Nicolas Grenier

Background/Objectives: MRI-guided focal laser ablation (MRI-FLA) is an emerging minimally invasive technique for treating localized prostate tumors, aiming to provide effective cancer control while minimizing side effects. This meta-analysis systematically evaluates the clinical outcomes, technical efficacy, and complication rates associated with MRI-FLA to better understand its therapeutic potential and safety profile in prostate cancer management. Methods: In July 2024, PubMed (MEDLINE) was searched for eligible trials using the PRISMA guidelines. The primary outcome was residual disease (RD). The secondary outcomes were technical efficacy, progression to metastatic disease, cancer-specific mortality, complications, and decreases in the prostate-specific antigen (PSA) level. Results: Nine clinical trials involving 296 patients with prostate tumors treated via MRI-FLA were analyzed. A random effects model showed that the overall RD prevalence after ablation was 20.37% (12.56–29.28%; p = 0.03) and the cancer-free survival rate was 75.62% (64.88–85.10%). The rate of major and minor adverse effects was 14.26% (0.61–37.3%, p < 0.01). Conclusions: MRI-FLA is safe, feasible, and effective, although further trials are required.

Our aim was to investigate which features were associated with clinical successes at short- and mid-terms following prostate artery embolization (PAE) for symptomatic benign prostate hypertrophy (BPH). All adults treated by PAE for BPH at our referral center between January 2017 and March 2021, with pre-treatment MRI, technical success, and follow-up at 3 months and 2 years were included in this single-center retrospective study. Radiologists reviewed the prostatic protrusion index (PPI), adenomatous dominant BPH (adBPH), and Wasserman classification on pre-treatment MRI. Radiomics analysis was achieved on the transitional zone on pre-treatment T2-weighted imaging (WI) and ADC, and comprised reproducibility assessment, unsupervised classifications, and supervised radiomics scores obtained with cross-validated Elasticnet regressions. Eighty-eight patients were included (median age: 65 years), with 81.8% clinical successes at 3 months and 60.2% at 2 years. No feature was associated with success at 3 months, except the radiomics score trained on T2-WI and ADC (AUROC = 0.694). Regarding success at 2 years, no radiomics approaches provided significant performances; however, Wasserman type-1 and change in international prostate symptom score (IPSS) at 3 months ≤ −35% were associated with success in multivariable analysis (OR = 5.82, p = 0.0296, and OR = 9.04, p = 0.0002). Thus, while radiomics provided limited interest, Wasserman classification and early IPSS changes appeared predictive of mid-term outcomes.

Purpose: The aim of this study was to ascertain whether radiomics data can assist in differentiating small (<4 cm) clear cell renal cell carcinomas (ccRCCs) from small oncocytomas using T2-weighted magnetic resonance imaging (MRI). Material and Methods: This retrospective study incorporated 48 tumors, 28 of which were ccRCCs and 20 were oncocytomas. All tumors were less than 4 cm in size and had undergone pre-biopsy or pre-surgery MRI. Following image pre-processing, 102 radiomics features were evaluated. A univariate analysis was performed using the Wilcoxon rank-sum test with Bonferroni correction. We compared multiple radiomics pipelines of normalization, feature selection, and machine learning (ML) algorithms, including random forest (RF), logistic regression (LR), AdaBoost, K-nearest neighbor, and support vector machine, using a supervised ML approach. Results: No statistically significant features were identified via the univariate analysis with Bonferroni correction. The most effective algorithm was identified using a pipeline incorporating standard normalization, RF-based feature selection, and LR, which achieved an area under the curve (AUC) of 83%, accuracy of 73%, sensitivity of 79%, and specificity of 65%. Subsequently, the most significant features were identified from this algorithm, and two groups of uncorrelated features were established based on Pearson correlation scores. Using these features, an algorithm was established after a pipeline of standard normalization and LR, achieving an AUC of 90%, an accuracy of 77%, sensitivity of 83%, and specificity of 69% for distinguishing ccRCCs from oncocytomas. Conclusions: Radiomics analysis based on T2-weighted MRI can aid in distinguishing small ccRCCs from small oncocytomas. However, it is not superior to standard multiparameter renal MRI and does not yet allow us to dispense with percutaneous biopsy.

Background: Differentiating benign from malignant renal tumors is important for patient management, and it may be improved by quantitative CT features analysis including radiomic. Purpose: This study aimed to compare performances of machine learning models using bio-clinical, conventional radiologic and 3D-radiomic features for the differentiation of benign and malignant solid renal tumors using pre-operative multiphasic contrast-enhanced CT examinations. Materials and methods: A unicentric retrospective analysis of prospectively acquired data from a national kidney cancer database was conducted between January 2016 and December 2020. Histologic findings were obtained by robotic-assisted partial nephrectomy. Lesion images were semi-automatically segmented, allowing for a 3D-radiomic features extraction in the nephrographic phase. Conventional radiologic parameters such as shape, content and enhancement were combined in the analysis. Biological and clinical features were obtained from the national database. Eight machine learning (ML) models were trained and validated using a ten-fold cross-validation. Predictive performances were evaluated comparing sensitivity, specificity, accuracy and AUC. Results: A total of 122 patients with 132 renal lesions, including 111 renal cell carcinomas (RCCs) (111/132, 84%) and 21 benign tumors (21/132, 16%), were evaluated (58 +/− 14 years, men 74%). Unilaterality (100/111, 90% vs. 13/21, 62%; p = 0.02), necrosis (81/111, 73% vs. 8/21, 38%; p = 0.02), lower values of tumor/cortex ratio at portal time (0.61 vs. 0.74, p = 0.01) and higher variation of tumor/cortex ratio between arterial and portal times (0.22 vs. 0.05, p = 0.008) were associated with malignancy. A total of 35 radiomics features were selected, and “intensity mean value” was associated with RCCs in multivariate analysis (OR = 0.99). After ten-fold cross-validation, a C5.0Tree model was retained for its predictive performances, yielding a sensitivity of 95%, specificity of 42%, accuracy of 87% and AUC of 0.74. Conclusion: Our machine learning-based model combining clinical, radiologic and radiomics features from multiphasic contrast-enhanced CT scans may help differentiate benign from malignant solid renal tumors.

Objectives: To evaluate indirect criteria of pelvic venous insufficiency (PVI) of a short tau inversion recovery (STIR) sequence retrospectively compared with phlebographic findings. Methods: Between 2008 and 2018, 164 women who had received MRI and phlebography for pelvic congestion syndrome (60), varicose veins in the lower limbs (45), both (43), or other symptoms (16) were included. The presence of periuterine varicosities and perivaginal varicosities were compared to the findings of phlebography: grading of left ovarian vein reflux and presence of internal pudendal or obturator leak. Results: There was a correlation between the grading of LOV reflux on phlebography and the diameter of periuterine varicosities on STIR sequence (p = 0.008, rho = 0.206, CIrho [0.0549 to 0.349]). Periuterine varicosities had a positive predictive value of 93% for left ovarian reflux (95% CI [88.84% to 95.50%]). Obturator or internal pudendal leaks were found for 118 women (72%) and iliac insufficiency for 120 women (73%). Conclusions: Non-injected MRI offers a satisfactory exploration of PVI with STIR sequence. STIR sequences alone enabled the detection of left ovarian and iliac insufficiency.

Purpose: We investigated the long-term safety and efficacy of hepatic transarterial embolization (TAE) in patients with symptomatic polycystic liver disease (PLD). Materials and Methods: A total of 26 patients were included, mean age of 52.3 years (range: 33–78 years), undergoing 32 TAE procedures between January 2012 and December 2019 were included in this retrospective study. Distal embolization of the segmental hepatic artery was performed with 300–500 µm embolic microspheres associated with proximal embolization using microcoils. The primary endpoint was clinical efficacy, defined by an improvement in health-related quality of life using a modified Short Form-36 Health Survey and improvement in symptoms (digestive or respiratory symptoms and chronic abdominal pain), without invasive therapy during the follow-up period. Secondary endpoints were a decrease in total liver volume and treated liver volume and complications. Results: Hepatic embolization was performed successfully in 30 of 32 procedures with no major adverse events. Clinical efficacy was 73% (19/26). The mean reduction in hepatic volume was −12.6% at 3 months and −27.8% at the last follow-up 51 ± 15.2 months after TAE (range: 30–81 months; both ps < 0.01). The mean visual analog scale pain score was 5.4 ± 2.8 before TAE and decreased to 2.7 ± 1.9 after treatment. Three patients had minor adverse events, and one patient had an adverse event of moderate severity. Conclusion: Hepatic embolization using microspheres and microcoils is a safe and effective treatment for PLD that improves symptoms and reduces the volume of hepatic cysts.

Pelvic venous pathologies in females are responsible for chronic symptoms grouped under the term pelvic congestion syndrome, which includes chronic pelvic pain, perineal heaviness, urgency, and postcoital pain, along with vulvar, perineal, and lower limb varicose veins. These conditions are also associated with ovarian and pelvic venous reflux and venous obstruction. This review aimed to explore the clinical and imaging modalities for diagnosing pelvic congestion syndrome, pelvic venous pathologies, their therapeutic management, and their outcomes.

Our goal was to evaluate the feasibility, safety, and short-term outcomes of prostate artery embolization (PAE) with N-butyl cyanoacrylate (NBCA) glue as the only embolic agent in patients with benign prostatic hyperplasia (BPH)-related lower urinary tract symptoms (LUTSs). A two-center retrospective study of 50 patients (mean age, 67.6 ± 7.4 years; range, 54–85 years) treated with NBCA between 2017 and 2020 was conducted. PAE was performed using a mixture of Glubran 2 glue and Lipiodol in a 1:8 ratio, under local anesthesia, on an outpatient basis, after cone-beam computed tomography vascular mapping. Mean total injected NBCA/Lipiodol volume was 0.9 ± 0.3 mL, total injection time was 21.9 ± 7.8 s, and total radiation dose was 18,458 ± 16,397 mGy·cm. Statistically significant improvements over time occurred for the International Prostate Symptoms Score (9.9 ± 6.8 versus 20.5 ± 6.7, p = 0.0001), quality-of-life score (2.2 ± 1.5 versus 4.9 ± 1.0, p = 0.0001), prostate-specific antigen level (4.6 ± 3.0 versus 6.4 ± 3.7, p = 0.0001), and prostate volume (77.3 ± 30.5 versus 98.3 ± 40.2, p = 0.0001) at a median of 3 months versus baseline. Minor adverse events developed in 11/50 (22%) patients, but no major complications occurred. The International Index of Erectile Function did not change significantly. PAE with NBCA is feasible, safe, fast, and effective for patients with BPH-related LUTSs. Prospective comparative studies with longer follow-ups are warranted.

Introduction Although living kidney donation is not a high-risk surgery, there is still a need to identify situations at risk of kidney disease after uninephrectomy. Estrogens exhibit a protective role against various nephropathies. The aim of this study was to assess renal adaptation following nephrectomy according to menopausal status in women. Methods A prospective bicentric study including living women donors measured glomerular filtration rate (GFR) (inulin or ⁵¹⁻Cr-EDTA clearances) and kidney volume (using CT-scan and 3-dimensional reconstruction), before and after 1-year post-uninephrectomy. Renal adaptation was compared according to menopausal status. Results Sixteen non-menopausal women and 18 menopausal women were included. One year following uninephrectomy, the mean decrease in GFR (global population) was − 32 ± 12 ml/min/1.73 m², and the mean increase in remnant kidney volume was + 32 ± 13 cm³/1.73 m². No significant difference was observed between the two groups for both the decrease in GFR (-32.9 ± 13.3 in non-menopausal vs − 31.5 ± 9.9 in menopausal, ml/min/1.73 m², p = 0.84), and the increase in kidney volume (+ 36.1 ± 13.4 in non-menopausal vs + 28.1 ± 12.5 in menopausal, cm³/1.73 m², p = 0.09). Discussion Menopausal status did not influence kidney adaptation following uninephrectomy, and in this respect is not a potential limiting factor for living kidney donation. Graphic abstract