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Silverman, Stuart G.; Gan, Yu Unn; Mortele, Koenraad J.; Tuncali, Kemal; Cibas, Edmund S.
doi: 10.1148/radiol.2401050061pmid: 16709793
Although percutaneous renal mass biopsy with cross-sectional imaging guidance has long been considered to be safe and accurate, there have been recent advances in imaging, interventional, and cytologic techniques that have increased the role of percutaneous biopsy in the diagnosis of renal masses. Today, biopsy plays a fundamental role in the care of patients with a renal mass. Biopsy results are used to confirm the diagnosis of renal cancers, metastases, and infections, and there is increasing evidence to suggest that biopsy can help subtype and grade many primary renal cancers. Because a considerable fraction of small solid renal masses are benign and do not need treatment, there is an increasing need to diagnose them. Biopsy after a full imaging work-up can help prevent unnecessary and potentially morbid surgical and ablation procedures in a substantial number of patients. Although more data are needed to understand the overall accuracy of biopsy for the diagnosis of benign lesions, many can be diagnosed with the aid of biopsy findings. This article reviews reported experience with percutaneous renal mass biopsy, discusses the technical factors that contribute to results, and details seven specific clinical settings that should prompt the clinician to consider percutaneous biopsy when encountering a renal mass.
Cho, Nariya; Moon, Woo Kyung; Cha, Joo Hee; Kim, Sun Mi; Han, Boo-Kyung; Kim, Eun-Kyung; Kim, Mi Hye; Chung, Soo Young; Choi, Hye-Young; Im, Jung-Gi
doi: 10.1148/radiol.2401050743pmid: 16684920
Maas, Angela H. E. M.; van der Schouw, Yvonne T.; Beijerinck, David; Deurenberg, Jan J. M.; Mali, Willem P. T. M.; van der Graaf, Yolanda
doi: 10.1148/radiol.2401050170pmid: 16720869
Purpose: To retrospectively assess if mammographic calcium deposits are related to coronary heart disease (CHD) risk factors and reproductive factors in a subset of women participating in the European Prospective Investigation into Cancer and Nutrition study. Materials and Methods: The study was approved by the institutional review board of the University Medical Center Utrecht; informed consent was obtained. Mammograms were evaluated by two radiologists for the presence of breast arterial calcifications (BAC) in the Prospect cohort, a breast cancer screening population of women aged 49–70 years (mean, 57 years) within the European Prospective Investigation into Cancer and Nutrition study. Cardiovascular risk factors and reproductive factors were examined for independent effects on the prevalence of BAC. Logistic regression analysis was performed. Results: BAC was present in 194 of 1699 (11%) women and increased with age to 20% in the highest quartile of age (mean, 66 years). The odds ratio was 4.7 in the highest versus the lowest quartile of age (95% confidence interval CI, 2.9, 7.6). After adjustment for age, no significant association was found between BAC and traditional cardiovascular risk factors. Current smoking was inversely related to BAC (odds ratio, 0.6; 95% CI: 0.4, 0.9). BAC was prevalent in 2.5% of nulliparous women, in 9% of women with one or two children, and in 17% of women with three or more children (odds ratio, 7.2; 95% CI: 2.9, 18.0). Breast feeding after pregnancy was significantly associated with BAC in women who ever were pregnant (odds ratio, 2.2; 95% CI: 1.4, 3.6). Conclusion: Calcifications in arteries on mammograms are associated with increasing age, pregnancy, and lactation but not with various cardiovascular risk factors.
Cury, Ricardo C.; Cattani, Cesar A. M.; Gabure, Luiz A. G.; Racy, Douglas J.; de Gois, Jose M.; Siebert, Uwe; Lima, Sergio S.; Brady, Thomas J.
doi: 10.1148/radiol.2401051161pmid: 16793971
Purpose: To prospectively determine the accuracy of a combined magnetic resonance (MR) imaging approach (stress first-pass perfusion imaging followed by delayed-enhancement imaging) for depicting clinically significant coronary artery stenosis (≥70% stenosis) in patients suspected of having or known to have coronary artery disease (CAD), with coronary angiography serving as the reference standard. Materials and Methods: The committee on human research approved the study protocol, and all participants gave written informed consent. This study was HIPAA compliant. Forty-seven patients (38 men and nine women; mean age, 63 years ± 5.3 standard deviation) scheduled for coronary angiography were prospectively enrolled: 33 were suspected of having CAD (group A) and 14 had experienced a previous myocardial infarction and were suspected of having new lesions (group B). The MR imaging protocol included cine function, gadolinium-enhanced stress and rest first-pass perfusion MR imaging, and delayed-enhancement MR imaging. Myocardial ischemia was defined as a segment with perfusion deficit at stress first-pass perfusion MR imaging and no hyperenhancement at delayed-enhancement imaging. Myocardial infarction was defined as an area with hyperenhancement at delayed-enhancement imaging. Results: One patient was excluded from analysis because of poor-quality MR images. Coronary angiography depicted significant stenosis in 30 of 46 patients (65%). In a per-vessel analysis ( n = 138), stress first-pass perfusion MR imaging and delayed-enhancement imaging yielded sensitivity of 0.87, specificity of 0.89, and accuracy of 0.88, when compared with coronary angiography. The diagnostic accuracy of stress first-pass perfusion MR imaging and delayed-enhancement imaging was slightly better than that of stress and rest first-pass perfusion MR imaging in the entire population (0.88 vs 0.85), in group A (0.86 vs 0.82), and in group B (0.93 vs 0.90). Conclusion: Stress first-pass perfusion MR imaging followed by delayed-enhancement imaging is an accurate method to depict significant coronary stenosis in patients suspected of having or known to have CAD.
Alkadhi, Hatem; Wildermuth, Simon; Plass, Andre; Bettex, Dominique; Baumert, Bernhard; Leschka, Sebastian; Desbiolles, Lotus M.; Marincek, Borut; Boehm, Thomas
doi: 10.1148/radiol.2393050458pmid: 16709791
Purpose: To prospectively evaluate whether planimetric measurements of aortic valve area (AVA) with 16–detector row computed tomography (CT) allow classification of aortic stenosis (AS). Materials and Methods: The study had institutional review board approval; patients gave informed consent. Twenty patients (11 men, nine women; mean age, 63 years) with AS and 20 patients (10 men, 10 women; mean age, 65 years) without underwent transthoracic echocardiography (TTE), transesophageal echocardiography (TEE), and retrospectively electrocardiographically gated 16–detector row CT. Twenty CT data sets were reconstructed in 5% steps of R-R interval; data analysis was performed with four-dimensional software. Maximum AVA in systole planimetrically measured with CT (AVA CT ) was compared with AVA planimetrically measured with TEE (AVA TEE ), AVA calculated with the continuity equation and TTE (AVA TTE ), and transvalvular pressure gradients determined with the Bernoulli equation and TTE. Correlations among AVA CT , AVA TTE , AVA TEE , and transvalvular pressure gradients were tested with bivariate regression analysis; agreement between methods was assessed with the Bland-Altman method. Results: In patients without AS, mean AVA CT was 3.56 cm 2 ± 0.66 and mean AVA TEE was 3.43 cm 2 ± 0.69. In patients with AS, mean AVA CT was 0.89 cm 2 ± 0.35; mean AVA TEE , 0.86 cm 2 ± 0.35; and mean AVA TTE , 0.83 cm 2 ± 0.33. Mean transvalvular pressure gradient was 51 mm Hg ± 22. Significant correlations were present between AVA CT and AVA TEE ( r = 0.99, P < .001), AVA CT and AVA TTE ( r = 0.95, P < .001), and AVA CT and transvalvular pressure gradients ( r = −0.74, P < .01). Mean differences were −0.08 cm 2 (limits of agreement: −0.32, 0.16) for AVA CT versus AVA TEE and 0.06 cm 2 (limits of agreement: −0.15, 0.26) for AVA CT versus AVA TTE . Conclusion: Planimetric measurements of AVA with retrospectively electrocardiographically gated 16–detector row CT allow classification of AS that is similar to that achieved with measurements by using echocardiographic methods.
Schild, Hans H.; Kuhl, Christiane K.; Hübner-Steiner, Ute; Böhm, Ingrid; Speck, Ulrich
doi: 10.1148/radiol.2393050560pmid: 16720865
Purpose: To prospectively evaluate adverse events (AEs) in patients who underwent nonionic monomeric or dimeric contrast media–enhanced computed tomography (CT) and to compare these effects with AEs in patients who underwent unenhanced CT. Materials and Methods: Local ethics committee approval and written informed consent were obtained. Patients were randomly assigned to the dimeric group, monomeric group, or concurrent control group. Acute (occurring during or within 1 hour after contrast agent injection) and delayed (occurring between 1 hour and 7 days after contrast agent injection) AEs were evaluated and categorized (mild, not requiring treatment; moderate, self-limiting AE requiring simple treatment; severe, AE requiring extensive treatment or endangering life). The two-sided Fisher exact test and the Mann-Whitney U and Wilcoxon signed rank tests were used for statistical analysis. Results: A total of 895 patients were recruited. Acute AEs were noted significantly ( P < .05) more often in the monomeric group (44.8% 133 of 297 patients) than in the dimeric (23.7% 71 of 300 patients) or control (9.4% 28 of 298 patients) groups. Two moderate acute AEs were noted in one patient in each contrast agent group; all other acute AEs were mild. There was no significant difference in the overall incidence of delayed AEs between the dimeric and monomeric groups (53.1% 139 of 262 patients vs 50.8% 131 of 258 patients). Delayed cutaneous AEs were noted significantly ( P < .05) more often in the dimeric group. A total 16 AEs (2.0%) were moderate; no AE was severe. Conclusion: The dimeric contrast agent caused fewer acute AEs than the monomeric contrast agent; however, the dimeric and monomeric agents caused a similar overall number of delayed AEs. Delayed cutaneous symptoms were noted more often with the dimeric contrast agent. Both contrast agents were safe in that no severe AEs and only a few moderate AEs were observed.
doi: 10.1148/radiol.2401050134pmid: 16720868
Purpose: To perform a systematic review of the short- to midterm effects of transrenal fixation of aortic stent-grafts on renal function in patients with abdominal aortic aneurysms. Materials and Methods: A search of the PubMed, MEDLINE, and EMBASE databases for English-language literature was performed. Studies with at least 10 patients were included for data analysis. Only studies on transrenal fixation of aortic stent-grafts that included follow-up results for renal function were included. A log-linear model was used for meta-analysis to compare transrenal fixation with infrarenal fixation. Results: Twenty-two studies met the inclusion criteria. Because two studies analyzed the same group of patients, one was excluded, for a total of 21 studies. Comparisons between transrenal fixation and infrarenal fixation were found in seven studies. For transrenal versus infrarenal fixation, the combined odds ratio, 95% confidence interval, and P value were found to be statistically significant with respect to postprocedural renal infarction only (combined odds ratio, 5.189; 95% confidence interval: 3.198, 8.420; P < .001). No significant difference was found between transrenal and infrarenal fixation with respect to renal dysfunction, renal artery occlusion, or endoleaks ( P > .05). Conclusion: Transrenal fixation of aortic stent-grafts seems to be a relatively safe alternative compared with infrarenal fixation in terms of short- to midterm follow-up. Postprocedural renal infarction, however, was significantly higher for transrenal fixation.
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Purpose: To compare prospectively obtained static two-dimensional (2D) and three-dimensional (3D) ultrasonographic (US) images in the diagnostic performance of radiologists with respect to the differentiation of benign from malignant solid breast masses with histopathologic examination as the reference standard. Materials and Methods: This study had institutional review board approval, and patient informed consent was obtained. Conventional 2D and 3D US images were obtained from 141 patients (age range, 25–71 years; mean age, 46 years) with 150 solid breast masses (60 cancers and 90 benign lesions) before excisonal or needle biopsy. Four radiologists who had not performed the examinations independently reviewed 2D US images and stored 3D US data and provided a level of suspicion concerning probability of malignancy. The sensitivity, specificity, and negative predictive values of 2D images were compared with those of 3D US images. Results: For all readers, 3D US images were the same as or better than 2D US images in terms of sensitivity (100% vs 100% for reader 1; 100% vs 98% for reader 2; 98% vs 93% for reader 3; 93% vs 92% for reader 4), specificity (58% vs 56% for reader 1; 51% vs 46% for reader 2; 83% vs 72% for reader 3; 86% vs 84% for reader 4), and negative predictive values (100% vs 100% for reader 1; 100% vs 98% for reader 2; 99% vs 94% for reader 3; 95% vs 94% for reader 4). These differences, however, were not statistically significant ( P > .05). Conclusion: The performance of the radiologists with respect to the characterization of solid breast masses with static 2D US images was similar to that with 3D US data.