RESUMO
PURPOSE: We aimed to assess the diagnostic accuracy of the clear cell likelihood score (ccLS) and value of other selected magnetic resonance imaging (MRI) features in the characterization of indeterminate small renal masses (SRMs). METHODS: Fifty patients with indeterminate SRMs discovered on MRI between 2012 and 2023 were included. The ccLS for the characterization of clear cell renal cell carcinoma (ccRCC) was calculated and compared to the final diagnosis (ccRCC vs. 'all other' masses). RESULTS: The ccLS = 5 had a satisfactory accuracy of 64.0% and a very high specificity of 96.3%; however, its sensitivity of 26.1% was relatively low. Receiver operating curve (ROC) analysis revealed that from the selected MRI features, only T1 ratio and arterial to delayed enhancement (ADER) were good discriminators between ccRCC and other types of renal masses (area under curve, AUC = 0.707, p = 0.01; AUC = 0.673, p = 0.03; respectively). The cut-off points determined in ROC analysis using the Youden index were 0.73 (p = 0.01) for T1 ratio and 0.99 for ADER (p = 0.03). The logistic regression model demonstrated that ccLS = 5 and T1 ratio (OR = 15.5 [1.1-218.72], p = 0.04; OR = 0.002 [0.00-0.81], p = 0.04) were significant predictors of ccRCC. CONCLUSIONS: The ccLS algorithm offers an encouraging method for the standardization of imaging protocols to aid in the diagnosis and management of SRMs in daily clinical practice by enhancing detectability of ccRCC and reducing the number of unnecessary invasive procedures for benign or indolent lesions. However, its diagnostic performance needs multi-center large cohort studies to validate it before it can be incorporated as a diagnostic algorithm and will guide future iterations of clinical guidelines. The retrospective nature of our study and small patient population confined to a single clinical center may impact the generalizability of the results; thus, future studies are required to define whether employment of the T1 ratio or ADER parameter may strengthen the diagnostic accuracy of ccRCC diagnosis.
RESUMO
OBJECTIVE: Diet plays a key role in the management of chronic kidney disease. The aim of our study was to evaluate the usage of a self-developed mobile application supporting proper dietary choices among maintenance hemodialysis (HD) patients. METHODS: The primary functions of the application are to provide databases of products and recipes. Data on user activity recorded using Internet solutions were collected for 12 months from April 2021. The application was promoted both via the Internet and directly to patients. Additionally, a questionnaire was employed to evaluate the usage of the software. RESULTS: The application was downloaded by 841 smartphone users, 44.4% of whom were from 2 regions of Poland with the largest populations of HD patients. Residents of cities with a population above 250,000 accounted for 86.0% of users. Sixty HD patients (32 males, 28 females; age 56.2 ± 14.8 years) filled the questionnaire. All features of the application scored a median of 4.0 points or higher on a 5-point Likert scale; however, 63.3% of respondents indicated the need to improve particular functions of the application. There was a significant difference in dialysis vintage between respondents who used the application for less than 1 month and others (1.0 vs. 3.3 years; P = .02). The positive perception of its influence on diet adherence was significantly higher among younger (<50 years) compared to older users (5.0 vs. 4.0; P = .03) and among women compared to men (5.0 vs. 4.0; P = .01). CONCLUSION: HD patients showed interest in dietary mobile applications, and Internet channels were effective in promoting the software. Place of residency, age, gender, and dialysis vintage are factors that influence patient satisfaction with and the time of using the mobile application.
