Improving Accuracy, Reliability, and Efficiency of the RENAL Nephrometry Score With 3D Reconstructed Virtual Imaging

• Published in: Urology (Ridgewood, N.J.) N.J.), 2022-06, Vol.164, p.286-292
• Main Authors: Yoshitomi, Kasumi Kaneko, Komai, Yoshinobu, Yamamoto, Tatsuya, Fukagawa, Eri, Hamada, Kosuke, Yoneoka, Yusuke, Fujiwara, Motohiro, Fujiwara, Ryo, Oguchi, Tomohiko, Numao, Noboru, Yuasa, Takeshi, Yamamoto, Shinya, Fukui, Iwao, Yonese, Junji
• Format: Article
• Language: English
• ISSN: 0090-4295; 1527-9995
• DOI: 10.1016/j.urology.2022.01.024

To clarify the diagnostic performance of the three-dimensional reconstructed virtual image (3D-RVI) in evaluating RENAL nephrometry score (RENAL-NS). This study included 130 patients who underwent preoperative contrast-enhanced computed tomography followed by partial nephrectomy for renal tumors suggestive of renal cell carcinoma. RENAL-NS was calculated prior to the surgery, and tumor resection was performed referring to the score. We retrospectively reviewed preoperative contrast-enhanced computed tomography images. We calculated the inter-observer variability of RENAL-NS using 3D-RVI vs two-dimensional (2D) imaging and compared the ability of RENAL-NS using 3D-RVI vs 2D imaging to predict the risk of opening of the urinary collecting system. We also compared the two modalities for the time required to evaluate RENAL-NS. RENAL-NS evaluated using 3D-RVI showed a higher inter-observer agreement compared to 2D-imaging (rs = 0.85 vs rs = 0.65). The “nearness to sinus” score was more strongly associated with the opening of the urinary collecting system when evaluated using 3D-RVI than 2D-imaging (AUC = 0.71 vs AUC = 0.57, P = .016). RENAL-NS using 2D-imaging required a significantly longer time compared to 3D-RVI (P = .036). Using 3D-RVI improves the accuracy, reliability and efficiency of RENAL-NS evaluation in preoperative assessment and can play an important role in preoperative assessment and intraoperative navigation.