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Imaging of the Kidney and Urinary Tract

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A special issue of Medicina (ISSN 1648-9144).

Deadline for manuscript submissions: closed (28 February 2021) | Viewed by 76463

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Prof. Maria Assunta Cova

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Guest Editor

Department of Radiology, University of Trieste, ASUGI, Ospedale di Cattinara, Trieste, Italy
Interests: uroradiology; imaging of female pelvis; MR imaging

Prof. Dr. Michele Bertolotto

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Co-Guest Editor

Department of Radiology, University of Trieste, ASUGI, Ospedale di Cattinara, Trieste, Italy
Interests: uroradiology; male genital imaging; ultrasound

Dr. Fulvio Stacul

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Co-Guest Editor

Department of Radiology, Ospedale Maggiore, Trieste, Italy
Interests: uroradiology; contrast media; interventional oncology

Special Issue Information

Dear Colleagues,

Kidney and urinary tract diseases represent a major health problem with an increasing impact on the health of the population. Today, specialists in medical imaging must acquire specific competences in order to meet clinicians’ new needs. An integrated and multiparametric imaging approach is increasingly needed to characterize and stage lesions. This requires knowledge of the different pathologies of the urinary system, of the treatment options, and of the possible treatment-related complications. Today, the radiologist must know what specific information to provide to the surgeon in different clinical situations and what are the features of the various organs after surgery and after different mini-invasive procedures.

International guidelines provide for an increasingly less-invasive approach for the treatment of various diseases of the kidney and urinary tract, whose indications are often placed on the basis of integrated multiparametric imaging. Minimally invasive treatments for tumor therapy also require a precise guidance that imaging guarantees, and the success of the procedures can only be assessed with imaging methods.

This Special Issue aims to provide tools for clinically oriented integrated imaging in the different sectors of the urinary system that can be useful for improving the management of patients with urinary pathologies according to the most modern diagnostic and therapeutic approaches.

Prof. Maria Assunta Cova
Prof. Michele Bertolotto
Dr. Fulvio Stacul
Guest Editors

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Keywords

kidney imaging
urinary tract imaging
kidney inflammatory disease
urinary tract tumor
urinary tract inflammatory disease
kidney tumors
kidney trauma
kidney stone
bladder tumor
kidney cryoablation
kidney interventional procedures

Published Papers (11 papers)

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Editorial

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3 pages, 217 KiB

Open AccessEditorial

Imaging of the Kidney and Urinary Tract: Current and Future Trends

by Maria Assunta Cova, Fulvio Stacul and Michele Bertolotto

Medicina 2022, 58(5), 673; https://0-doi-org.brum.beds.ac.uk/10.3390/medicina58050673 - 19 May 2022

Cited by 1 | Viewed by 1378

Abstract

The role of imaging in healthcare has become more and more significant in the last decades [...] Full article

(This article belongs to the Special Issue Imaging of the Kidney and Urinary Tract)

Research

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17 pages, 6373 KiB

Open AccessArticle

Percutaneous CT-Guided Renal Cryoablation: Technical Aspects, Safety, and Long-Term Oncological Outcomes in a Single Center

by Stefano Cernic, Cristina Marrocchio, Riccardo Ciabattoni, Ilaria Fiorese, Fulvio Stacul, Fabiola Giudici, Michele Rizzo and Maria Assunta Cova

Medicina 2021, 57(3), 291; https://0-doi-org.brum.beds.ac.uk/10.3390/medicina57030291 - 20 Mar 2021

Cited by 4 | Viewed by 2531

Abstract

Background and objectives: Cryoablation is emerging as a safe and effective therapeutic option for treating renal cell carcinoma. This study analyzed the safety and long-term oncological outcomes of cryoablation in our center. Materials and methods: Patients who underwent computed tomography (CT)-guided percutaneous cryoablation between February 2011 and June 2020 for one or more clinically localized renal tumors were identified. Technical success and treatment efficacy were assessed. Post-procedural complications were classified according to the Clavien-Dindo system. Recurrence–free survival was determined for biopsy-proven malignant renal tumors. Results: A total of 174 renal tumors, 78 of which were biopsy-proven malignant carcinomas, were treated in 138 patients (97 males and 41 females, mean age: 73 years, range: 43–89 years). Mean tumor size was 2.25 cm and 54.6% of the lesions required a complex approach. Technical success was achieved in 171 out of 174 tumors (98.3%). Primary treatment efficacy was 95.3% and increased to 98.2% when retreats were taken into account. The overall complication rate was 29.8%. No complications of Clavien-Dindo grade III or more were encountered. Median follow-up was 21.92 months (range: 0.02–99.87). Recurrence-free survival was 100% at 1 year, 95.3% (95% CI: 82.1%–98.8%) at 3 years, and 88.6% (95% CI: 71.8%–95.7%) at 5 years. Conclusions: Cryoablation is a safe and effective technique for the treatment of small renal lesions, with no major complications when performed by expert interventional radiologists. The multidisciplinary discussion is essential, especially considering the high number of histologically undetermined lesions. Our long-term oncological outcomes are encouraging and in line with the literature. Full article

(This article belongs to the Special Issue Imaging of the Kidney and Urinary Tract)

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10 pages, 1893 KiB

Open AccessArticle

Evaluation of the Diagnostic Value of Contrast-Enhanced Voiding Urosonography with Regard to the Further Therapy Regime and Patient Outcome—A Single-Center Experience in an Interdisciplinary Uroradiological Setting

by Constantin A. Marschner, Vincent Schwarze, Regina Stredele, Matthias F. Froelich, Johannes Rübenthaler, Thomas Geyer and Dirk-André Clevert

Medicina 2021, 57(1), 56; https://0-doi-org.brum.beds.ac.uk/10.3390/medicina57010056 - 09 Jan 2021

Cited by 6 | Viewed by 2184

Abstract

Background and Objectives: Vesicoureteral reflux (VUR) describes a common pediatric anomaly in pediatric urology with a prevalence of 1–2%. In diagnostics, in addition to the gold standard of voiding cystourethrography (VCUG), contrast-enhanced urosonography (ceVUS) offers a radiation-free procedure, which, despite its advantages, is not yet widely used. In the present single-center study, subsequent therapeutic procedures and outcomes after ceVUS of 49 patients were investigated. The aim of the study is to investigate the efficacy of ceVUS with the intention of broader clinical implementation. Materials and Methods: Between 2016 and 2020, 49 patients were retrospectively included and received a ceVUS to evaluate VUR. With a distribution of 47:2 (95.9%), a clear female predominance was present. The age of the patients varied between 5 months and 60 years at the time of ceVUS. All examinations were all performed and subsequently interpreted by a single experienced radiologist (EFSUMB level 3). Results: Compared to intraoperative findings, ceVUS shows a sensitivity of 95.7% with a specificity of 100%. Allergic reactions to the contrast medium could not be observed. Conclusion: With its high sensitivity and intraoperative validation, ceVUS offers an excellent alternative to VCUG, the gold standard in the diagnosis of VUR. In addition, ceVUS is a radiation-free examination method with a low risk profile that offers an exceptional diagnostic tool in the diagnostic clarification of recurrent urinary tract infections with the suspected diagnosis of VUR and should also be included in the consideration of a diagnosis next to the established VCUG, especially in younger children. Full article

(This article belongs to the Special Issue Imaging of the Kidney and Urinary Tract)

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16 pages, 2577 KiB

Open AccessArticle

Contrast-Enhanced Ultrasound (CEUS) for the Evaluation of Bosniak III Complex Renal Cystic Lesions—A 10-Year Specialized European Single-Center Experience with Histopathological Validation

by Vincent Schwarze, Johannes Rübenthaler, Saša Čečatka, Constantin Marschner, Matthias Frank Froelich, Bastian Oliver Sabel, Michael Staehler, Thomas Knösel, Thomas Geyer and Dirk-André Clevert

Medicina 2020, 56(12), 692; https://0-doi-org.brum.beds.ac.uk/10.3390/medicina56120692 - 12 Dec 2020

Cited by 11 | Viewed by 2357

Abstract

Background and objectives: The aim of the present retrospective single-center study is to evaluate the diagnostic performance of contrast-enhanced ultrasound (CEUS) for assessing Bosniak III complex renal cystic lesions with histopathological validation. Materials and Methods: 49 patients with CEUS-categorized Bosniak III renal cystic lesions were included in this retrospective study. All patients underwent native B-mode, Color Doppler, contrast-enhanced ultrasound (CEUS) between 2010–2020. Eight and five patients underwent computed tomography (CT) and magnetic resonance imaging (MRI), respectively. Twenty-nine underwent (partial) nephrectomy allowing for histopathological analysis. The applied contrast agent for CEUS was a second-generation blood pool agent. Ultrasonography examinations were performed and interpreted by a single experienced radiologist with more than 15 years of experience (EFSUMB Level 3). Results: CEUS examinations were successfully performed in all included patients without registering any adverse effects. The malignancy rate of CEUS-categorized Bosniak III renal lesions accounted for 66%. Initially, cystic complexity was visualized in native B-mode. In none of the renal lesions hypervascularization was detected in Color Doppler. CEUS allowed for detection of contrast enhancement patterns in all included Bosniak III renal lesions. Delayed wash-out could be detected in 6/29 renal lesions. In two cases of histopathologically confirmed clear-cell RCC, appropriate up-grading from Bosniak IIF to III was achieved by CEUS. Conclusions: CEUS depicts a promising imaging modality for the precise diagnostic workup and stratification of renal cystic lesions according to the Bosniak classification system, thereby helping guidance of adequate clinical management in the future. Full article

(This article belongs to the Special Issue Imaging of the Kidney and Urinary Tract)

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8 pages, 3708 KiB

Open AccessArticle

Diagnostic Performance of Contrast-Enhanced Ultrasound (CEUS) in the Evaluation of Solid Renal Masses

by Thomas Geyer, Vincent Schwarze, Constantin Marschner, Moritz L. Schnitzer, Matthias F. Froelich, Johannes Rübenthaler and Dirk-André Clevert

Medicina 2020, 56(11), 624; https://0-doi-org.brum.beds.ac.uk/10.3390/medicina56110624 - 19 Nov 2020

Cited by 12 | Viewed by 2338

Abstract

Background: The present study aims to evaluate the diagnostic performance of contrast-enhanced ultrasound (CEUS) for discriminating between benign and malignant solid renal masses. Methods: 18 patients with histopathologically confirmed benign solid renal masses (11 oncocytomas, seven angiomyolipomas) as well as 96 patients with confirmed renal cell carcinoma (RCC) who underwent CEUS followed by radical or partial nephrectomy were included in this single-center study. CEUS examinations were performed by an experienced radiologist (EFSUMB Level 3) and included the application of a second-generation contrast agent. Results: Renal angiomyolipomas, oncocytomas, and renal cell carcinomas showed varying sonomorphological characteristics in CEUS. Angiomyolipomas showed heterogeneous echogenicity (57% hypo-, 43% hyperechoic), while all lesions showed rapid contrast-enhancement with two lesions also showing venous wash-out (29%). Notably, 9/11 oncocytomas could be detected in conventional ultrasound (64% hypo-, 9% hyper-, 9% isoechoic) and 2/11 only demarcated upon intravenous application of contrast agent (18%). All oncocytomas showed hyperenhancement in CEUS, venous wash-out was registered in 7/11 lesions (64%). Conclusions: In line with the current state of knowledge, no specific sonomorphological characteristics allowing for accurate distinction between benign and malignant solid renal masses in CEUS could be detected in our study. Full article

(This article belongs to the Special Issue Imaging of the Kidney and Urinary Tract)

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12 pages, 2298 KiB

Open AccessArticle

Differentiation of Clear Cell Renal Cell Carcinoma from other Renal Cell Carcinoma Subtypes and Benign Oncocytoma Using Quantitative MDCT Enhancement Parameters

by Claudia-Gabriela Moldovanu, Bianca Petresc, Andrei Lebovici, Attila Tamas-Szora, Mihai Suciu, Nicolae Crisan, Paul Medan and Mircea Marian Buruian

Medicina 2020, 56(11), 569; https://0-doi-org.brum.beds.ac.uk/10.3390/medicina56110569 - 28 Oct 2020

Cited by 8 | Viewed by 1905

Abstract

Background and objectives: The use of non-invasive techniques to predict the histological type of renal masses can avoid a renal mass biopsy, thus being of great clinical interest. The aim of our study was to assess if quantitative multiphasic multidetector computed tomography (MDCT) enhancement patterns of renal masses (malignant and benign) may be useful to enable lesion differentiation by their enhancement characteristics. Materials and Methods: A total of 154 renal tumors were retrospectively analyzed with a four-phase MDCT protocol. We studied attenuation values using the values within the most avidly enhancing portion of the tumor (2D analysis) and within the whole tumor volume (3D analysis). A region of interest (ROI) was also placed in the adjacent uninvolved renal cortex to calculate the relative tumor enhancement ratio. Results: Significant differences were noted in enhancement and de-enhancement (diminution of attenuation measurements between the postcontrast phases) values by histology. The highest areas under the receiver operating characteristic curves (AUCs) of 0.976 (95% CI: 0.924–0.995) and 0.827 (95% CI: 0.752–0.887), respectively, were demonstrated between clear cell renal cell carcinoma (ccRCC) and papillary RCC (pRCC)/oncocytoma. The 3D analysis allowed the differentiation of ccRCC from chromophobe RCC (chrRCC) with a AUC of 0.643 (95% CI: 0.555–0.724). Wash-out values proved useful only for discrimination between ccRCC and oncocytoma (43.34 vs 64.10, p < 0.001). However, the relative tumor enhancement ratio (corticomedullary (CM) and nephrographic phases) proved useful for discrimination between ccRCC, pRCC, and chrRCC, with the values from the CM phase having higher AUCs of 0.973 (95% CI: 0.929–0.993) and 0.799 (95% CI: 0.721–0.864), respectively. Conclusions: Our observations point out that imaging features may contribute to providing prognostic information helpful in the management strategy of renal masses. Full article

(This article belongs to the Special Issue Imaging of the Kidney and Urinary Tract)

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Review

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23 pages, 11362 KiB

Open AccessReview

Endovascular Interventional Radiology of the Urogenital Tract

by Fabio Pozzi Mucelli, Roberta A. Pozzi Mucelli, Cristina Marrocchio, Saverio Tollot and Maria A. Cova

Medicina 2021, 57(3), 278; https://0-doi-org.brum.beds.ac.uk/10.3390/medicina57030278 - 17 Mar 2021

Cited by 5 | Viewed by 3809

Abstract

Interventional radiology of the male urogenital system includes percutaneous and endovascular procedures, and these last consist mostly of transcatheter arterial embolizations. At the kidney level, arterial embolizations are performed mainly for palliative treatment of parenchymal tumors, for renal traumas and, less frequently, for arteriovenous fistulas and renal aneurysms and pseudoaneurysms. These latter may often require emergency intervention as they can cause renal or peri-renal hematomas or significant hematuria. Transcatheter arterial embolization is also an effective therapy for intractable severe bladder hematuria secondary to a number of neoplastic and inflammatory conditions in the pelvis, including unresectable bladder cancer and radiation-induced or cyclophosphamide-induced hemorrhagic cystitis. Endovascular interventional procedures for the penis are indicated for the treatment of post-traumatic priapism. In this article, we review the main endovascular radiological interventions of the male urogenital system, describing the technical aspects, results, and complications of each procedure at the various anatomical districts. Full article

(This article belongs to the Special Issue Imaging of the Kidney and Urinary Tract)

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22 pages, 5714 KiB

Open AccessReview

Imaging of Bladder Cancer: Standard Applications and Future Trends

by Rasha Taha Abouelkheir, Abdalla Abdelhamid, Mohamed Abou El-Ghar and Tarek El-Diasty

Medicina 2021, 57(3), 220; https://0-doi-org.brum.beds.ac.uk/10.3390/medicina57030220 - 01 Mar 2021

Cited by 22 | Viewed by 14576

Abstract

The evolution in imaging has had an increasing role in the diagnosis, staging and follow up of bladder cancer. Conventional cystoscopy is crucial in the diagnosis of bladder cancer. However, a cystoscopic procedure cannot always depict carcinoma in situ (CIS) or differentiate benign from malignant tumors prior to biopsy. This review will discuss the standard application, novel imaging modalities and their additive role in patients with bladder cancer. Staging can be performed with CT, but distinguishing between T1 and T2 BCa (bladder cancer) cannot be assessed. MRI can distinguish muscle-invasive from non-muscle-invasive tumors with accurate local staging. Vesical Imaging-Reporting and Data System (VI-RADS) score is a new diagnostic modality used for the prediction of tumor aggressiveness and therapeutic response. Bone scintigraphy is recommended in patients with muscle-invasive BCa with suspected bony metastases. CT shows low sensitivity for nodal staging; however, PET (Positron Emission Tomography)/CT is superior and highly recommended for restaging and determining therapeutic effect. PET/MRI is a new imaging technique in bladder cancer imaging and its role is promising. Texture analysis has shown significant steps in discriminating low-grade from high-grade bladder cancer. Radiomics could be a reliable method for quantitative assessment of the muscle invasion of bladder cancer. Full article

(This article belongs to the Special Issue Imaging of the Kidney and Urinary Tract)

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19 pages, 4192 KiB

Open AccessEditor’s ChoiceReview

Imaging Characterization of Renal Masses

by Carlos Nicolau, Natalie Antunes, Blanca Paño and Carmen Sebastia

Medicina 2021, 57(1), 51; https://0-doi-org.brum.beds.ac.uk/10.3390/medicina57010051 - 08 Jan 2021

Cited by 33 | Viewed by 11739

Abstract

The detection of a renal mass is a relatively frequent occurrence in the daily practice of any Radiology Department. The diagnostic approaches depend on whether the lesion is cystic or solid. Cystic lesions can be managed using the Bosniak classification, while management of solid lesions depends on whether the lesion is well-defined or infiltrative. The approach to well-defined lesions focuses mainly on the differentiation between renal cancer and benign tumors such as angiomyolipoma (AML) and oncocytoma. Differential diagnosis of infiltrative lesions is wider, including primary and secondary malignancies and inflammatory disease, and knowledge of the patient history is essential. Radiologists may establish a possible differential diagnosis based on the imaging features of the renal masses and the clinical history. The aim of this review is to present the contribution of the different imaging techniques and image guided biopsies in the diagnostic management of cystic and solid renal lesions. Full article

(This article belongs to the Special Issue Imaging of the Kidney and Urinary Tract)

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23 pages, 13015 KiB

Open AccessReview

CT and MRI in Urinary Tract Infections: A Spectrum of Different Imaging Findings

by Mohamed Abou El-Ghar, Hashim Farg, Doaa Elsayed Sharaf and Tarek El-Diasty

Medicina 2021, 57(1), 32; https://0-doi-org.brum.beds.ac.uk/10.3390/medicina57010032 - 01 Jan 2021

Cited by 19 | Viewed by 17855

Abstract

There are many acute and chronic infections affecting the urinary tract including bacterial, fungal and viral infections. Urinary tract infections (UTIs) can present in many different patterns with variable degrees of severity varying from asymptomatic and uncomplicated forms to life threatening complicated infections. Cross-sectional imaging techniques—including both computed tomography (CT) and magnetic resonance imaging (MRI)—have become very important tools not only for evaluation of UTIs, but also for detection of associated complications. Selection of either CT or MRI in the UTI evaluation depends on several factors such as the presence of contraindication, experience, cost and availability. CT and MRI help in early detection and management of UTIs that reduce the prevalence and severity of complications. In this article we will present the radiologic findings at CT and MRI in different types of upper and lower UTIs including acute pyelonephritis, intrarenal and perinephric abscesses, pyonephrosis, chronic pyelonephritis, emphysematous UTIs, xanthogranulomatous pyelonephritis, tuberculosis (TB), bilharziasis, fungal infection, corynebacterium infection, ureteritis, cystitis, prostatitis, prostatic abscess and urethritis. Full article

(This article belongs to the Special Issue Imaging of the Kidney and Urinary Tract)

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15 pages, 15612 KiB

Open AccessReview

CT Urography Findings of Upper Urinary Tract Carcinoma and Its Mimickers: A Pictorial Review

by Paola Martingano, Marco F. M. Cavallaro, Alessandro M. Bozzato, Elisa Baratella and Maria A. Cova

Medicina 2020, 56(12), 705; https://0-doi-org.brum.beds.ac.uk/10.3390/medicina56120705 - 17 Dec 2020

Cited by 9 | Viewed by 13605

Abstract

Urothelial carcinoma (UC) is the fourth most frequent tumor in Western countries and upper tract urothelial carcinoma (UTUC), affecting pyelocaliceal cavities and ureter, accounts for 5–10% of all UCs. Computed tomography urography (CTU) is now considered the imaging modality of choice for diagnosis and staging of UTUC, guiding disease management. Although its specificity is very high, both benign and malignant diseases could mimic UTUCs and therefore have to be well-known to avoid misdiagnosis. We describe CTU findings of upper urinary tract carcinoma, features that influence disease management, and possible differential diagnosis. Full article

(This article belongs to the Special Issue Imaging of the Kidney and Urinary Tract)

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