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1.
Praxis (Bern 1994) ; 109(2): 71-77, 2020 Feb.
Artigo em Alemão | MEDLINE | ID: mdl-32019452

RESUMO

CME Sonography 89: Differential Diagnosis of Kidney Masses Abstract. Cystic and solid renal lesions are common in ultrasound diagnostics. The solid pseudotumor of the kidney, the so-called renal parenchymal cone, is found in up to 50 % of patients. Pathologically-anatomically it is either a hypertrophy of the column of Bertini or the entire renal lobus, which is located in the renal sinus. Renal cysts were found in a dissected section in 50 % of those over 50 years old. The cystic lesions are subdivided into five categories with the Bosniak classification. This classification is possible with CECT, CEMR and CEUS. The solid lesions are also evaluated by these methods, but the distinction is more difficult here. By measuring the echo intensity in ultrasound, the differentiation of the hyperechoic angiomyolipomas from other solid tumors and pseudotumors is possible. In color-coded Doppler sonography (CCDS), the clear-cell renal cell carcinoma (RCC) is often depicted with many tumor vessels, the remaining tumors with few or only single vessels. In CEUS and TIC, this tumor is shown to be highly perfused, and the influx in the TIC is often faster and stronger than in the surrounding healthy renal cortex. The other tumors are mostly perfused to a lesser extent, especially the papillary carcinomas are significantly less perfused than the renal cortex.


Assuntos
Carcinoma de Células Renais , Doenças Renais Císticas , Neoplasias Renais , Ultrassonografia , Carcinoma de Células Renais/diagnóstico por imagem , Meios de Contraste , Diagnóstico Diferencial , Humanos , Rim , Doenças Renais Císticas/diagnóstico por imagem , Neoplasias Renais/diagnóstico por imagem , Pessoa de Meia-Idade
2.
Medicine (Baltimore) ; 99(7): e19190, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32049855

RESUMO

To analyze the degree and pattern of influence of contrast-enhanced ultrasonography (CEUS) on the Bosniak classification system for complex renal cystic mass as compared with conventional ultrasonography (US). One hundred two consecutive patients with complex renal cystic masses were retrospectively analyzed. The diagnostic performance of the Conventional US and CEUS were evaluated separately for malignant and benign lesions. The diagnostic concordance rates were calculated according to pathologic diagnoses. ROC curve analysis determined the confidence in the diagnostic accuracy by calculating the area under each ROC curve. Compared to the Conventional US, septae number, wall and/or septae thickness, solid component and the Bosniak classification changed in 17 (16.7%), 39 (38.2%), 31 (30.4%), and 67 (65.7%) patients as compared with 0 (0.0%), 21 (20.6%), 31 (30.4%), and 37 (36.3%) of the treatment strategy that changed after CEUS respectively. The diagnostic performance of CEUS showed overall higher in terms of sensitivity (100.0 vs 97.2%); specificity (90.9 vs 62.1%); positive predictive value (PPV) (85.7 vs 58.3%); negative predictive value (NPV) (100.0 vs 97.6%); and the concordance with pathology (kappa = 0.876 vs 0.515). CEUS had a higher diagnostic confidence (P < .05) according to the area under the ROC curve (AUC = 0.968 vs 0.799).CEUS performed better than the Conventional US in the diagnosis of complex renal cystic mass, and it might be considered as the first tool to evaluate a complex cystic renal mass, especially for these Bosniak III masses displaying the presence of hemorrhage or infection.


Assuntos
Doenças Renais Císticas/diagnóstico por imagem , Fosfolipídeos , Hexafluoreto de Enxofre , Ultrassonografia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Doenças Renais Císticas/classificação , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Adulto Jovem
3.
Am J Forensic Med Pathol ; 41(1): 56-59, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31929321

RESUMO

Postmortem personal identification in forensic science is performed using various methods. However, severely burnt bodies are hard to identify using odontological or skeletal features because of carbonization, and sometimes DNA profiling is impracticable because of the unavailability of the relatives. We present a case of a burn victim found after a house fire. Personal identification was attempted, but the body was heavily charred to the bones and the use of physical appearance was impracticable. There were no known relatives or personal belongings of the deceased for comparison of DNA typing. We obtained a series of abdominal computed tomography (CT) scans taken antemortem and found bilateral multiple renal cysts, left renal artery calcification, and a big right inguinal hernia, which matched the deceased's postmortem CT findings and autopsy findings. To date, studies of identification by CT have acted for a rise in precision, but they require complicated calculation or high graphical methods. Calcification of the arteries or renal cysts seen in our case are very common lesions present in many adults with abundant variation; thus, they may be helpful as simple indicators for identification.


Assuntos
Fogo , Hérnia Inguinal/diagnóstico por imagem , Doenças Renais Císticas/diagnóstico por imagem , Artéria Renal/diagnóstico por imagem , Calcificação Vascular/diagnóstico por imagem , Autopsia/métodos , Queimaduras/patologia , Impressões Digitais de DNA , Medicina Legal/métodos , Humanos , Masculino , Pessoa de Meia-Idade , Tomografia Computadorizada por Raios X
5.
J Comput Assist Tomogr ; 43(6): 852-856, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31738204

RESUMO

OBJECTIVE: The objective of this study was to assess renal lesions measuring less than 20 Hounsfield units (HU) on noncontrast computed tomography (NCT). METHODS: Twenty-one (18.1%) of 116 consecutive pathologically proven renal cell carcinomas measured less than 20 HU on NCT and were compared with 40 confirmed benign cysts also measuring less than 20 HU. All lesions were assessed qualitatively (heterogeneous or homogenous) by 3 blinded readers and quantitatively with commercially available textural analysis software. Finally, a combined assessment was performed. RESULTS: Qualitative assessment performed well (sensitivity, 76%-90%; specificity, 70%-88%). Quantitative assessment revealed mean positive pixels as having the highest performance (area under the curve, 0.912; sensitivity, 90%; specificity, 80% at a cutoff value of 21). The combined assessment, using the mean positive pixel cutoff, improved the sensitivity (reader 1, 100%; reader 2, 95%; and reader 3, 95%). CONCLUSION: Qualitative and quantitative assessments have relatively good performance, but the combination can nearly eliminate renal cell carcinomas being missed on NCT.


Assuntos
Carcinoma de Células Renais/diagnóstico por imagem , Neoplasias Renais/diagnóstico por imagem , Interpretação de Imagem Radiográfica Assistida por Computador/métodos , Diagnóstico Diferencial , Feminino , Humanos , Doenças Renais Císticas/diagnóstico por imagem , Masculino , Projetos Piloto , Sensibilidade e Especificidade , Tomografia Computadorizada por Raios X
6.
Curr Urol Rep ; 20(11): 73, 2019 Oct 17.
Artigo em Inglês | MEDLINE | ID: mdl-31624973

RESUMO

PURPOSE OF REVIEW: In recent years, there has been renewed interest in the use of contrast-enhanced ultrasound (CEUS) in abdominal imaging and intervention. The goal of this article is to review the practical applications of CEUS in the kidney, including renal mass characterization, treatment monitoring during and after percutaneous ablation, and biopsy guidance. RECENT FINDINGS: Current evidence suggests that CEUS allows accurate differentiation of solid and cystic renal masses and is an acceptable alternative to either computed tomography (CT) or magnetic resonance imaging (MRI) for characterization of indeterminate renal masses. CEUS is sensitive and specific for diagnosing residual or recurrent renal cell carcinoma (RCC) following percutaneous ablation. Furthermore, given its excellent spatial and temporal resolution, CEUS is well suited to demonstrate tumoral microvascularity associated with malignant renal masses and is an effective complement to conventional grayscale ultrasound (US) for percutaneous biopsy guidance. Currently underutilized, CEUS is an important problem-solving tool in renal imaging and intervention whose role will continue to expand in coming years.


Assuntos
Carcinoma de Células Renais/diagnóstico por imagem , Meios de Contraste , Doenças Renais Císticas/diagnóstico por imagem , Neoplasias Renais/diagnóstico por imagem , Ultrassonografia de Intervenção , Ultrassonografia/métodos , Biópsia/métodos , Feminino , Humanos , Rim/diagnóstico por imagem , Rim/patologia , Masculino , Pessoa de Meia-Idade
8.
Indian J Pathol Microbiol ; 62(3): 430-432, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31361232

RESUMO

Conjoined twins are a very rare complication of monozygotic twinning, most common being thoracopagus. Here we report about two cases of thoracopagus male twins illustrating the autopsy details of one case and the prenatal magnetic resonance imaging (MRI) details of another case. While the first case was misdiagnosed as separate twins on antenatal USG, only to be later confirmed as thoracopagus twins after birth, the antenatal MRI done in the second case helped in accurate detection of thoracopagus twins. Bilateral peripheral cortical cysts with dysplasia was noted in one of the twins of the first case, which has not been reported earlier in conjoint thoracopagii. Early prenatal diagnosis of conjoined twins is essential for better counselling of parents regarding post natal surgical management or termination of pregnancy. Importance of prenatal MRI for accurate detection of these cases is thereby highlighted.


Assuntos
Diagnóstico Pré-Natal , Gêmeos Unidos/patologia , Adulto , Autopsia , Feminino , Humanos , Doenças Renais Císticas/diagnóstico por imagem , Imagem por Ressonância Magnética , Masculino , Gravidez , Gêmeos Unidos/cirurgia
9.
Br J Radiol ; 92(1099): 20181038, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31067075

RESUMO

OBJECTIVE: Bosniak classification system provides a fine imaging evaluation for the malignant cystic renal masses. Superb microvascular imaging (SMI) is a new ultrasonic technique which apply advanced clutter suppression to reflect microflow information. The aim of this study was to evaluate the performance of ultrasound Bosniak classification aided by SMI in diagnosis of cystic renal masses. METHODS: By comparing with contrast-enhanced ultrasound (CEUS) and pathology, we evaluated the sensitivity, specificity and accuracy of conventional ultrasound and SMI combination in the diagnosis of renal cystic masses. RESULTS: Color Doppler Flow image (CDFI) and SMI had significant difference in evaluation the blood flow and Bosniak classification for cystic renal mass of IIf, III and IV (p = 0.020). SMI was consistent with CEUS for cystic renal mass Bosniak classification of IIf, III and IV. Although, CEUS had highest sensitivity of 97.4%, SMI had the highest area under curve in differential diagnosis malignance from benign masses [area under curve = 0.869 (0.743 - 0.995), p < 0.001]. CONCLUSION: SMI can display better in observing blood flow in septa and solid structures of renal cystic lesions compared with CDFI, thus, it can perform more accurate Bosniak classification for renal cystic mass. SMI and CEUS are consistent in Bosniak classification. Bosniak classification aided by SMI maybe an accurate non-invasive ultrasonic examination in distinguishing benign and malignant renal cystic lesions. ADVANCES IN KNOWLEDGE: Conventional ultrasound had limited ability to distinguish malignance in Bosniak classifications IIf and III. SMI can display better in observing blood flow in septa and solid structures of renal cystic lesions compared with CDFI.


Assuntos
Interpretação de Imagem Assistida por Computador/métodos , Doenças Renais Císticas/diagnóstico por imagem , Microvasos/diagnóstico por imagem , Ultrassonografia/métodos , Adulto , Idoso , Diagnóstico Diferencial , Feminino , Seguimentos , Humanos , Rim/irrigação sanguínea , Rim/patologia , Masculino , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , Sensibilidade e Especificidade
10.
Br J Radiol ; 92(1100): 20180915, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31124701

RESUMO

OBJECTIVES: To evaluate the added value of spectral results derived from Spectral Detector CT (SDCT) to the characterization of renal cystic lesions (RCL). METHODS: This retrospective study was approved by the local Institutional review board. 70 consecutive patients who underwent abdominopelvic SDCT and had at least one RCL were included. 84 RCL were categorized as simple, complex or neoplastic based on attenuation values on single-phase post-contrast images. Attenuation values were measured in each lesion on standard conventional CT images (stCI) and virtual monoenergetic images of 40keV and 100keV. A spectral curve slope was calculated and intra lesional iodine concentration (IC) was measured using iodine-density maps. Reference standard was established using histopathologic correlation, prior and follow-up imaging. Analysis of variance (ANOVA) was used to compare between the groups. RESULTS: Mean attenuation values for benign simple and complex RCL differed significantly (42 ± 16 vs 8 ± 3 HU; p < 0.001). IC was almost identical in benign simple and complex RCL (0.23 ± 0.04 mg ml-1 vs 0.24 ± 0.04 mg ml-1), while IC in neoplastic RCL was significantly higher (2.10 ± 0.08 mg ml-1 ; p < 0.001). The mean spectral curve slope did not differ significantly between simple and complex RCL (0.30 ± 0.03 vs 0.33 ± 0.05) but was significantly higher in neoplastic RCL (2.60 ± 0.10; p < 0.001). CONCLUSIONS: Spectral results of SDCT are highly promising in distinguishing benign complex RCL from enhancing neoplastic RCL based on single-phase post-contrast imaging only. ADVANCES IN KNOWLEDGE: SDCT can assist in differentiating between benign complex and neoplastic renal cystic lesions.


Assuntos
Doenças Renais Císticas/diagnóstico por imagem , Neoplasias Renais/diagnóstico por imagem , Interpretação de Imagem Radiográfica Assistida por Computador/métodos , Tomografia Computadorizada por Raios X/métodos , Idoso , Feminino , Humanos , Rim/diagnóstico por imagem , Masculino , Estudos Retrospectivos , Razão Sinal-Ruído
11.
J Coll Physicians Surg Pak ; 29(5): 456-458, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31036118

RESUMO

OBJECTIVE: To evaluate the variables of cystic renal lesions to predict the renal tumors. STUDY DESIGN: An observational study. PLACE AND DURATION OF STUDY: Urology Department, Ankara Yüksek Ihtisas, Samsun Research and Training Hospitals, Turkey, from January 2013 to June 2017. METHODOLOGY: Records of patients with renal cystic lesions were retrospectively evaluated. Preoperative CT results in terms of diameter number and enhancement; and clinical variables such as gender body mass index [(weight (kg)/ height²(m)] and smoking status were recorded. Student's t-test and ANOVA were used for determing significance, which was set at p<0.05. RESULTS: Due to pathology results, all group I patients were benign, 7.9% (3/38) of group II, 31.8% (7/22) of group II-F, 55.3% (21/38) of group III, 69% (40/58) group IV patients were found to be malignant. For clinical factors, obesity and smoking, while for radiological parameters, about 59.3 +11.7 HU enhancement were found to be predictor significant of malignancy (all p<0.05). No significant difference was observed between cystic lesion diameter number or laterality (right/left) and malignancy. CONCLUSION: Renal cysts have a high malignancy possibility in the patients with history of smoking in the past or actively, high BMI, and preoperative CT with about 59.3 +11.7 HU post-contrast enhancement.


Assuntos
Carcinoma de Células Renais/diagnóstico por imagem , Doenças Renais Císticas/classificação , Doenças Renais Císticas/diagnóstico por imagem , Neoplasias Renais/diagnóstico por imagem , Rim/diagnóstico por imagem , Tomografia Computadorizada por Raios X/métodos , Adulto , Idoso , Carcinoma de Células Renais/patologia , Meios de Contraste , Progressão da Doença , Feminino , Humanos , Doenças Renais Císticas/patologia , Doenças Renais Císticas/cirurgia , Neoplasias Renais/patologia , Neoplasias Renais/cirurgia , Masculino , Pessoa de Meia-Idade , Gradação de Tumores , Metástase Neoplásica , Cuidados Pré-Operatórios/métodos , Estudos Retrospectivos , Índice de Gravidade de Doença
12.
Arch. esp. urol. (Ed. impr.) ; 72(4): 422-428, mayo 2019. tab, ilus
Artigo em Espanhol | IBECS | ID: ibc-FGT-3024

RESUMO

Objetivo: La incidencia de los quistes renales simples es muy frecuente, sobre todo en personas de edad avanzada. Sin embargo, la transformación maligna de un quiste renal simple es excepcional. Así mismo, el tratamiento a realizar, en estos casos raros, es un motivo de controversia, con respecto a optar por una cirugía radical renal. Métodos: Presentamos el caso de un paciente con nódulo sólido en un quiste de gran tamaño. Se realiza extirpación completa del quiste mediante técnica de laparoscopia vía transperitoneal. El estudio histopatológico de la pieza quirúrgica revela la existencia un quiste con un carcinoma renal de células claras con grado nucleolar 2. La evolución clínica ha sido satisfactoria, realizando una cirugía de mínima invasión (quistectomía laparoscópica). Discusión: Aunque se considera que el tratamiento quirúrgico es la cirugía radical en estos casos, nosotros consideramos que la cirugía preservadora de nefronas puede representar una opción terapéutica, teniendo en cuenta la edad de nuestro paciente. Se comenta una hipótesis histogenética para explicar la aparición de un tumor de células claras en un quiste renal simple. Conclusiones: El desarrollo de un carcinoma de células renales en quistes renales simples es una patología muy infrecuente. La quistectomía total laparoscópica es una opción terapéutica mínimamente invasiva, para el tratamiento del carcinoma de células renales originado en un quiste renal simple, aunque éste sea de un tamaño importante. Proponemos la hipótesis de una migración de las células de los túbulos renales en la pared del quiste para explicar la transformación maligna del quiste simple renal


Objective: The incidence of simple renal cysts is very high, especially in elderly people. However, malignant transformation of a simple renal cyst is exceptional. Likewise, the treatment to be carried out, in these rare cases, is controversial, with respect to opting for radical renal surgery. Methods: We present the case of a patient with a solid nodule in a large cyst. Complete removal of the cyst was performed by transperitoneal laparoscopic technique. The histopathological study of the surgical piece revealed the existence of a cyst with clear renal cell carcinoma with nucleolar grade 2. The clinical evolution has been satisfactory, performing a minimally invasive surgery (laparoscopic cyst excision). Discussion: Although it is considered that surgical treatment of choice is radical surgery in these cases, we believe that nephron sparing surgery may represent a therapeutic option, taking into account the young age of our patient. A histogenetic hypothesis is discussed to explain the appearance of a clear cell tumor in a simple renal cyst. Conclusion: The development of a renal cell carcinoma in simple renal cysts is a very infrequent pathology Laparoscopic total cystectomy is a minimally invasive therapeutic option for the treatment of renal cell carcinoma originating in a simple renal cyst, although it is of an important size. We establish the hypothesis of migration of the cells of the renal collecting tubes into the cyst wall to explain the malignant transformation of the renal simple cyst


Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias Renais/cirurgia , Carcinoma de Células Renais/cirurgia , Doenças Renais Císticas/cirurgia , Neoplasias Renais/diagnóstico por imagem , Carcinoma de Células Renais/diagnóstico por imagem , Doenças Renais Císticas/diagnóstico por imagem , Laparoscopia
13.
J Urol ; 202(2): 394-399, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-30958740

RESUMO

PURPOSE: The growing availability of modern-day imaging has resulted in an increase in the number of renal cysts detected in the pediatric population. Few publications have reported outcomes of these childhood cysts. In this study we assessed the prevalence and evolution of renal cysts in children, and described clinical characteristics, mode of presentation and ultimate outcomes. MATERIALS AND METHODS: Our institutional ultrasound database was searched for all abdominal ultrasound reports from 2006 to 2017. These reports were then cross-referenced with a manual retrospective chart review. Clinical characteristics including mode of presentation, cyst characteristics, and outcomes were analyzed using descriptive and nonparametric statistical methods. RESULTS: Of 70,500 abdominal ultrasound scans during the study period 1,531 (2.2%) met the study inclusion criteria. Overall 26% of cysts were complex and 10.1% of cases were associated with hydronephrosis. Echogenic kidneys were more likely to be associated with simple cysts (p=0.0001). There was no difference between cyst diameter and symptomatology (p=0.82). The conversion of simple to complex renal cysts was less than 1% and 1.8% of complex cysts developed renal cell carcinoma. CONCLUSIONS: In a large cohort of children who underwent abdominal imaging we found a 10-year renal cyst prevalence of 2.2%. Given that nearly all cysts follow a benign course and that simple cysts will invariably grow within 2 years, we believe that these cases could be safely discharged after that point. We continue to recommend surveillance for patients with cysts larger than 15 mm, complex cysts, family history of adult polycystic kidney disease or those with concomitant genitourinary anomalies requiring ongoing followup.


Assuntos
Doenças Renais Císticas/diagnóstico por imagem , Adolescente , Criança , Pré-Escolar , Feminino , Humanos , Achados Incidentais , Lactente , Doenças Renais Císticas/diagnóstico , Doenças Renais Císticas/epidemiologia , Doenças Renais Císticas/terapia , Masculino , Prevalência , Estudos Retrospectivos , Resultado do Tratamento , Ultrassonografia , Adulto Jovem
14.
Medicine (Baltimore) ; 98(16): e15249, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31008960

RESUMO

RATIONALE: Simple renal cyst (SRC) is a benign disease. However, rarely renal cell carcinoma (RCC) may be raised at the wall of a preexisting SRC. We herein describe 2 unusual cases of RCC arising from the outer surface of the free wall of the renal cyst. PATIENT CONCERNS: A 75-year-old female and a male were admitted to our department because of an asymptomatic renal cystic mass. Although the case history, preoperative imaging, and intraoperative examination of the cyst were carefully evaluated, no concerns were raised with respect to the underlying malignancy. DIAGNOSIS: RCC of the clear cell type was diagnosed based on the histology and pathological examination. INTERVENTIONS: With an initial diagnosis of SRC, the retroperitoneal laparoscopic de-roofing of the SRC was performed in both of the patients. When the diagnoses were confirmed 7 days postoperative, both of them were readmitted to our department for a radical nephroureterectomy. OUTCOMES: The postoperative course was uneventful and the two patients did not undergo further chemotherapy. They are currently well and have no clinical or radiological signs of recurrence. LESSONS: Such cases remind us that seemingly benign renal cysts may harbor underlying neoplasia. Further evaluation and periodical follow-up are also recommended on the management of those seemingly benign renal cysts.


Assuntos
Carcinoma de Células Renais/patologia , Doenças Renais Císticas/complicações , Neoplasias Renais/patologia , Idoso , Carcinoma de Células Renais/diagnóstico por imagem , Carcinoma de Células Renais/etiologia , Feminino , Humanos , Doenças Renais Císticas/diagnóstico por imagem , Doenças Renais Císticas/patologia , Neoplasias Renais/diagnóstico por imagem , Neoplasias Renais/etiologia , Masculino , Tomografia Computadorizada por Raios X
15.
Ann Hematol ; 98(6): 1333-1339, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30891614

RESUMO

We determined the prevalence of incidental extracardiac findings (IEF) at Magnetic Resonance Imaging (MRI) potentially related to anemia and hypoxia in age- and sex-matched populations (N = 318) with thalassemia major (TM) and thalassemia intermedia (TI) enrolled in the Myocardial Iron Overload in Thalassemia network. Overall, IEFs were detected in 33.3% and 25.8% of patients with TI and TM, respectively (P = 0.114). TI and TM patients had elevated but comparable prevalence of renal, splenic and liver cysts, and vertebral hemangiomas while TI patients had a significant higher frequency of extramedullary hematopoiesis (EMH) (15.1% vs 4.4%; P = 0.002). The prevalence of total IEFs increased with advancing age. TI non-transfusion-dependent patients had a significantly lower frequency of renal cysts than TI transfusion-dependent patients (8.8% vs 26.4%; P = 0.005). The prevalence of renal cysts in the thalassemic population was significantly higher than that in the general population (19.2% vs 1.9%; P < 0.0001). Our data on renal cysts indicate a significant higher prevalence of these IEFs compared to the general population, suggesting the role of the inappropriate activation of the hypoxia-inducible factor system linked to the chronic hypoxia. The significant prevalence of IEF in thalassemia patients undergoing MRI for iron quantification should prompt the discussion of the inclusion of IEF in the MRI report.


Assuntos
Cistos/epidemiologia , Hemangioma/epidemiologia , Hematopoese Extramedular , Doenças Renais Císticas/epidemiologia , Neoplasias da Coluna Vertebral/epidemiologia , Esplenopatias/epidemiologia , Talassemia/complicações , Adulto , Distribuição por Idade , Anemia/complicações , Transfusão de Sangue , Cistos/diagnóstico por imagem , Cistos/etiologia , Feminino , Hemangioma/diagnóstico por imagem , Hemangioma/etiologia , Humanos , Hipóxia/complicações , Serviços de Informação , Quelantes de Ferro/uso terapêutico , Sobrecarga de Ferro/tratamento farmacológico , Sobrecarga de Ferro/epidemiologia , Sobrecarga de Ferro/etiologia , Itália/epidemiologia , Doenças Renais Císticas/diagnóstico por imagem , Doenças Renais Císticas/etiologia , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Prevalência , Estudos Retrospectivos , Neoplasias da Coluna Vertebral/diagnóstico por imagem , Neoplasias da Coluna Vertebral/etiologia , Esplenopatias/diagnóstico por imagem , Esplenopatias/etiologia , Talassemia/sangue , Talassemia/terapia , Adulto Jovem
16.
G Ital Nefrol ; 36(1)2019 Feb.
Artigo em Italiano | MEDLINE | ID: mdl-30758150

RESUMO

We describe the case of a 5-year-old who came to our attention for a growth delay. Among the investigations planned because of the child's short stature, we performed an abdominal ultrasound showing normal-sized kidneys with signs of cortico-medullar de-differentiation, diffuse medullary hyperechogenicity with reduction of cortical thickness and cortical-medullary cysts. The ultrasound findings, also confirmed in MRI, led us to suspect a genetically determined cystic nephropathy of the nephronophthisis or medullary cystic disease type. No mutation was identified in NPHP1, HNFb1 and UMOD genes. Interestingly, laboratory investigations revealed a severe metabolic acidosis with normal renal function and hypokalemia. These findings are not characteristics of a nephronophthisis. We therefore also performed molecular analysis for distal tubular acidosis (dRTA) that showed the association of two genetic variants of ATP6V1B1 and SLC4A genes. These "double mutations" have been inherited from the mother, which however does not have the classic dRTA phenotype. These variants do not currently meet the criteria for a conclusive molecular diagnosis of dRTA but represent variants of uncertain clinical significance. However, considering the clinical and laboratory data one can reasonably conclude that the child has a "probable" diagnosis of distal tubular acidosis. The rapid recovery of staturo-ponderal growth after the start of alkalizing treatment supports our diagnostic hypothesis. The association between distal tubular acidosis and renal cysts is well described in the literature. The hypothesis is that chronic hypokalemia may play a possible role in the formation of renal cysts.


Assuntos
Acidose Tubular Renal/genética , Transtornos do Crescimento/complicações , Doenças Renais Císticas/complicações , Proteínas SLC4A/genética , ATPases Vacuolares Próton-Translocadoras/genética , Acidose/diagnóstico , Acidose Tubular Renal/complicações , Acidose Tubular Renal/diagnóstico , Pré-Escolar , Humanos , Hipopotassemia/diagnóstico , Rim/diagnóstico por imagem , Doenças Renais Císticas/diagnóstico por imagem , Masculino , Mutação , Ultrassonografia
17.
J Comput Assist Tomogr ; 43(3): 485-492, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30801565

RESUMO

OBJECTIVE: The aim of this study was to determine which apparent diffusion coefficient-derived texture features are associated with malignancy in Bosniak IIF and III renal cystic lesions. METHODS: Twenty benign and 7 malignant Bosniak IIF (22) or III (5) renal cysts, as evaluated with magnetic resonance imaging, were assessed for progression to pathology-confirmed malignancy. Whole-cyst volumes of interest were manually segmented from apparent diffusion coefficient maps. Texture features were extracted from each volume of interest, including first-order histogram-based features and higher-order features, and data were analyzed with the Mann-Whitney U test to predict malignant progression. RESULTS: Eleven of 17 first-order features were significantly greater in benign compared with malignant cysts. Eight higher-order gray-level co-occurrence matrix (GLCM) texture features were significantly different between groups, 5 of which were greater in the benign population. CONCLUSIONS: Apparent diffusion coefficient-derived texture measures may help differentiate between benign and malignant Bosniak IIF and III cysts.


Assuntos
Imagem de Difusão por Ressonância Magnética/métodos , Doenças Renais Císticas/diagnóstico por imagem , Neoplasias Renais/diagnóstico por imagem , Idoso , Diagnóstico Diferencial , Progressão da Doença , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Interpretação de Imagem Radiográfica Assistida por Computador , Estudos Retrospectivos
18.
Urol Int ; 102(4): 390-398, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30636255

RESUMO

BACKGROUND: There is a lack of detailed population-based data for renal cell carcinoma (RCC). OBJECTIVES: The study aimed to examine the contemporary changes in the clinical picture and treatment of RCC. METHODS: A total of 1,719 consecutive patients living in the Helsinki metropolitan area with a solid or cystic renal mass (Bosniak 3-4) ≥10 mm were identified. Data from medical records was evaluated for clinical characteristics and treatments in the periods I (2006-2008), II (2009-2011), III (2012-2014), and IV (2015-2016). RESULTS: The proportions of patients with comorbidities (Charlson index ≥2) and frailty (Eastern Co-operative Oncology Group classification ≥2) increased significantly during the study period. The percentage of clinical stage I patients, cystic tumors and use of needle biopsies increased significantly. Use of observation increased from 9% (I) to 32% (IV; p < 0.001). First-line oncological treatments within 6 months were given to 47% of 262 patients with metastases and -cytoreductive nephrectomy (CN) was delivered to 54% of those patients. CONCLUSIONS: The size of renal tumors continued to decrease, while the percentage of patients with significant comorbidity or frailty increased. Active surveillance emerged as the initial strategy. Tyrosine kinase inhibitors with CN remained the primary option in patients with metastatic RCC.


Assuntos
Carcinoma de Células Renais/diagnóstico por imagem , Carcinoma de Células Renais/epidemiologia , Neoplasias Renais/diagnóstico por imagem , Neoplasias Renais/epidemiologia , Idoso , Antineoplásicos/administração & dosagem , Biópsia por Agulha , Terapia Combinada , Comorbidade , Cistos/patologia , Feminino , Finlândia/epidemiologia , Idoso Fragilizado , Fragilidade , Humanos , Achados Incidentais , Rim/patologia , Doenças Renais Císticas/diagnóstico por imagem , Doenças Renais Císticas/patologia , Masculino , Pessoa de Meia-Idade , Metástase Neoplásica , Nefrectomia , Pacientes Ambulatoriais , População Urbana
19.
Radiology ; 290(3): 769-782, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30599104

RESUMO

Kidney cysts can manifest as focal disease (simple and complex kidney cysts), affect a whole kidney (eg, multicystic dysplastic kidney or cystic dysplasia), or manifest as bilateral cystic disease (eg, autosomal recessive polycystic kidney disease [ARPKD] or autosomal dominant polycystic kidney disease [ADPKD]). In children, as opposed to adults, a larger proportion of kidney cysts are due to genetic diseases (eg, HNF1B nephropathy, various ciliopathies, and tuberous sclerosis complex), and fewer patients have simple cysts or acquired cystic kidney disease. The purpose of this consensus statement is to provide clinical guidance on standardization of imaging tests to evaluate kidney cysts in children. A committee of international experts in pediatric nephrology, pediatric radiology, pediatric US, and adult nephrology prepared systematic literature reviews and formulated recommendations at a consensus meeting. The final statement was endorsed by the European Society of Pediatric Radiology, the European Federation of Societies for Ultrasound in Medicine and Biology, the European Society of Pediatric Nephrology, and reviewed by the European Reference Network for Rare Kidney Diseases. Main recommendations are as follows: US is the method of choice when assessing pediatric kidney cysts, with selected indications for MRI and contrast-enhanced US. CT should be avoided whenever possible because of ionizing radiation. Renal US yields essential diagnostic information in many cases. In patients with ARPKD or other ciliopathies, abdominal US is needed for diagnosis and screening of portal hypertension. US is usually sufficient for follow-up kidney imaging, but MRI can be valuable for clinical trials in patients with ADPKD or in older children with tuberous sclerosis complex to evaluate both kidney cysts and angiomyolipomas.


Assuntos
Diagnóstico por Imagem/normas , Doenças Renais Císticas/diagnóstico por imagem , Criança , Consenso , Europa (Continente) , Humanos
20.
Clin Radiol ; 74(2): 83-94, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30314810

RESUMO

This article presents an updated review of cystic renal mass imaging. Most cystic renal masses encountered incidentally are benign and can be diagnosed confidently on imaging and require no follow-up. Hyperattenuating masses discovered at unenhanced or single-phase enhanced computed tomography (CT) measuring between 20-70 HU are indeterminate and can be further investigated first by using ultrasound and, then with multi-phase CT or magnetic resonance imaging (MRI); as the majority represent haemorrhagic/proteinaceous cysts (HPCs). Dual-energy CT may improve differentiation between HPCs and masses by suppressing unwanted pseudo-enhancement observed with conventional CT. HPCs can be diagnosed confidently when measuring >70 HU at unenhanced CT or showing markedly increased signal on T1-weighted imaging. Although the Bosniak criteria remains the reference standard for diagnosis and classification of cystic renal masses, histopathological classification and current management has evolved: multilocular cystic renal cell carcinoma (RCC) has been reclassified as a cystic renal neoplasm of low malignant potential, few Bosniak 2F cystic masses progress radiologically during follow-up; RCC with predominantly cystic components are less aggressive than solid RCC; and Bosniak III cystic masses behave non-aggressively. These advances have led to an increase in non-radical management or surveillance of cystic renal masses including Bosniak 3 lesions. Tubulocystic RCC is a newly described entity with distinct imaging characteristics, resembling a pancreatic serous microcystadenoma. Other benign cystic masses including: mixed epithelial stromal tumours (MEST) are now considered in the spectrum of cystic nephroma and angiomyolipoma (AML) with epithelial cysts (AMLEC) resemble a fat-poor AML with cystic components.


Assuntos
Angiomiolipoma/diagnóstico por imagem , Carcinoma de Células Renais/diagnóstico por imagem , Doenças Renais Císticas/diagnóstico por imagem , Neoplasias Renais/diagnóstico por imagem , Imagem por Ressonância Magnética/métodos , Tomografia Computadorizada por Raios X/métodos , Diagnóstico Diferencial , Humanos , Rim/diagnóstico por imagem
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