Identification of specific SUVmax ratios enhances diagnostic accuracy for staging of intrathoracic nodes in lung cancer.

INTRODUCTION: Studies demonstrating limited accuracy of 'positive' and 'negative' lymph nodes on fluorodeoxyglucose (FDG) PET-CT in staging for lung cancer have led to guidelines stating mediastinal nodes enlarged on computed tomography, irrespective of FDG uptake, require endobronchial ultrasound (EBUS)-transbronchial needle aspiration (TBNA). However FDG uptake occurs on a continuous spectrum and the use of standardised uptake value (SUV)max ratios, rather than a binary classification, may have improved diagnostic accuracy. METHODS: This was a retrospective analysis of patients with lung cancer who had PET-CT and EBUS-TBNA in 2015-2018. Results from EBUS and the SUVmax ratio of sampled lymph nodes to mediastinal blood pool (SUVmax LN/MBP) were analysed. RESULTS: From 99 patients 102 malignant and 54 benign nodes were identified. The SUVmax range was 2.5-52 for malignant and 1.6-5.4 for benign nodes. The SUVmax LN/MBP was 1.3-23 for malignant and 0.7-2.3 for benign nodes. All nodes with SUVmax LN/MBP <1.3 were benign with 100% negative predictive value (NPV). All nodes with SUVmax LN/MBP >2.3 were malignant with 100% positive predictive value (PPV). CONCLUSION: In this relatively small sample, SUVmax LN/MBP <1.3 had a NPV of 100% for excluding malignant nodes and SUVmax LN/MBP >2.3 had a PPV of 100% for diagnosing malignant nodes. Using SUVmax ratios could obviate the need for staging EBUS in selected patients with resultant time and cost savings. Selecting different SUVmax ratios, chosen to provide high accuracies for the parameter of interest to change management, is a potentially powerful diagnostic tool that is overlooked when FDG uptake is only classified as 'positive' or 'negative'.

Long-term Graft and Patient Survival after Percutaneous Angioplasty or Arterial Stent Placement for Transplant Renal Artery Stenosis: A 21-year Matched Cohort Study.

Purpose To compare long-term graft and patient survival after percutaneous angioplasty (PTA) or stent placement for transplant renal artery stenosis (TRAS) with a control cohort without TRAS. Materials and Methods This is a retrospective matched cohort study of 41 patients (median age, 49 years; range, 18-72 years), including 27 male patients (median age, 48 years; range, 18-67 years) and 14 female patients (median age, 52 years; range, 24-68 years), with TRAS from December 1995 through 2016. Primary end points were death-censored graft and patient survival, compared by using log-rank test and Cox proportional regression. Secondary outcomes were improvement in renal function, blood pressure (BP), and complications. Results Twenty-four patients underwent PTA and 17 received stent placements. Ten-year graft survival was 92.1% (range, 83.2%-100%) versus 81.4% (range, 67.8%-95.3%) (P = .56), and 10-year patient survival was 89.9% (79.1%-100%) versus 84.7% (72.1%-97.5%) (P = .49), for the study and control groups, respectively. Five patients (12%) resumed dialysis in each group and a total of 17 patients died (eight in the study group and nine in the control group). Most patients died with a functioning graft (seven of eight in the study group and seven of nine in the control group). Posttreatment median systolic and diastolic BP improved by 12% and 7.4%, respectively, and serum creatinine improved by 27%. Normal systolic BP and serum creatinine level at 1 year after treatment were associated with better survival for patients (P = .04; hazard ratio [HR], 1.04; 95% confidence interval [CI]: 1.0, 1.075) and grafts (P < .001; HR, 1.02; 95% CI: 1.0, 1.027). Other covariates, including PTA versus renal stent placement, intra-arterial pressure gradient greater than 10%, diastolic BP, age at transplantation, sex, graft type, rejection, and delayed graft function, were not significant. Five patients (12.2%) had a complication (Society of Interventional Radiology class A, two of 41 [4.9%]; class B, two of 41 [4.9%]; and class D, one of 41 [2.4%]); 30-day graft loss and patient mortality were zero. Conclusion Long-term graft and patient survival after endovascular correction of transplant renal artery stenosis (TRAS) was similar to that without TRAS and most patients avoided returning to dialysis. © RSNA, 2018 Online supplemental material is available for this article. See also the editorial by Dickey and Durrani in this issue.

Long-term Graft and Patient Survival after Balloon Dilation of Ureteric Stenosis after Renal Transplant: A 23-year Retrospective Matched Cohort Study.

Purpose To study long-term graft and patient survival after percutaneous ureteroplasty of ureteric stenosis after renal transplantation and to compare the outcomes to those of patients who did not develop ureteric stenosis. Materials and Methods An ethical waiver was obtained for this 23-year retrospective matched cohort study of 52 of 1476 consecutive kidney transplant recipients who developed postoperative ureteric stenosis. Data were collected between January 1990 and December 2012. All patients (mean age, 47 years [range, 23-72 years]; 36 men aged 29-72 years [mean age, 49 years] and 24 women aged 23-68 years [mean age, 42 years]) underwent percutaneous ureteroplasty; recurrent stenosis was managed surgically or by means of long-term ureteric stent placement. Outcomes were compared with those of a matched control group of transplant recipients with no history of ureteric stenosis. Primary outcome measures were death-censored graft failure and all-cause mortality. Secondary outcome measures were the effect of time of stricture onset on graft survival, complications, and risk factors for recurrent stenosis. Kaplan-Meier curves were compared by using log-rank tests, with P < .05 indicative of a statistically significant difference. Results Balloon dilation was technically successful in all 52 strictures, but stenosis recurred in 10 patients and was treated with surgery (n = 5) or long-term stent placement (n = 5). The 10-year graft and patient survival were not significantly different in study versus control groups, with graft survival of 64.5% (95% confidence interval [CI]: 43.4%, 79.4%) versus 76.3% (95% CI: 58.6%, 87.2%), respectively (P = .372), and patient survival of 82.2% (95% CI: 62.9%, 92%) versus 89.9% (95% CI: 74.6%, 96.2%) (P = .632). Subgroup analysis showed that stenosis occurring less than 3 months (10-year graft survival, 59.1%), at least 3 months (10-year graft survival, 67.3%), and at least 6 months (10-year graft survival, 53.0%) after transplantation did not adversely affect graft survival compared with that of the control group (P > .05). Cold ischemia time was longer in those with recurrent stenosis than in control subjects (16.1 vs 8.4 hours, respectively; P = .034). The minor and major complication rates were 13% and 5.7%, respectively, with no 30-day graft loss and patient mortality. Conclusion Long-term graft and patient survival in patients with percutaneous ureteroplasty of transplant ureteric stenosis were not significantly worse than those in a control group. (©) RSNA, 2016.

Thirty-Day Outcomes After Percutaneous Nephrostomy of Renal Transplant Kidneys: 19-Year Experience and Comparison With Existing Practice Parameters.

OBJECTIVE: The purpose of our study was to document the technical success rate, complications, and 30-day outcome after percutaneous nephrostomy catheter insertion into renal grafts. MATERIALS AND METHODS: Radiologic and clinical databases were used to identify all adult patients who underwent renal transplantation from January 1994 through December 2012. Patients who underwent transplant percutaneous nephrostomy catheter insertion for the immediate management of ureteric obstruction or leak were identified, and the 30-day outcomes were recorded. Complications were graded using the Society of Interventional Radiology and Clavien classification systems. RESULTS: Of 1476 consecutive kidney transplants, a total of 73 nephrostomy catheters were successfully inserted into 52 patients (male, 36; age range, 24-72 years), 45 with strictures and seven with strictures with leaks. The median serum creatinine level improved from 276 µmol/L (95% CI, 229-342 µmol/L) to 195 µmol/L (95% CI, 170-223 µmol/L) 7 days after intervention (p = 0.0001). Five complications were seen within 30 days and all were related to bleeding (Society of Interventional Radiology classification: grade A, n = 2; grade B, n = 2; grade D, n = 1; and Clavien classification system: grade I, n = 4; grade IIIa, n = 1). The overall complication rate was 6.8% (5/73), and the major complication rate was 1.4% (1/73). There were no cases of bowel injury or septicemia. The 30-day graft and mortality rates were 0%. CONCLUSION: Transplant percutaneous nephrostomy catheter insertion has a high technical and clinical success rate. The 30-day graft and mortality rates were 0%, the overall complication rate was 6.8%, and the major complication rate was 1.4%.