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Abstract Objective: To evaluate the accuracy of steady-state free precession (SSFP) unenhanced magnetic resonance angiography (MRA) at 1.5 T for the identification of multiple renal arteries, using computed tomography angiography (CTA) as the reference standard. Materials and Methods: This was a prospective study involving 39 patients (26 males; mean age, 62.6 years) who underwent CTA and unenhanced MRA to evaluate the proximal and middle segments of the renal arteries. The analysis was performed in two phases: the quality of unenhanced MRA images was classified as diagnostic or nondiagnostic for the presence of multiple renal arteries by two independent readers; two other independent readers then evaluated the images previously classified as being of diagnostic quality. The sensitivity, specificity, and overall accuracy of unenhanced MRA were calculated, CTA being used as the reference standard. The kappa statistic was used in order to calculate interobserver agreement. Results: The image quality of unenhanced MRA was considered diagnostic in 70-90% of the extrarenal arterial segments. The CTA examination revealed 19 multiple renal arteries (8 on the right and 11 on the left). The accuracy of unenhanced MRA for the identification of multiple renal arteries was greater than 90%, with a sensitivity of 72.7-100% and a specificity of 96.3-100%. Conclusion: Unenhanced MRA provides high quality imaging of the extrarenal segments of renal arteries. This method may be used as an alternative for the evaluation of the renal arteries, given that it has an accuracy comparable to that of CTA.
Resumo Objetivo: Avaliar, prospectivamente, a acurácia da angiografia por ressonância magnética (angio-RM) sem contraste, com a sequência steady-state free precession (SSFP) 1,5 T, para a identificação de artérias renais múltiplas, usando para isso a angiografia por tomografia computadorizada (angio-TC) como padrão de referência. Materiais e Métodos: Trinta e nove pacientes (26 do sexo masculino; idade média de 62,6 anos) foram submetidos a angio-TC e angio-RM para avaliação dos segmentos proximais e médios das artérias renais. A análise dividiu-se em duas partes: inicialmente, a qualidade das imagens de angio-RM foi classificada como diagnóstica ou não diagnóstica por dois avaliadores independentes; posteriormente, outros dois avaliadores analisaram as imagens consideradas diagnósticas quanto à presença de múltiplas artérias renais. Sensibilidade, especificidade e acurácia da angio-RM foram calculadas utilizando-se a angio-TC como referência. Estatística kappa foi utilizada para cálculo da concordância interobservador. Resultados: A qualidade das imagens de angio-RM foi considerada diagnóstica em 70-90% dos segmentos arteriais extrarrenais. A angio-TC revelou 19 artérias renais múltiplas (8 direitas e 11 esquerdas). A acurácia da angio-RM para identificação de artérias renais múltiplas foi maior que 90%, com sensibilidade variando de 72,7% a 100% e especificidade variando de 96,3% a 100%. Conclusão: A angio-RM sem contraste proporciona imagens de alta qualidade dos segmentos extrarrenais das artérias renais. Este método pode ser alternativamente utilizado para avaliação renal, com acurácia comparável à da angio-TC.
ABSTRACT
Objective@#To investigate the safety and effectiveness of percutaneous nephrolithotomy(PCNL) with X-ray and ultrasound in the design and implementation of the best percutaneous puncture pathway for complex renal calculi.@*Methods@#Eighty-six patients with complex renal calculi treated in Shengjing Hospital Affiliated to China Medical University from May 2015 to May 2018 were collected.Before operation, CT/IVP was used to design the best percutaneous puncture pathway and selected the calices to be punctured.The intersection of the central axis of the calyx fornix, the neck of the calyx and the body surface were regarded as the puncture point on the body surface, and the connection between the central axis of the calyx fornix and the center of the calyx fornix was the puncture line.The ultrasound probe was placed slightly below the planned puncture point.According to the order of echolocation of hydronephrosis or hump-like calculi, two-step puncture was adopted to puncture the calyx along the central axis of the calyx dome and the calyx neck.The guide wire was retained and the channel was gradually expanded to F24 standard channel for ballistic or ultrasonic lithotripsy.@*Results@#Percutaneous puncture pathways were successfully established in 86 cases, 65 cases were single-channel and 21 cases were double-channel.The operation time(from puncture to indwelling nephrostomy) was (65.3±17.2)min, and the hemoglobin decreased in (10.1±4.5)g/L.The hospitalization time of the patients was (7.2±5.2)d.The first stage stone clearance rate was 74.4%(64/86), and the second stage stone clearance rate was 95.3%(82/86).@*Conclusion@#Combined with the advantages of X-ray and ultrasound, the puncture route shoud be designed by CT/IVP before operation, and puncture shoud be carried out under the guidance of ultrasound during operation.The best percutaneous puncture pathway can be established to complete the treatment of complex renal calculi.
ABSTRACT
Objective To investigate the safety and effectiveness of percutaneous nephrolithotomy (PCNL)with X-ray and ultrasound in the design and implementation of the best percutaneous puncture pathway for complex renal calculi.Methods Eighty-six patients with complex renal calculi treated in Shengjing Hospital Affiliated to China Medical University from May 2015 to May 2018 were collected.Before operation,CT/IVP was used to design the best percutaneous puncture pathway and selected the calices to be punctured.The intersection of the central axis of the calyx fornix,the neck of the calyx and the body surface were regarded as the puncture point on the body surface,and the connection between the central axis of the calyx fornix and the center of the calyx fornix was the puncture line.The ultrasound probe was placed slightly below the planned puncture point.According to the order of echolocation of hydronephrosis or hump-like calculi,two-step puncture was adopted to puncture the calyx along the central axis of the calyx dome and the calyx neck.The guide wire was retained and the channel was gradually expanded to F24 standard channel for ballistic or ultrasonic lithotripsy.Results Percutaneous puncture pathways were successfully established in 86 cases,65 cases were single-channel and 21 cases were double-channel.The operation time(from puncture to indwelling nephrostomy) was (65.3 ± 17.2)min,and the hemoglobin decreased in (10.1 ± 4.5)g/L.The hospitalization time of the patients was (7.2 ± 5.2) d.The first stage stone clearance rate was 74.4％ (64/86),and the second stage stone clearance rate was 95.3％ (82/86).Conclusion Combined with the advantages of X-ray and ultrasound,the puncture route shoud be designed by CT/IVP before operation,and puncture shoud be carried out under the guidance of ultrasound during operation.The best percutaneous puncture pathway can be established to complete the treatment of complex renal calculi.
ABSTRACT
Purpose Bladder cancer (BC) is the second most common malignancy of the urinary tract, with high mortality. The knowledge of the molecular pathways associated with BC carcinogenesis is crucial to identify new diagnostic and prognostic biomarkers. MicroRNAs (miRNAs) are short non-coding RNA molecules that play important roles in the regulation of gene expression by acting directly on mRNAs. miR-145 has been considered as a tumor suppressor, which targets the c-MYC, MUC-1 and FSCN1 genes. Our aim was to evaluate the expression profile of miR-145 in low-grade non-invasive and high-grade invasive bladder urothelial carcinomas. Materials and Methods We studied 30 specimens of low-grade, non-invasive pTa and 30 of pT2/pT3 high-grade invasive UC obtained by transurethral resection or radical cystectomy, followed over a mean time of 16.1 months. Normal controls were represented by five samples of normal bladder biopsy from patients who underwent retropubic prostatectomy to treat BPH. miRNA extraction and cDNA generation were performed using commercial kits. Analysis was performed by qRT-PCR, and miR-145 expression was calculated using the 2-∆∆ct method; we used RNU-43 and RNU-48 as endogenous controls. Results miR-145 was under-expressed in 73.3% and 86.7% of pTa and pT2/pT3, respectively, with expression means of 1.61 for the former and 0.66 for the last. There were no significant differences in miR-145 expression and histological grade, tumor stage, angiolymphatic neoplastic invasion and tumor recurrence. Conclusion miR-145 is under-expressed in low-grade, non-invasive and high-grade invasive urothelial bladder carcinoma and may play an important role in the carcinogenesis pathway, being an interesting candidate diagnostic marker. .