Three-dimensional imaging and displayof renal tumors using spiral CT a potential aid to partial nephrectomy (original) (raw)
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Radiologic evaluation in planning surgery of renal tumors
Abdominal Imaging, 2004
The evolution in diagnostic imaging modalities, mainly in computed tomography (CT) and magnetic resonance imaging (MRI), have made it possible to extend the applications of these techniques from diagnosis to staging and surgical planning. Nowadays, the possibility to present images on different planes with an intrinsic resolution close to that of the original axial sections allows presentation of the kidney on sagittal, coronal, and oblique planes. Three-dimensional reconstructions can be obtained with different methods and have attained excellent image quality. Multidetector spiral CT presently is the best technique for planning surgery, but MRI also enables high-quality images to be obtained if state-of-the-art equipment is available. This update reviews the current status and possibilities of diagnostic imaging modalities in planning surgery of renal tumors.
Multiphase computed tomography of malignant kidney tumors: radiologic-pathologic comparison
Acta Clinica Croatica, 2012
The aim of this retrospective study was to evaluate diagnostic test parameters of multiphase spiral computed tomography (Ct) of the kidneys in the assessment of malignant renal tumors. fifty-one patient records were reviewed. The imaging protocol included unenhanced and postcontrast scans during arterial and nephrographic phase. Ct findings were compared with pathology findings to assess the value of spiral Ct (sensitivity, specificity, negative predictive value, positive predictive value and accuracy) in the detection and characterization of tumors, and in the evaluation of local extension of malignant renal tumors. Spiral Ct had a 96.08% sensitivity and accuracy in the detection of tumors. Characterization of renal tumors with Ct had a sensitivity of 94.12% and accuracy of 96.08%. in the detection of fibrous capsule penetration, Ct reached a sensitivity of 91.97% and specificity of 51.28%. in the evaluation of canal system propagation, the sensitivity was 100% and specificity 90.70%. Ct had a sensitivity of 75%, specificity of 95.75% and positive predictive value of 60% in the evaluation of regional lymph node involvement. in the detection of the main renal vein invasion, Ct showed 60% sensitivity and 100% specificity. Spearman's rank correlation coefficient between the mean tumor size on Ct images and renal specimen was 0.916. in conclusion, multiphase spiral Ct has satisfactory diagnostic parameters in the detection, characterization and evaluation of local extension of renal tumors except for detection of the main renal vein invasion.
Imaging Techniques for the Patient With Renal Cell Carcinoma
Seminars in Nephrology, 2011
The imaging of renal cell carcinoma continues to evolve from radiographic tomography to state-ofthe-art three-dimensional imagery using computed tomography (CT) or magnetic resonance imaging (MRI). This article reviews the current techniques of imaging the patient with renal cell carcinoma. Careful and accurate imaging of these patients allows for the appropriate diagnosis, treatment planning, and follow-up care. At each point in the care of these patients, imaging plays an important role. In particular, the diagnosis and staging of renal cell carcinoma can be accomplished with CT and MRI, with each modality having strengths and weaknesses that are contrasted. Intraoperative ultrasound is used during laparoscopic or conventional partial nephrectomies, whereas ultrasound, CT, and MRI can be used for guiding ablative technologies. Imaging also plays an important role in the follow-up care of these patients. The particular follow-up care is dependent on the stage and grade of the lesion and the treatment modality used. In summary, this article reviews the current imaging approaches for the diagnosis, staging, treatment, and follow-up care of patients with renal cell carcinoma. Semin Nephrol 31:245-253
Preoperative Use of 3D Volume Rendering to Demonstrate Renal Tumors and Renal Anatomy 1
With increased use of computed tomography (CT) and abdominal ul-trasonography, the indications for nephron-sparing surgery are also increasing. Triphasic helical CT and three-dimensional (3D) volume rendering can be combined into a single noninvasive test to delineate renal tumors and normal and complex renal anatomy prior to neph-ron-sparing surgery. This combination technique has proved accurate and very useful for both preoperative and intraoperative planning by demonstrating renal position, tumor location and depth of tumor extension into the kidney, relationship of the tumor to the collecting system , and renal vascular anatomy. Knowledge of the position of the kidney relative to the lower rib cage, iliac crest, and spine helps in planning the initial surgical incision. By depicting tumor location and depth of extension, helical CT with 3D volume rendering helps ensure complete tumor excision and conservation of adjacent normal renal parenchyma. Depiction of the relationship of the tumor to the collecting system helps anticipate further tumor extension and minimize postoperative complications. Identification of normal renal vasculature and anatomic variants can help minimize ischemic injury and intraop-erative bleeding. Radiologists should be familiar with current indications for nephron-sparing surgery and understand what information is required prior to surgery. Abbreviation: 3D = three-dimensional
BJU International, 2019
ObjectivesTo apply the standard PADUA and RENAL nephrometry score variables to three‐dimensional (3D) virtual models (VMs) produced from standard bi‐dimensional imaging, thereby creating three‐dimensional (3D)‐based (PADUA and RENAL) nephrometry scores/categories for the reclassification of the surgical complexity of renal masses, and to compare the new 3D nephrometry score/category with the standard 2D‐based nephrometry score/category, in order to evaluate their predictive role for postoperative complications.Materials and MethodsAll patients with localized renal tumours scheduled for minimally invasive partial nephrectomy (PN) between September 2016 and September 2018 underwent 3D and 2D nephrometry score/category assessments preoperatively. After nephrometry score/category evaluation, all the patients underwent surgery. Chi‐squared tests were used to evaluate the individual patients’ grouping on the basis of the imaging tool (3D VMs and 2D imaging) used to assess the nephrometry ...
Imaging renal cell carcinoma with ultrasonography, CT and MRI
Nature Reviews Urology, 2010
| The increased use of abdominal imaging techniques for a variety of indications has contributed to more-frequent detection of renal cell carcinoma (RCC). Ultrasonography has been used to characterize the solid versus cystic nature of renal masses. This modality has limitations, however, in further characterization of solid tumors and in staging of malignancy, although contrast-enhanced ultrasonography has shown promise. Crosssectional imaging with multiplanar reconstruction capability via CT or MRI has become the standard-bearer in the diagnosis, staging and surveillance of renal cancers. The use of specific protocols and the exploitation of different imaging characteristics of RCC subtypes, including variations in contrast agent timing, MRI weighting and digital subtraction, have contributed to this diagnostic capability. Cystic renal masses are a special case, evaluation of which can require multiple imaging modalities. Rigorous evaluation of these lesions can provide information that is crucial to prediction of the likelihood of malignancy. Such imaging is not without risk, however, as radiation from frequent CT imaging has been implicated in the development of secondary malignancies, and contrast agents for CT and MRI can pose risks, particularly in patients with compromised renal function.
Role of computed tomography in staging of renal cell carcinoma
Computerized Radiology, 1986
Accurate pre-operative staging of renal cell carcinoma is necessary to determine the surgical approach and prognosis. The advent of computed tomography has brought about a remarkable improvement in accuracy of pre-operative staging in such cases by non-invasive means. The role of computed tomography in staging of renal cell carcinoma has been evaluated in 28 cases and correlated with clinical and surgical findings.
Computed tomography of renal cell carcinoma in patients with terminal renal impairment
European Journal of Radiology, 2007
Purpose: An increased incidence of renal tumors has been observed in patients with end-stage-renal-disease (ESRD). The very strong association with acquired renal cystic disease (ACRD) and increased incidence of the renal tumors (conventional renal cell carcinoma (CRCC), papillary renal cell carcinoma (PRCC) or papillary renal cell adenoma (PRCA)) was reported. This study discusses the role of computed tomography (CT) in detecting renal tumors in patients with renal impairment: pre-dialysis, those receiving dialysis or with renal allograft transplants. Materials and methods: Ten patients (nine male, one female) with renal cell tumors were enrolled into a retrospective study; two were new dialysis patients, three on long-term dialysis, and five were renal transplant recipients with history of dialysis. All patients underwent helical CT, a total of 11 procedures were performed. Sixteen-row detector system was used five times, and a 64-row detector system for the six examinations. All patients underwent nephrectomy of kidney with suspected tumor, 15 nephrectomies were performed, and 1 kidney was assessed during autopsy. CT findings were compared with macroscopic and microscopic assessments of the kidney specimen in 16 cases. Results: Very advanced renal parenchyma atrophy with small cysts corresponding to ESRD was found in nine patients, chronic pyelonephritis in remained one. A spontaneously ruptured tumor was detected incidentally in one case, patient died 2 years later. In the present study, 6.25% (1/16) were multiple PRCA, 12.5% (2/16) were solitary PRCC, 12.5% tumors (2/16) were solitary conventional renal cell carcinomas (CRCC's), 12.5% tumors (2/16) were multiple conventional renal cell carcinomas (CRCC's), 25% (4/16) were CRCC's combined with multiple papillary renal cell carcinomas with adenomas (PRCC's and PRCA's), and 25% (4/16) of the tumors were multiple PRCC's combined with PRCA's without coexisting CRCC's. Bilateral renal tumors were found in our study in 60% (6/10) confirmed in six cases, one kidney left on follow-up due to the small tumors. Conclusions: With the use of a multi-detector row system, it is possible to detect smaller foci suspected to originate in multiple tumors, especially when up to 3-mm thin multi-planar reconstructions are used. Two cases demonstrated the possibility the development of RCC in impaired kidneys may start before dialysis initiation.
A Retrospective Study of Role of Computed Tomography in the Evaluation of Malignant Renal Masses
IOSR Journals , 2019
Introduction: Computed Tomography (CT) has been found to be extremely useful in the diagnosis and treatment of renal masses. It provides an accurate morphologic picture of the renal mass. The precise contrast resolution makes identification of the characteristic attenuation values possible. Renal Cell Carcinoma (RCC) is the most common malignant tumour of the kidney, accounting for 85%-90% of adult renal malignancies, and 1%-2% of all malignancies. Although radical surgery remains the only efficient and curative treatment both in localized and advanced RCC, surgical techniques have evolved over the years. renal mass, who had undergone computed tomographic evaluation during this period, were studied irrespective of age and sex.. This study was carried out on Toshiba 16 Slice CT scan machine. A total number of 70 patients with suspected renal mass, who had undergone computed tomographic evaluation during this period, were studied irrespective of age and sex. Both plain and contrast studies were performed. Results: Computed tomography was a very useful investigation for malignant renal masses, because it has got the ability to better characterise the lesions and it is accurate for pre-operative staging. Conclusion: This can be concluded from our study that contrast CT scan is investigation of choice for pre-operative staging of malignant renal masses due to its ability in demonstrating perinephric extension, invasion of renal fascia, evaluation of retroperitoneum and detection of distant metastases.