Research Presentation Session: Genitourinary

RPS 2207 - Non-oncological genitourinary diseases

March 3, 08:00 - 09:00 CET

7 min
Revolutionising the diagnosis of congenital cervical malformations: a novel magnetic resonance imaging-based classification for streamlined standardised assessment
Zhilin Yuan, Beijing / China
Author Block: Z. Yuan, Y-L. He, Y. Li, J. Ren, M. Huang, X. Liu, C. Wang, Z. Y. Jin, H-D. Xue; Beijing/CN
Purpose: The aim of this study was to develop an innovative MRI-Based classification method to optimise standardised diagnosis of congenital cervical malformations (CCMs) and summarise their unique MRI Features.
Methods or Background: A total of 79 consecutive patients with CCMs, pre-treatment pelvic MRI scans were conducted and subsequently reviewed by three experienced gynaecological radiologists. Various characteristics, such as signal patterns, morphological classifications, and other relevant factors, were meticulously documented. Furthermore, any accompanying abnormalities were noted for subsequent analysis.
Results or Findings: Morphologically, CCMs can be categorised into three types as follows: Type I (42,53%), characterised by the presence of a cervix with visible cervical canals; Type II (18,23%), featuring an existing cervix with concealed cervical canals; and Type III (19,24%), indicating cervical aplasia, which involves a blind end in the lower part of the uterine corpus. Haematometra was significantly more prevalent in Type I compared to Type II patients (p<0.001), and Type I patients exhibited a significantly longer mean sagittal length than Type II patients (p<0.001). Cervical detection had three signal patterns: no signal (27%), no-evident layer differentiation (21%), and multiple-evident layer differentiation with haematocele (52%). Most patients (94%) had complete vaginal atresia.
Conclusion: The MRI-based classification system proposed for CCMs, along with the highlighted key MRI features, demonstrates substantial potential to improve the effectiveness of clinical diagnoses for individuals with CCMs.
Limitations: The current study has some inherent limitations. Firstly, it was a retrospective observational study conducted at a single centre, which may have introduced certain sampling biases. Second, the number of enrolled patients was relatively small. Given the rarity of CCMs, collecting larger datasets from multiple centres would be advantageous for the continued improvement of this classification system.
Funding for this study: This work was supported by grants from National High Level Hospital Clinical Research Funding (grant No. 2022-PUMCH-A-004) and Natural Science Foundation of China (grant No. 82271886)
Has your study been approved by an ethics committee? Yes
Ethics committee - additional information: Ethical approval for this study was obtained from the Institutional Review Board.
7 min
Correlation between total fibrotic kidney volume and parasympathetic activity in autosomal‐dominant polycystic kidney disease patients: a pilot study
Antonella Borrelli, Rome / Italy
Author Block: A. Borrelli, L. Laschena, S. Lucciola, A. Dehghanpour, C. Catalano, V. Panebianco; Rome/IT
Purpose: In patients with autosomal-dominant polycystic kidney disease (ADPKD) cystic enlargement may cause parenchymal hypoxia, renin secretion, and endothelial dysfunction, causing hyperactivation of renin–angiotensin system and early hypertension, affecting blood pressure circadian rhythm. Aim of this study is to evaluate renal damage progression, indicated by MRI-based parameter, in ADPKD patients, correlating with sympathetic/parasympathetic balance using heart rate variability (HRV) parameters.
Methods or Background: Sixteen adult ADPKD patients were enrolled, undergoing MRI with three Tesla scanner, to evaluate especially total kidney volume (TKV) and total fibrotic volume (TFV). A post-processed slice-by-slice renal segmentation, with colorimetric maps was obtained. A software was used for three-dimensional volume rendering reconstruction, which resulted in semiquantitative estimation of parenchymal perfused tissue and fibrotic areas, giving indication of functional parenchymal areas. These data were correlated with HRV parameters, calculated using 24 h-ECG Holter (low frequency, LF, and high frequency, HF).
Results or Findings: A statistically significant positive linear correlation was observed between length of kidneys and LF (r = 0.595, p < 0.05), and LF-day (r = 0.587, p < 0.05). Moreover, a statistically significant positive linear correlation exists between HF and TFV (r = 0.804, p < 0.01) and height- adjusted (ha) TFV (r = 0.801, p < 0.01). Finally, we found a statistically significant positive linear correlation between HFnight and TKV (r = 0.608, p < 0.05), ha-TKV (r = 0.685, p < 0.01), TFV (r = 0.594, p < 0.05) and ha-TFV (r = 0.615, p < 0.05).
Conclusion: The increase in TKV and TFV could lead to parasympathetic tone hyperactivation, probably in response to hypoxic stress and vasoconstriction due to cystic enlargement.
Limitations: Limited sample size: however, ADPKD represents a rare disease, therefore the sample may be considered representative
Funding for this study: No funding was available for this study.
Has your study been approved by an ethics committee? Yes
Ethics committee - additional information: Ethical approval for this study was obtained from the Institutional Ehtics committee.
7 min
MRI of pelvic endometriosis: evaluation of the mr#Enzian classification and the importance of adenomyosis subtypes
Antonia-Maria Pausch, Zurich / Switzerland
Author Block: A-M. Pausch, V. Filleböck, M. Benli, I. Witzel, A. M. Hötker; Zurich/CH
Purpose: This study aimed to investigate the utility of the #Enzian classification in magnetic resonance imaging (MRI) for endometriosis assessment, focusing on inter-reader agreement, diagnostic accuracy, and the correlation of adenomyosis with deep infiltrating endometriosis (DIE).
Methods or Background: This IRB-approved retrospective single-centre study included 412 women who underwent MRI evaluation for endometriosis between February 2017 and June 2022. Two experienced radiologists independently analysed MRI images using the #Enzian classification and assessed the type of adenomyosis, if any. The surgical #Enzian classification served as the gold standard for evaluating preoperative MRI results. Statistical analysis was performed to assess inter-reader agreement and diagnostic accuracy.
Results or Findings: Inter-reader agreement was substantial to excellent (Cohen’s kappa 0.75 – 0.96) for most compartments except peritoneal involvement (0.39). The preoperative MRI showed mostly substantial to excellent accuracy (0.84 – 0.98), sensitivity (0.62 – 1.00), specificity (0.87 – 1.00), positive (0.58 – 1.00) and negative predictive values (0.86 – 1.00) for most compartments, except for peritoneal lesions (0.36, 0.17, 1.00, 1.00, 0.26 respectively). A trend with a higher prevalence of concordant DIE in women with external compared to those with internal adenomyosis was visible (p = 0.067).
Conclusion: The mr#Enzian showed mostly high inter-reader agreement and diagnostic accuracy for various endometriosis compartments. MRI's role is particularly significant in the context of the current paradigm shift towards medical endometriosis treatment. The inclusion of information about the type of adenomyosis in the mr#Enzian classification could enhance diagnostic accuracy and inform treatment planning.
Limitations: The study may have selection bias due to the highly subspecialised gynaecology department as referral source, moreover, the use of laparoscopy with histological confirmation as the gold standard, despite its known limitations, could introduce further bias.
Funding for this study: No funding was obtained for this study.
Has your study been approved by an ethics committee? Yes
Ethics committee - additional information: Cantonal Ethics Committee Zurich gave the ethical approval for this study.
7 min
The hidden connections: the relationship between endometrioma size, adenomyosis and deep infiltrating endometriosis
Hande Özen Atalay, Istanbul / Turkey
Author Block: H. Özen Atalay, M. S. Sogut, U. Kalkan, A. Durur Karakaya; Istanbul/TR
Purpose: The purpose of this study was to evaluate the association between endometrioma size, the presence of adenomyosis, and deep-infiltrating endometriosis.
Methods or Background: The present retrospective study was performed at a single center, involving a total of 118 patients who were diagnosed with endometrioma. The longest diameter of the biggest endometrioma, the presence of adenomyosis, and the presence of deep-infiltrating endometriosis were evaluated in the pelvic MRI by two radiologists with consensus. The Kruskal-Wallis test, Pearson correlation coefficient and Fisher's exact test were used to calculate the correlation coefficient, and to detect possible relationships.
Results or Findings: Seventy-one patients have deep-infiltrating endometriosis, and thirty-one patients have adenomyosis, in total of 118 patients with endometrioma. The mean diameter of the endometriomas was 40.79±18.9 mm. The mean diameter of the endometrioma did not have a statistically significant effect on the presence of adenomyosis or deep-infiltrating endometriosis (p=0.812). There were weak correlations between the mean diameter of the endometrioma and the presence of adenomyosis and DIE (r=0.028 and r=0.060, p>0.05 respectively). However, there was a significant association between the presence of adenomyosis and deep-infiltrating endometriosis (p=0.001). The Pearson’s r correlation test yielded a moderately positive correlation (r=0.301, p=0.001).
Conclusion: This study indicates that endometrioma size is not significantly correlated with the presence of adenomyosis or deep-infiltrating endometriosis. However, a significant association exists between the presence of adenomyosis and deep-infiltrating endometriosis. These findings suggest that while endometrioma size may not be a predictive factor, the co-occurrence of adenomyosis and deep-infiltrating endometriosis should be considered in clinical evaluations.
Limitations: This retrospective study included a limited number of patients from a single institution.
Funding for this study: No funding was obtained for this study.
Has your study been approved by an ethics committee? Yes
Ethics committee - additional information: Koc University Biomedical Research Ethics Committee, Istanbul/Turkey ethically approved this study.
7 min
Photon-counting detector CT for kidney stone detection in contrast-enhanced urography: a comparison between virtual non-contrast and virtual non-iodine reconstructions in a 3D printed kidney phantom
Andre Euler, Baden / Switzerland
Author Block: P. S. Breiding1, M. Turrion2, K. Martini2, D. N. Nakhostin2, H. Alkadhi2, A. Euler3; 1Bern/CH, 2Zurich/CH, 3Baden/CH
Purpose: The aim of this study was to compare contrast media subtraction, kidney stone visibility and subjective image quality between a novel virtual non-iodine reconstruction algorithm (VNI; PureCalcium) and a virtual non-contrast (VNC) algorithm on photon-counting detector CT (PCD-CT).
Methods or Background: Calcium oxalate and uric acid stones were placed into contrast-filled calyces of a 3D printed kidney phantom and imaged on PCD-CT. Two blinded readers assessed quality of PC and VNC images using a five-point visual scale. The readers were asked to rate contrast media subtraction and erroneous kidney stone subtraction in each cylinder using a three-point visual scale.
Results or Findings: Overall image quality was rated higher for VNI images compared to VNC images by one reader (4.9 vs. 4.0; p < 0.05). Inter-reader agreement for how well contrast was subtracted was substantial for both VNC and PC images (Krippendorff's alpha = 0.628 and 0.731). Incomplete contrast subtraction was observed more frequently for VNI images compared to VNC images by one reader (29% vs. 15%; p < 0.05). Inter-reader agreement for kidney stone subtraction was substantial for both VNC and PC images (Krippendorff's alpha = 0.748 and 0.668). Kidney stones were subtracted more frequently with VNI compared to VNC (Reader 1: 22% vs. 16%; Reader 2: 25% vs. 10%; p < 0.05). Smaller stones were subtracted more frequently than larger stones irrespective of reconstruction method for both readers (p < 0.05).
Conclusion: Overall subjective image quality was higher for VNI images compared to VNC images. Incomplete contrast subtraction and subtraction of kidney stones was more frequent for VNI images.
Limitations: The phantom model may be prone to artifacts and does not reflect true tissue heterogenicitiy or dynamic tissue properties. We only used two keV levels to reconstruct the monoenergetic PC images.
Funding for this study: No funding was obtained for this study.
Has your study been approved by an ethics committee? Yes
Ethics committee - additional information: This study was ethically approved the Ethics committee - University of Zürich.
7 min
Quantitative measurement of renal artery spin labelling imaging: a non-invasive index to evaluate perfusion in patients with renal artery stenosis
Xiaoxiao Zhang, Beijing / China
Author Block: X. Zhang, G. Zhang, L. Xu, X. Bai, J. Zhang, L. Chen, H. Sun, Z. Jin; Beijing/CN
Purpose: The objective of this study was to evaluate the effect of interventional therapy on renal blood flow (RBF) in renal artery stenosis (RAS) patients and to explore the correlation between RBF and kidney glomerular filtration rate (GFR).
Methods or Background: Eleven RAS patients underwent preoperative arterial spin labeling mapping (ASL) exam and interventional therapy were enrolled, and seven patients underwent postoperative ASL examination. We analysed 22 renal arteries and kidneys as independent subjects, dividing them into no renal artery stenosis, mild renal artery stenosis (≤75%), and severe renal artery stenosis (>75%) groups based on the degree of luminal stenosis. We evaluated the correlation between preoperative cortical RBF and preoperative single kidney GFR, and differences between preoperative and postoperative RBF were compared.
Results or Findings: All RAS patients experienced a decrease in systolic and diastolic blood pressure post-interventional therapy. The RBF without renal artery stenosis was higher than that in the renal artery stenosis group (273.68 ±62.77 vs 172.05±62.44), and the RBF in the mild renal artery stenosis group was higher than that in the severe renal artery stenosis group (187.33±49.66 vs 156.77±75.21). A positive correlation was found between preoperative cortical RBF and preoperative single kidney GFR, with no significant correlation between preoperative cortical RBF and preoperative estimated GFR. The renal cortical RBF was higher than preoperative RBF (203.19±51.42 vs.164.00±68.10). The postoperative RBF in the region of abnormal perfusion was also higher than the preoperative RBF (159.92±46.10 vs. 108.55±39.57).
Conclusion: Renal RBF obtained by ASL images was significantly correlated with single renal function and could be used to evaluate the perfusion improvement in RAS patients after interventional therapy.
Limitations: The main limitations of this study are that the sample size is too small and that some patients did not undergo postoperative review.
Funding for this study: No funding was obtained for this study.
Has your study been approved by an ethics committee? Yes
Ethics committee - additional information: Ethical approval was sought from the Institutional Review Board of Peking Union Medical College Hospital.
7 min
Follow-up in acute pyelonephritis (PNA) using DWI sequences in MRI: our experience
Giuseppe Di Guardia, Verduno / Italy
Author Block: G. Di Guardia, P. Lasciarrea, F. Testa, V. Verna, S. Rubiolo, X. Kaci, F. Lucio, A. Cappelletti; Verduno/IT
Purpose: Several studies have highlighted the role of MRI and diffusion-weighted sequences (MRI-DW) in the diagnosis of PNA and its impact regarding the planning of an adequate therapeutic strategy by nephrologists.
The aim of our study is to evaluate the changes in signal alteration in diffusion-weighted sequences (DWI) and ADC values in patients (pts) with PNA, by comparison with the mean ADC value (ADCm) of both the pathological kidney and the contralateral, in acute and during follow-up.
Methods or Background: From June 2016 to February 2020, 101 patients were studied (10 males, 91 females, average age 40 years, minimum age 18 years, maximum age 68 years) with clinical-laboratory diagnosis of PNA. 26/101 patients were evaluated retrospectively by evaluating the DWI sequences, demarcating circular regions of interest (ROI) on the areas of impaired signal and comparing them both with the ADCm value of the ipsilateral healthy renal parenchyma, and with the contralateral, obtaining an ADC ratio ( ADCr).
Results or Findings: In the acute phase (t0), 94 outbreaks of PNA were identified, with ADCm 1.26 ± 0.17 x 10-3 mm2 / s, ADCr0 = 0.64 ± 0.08. At follow-up after therapy (mean follow-up time 36.4 ± 11.7 days) we observed clinical-laboratory resolution in all patients, but only 39/94 foci demonstrated complete resolution on MRI (41%) in agreement with the data in the literature.
Conclusion: RM-DW allows a valid monitoring of PNA outbreaks, also identifying the different degrees of evolution. For the calculation of the ADCr we did not detect statistically significant changes using the free parenchyma of the pathological kidney compared to the contralateral kidney.
Limitations: No limitations have been identified for this study.
Funding for this study: No funds were sought for this study.
Has your study been approved by an ethics committee? Not applicable
Ethics committee - additional information: No ethics committee approval was required.
7 min
Reliable volume measurements in polycystic kidneys: a comparison between 3D volumetry and Mayo clinic’s kidney volume calculator based on the ellipsoid equation
Claudia Gerlotti Slusnys, Madrid / Spain
Author Block: C. Gerlotti Slusnys1, M. Paniagua González1, D. D´Elia Torrence2, P. López Gómez1, M. Camarena Gea1, M. Poida1, A. Garcia Perez1, C. Calles Blanco1, J. Amorim Sortino1; 1Madrid/ES, 2Logroño/ES
Purpose: This study focuses on the precise determination of total kidney volume (TKV) in individuals with polycystic kidney disease (PKD). Accurate TKV measurement is important for predicting renal functional decline and assessing Tolvaptan treatment candidates. The widely used Mayo clinic ellipsoid equation is simpler but tends to underestimate TKV. We aim to assess its accuracy compared to the more precise 3D volumetry method.
Methods or Background: We retrospectively studied 15 PKD patients (30 kidneys) who had CT scans from 2019 to 2023. TKV was calculated using the Mayo Clinic method (MCM) and 3D volumetry method (3DM) with manual segmentation. In this study, a predetermined threshold was set, deeming a difference of less than 10 percent between the two volumes as clinically not relevant according to expert nephrologists. The paired Student’s T-test, dispersion, and Pearson’s correlation analysis were employed for hypothesis testing.
Results or Findings: The paired Student’s T-test revealed a statistically significant difference between the means of both methods, with an 8.55% variation. Dispersion analysis showed a range from -140 cc to +286 cc. Pearson’s correlation analysis demonstrated a strong linear correlation, enabling the creation of a formula to predict 3DM volumetric values based on MCM calculations.
Conclusion: Our study, consistent with existing literature, found that the statistical difference between methods is below 10%. Although 3DM is more precise, MCM remains a simpler and practical TKV calculation option. The linear correlation allows us to predict 3DM values based on MCM results. In conclusion, both tests are functional, and we introduce a tool that could potentially reduce the need for 3D reconstruction.
Limitations: No limitations were identified.
Funding for this study: No funding was received for this study.
Has your study been approved by an ethics committee? Not applicable
Ethics committee - additional information: Not applicable

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