Whitney J. Palmer has been with Diagnostic Imaging since 2011, serving as the Senior Editor since November 2019. She has 20 years experience in healthcare and academic medicine reporting.

Whitney J. Palmer

Using MRI to non-invasively capture a clear cell likelihood score (ccLS) can help providers better determine how quickly small kidney masses are growing. With this knowledge that can make better decisions about management strategies.

a team of investigators from the University of Texas Southwestern Medical Center showed that relying on MRI-derived ccLS rather than pre-operative percutaneous renal mass biopsy can effectively grade whether a mass will come back as renal cell carcinoma after evaluation.

ccLS scores are used to assess the likelihood that a small renal mass (equal to or less than 4 cm) is actually cancer with a score of 1 being unlikely and a score of 5 being very likely. The team, led by Ivan Pedrosa, M.D., Ph.D., professor of radiology and vice chair of radiology research, found that, based on their evaluations, higher ccLS scores correlate to more significant growth rates.

“The ccLS of small renal masses is significantly associated with growth. ccLS4-5 small renal masses grow more rapidly than ccLS1-2 and ccLS3 small renal masses,” the team said. “The information provided by ccLS may be beneficial in counseling patients and planning personalized management strategies.”

64-Year-Old Man With Clear Cell Likelihood Score (ccLS) 5 Renal Masses: 

Coronal T2-weighted single shot fast spin echo and coronal T1-weighted fat-saturated spoiled gradient echo acquired during corticomedullary phase—ccLS5 lesion outlined red for clarity.

Credit: American Journal of Roentgenology

This is the first study, the team said, that examines the correlation between ccLS and small renal mass growth.

For their retrospective study, the team evaluated ccLS scores derived from MRI scans conducted on 339 patients with an average age of 65 between June 2016 and November 2019. They examined tumor size measurements and tumor progression.

Axial T1-weighted gradient echo opposed-phase and in-phase images.

Overall, the team looked at 386 small renal masses. They determined that ccLS was correlated with growth rate by size – ccLS4-5 of 9 percent annually and ccLS 1-2 by 5 percent annually – as well as by volume – ccLS4-5 by 29 percent annually and ccLS1-2 by 16 percent annually.

Follow-up coronal T2-weighted single shot fast spin echo at 2.79 years. ccLS5 renal mass heterogeneously hyperintense with intense corticomedullary enhancement, presence of microscopic fat (i.e., drop in signal intensity on opposed-phase compared to in-phase), and significant interval growth (50.4%/year volume growth).

“Our study supports the conclusion of the more aggressive faster-growing nature of ccLS4-5 small renal masses. This…favors our recommendation of disease intervention in larger ccLS4-5 masses, in consideration of the patients’ clinical context and preferences,” the team said. “The results support the use of the ccLS as an ‘informational tool’ to assist with clinical decision making.”

In that vein, the team said they created an online calculator that patients and treating providers can use when making management decisions, helping them consider the likelihood of tumor growth in context with the patient’s life expectancy and co-morbidities.

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The clear cell likelihood score can help providers determine the growth rate of masses that could be cancerous.

MRI-Derived Score Helps Determine Renal Mass Growth Rate

Adding ultrasound screening to routine annual visits for older patients can potentially catch more emerging chronic conditions or other problems in nearly all cases.

In an article published this week in the 

a team of investigators from Allina Health in Minnesota showed that including ultrasound as a preventive measure in regular wellness checks can be beneficial for older individuals.

Currently, a blood pressure check is the only required physical examination under the Standard Medicare Wellness checkup, but the team, led by Terry K. Rosborough, M.D., an internal medicine specialist with Northwestern Memorial Hospital’s graduate medical education department, showed doctors could perform more assessments with little additional cost for follow-up testing. 

“One or more abnormalities were found in 94 percent of our participants, the great majority of which would have been undetected by a traditional physical exam,” the team said. “Many participants benefited from the information and harm was rare and only economic.”

For their study, the team launched a program where experienced physicians used ultrasound to screen 108 adults between ages 65 and 85 during their annual Medicare Wellness appointments. Based on these exams, providers detected 283 abnormalities and made 172 new diagnoses, resulting in 30 ordered follow-ups.

Of the results, new diagnoses of liver steatosis (19 percent of patients) and kidney cysts (10 percent of patients) were the most common abdominal findings. Among the cardiovascular outcomes, the physicians pinpointed new cases of carotid plaque (44 percent of patients), left ventricular diastolic dysfunction (14 percent of patients), and tricuspid value regurgitation (22 percent of patients) the most.

Alongside the added benefit of these new findings, most patients (76 percent) saw no added cost. The price tag for most visits ranged from $5 to $50, the team said. But, those medical bills could have been higher later down the road had these findings not been identified.

While not every patient qualifies for or needs an added ultrasound screening during their routine annual check-up, Rosborough’s team contended such a program still does provide benefit overall. Additional work is needed on how best to design and use these initiatives, though.

“The assessed benefit of these abnormalities was rarely negative and often mild to moderately positive, with important new chronic conditions identified,” the team said. “We continue to investigate how to implement an ultrasound screening exam for select patients having periodic health visits.”

Including the screening adds little extra cost and can identify emerging problems in almost all patients.

Adding Ultrasound to Routine Check-Ups Catches More Abnormalities in Older Patients

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Diagnostic Imaging's Weekly Scan: July 19, 2021, to July 23, 2021

When it comes to predicting major cardiac events, the Coronary Artery Disease Reporting and Data System (CAD-RADS) does a better job with patients who have chest pain than coronary artery calcium (CAC) scoring.

investigators from South Korea showed that the CAD-RADS system, introduced in 2016, performs well in accurately predicting these events when acute pain is present. The system has already been shown to outperform CAC scoring for more stable chest pain.

Their work shows relying on CAD-RADS can provide benefit to patients who could be facing major adverse cardiovascular events (MACE).

“The Coronary Artery Disease Reporting and Data System category had an incremental prognostic value compared with clinical risk factors and coronary artery calcium score to predict future major adverse cardiovascular events in patients with acute chest pain presenting to the emergency department,” said the team led by Ji Won Lee, M.D., Ph.D., from the Pusan National University radiology department. “Our results showed that a higher CACS, higher CAD-RADS categories, and presence of high-risk plaque are associated with future MACE risk after adjusting for clinical risk factors.”

For their study, Lee’s team assessed CCTA exams from 1,492 patients who presented to four emergency department between January 2010 and December 2017. During that time, they determined that CAD-RADS augmented risk stratification more than clinical risk factors did with or without CAC scoring. Their findings also showed that CAD-RADS and existing high-risk plaque were independent MACE predictors.

Specifically, during 31.5 months of follow-up, 103 patients (7 percent) experienced MACEs. The team’s analysis revealed that having moderate-to-severe CACS was associated with MACE after adjusting for clinical risk factors, as were CAD-RADS categories 3, 4, or 5. Ultimately, the C statistics showed that CAD-RADS risk stratification improvement was 0.85 over clinical factors alone (0.63) or in combination with CAC scoring (0.76).

, Rozemarijn Vliegenthart, M.D., Ph.D., a radiologist at the University Medical Center Gröningen in The Netherlands, said this study is the first to her knowledge that takes an in-depth look at prognostic value that CAD-RADS brings to evaluating patients with acute chest pain.

She noted that these findings underscore ongoing efforts that show the system can help radiologists better communicate CT findings to referring providers. In addition, she pointed out that the system could help with quality-of-care standardization, ultimately improving patient outcomes.

“This valuable study…gives a first glimpse, but a defining and consequential one, of the value that a standardized CCTA reporting system, including its additional CAD features, can have in patients with acute chest pain,” she said. “CAD-RADS helps to standardize quality of care and, moreover, may improve the outcome in patients with acute chest pain across emergency departments. Although it may still be, as to be expected in such a study, a preliminary expectation, in my opinion, it is a big step in the right direction.”

System does a better job of indicating which patients with acute chest pain could experience adverse outcomes. 

Whitney J. Palmer

Articles

MRI-Derived Score Helps Determine Renal Mass Growth Rate

Adding Ultrasound to Routine Check-Ups Catches More Abnormalities in Older Patients

Diagnostic Imaging's Weekly Scan: July 19, 2021, to July 23, 2021

CAD-RADS Outperforms CAC Scoring in Predicting Major Cardiovascular Events