measured in quality-adjusted life years (QALY), and costs as averages per patient including costs of imaging and surgical treatment. RESULTS: Compared to the 'gold standard' of ceCT, ceMRI was more effective but also more expensive, with a resulting incremental cost-effectiveness ratio (ICER) >€70 000 (Euro) per QALY gained. CEUS was dominant compared to ceCT in both Bosniak IIF and III renal cysts in terms of QALYs and costs. Probabilistic sensitivity analysis confirmed these results in the majority of iterations. CONCLUSION: Both ceMRI and CEUS can be used as alternatives to ceCT in the diagnosis and follow-up of intermediately complex cystic renal lesions without compromising effectiveness, while CEUS is clearly cost-effective. The economic results apply to a large university hospital and must be adapted for smaller hospitals.

Quality Assessment of CEUS in Individuals with Small Renal Masses-Which Individual Factors Are Associated with High Image Quality?

Obesity and bowel gas are known to impair image quality in abdominal ultrasound (US). The present study aims at identifying individual factors in B-mode US that influence contrast-enhanced US (CEUS) image quality to optimize further imaging workup of incidentally detected focal renal masses. We retrospectively analyzed renal CEUS of focal renal masses ≤ 4 cm performed at our center in 143 patients between 2016 and 2020. Patient and lesion characteristics were tested for their influence on focal and overall image quality assessed by two experienced radiologists using Likert scales. Effects of significant variables were quantified by receiver operating characteristics (ROC) curve analysis with area under the curve (AUC), and combined effects were assessed by binary logistic regression. Shrunken kidney, kidney depth, lesion depth, lesion size, and exophytic lesion growth were found to influence focal renal lesion image quality, and all factors except lesion size also influenced overall image quality. Combination of all parameters except kidney depth best predicted good CEUS image quality showing an AUC of 0.91 (p < 0.001, 95%-CI 0.863-0.958). The B-mode US parameters investigated can identify patients expected to have good CEUS image quality and thus help select the most suitable contrast-enhanced imaging strategy for workup of renal lesions.