Fully automated kidney image biomarker prediction in ultrasound scans using Fast-Unet+.

Any kidney dimension and volume variation can be a remarkable indicator of kidney disorders. Precise kidney segmentation in standard planes plays an undeniable role in predicting kidney size and volume. On the other hand, ultrasound is the modality of choice in diagnostic procedures. This paper proposes a convolutional neural network with nested layers, namely Fast-Unet++, promoting the Fast and accurate Unet model. First, the model was trained and evaluated for segmenting sagittal and axial images of the kidney. Then, the predicted masks were used to estimate the kidney image biomarkers, including its volume and dimensions (length, width, thickness, and parenchymal thickness). Finally, the proposed model was tested on a publicly available dataset with various shapes and compared with the related networks. Moreover, the network was evaluated using a set of patients who had undergone ultrasound and computed tomography. The dice metric, Jaccard coefficient, and mean absolute distance were used to evaluate the segmentation step. 0.97, 0.94, and 3.23 mm for the sagittal frame, and 0.95, 0.9, and 3.87 mm for the axial frame were achieved. The kidney dimensions and volume were evaluated using accuracy, the area under the curve, sensitivity, specificity, precision, and F1.

Essential thrombocythemia associated with fibrosis involving bilateral renal sinuses: A case report.

Essential thrombocythemia (ET) is associated with an increased risk of thrombosis and autoimmune renal involvement. We report an extremely rare case of an acute kidney injury (AKI) in the presence of bilateral renal pelvises fibrosis in a patient with a proven diagnosis of ET. A 48-year-old male patient with a past medical history of mild chronic kidney disease and ET was admitted to our hospital with AKI. The patient discontinued his hydroxyurea treatment for the past 2 months and laboratory data showed increasing serum creatinine levels and platelet counts with increased renal sizes, severe hydrocalyx, and bilateral renal sinuses' fibrosis in imaging. The patient started again on hydroxyurea therapy and showed improvement in all laboratory scales. ET and increased levels of platelet-derived growth factors could cause renal sinuses fibrosis and glomerulopathy. In ET patients with renal sinuses' fibrosis and glomerulopathy, initiating cytoreductive therapy could improve the outcome.

Estimating Patient Survival and Risk of End-Stage Kidney Disease in Patients With Autosomal Dominant Polycystic Kidney Disease in Iran.

INTRODUCTION: Autosomal dominant polycystic kidney disease (ADPKD) is a hereditary kidney disease that can affect several organs. The clinical course of the disease varies among patients; some never become symptomatic, and others reach end-stage kidney disease (ESKD) in the 5th decade of their life. METHODS: This historical cohort study was conducted on ADPKD patients to investigate kidney and patient survival rates and related risk factors in Iran. Survival analysis and risk ratio calculation were performed using the Cox proportional hazards model, Kaplan- Meier method, and log-rank test. RESULTS: Among the 145 participants, 67 developed ESKD, and 20 died before the end of the study period. Developing chronic kidney disease (CKD) at the age of ≤ 40, baseline serum creatinine level (SCr) of more than 1.5 mg/dL, and cardiovascular disease increased the risk of ESKD by 4, 1.8, and 2.4 times; respectively. Patient survival analysis revealed a fourfold increase in mortality if the glomerular filtration rate (GFR) declined more than 5 cc/min annually and if CKD was diagnosed at the age of ≤ 40. Vascular thrombotic events or ESKD in the course of disease increased the risk of death by approximately 6- and 7-fold, respectively. Kidney survival was 48% by the age of 60 and 28% by the age of 70. Patient survival was 86.05% at the age of 60 and 67.99% at the age of 70. Additionally, men had a significantly better renal function and survival than women. CONCLUSION: Elevated baseline SCr and cardiovascular disease can increase ESKD risk in ADPKD patients. A rapid decline in GFR, ESKD development, and vascular thrombotic events increase the risk of death, but early CKD can affect both.  DOI: 10.52547/ijkd.7551.

Percutaneous embolization of renal pseudoaneurysms: A retrospective study.

Introduction: We evaluated the efficacy of the mixture of autologous blood and a hemostatic agent, oxidized regenerative cellulose (ORC), as an alternative material for ultrasound (US)-guided percutaneous embolization of renal pseudoaneurysm (PA). Methods: In this retrospective study, consecutive patients diagnosed with renal PA were included. The exclusion criteria were: PA of the main renal artery, tiny PA not visualized on the colour doppler ultrasonography, PA more than 3 cm in max diameter or extracapsular PA with the possibility of massive bleeding, and patients with a history of coagulation disorders. After localizing the PA, a mixture of autologous blood and ORC was injected under US guidance with a 15G coaxial needle. Patients were followed up for at least 6 months. Results: Twenty-nine patients with PA were included, of which 26 had a history of percutaneous nephrolithotomy, and three patients had a history of renal biopsy (24 men and five women with an average age of 44.3 years). Gross hematuria was the most common mode of presentation. The mean size of the PA was 16.6 mm and the mean duration of follow-up was 9 months. The clinical and the technical success rate was 100%. The PA could be thrombosed in all the patients with a single-session of injection. No acute (hematoma, infection, and bleeding) or chronic (thromboembolic events, renal cortical atrophy, and recurrence) complications were seen. Conclusion: Percutaneous embolization of renal PA under US guidance with a mixture of autologous blood and ORC is an efficient and easily available first-line method to treat this potentially life-threatening condition when endovascular embolization or other expensive thrombotic agents are not available.

The Complete Response of a Renal Cell Carcinoma Metastatic to Brain, Lungs, and Liver to Second-Line Nivolumab: A Case Report.

Metastatic renal cell carcinoma (RCC) is a therapeutic challenge to clinicians since it shows significant resistance to chemotherapy and radiation therapy. With the introduction of immunotherapy, the treatment paradigm for RCC has evolved. Here, we describe the case of a 55-year-old male who presented with flank pain. An abdominal-pelvic computed tomography (CT) scan revealed a right renal mass. Following open right radical nephrectomy, first-line treatment with sunitinib was administered. After four months he developed multiple metastases to the liver, lungs, abdominal wall, and brain. He initiated second-line treatment with nivolumab and also received whole brain radiation therapy (WBRT). Six months following combined treatment with nivolumab and WBRT, a CT scan revealed complete radiologic response in the lungs, abdominal wall, brain, and liver except for the persistence of a subhepatic mass. Despite the discontinuation of nivolumab and starting bevacizumab due to financial problems, the patient was stable for 22 months, and after this, he was hospitalized with high bilirubin levels. An abdominal CT scan detected the development of the necrotic subhepatic mass compressing the common bile duct (CBD), with no other sign of metastatic disease. We believe that the explanation for this long-term disease control could be the combination of immune-checkpoint-inhibitor (ICI) with WBRT resulting in significant cranial and extracranial immune response, known as "the abscopal effect". This report highlights the importance of local therapy combined with ICI-based therapy in metastatic RCC.

Association of CT Scan Parameters with the Risk of Renal Angiomyolipoma Rupture; a Brief Report.

INTRODUCTION: Rupture of renal angiomyolipoma (AML) is an emergency and life-threatening complication. This study aimed to evaluate the association of computed tomography (CT) scan parameters with the risk of rupture in renal AMLs. METHODS: In this retrospective cross-sectional study, patients who were referred to a referral university hospital with diagnosis of AML, between 2007 and 2019, were included. Patients were divided into ruptured and non-ruptured cases based on surgery and CT scan findings and the baseline characteristics as well as CT scan parameters were compared between the two groups. RESULTS: 20 AML patients with the mean age of 39.6 ± 12.5 years were included (75% female). The lesion was ruptured in 8 (40%) patients. The mean size of the lesion was 97.0 ± 15.9 mm in the ruptured and 72.0 ± 29.4 in the non - ruptured AML ( p = 0.045). The mean fat density based on non-contrast enhanced CT (NCCT) scan (- 56.1 ± 16.3 vs - 74.9±24.1; p = 0.018) and contrast enhanced CT (CECT) scan (- 20.8 ± 16.9 vs - 50.5 ± 31.7; p = 0. 016) was significantly higher in the ruptured cases. Total tumor density based on NCCT scan was significantly greater in the ruptured AMLs ( 19.6 ± 25.9 vs -22.7±41.6, p=0.033). CONCLUSION: It seems that some CT scan parameters such as mean fat density and total tumor density could be used for differentiation between ruptured and non-ruptured AMLs.

Deep dorsal penile vein thrombosis in a patient with COVID-19 infection: A rare complication and the first reported case.

COVID-19 infection may have extrapulmunary manifestations such as blood hypercoagulability that may cause thrombosis in both arterial and venous system. Deep dorsal penile vein thrombosis is very rare, and the most common reason is coagulation disorders. The common observed symptom is penile pain especially during erection and it is diagnosed by ultrasound evaluation of the vein. It is necessary to distinguish deep dorsal penile vein thrombosis from superficial dorsal penile vein thrombosis as it needs anti-coagulant treatment. In present study, we describe a unique case of the deep dorsal penile vein thrombosis following COVID-19 infection.

Evaluation of the role of reflux pattern in Color Doppler Ultrasound on spermogram improvement after varicocelectomy.

PURPOSE: Many attempts are being made to find an association between varicocele characteristics and sperm parameters. In this study, we investigated the association between a newly introduced varicocele reflux grading pattern and sperm parameters, as well as its effect on spermogram improvement after varicocelectomy. METHODS: In a prospective study, 73 patients with a clinical single-sided varicocele who underwent corrective varicocelectomy were included. Reflux pattern was determined on Color Doppler Ultrasound (CDUS) and categorized into four grades: grade 1 (retrograde), grade 2 (augmentation), grade 3 (enhancement), and grade 4 (stasis). The association of pre- and postoperative spermogram with the patients' reflux pattern was evaluated. RESULTS: A significant positive association was found between the venous diameter and reflux pattern. Higher grades of the reflux pattern were associated with the more severe hemodynamic pattern of the reflux (shunt type). A significant association was found between the reflux pattern and preoperative semen characteristics, and this association was more prominent in constant venous diameter. In this respect, the enhancing reflux type was associated with the most impaired preoperative sperm count, motility, and morphology. The enhancing type also revealed the most improvement in spermogram after varicocelectomy. CONCLUSION: Patients with a higher reflex grade, particularly enhancing pattern, will most benefit from the surgical correction of varicocele. These findings suggest reflux pattern as a promising prognostic factor for a favorable outcome after varicocelectomy.

A Novel Method for Investigating the Role of Reflux Pattern in Color Doppler Ultrasound for Grading of Varicocele.

Varicocele is the most common correctable cause of infertility. Color Doppler Ultrasound (CDUS) has a sensitivity of 97% and specificity of 94% for diagnosing this condition. This study aimed to propose a new pattern of scrotal Doppler for predicting the severity of varicocele. An observational study was conducted from January 2016 to January 2017 on 120 testes units in 60 patients. Scrotal CDUS and semen analysis were done in all participants. Patients were evaluated for reflux pattern, pampiniform venous plexus diameter, and venous reflux time. The ultrasonography parameters and semen analysis data were compared to assess the correlations between the results. The reflux pattern and vein diameters had a significant correlation. Also, a significant correlation was detected between the reflux pattern and reflux time. There was a significant correlation between the reflux pattern and two parameters of semen analysis namely sperm count and its motility. In conclusion, the reflux pattern classification suggested in this study can be used as a useful predictor of varicocele severity and sperm parameters in patients with varicocele.

Tumoral vascular pattern in renal cell carcinoma and fat-poor renal angiomyolipoma as a novel helpful differentiating factor on contrast-enhanced CT scan.

Our objective was to evaluate the differences between tumoral vascular pattern of renal cell carcinoma and fat-poor angiomyolipoma by contrast-enhanced computed tomography. All included patients had a definitive pathological diagnosis of either angiomyolipoma or renal cell carcinoma, and then the contrast-enhanced computed tomography images of these patients were evaluated. The patients who had visible prominent vessels in cross-sectional imaging were selected. The tumor vascular pattern (prominent (>2 mm) intratumoral and peritumoral vessels), density, and diameter of the vessels in renal cell carcinoma and fat-poor angiomyolipoma were evaluated. All cases (n = 12) with fat-poor angiomyolipoma were found to have intratumoral vessels and all cases (n = 36) with clear cell renal cell carcinoma were found to have peritumoral vessels. There was no significant correlation detected between the diameter of tumor and the density as well as diameter of the vessels. In conclusion, the evaluation of the vascular pattern using contrast enhancement contrast-enhanced computed tomography may provide important information that is useful in helping accurate differential diagnosis of fat-poor angiomyolipoma or renal cell carcinoma preoperatively.

Comparison of Diagnostic Value of Sonourethrography with Retrograde Urethrography in Diagnosis of Anterior Urethral Stricture.

BACKGROUND: In spite of the advanced imaging methods, MRI and CT-Scan, the role of ultrasonography is still unique in some fields of genitourinary tract diseases. AIM: This study was aimed at assessing this role in the evaluation of male urinary stricture, and comparison with standard retrograde urethrography (SUG). METHODS: This was a cross-sectional study. The patients include those who were suspected of anterior urethral stricture and were introduced assessed with imaging techniques (RUG). The patient underwent ultrasonography too. The results of both methods were compared. RUG was considered as the gold standard for this comparison. RESULT: Ninety-seven patients were studied. The mean age was 46.9 ± 11.7 years (range 21-88 years), in RUG, 22 patients (22.8%) and SUG 23 patients (23.7%) had a stricture, 3 cases with a stricture in RUG had not evidenced of stenosis in SUG. The mean length of urethral stricture in RUG was 12.9 ± 8.1 mm and in SUG was 8.1 ± 7.3 mm. The estimated length in RUG way was significantly higher than SUG way (P=0.025). The sensitivity and specificity in using of SUG were 86.6% and 94.6%, respectively. CONCLUSION: The result of this study showed stricture length measured by ultrasound is shorter than the length measured by RUG and the sensitivity and specificity in using of SUG was 86.6% and 94.6% respectively that due to the advantages it is an acceptable way.

Successful ultrasound-guided percutaneous embolization of renal pseudoaneurysm by autologous blood clot: Preliminary report of a new method.

We report the case of a 25-year-old female with renal arteriovenous fistula and pseudoaneurysm (PA) formation following renal core-needle biopsy, treated successfully by ultrasound-guided percutaneous embolization with autologous blood clot injection. After inserting a 15-gauge needle within the PA sac, 10 ml of blood was retrieved from the sac, and then reinjected into the PA as well as in the needle tract after the obtained blood completely clotted. The procedure was completed by manual compression of the flank. Follow-up sonographic examinations revealed no complication, and the PA size reduced gradually over time due to fibrotic shrinkage. © 2017 Wiley Periodicals, Inc. J Clin Ultrasound 45:592-596, 2017.

The role of ultrasound (US) and magnetic resonance imaging (MRI) in penile fracture mapping for modified surgical repair.

PURPOSE: To determine the accuracy of ultrasound (US) and magnetic resonance imaging (MRI) in the diagnosis of penile fracture and preoperative mapping for modified surgical repair. METHODS: Twenty-five consecutive patients were included in the study prospectively over 29 months (from February 2014 to June 2016). US examination and MRI were performed on all patients and interpreted by two expert radiologists independently. The location of the defect in tunica albuginea was mapped onto a designed scheme preoperatively using each imaging modality. The detection rate, as well as agreement between preoperative radiologic mapping and surgical outcomes, was determined for each modality. RESULTS: The mean age of the patients was 28 ± 7.5 years. The most common etiology was intercourse (88%). The most common location of tunica albuginea rupture was mid-shaft of the penis (60%), and the mean length of tunica defects in their greatest dimension was 13.5 ± 3.95 mm. All patients had associated hematoma, but no urethral injury was detected. The detection rate of US and MRI was 88 and 100%, respectively. US mapped the tear location correctly in 18 patients [61 out of 75 items (81%); κ = 0.66], while MRI mapped it precisely in 23 patients [73 out of 75 items (97%); κ = 0.95]. CONCLUSION: Both modalities are extremely helpful for the diagnosis of penile fracture. Considering the cost-efficiency and accessibility of ultrasonography, US is recommended as the first-line tool for both diagnosis and preoperative mapping. MRI may be used as a complementary study in the patients for whom US fails to visualize or precisely define the tunica defect.

Percutaneous ultrasound-guided renal biopsy; A comparison of axial vs. sagittal probe location.

BACKGROUND: Renal biopsy is an important method for diagnosis of renal parenchymal abnormalities. Here, we compare the effectiveness and complications of percutaneous ultrasound-guided renal biopsy using axial vs. sagittal probe locations. METHODS: In a cross-sectional survey, in 2012, patients with a nephrologist order were biopsied by a radiology resident. Renal biopsy was done on 15 patients using axial (A group) and the same number of biopsies done with sagittal probe location (S group). The two groups were compared in term of the yields and complications of each method. RESULTS: In the A group, the ratio of glomeruli gathered to the number of obtained samples was significantly higher than in the S group. Nine patients in the A group (60%) required only two samplings, whereas 66.7% in the S group required more than two attempts. Microscopic hematuria was more common in the A; conversely, gross hematuria was less common in the A group. Meagre hematomas were more frequent in the S group. When compared with hemoglobin level before biopsy, its level 24 hours after biopsy was similar within groups. CONCLUSION: Our study shows that percutaneous ultrasound-guided renal biopsy using axial probe provides better yield with fewer efforts and fewer serious complications.

Not-to-tap cystic lesions: spectrum of hydatid disease.

Hydatid disease (HD) may occur almost anywhere in the body. Despite their characteristic radiologic manifestations at times, they may enlarge and produce bizarre imaging features which make diagnosis challenging, particularly for those radiologists working in areas of low incidence. Plain radiography, ultrasonography, computed tomography, and magnetic resonance imaging may demonstrate some of the typical imaging manifestations of HD as well as its exact extension. On the other hand, particular caution is required before any kind of interventions to be done in that biopsy or aspiration of such lesions may cause devastating consequences, in particular anaphylactic shock. Hence, being familiar with various radiologic features of HD is essential in improving diagnostic accuracy and also preventing adverse reactions in these patients. The purpose of this pictorial review is to illustrate the different radiological features of HD in various organs.

Computed tomographic imaging features of sudden cardiac arrest and impending cardiogenic shock.

We intend to describe the imaging findings of sudden cardiac arrest occurring during computed tomographic (CT) examination and also of impending cardiogenic shock in 4 patients. Despite rare reports of acute cardiac arrest occurring during or shortly after CT scan, CT features are quite characteristic. Familiarity with CT findings of these patients is essential for accurate interpretation of images, immediate initiation of resuscitation, as well as informing clinical physician in these conditions.