Ultrasound is the most used interdisciplinary non-ionizing imaging technique in clinical routine. Therefore, ultrasound has a special value in the diagnosis and monitoring of cystic renal lesions, ...which can be classified as non-complicated or complicated and by means of occurrence as solitary or multifocal lesions. The Bosniak classification (I-IV) classifies renal cysts in 5 different categories with the help of ultrasound and computed tomography image criteria and is used for decisions of further clinical treatment. Additionally to normal native B-mode sonography, several new methods are in clinical use to improve diagnostic accuracy of unclear cases. Contrast enhanced ultrasound and MRI/CT are able to find and characterize difficult pathologies. This review explains the most important pathologies of cystic lesions of the kidney and stresses the different imaging methods of native B-mode sonography and the new techniques of contrast enhanced ultrasound.
Somatostatin receptor positron emission tomography/computed tomography (SSTR-PET/CT) using
Ga-labeled tracers is a widely used imaging modality for neuroendocrine tumors (NET). Recently,
FSiTATE, a ...SiFAlin tagged Tyr3-octreotate (TATE) PET tracer, has shown great potential due to favorable clinical characteristics. We aimed to evaluate the reproducibility of Somatostatin Receptor-Reporting and Data System 1.0 (SSTR-RADS 1.0) for structured interpretation and treatment planning of NET using
FSiTATE.
Four readers assessed
FSiTATE-PET/CT of 95 patients according to the SSTR-RADS 1.0 criteria at two different time points. Each reader evaluated up to five target lesions per scan. The overall scan score and the decision on peptide receptor radionuclide therapy (PRRT) were considered. Inter- and intra-reader agreement was determined using the intraclass correlation coefficient (ICC).
The ICC analysis on the inter-reader agreement using SSTR-RADS 1.0 for identical target lesions (ICC ≥ 85%), overall scan score (ICC ≥ 90%), and the decision to recommend PRRT (ICC ≥ 85%) showed excellent agreement. However, significant differences were observed in recommending PRRT among experienced readers (ER) (p = 0.020) and inexperienced readers (IR) (p = 0.004). Compartment-based analysis demonstrated good to excellent inter-reader agreement for most organs (ICC ≥ 74%), except for lymph nodes (ICC ≥ 53%).
SSTR-RADS 1.0 represents a highly reproducible and consistent framework system for stratifying SSTR-targeted PET/CT scans, even using the novel SSTR-ligand
FSiTATE. Some inter-reader variability was observed regarding the evaluation of uptake intensity prior to PRRT as well as compartment scoring of lymph nodes, indicating that those categories require special attention during further clinical validation and might be refined in a future SSTR-RADS version 1.1.
SSTR-RADS 1.0 is a consistent framework for categorizing somatostatin receptor-targeted PET/CT scans when using
FSiTATE. The framework serves as a valuable tool for facilitating and improving the management of patients with NET.
SSTR-RADS 1.0 is a valuable tool for managing patients with NET. SSTR-RADS 1.0 categorizes patients with showing strong agreement across diverse reader expertise. As an alternative to
Ga-labeled PET/CT in neuroendocrine tumor imaging, SSTR-RADS 1.0 reliably classifies
FSiTATE-PET/CT.
Background Histopathology is the reference standard for diagnosing liver metastases of neuroendocrine tumors (NETs). Somatostatin receptor-positron emission tomography / computed tomography ...(SSR-PET/CT) has emerged as a promising non-invasive imaging modality for staging NETs. We aimed to assess the diagnostic accuracy of SSR-PET/CT in the identification of liver metastases in patients with proven NETs compared to histopathology. Methods Histopathologic reports of 139 resected or biopsied liver lesions of patients with known NET were correlated with matching SSR-PET/CTs and the positive/negative predictive value (PPV/NPV), sensitivity, specificity, and diagnostic accuracy of SSR-PET/CT were evaluated. PET/CT reading was performed by one expert reader blinded to histopathology and clinical data. Results 133 of 139 (95.7%) liver lesions showed malignant SSR-uptake in PET/CT while initial histopathology reported on 'liver metastases of NET´ in 127 (91.4%) cases, giving a PPV of 91.0%. Re-biopsy of the initially histopathologically negative lesions (reference standard) nevertheless diagnosed 'liver metastases of NET' in 6 cases, improving the PPV of PET/CT to 95.5%. Reasons for initial false-negative histopathology were inadequate sampling in the sense of non-target biopsies. The 6 (4.3%) SSR-negative lesions were all G2 NETs with a Ki-67 between 2-15%. Conclusion SSR-PET/CT is a highly accurate imaging modality for the diagnosis of liver metastases in patients with proven NETs. However, we found that due to the well-known tumor heterogeneity of NETs, specifically in G2 NETs approximately 4-5% are SSR-negative and may require additional imaging with .sup.18FFDG PET/CT. Keywords: NET, SSR, PET/CT, MRI, Liver metastases
Objectives
The aim of this retrospective study was to determine cost-effectiveness of stress myocardial CT perfusion (CTP), coronary CT angiography (CTA), and the combination of both in suspected ...obstructive coronary artery disease (CAD) or in-stent restenosis (ISR) in patients with previous coronary stent implantation.
Methods
A decision model based on Markov simulations estimated lifetime costs and quality-adjusted life years (QALYs) associated with CTA, CTP, and CTA + CTP. Model input parameters were obtained from published literature. Probabilistic sensitivity analysis was performed to evaluate overall model uncertainty. A single-variable deterministic sensitivity analysis evaluated the sensitivity of the results to plausible variations in model inputs. Cost-effectiveness was assessed based on a cost-effectiveness threshold of $100,000 per QALY.
Results
In the base-case scenario with willingness to pay of $100,000 per QALY, CTA resulted in total costs of $47,013.87 and an expected effectiveness of 6.84 QALYs, whereas CTP resulted in total costs of $46,758.83 with 6.93 QALYs. CTA + CTP reached costs of $47,455.63 with 6.85 QALYs. Therefore, strategies CTA and CTA + CTP were dominated by CTP in the base-case scenario. Deterministic sensitivity analysis demonstrated robustness of the model to variations of diagnostic efficacy parameters and costs in a broad range. CTP was cost-effective in the majority of iterations in the probabilistic sensitivity analysis as compared with CTA.
Conclusions
CTP is cost-effective for the detection of obstructive CAD or ISR in patients with previous stenting and therefore should be considered a feasible approach in daily clinical practice.
Key Points
•
CTP provides added diagnostic value in patients with previous coronary stents
.
•
CTP is a cost-effective method for the detection of obstructive CAD or ISR in patients with previous stenting
.
Purpose
To determine pre-therapeutic predictive factors for overall survival (OS) after yttrium (Y)-90 radioembolization (RE).
Methods
We retrospectively analyzed the pre-therapeutic characteristics ...(sex, age, tumor entity, hepatic tumor burden, extrahepatic disease EHD and liver function with focus on bilirubin and cholinesterase level) of 389 consecutive patients with various refractory liver-dominant tumors (hepatocellular carcinoma HCC, cholangiocarcinoma CCC, neuroendocrine tumor NET, colorectal cancer CRC and metastatic breast cancer MBC), who received Y-90 radioembolization for predicting survival. Predictive factors were selected by univariate Cox regression analysis and subsequently tested by multivariate analysis for predicting patient survival.
Results
The median OS was 356 days (95% CI 285–427 days). Stable disease was observed in 132 patients, an objective response in 71 (one of which was complete remission) and progressive disease in 122. The best survival rate was observed in patients with NET, and the worst in patients with MBC. In the univariate analyses, extrahepatic disease (
P
< 0.001), large tumor burden (
P
= 0.001), high bilirubin levels (>1.9 mg/dL,
P
< 0.001) and low cholinesterase levels (CHE <4.62 U/I,
P
< 0.001) at baseline were significantly associated with poor survival. Tumor entity, tumor burden, extrahepatic disease and CHE were confirmed in the multivariate analysis as independent predictors of survival. Sex, applied RE dose and age had no significant influence on OS.
Conclusions
Pre-therapeutic baseline bilirubin and CHE levels, extrahepatic disease and hepatic tumor burden are associated with patient survival after RE. Such parameters may be used to improve patient selection for RE of primary or metastatic liver tumors.
Frequently focal splenic lesions (FSL) - cysts, hemangioma, hamartoma, metastases or infarction amongst others - are incidentally found within the scope of the sonographic examination of the abdomen. ...By using native B-mode and Color Doppler the underlying entity often is not elucidated. Thus, more elaborate imaging modalities like CT and MRI scans with their associated risks are used to clarify the entity of FSL.
The aim of the present retrospective single-center study is to evaluate the diagnostic performance of CEUS examination for assessing splenic focal lesions by comparison with findings from CT and MRI scans.
Between 2010-2018 46 patients were included in the study. All patients underwent native B-mode, Color Doppler and CEUS after given informed consent. The applied contrast agent was a second-generation blood pool agent (SonoVue®, Bracco, Milan, Italy). CEUS examinations were performed and interpreted by a single experienced radiologist (EFSUMB Level 3).
All patients were examined without occurrence of any side effects. In total, 53 FSL were investigated (9% traumatic vs. 91% non-traumatic). Compared to CT, CEUS showed a sensitivity, specificity, PPV, NPV of 100% for assessing infarction, hematoma, hamartoma, cystic and malignant lesions. In comparison with MRI, CEUS presented a sensitivity, specificity, PPV, NPV of 100% for evaluating pseudolesions, hemangioma, hamartoma, cystic and malignant lesions.
With an excellent safety profile CEUS shows an equipollent diagnostic performance for differentiating FSL compared to CT and MRI scans.
Renal cell carcinomas (RCC) represent a heterogeneous group of hypo- and hypervascularized malignancies. Using contrast-enhanced ultrasound (CEUS) specific imaging features of clear cell (ccRCC), ...papillary (pRCC) and chromophobe RCC (chRCC) subtypes have been demonstrated. However, some RCCs show atypical imaging features making it difficult to distinguish between the subtypes.
This study was performed to evaluate the observed enhancement features of pRCC in CEUS and to assess the sensitivity in the diagnosis of suspected renal malignancies in a 10 year retrospective analysis at our institution.
The study population consisted of 60 patients with histologically confirmed pRCC. All patients underwent CEUS imaging between 2005 and 2015 as part of their diagnostic workup.
In 45 out of 60 (75%) cases the examined pRCC showed typical hypoenhancement and wash-out. 15 out of 60 (25%) pRCC showed atypical enhancement features; in 14 cases the contrast enhancement indicated a ccRCC. 1 complex cyst was falsely reported as IIF lesion. 59 out of 60 malignancies were reported as malignant using CEUS resulting in a sensitivity of 98.4%.
CEUS is an eligible imaging technique to visualize the contrast enhancement features of pRCC. However, up to 25% of pRCCs show an atypical enhancement pattern making it difficult to distinguish it from other renal lesions.
Despite of the more potent immunosuppressive medication, vascular rejection is still a major issue after renal transplantation. Renal biopsy is the gold standard diagnostic to evaluate acute and ...chronic allograft rejection. As it is an invasive diagnostic there is the risk of complications like haematoma, arteriovenous fistulas, active bleeding or infection. Contrast-enhanced ultrasound is a non-invasive imaging modality that allows visualising renal transplant perfusion.
To analyse the sensitivity and specificity of contrast-enhanced ultrasound (CEUS) compared to biopsy as gold standard in diagnosing vascular rejection in renal transplant patients.
A total of 57 renal transplant recipients with poor renal allograft function with initial diagnostic imaging between 2006 and 2017 were included in the study. Clinical data and imaging studies were analysed retrospectively. The diagnostic accuracy of CEUS in diagnosing vascular rejection of the renal transplant was compared to renal biopsy as gold standard. Out of 57 patients 7 patients showed signs of vascular rejection in biopsy. In 6 out of these 7 patients CEUS described irregularities in renal perfusion suspicious of vascular rejection.
CEUS showed a sensitivity of 85.7%, a specificity of 100%, a positive predictive value (PPV) of 100%, and a negative predictive value (NPV) of 98.0%.
CEUS is a safe, non-nephrotoxic imaging modality for the initial imaging of renal transplant recipients with elevated kidney function parameters suspicious of vascular rejection. Compared to renal biopsy as gold standard CEUS shows a high specificity and PPV in detecting signs of vascular rejection. Since sub-types of vascular rejection with cellular and humoral components with greater risk for allograft loss have been described renal biopsy is inevitable in these cases.
HCC is the most frequent primary liver cancer entity. Major risk factors comprise chronic HBC and HCV infections, ALD or NAFLD. Apart from the anamnesis, the clinical examination and serologic ...analysis, an essential part of the diagnostic HCC work-up is due to imaging findings from sonography, CT or MRI scans. HCC lesions feature a distinct vascularization pattern: hyperenhancement during early arterial and hypoenhancement/wash-out during portal venous or delayed phases. CEUS facilitates dynamic assessment of microperfusion patterns of suspicious liver lesions.
The purpose of the present retrospective single-center study was to determine the diagnostic value of CEUS for assessing HCC by comparison with findings from MRI scans.
Between 2004-2018 292 patients with suspicious liver lesions underwent CEUS and MRI. All patients underwent native B-mode, Color Doppler and CEUS after given informed consent. The applied contrast agent was a second-generation blood pool agent (SonoVue®, Bracco, Milan, Italy). Every CEUS examination was performed and interpreted by a single experienced radiologist (EFSUMB Level 3).
CEUS was performed on all included patients without occurrence of any adverse effects. CEUS showed a sensitivity of 96%, a specificity of 91%, a PPV of 95% and a NPV of 94% for analyzing HCC in comparison with MRI as the diagnostic gold standard.
With a distinguished safety profile CEUS shows a high diagnostic accuracy in assessing HCC compared to corresponding results from MRI scans.
Popliteal artery aneurysms (PAA) are the most common peripheral artery aneurysms. Most common cause is arteriosclerosis. Acute thromboembolic limb ischemia and rupture of the PAA depict severe ...complications. Diagnostic tools for identifying PAAs are (Doppler) ultrasound, CT/MR angiography and DSA.
The aim of the present retrospective single-center study is to assess the application and safety of CEUS for assessing untreated and treated PAAs.
13 patients were included in this study on whom CEUS was performed between 2007-2016. CEUS examinations were performed and interpreted by an experienced single radiologist (EFSUMB Level 3).
CEUS allowed for the detection of PAAs in all cases. CEUS allowed for detection of partial thrombosis of PAA in 7/8 of untreated patients, proper exclusion of PAA upon femoro-popliteal bypass in 3 patients, incomplete exclusion of PAA upon femoro-popliteal bypass in 1 patient and ruling out of in-stent stenosis in 1 patient.
CEUS is a useful and safe tool for in real-time evaluation of PAAs in the pre-/post-treatment status. In addition to conventional (Doppler) ultrasound and as an alternative tool to more elaborate imaging modalities, CEUS might be integrated in the future diagnostic work-up and follow-up of PAA patients.
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