Multiphase computed tomography of malignant kidney tumors: radiologic-pathologic comparison (original) (raw)
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1994
Objective. A new technique for creating three-dimensional (3D) images of renal tumors using contrast-enhanced spiral computed tomography (CT) is described and preliminarily investigated. Methods. 3D spiral CT was employed in 2 patients before radical nephrectomy and in 5 patients before partial nephrectomy. Preoperative and postoperative image analyses were conducted to evaluate the ability of the images to depict key anatomic relationships in planning partial nephrectomies. Results. 3D spiral CT defined the tumor's location and relationship to the kidney surface better than the tumor's proximity to renal hilar vessels and collecting system. Negative surgical margins were obtained in all 4 patients with renal cell carcinoma, and postoperative serum creatinine remained less than 2 mg/dL in all 5 patients after partial nephrectomy. Conclusions. This early experience suggests that 3D spiral CT can help in the planning of partial nephrectomy and in attaining complete resection of renal cell carcinoma while conserving normal renal tissue.
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.
Clinical versus Pathologic staging of Renal Tumors: Role of Multi-Detector CT Urography
Electronic physician, 2016
Introduction: Our ability to diagnose renal cell carcinoma (RCC) has increased in the past 30 years as a result of the extensive application of imaging techniques, such as ultrasonography, computed tomography, and magnetic resonance imaging. Multi-detector computed tomography (MDCT) remains the most appropriate imaging modality for the diagnosis and staging of RCC. The aim of this work was to compare the findings of MDCT with surgical pathology to determine the accuracy of delineating tumor size, localization, organ confinement, lymph node metastases, and the extent of tumor thrombus in the renal vein and inferior vena cava. Methods: The clinical, surgical, and anatomo-pathologic records of 99 patients treated by nephrectomy (radical or partial) for solid renal tumors at Theodor Bilharz Research Institute and Nasser Institute from 2005 to 2011 were reviewed retrospectively. All cases were staged pre-operatively with abdominal MDCT (pre-and postcontrast enhancement) in addition to the routine biochemical, hematological, and radiological work-up. The tumors' histologic types were determined according to the WHO classification of renal tumors in adults in 2004, and staging was updated to the TNM 2010 system. Data were analyzed using the t-test. Results: The mean age was 52 (range 21-73). Seventy-eight patients were males, and 21 patients were females (Male/Female ratio: 3.7:1). There were no significant differences in the mean tumor size between radiographic and pathologic assessments in different tumor stages. The overall incidence of lymph node invasion in surgical specimens was 76%, whereas MDCT showed a positive incidence in 68.4% of cases (false negative result in 7 cases, 7.6%). Conclusion: Our findings indicated that MDCT urography is an accurate method to estimate renal tumor size, lymph node, vascular and visceral metastases preoperatively. Also, preoperative staging of renal tumors with MDCT represents a valuable and accurate tool.
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.
European Journal of Radiology, 1991
Three dynamic computed tomographic methods used for staging of renal carcinoma in 70 patients are described and compared. Twentyeight patients were examined using incremental dynamic scanning across the kidneys whilst infusing contrast via an arm vein (technique 1). Eighteen patients were staged using a single location dynamic scan sequence at the level of the renal hi1um followed by an incremental sequence during an infusion of contrast into the femoral vein (technique 2). Twenty-four patients were examined using a single location sequence at the level of the renal veins and a rapid bolus incremental dynamic technique (technique 3). Technique I correctly staged 20 patients (72%) with 4 patients (14%) understaged and 4 (14%) overstaged, technique 2 correctly staged 11 (61%) patients with 3 (17%) overstaged and 4 (22%) understaged and technique 3 staged 17 (71%) correctly with 3 (13%) understaged and 4 (17%) overstaged. The techniques using single location scanning were more accurate in demonstrating tumour involvement of the renal vein and inferior vena cava but were less accurate in assessing extracapsular spread. Technique 3 was the most accurate in the diagnosis of lymph-node involvement. As accurate pre-operative knowledge of vascular involvement by tumour is more important to the surgeon than the presence of extracapsular spread, the combined single location and incremental scan technique is advocated.
Role of Computed Tomography in the Evaluation of Renal Masses
Journal of Evolution of Medical and Dental Sciences, 2017
BACKGROUND In recent years, 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. Aims and Objectives-To characterise benign vs. malignant renal lesions based on CECT image analysis and to stage wherever possible. MATERIALS AND METHODS 60 patients with suspected renal mass underwent CECT in Gauhati Medical College for a period from June 2014 to August 2015; patients who were diagnosed to have renal mass on ultrasound and referred for a CT scan for further evaluation. The images were analysed in unenhanced, corticomedullary, nephrographic and excretory phases after administration of non-ionic intravenous contrast. The lesion detection, enhancement pattern, local invasion and distant metastasis were assessed in pre-and post-contrast studies. RESULTS There were 45 malignant and 15 benign lesions in our study; the radiological diagnoses of malignant mass was confirmed by histopathology, whereas benign lesions were followed up to confirm their benignity. We had two false positive cases in our study, one was an oncocytoma and another was an angiomyolipoma. MDCT was 100% sensitive, 88.2% specificity and reached an accuracy rate of 96.7%. CONCLUSION As a result of the study, the following conclusions can be stated: CT has excellent accuracy in the diagnosis, characterisation and differentiating benign and malignant renal masses and for the characterisation of small renal mass the degree of enhancement on the corticomedullary phase is the most valuable parameter.
European Urology Supplements, 2007
To evaluate the efficacy of the biphasic and triphasic dynamic multidedector computerized tomography (MDCT) in the preoperative prediction of histological subtypes of renal cell carcinoma (RCC). Materials and methods: The preoperative dynamic MDCT findings of 51 patients with renal mass who had undergone nephrectomy were reviewed retrospectively. Twenty-five of the patients had biphasic (portal and excretory) and 26 had triphasic (arterial, portal, and excretory) MDCT images. Tumor size, presence of calcification, tumor-aorta attenuation values in all phases and homogeneicity of the tumor were noted for every patient. In heterogeneous tumors, the minimum and maximum attenuation values were noted to determine the extent of heterogeneicity. These data were compared for histopathological subtypes of the tumors. Results: In 8 patients, calcifications were detected in the mass although there were no significant differences among tumor subtypes with regard to the presence of calcification. In 33 patients the tumor was hypervascular with 24 clear type and clear type RCC showed more prominent contrast enhancement than papillary RCC. The enhancement degree showed no significant difference among other tumor subtypes. Moreover, when biphasic and triphasic computed tomography (CT) findings were compared, the positive predictive value of triphasic CT in detecting hypervascular clear tumors was greater (17/18; 94.4% versus 7/11; 63.6%). Conclusion: The dynamic MDCT technique appears to be useful in preoperative evaluation of renal masses suspected of being malignant and may also provide information about the histopathological subtype of RCC.
Ramathibodi Medical Journal, 2020
Background: The increased use of imaging modalities has led to a greater incidence in depicting solid renal mass. These lesions comprise a wide spectrum of malignant such as renal cell carcinoma (RCC) and benign histologies. Objective: To determine the multidetector computed tomography (MDCT) features that discriminate RCC from other focal renal lesions. Methods: A retrospective review was performed on 148 patients who underwent renal CT scan followed by renal surgery or biopsy during January 2008 to July 2014. Specific predictive MDCT features of RCC were determined by logistic regression analysis. Interobserver agreement (kappa [κ] values) was also calculated for each CT feature. Results: In 148 pathologic proved focal renal lesions, 91 (61.5%) were RCCs and 57 (38.5%) were non-RCCs. RCCs were more likely to be in male patients (OR, 5.39; 95% CI, 2.25-12.90), no internal fat component (OR, 46.50; 95% CI, 5.25-411.90), locate at peripheral (OR, 7.41; 95% CI, 1.63-33.73), and mixed central-peripheral locations (OR, 26.22; 95% CI, 4.23-162.58) of the kidney. There was moderate-to-excellent agreement among the readers over all these features (κ = 0.43-0.91). Conclusions: Focal renal lesion with no internal fat component in MDCT is the most useful characteristic in differentiating RCCs from others.
CT Evaluation and C Haracterization of Renal Masses
Journal of evolution of medical and dental sciences, 2015
CONTEXT/BACKGROUND: The detection rate of renal masses has increased in the last decades owing to the widespread use of CT and MRI. Therefore, an accurate characterization of renal masses is essential to ensure appropriate case management. This study was done to evaluate and characterize renal masses on CT for early and prompt management. AIMS: To detect the presence of solid renal masses on CT and to characterize them into benign and malignant masses with histopathological correlation. To assess the diagnostic accuracy of CT in distinguishing between benign and malignant lesions. A prospective study of 60 subjects was carried out from those referred to the Department of Radiodiagnosis for CT evaluation and characterization of renal masses after being clinically suspected or incidentally detected on other imaging studies. The patients were subjected to contrast enhanced helical CT. The CT findings were correlated with the surgical or histological findings or the therapeutic response in the case of inflammatory lesions. STATISTICAL ANALYSIS: It was done using sensitivity, specificity positive predictive value and negative predictive value. CT diagnosis was compared with histopathological diagnosis, which was considered as the gold standard. RESULTS: Neoplastic lesions were observed in 42 cases (70%) cases and inflammatory lesions in 9 cases (15%). Renal cell carcinoma was observed in 27 cases, Wilm's tumour in 6, oncocytoma in 3 cases and angiomyolipoma in 6 patients. The inflammatory renal lesions observed were focal pyelonephritis in 4, renal abscesses in 4 and emphysematous pyelonephritis in 1. CONCLUSION: This study concludes that contrast enhanced spiral CT is sensitive as well as specific not only to diagnose neoplastic renal mass lesions but also to diagnose other non-neoplastic renal mass lesions.
Aims & Objectives: The aim of this study was to assess the role of multi detector computed tomography (MDCT) in diagnosis and preoperative staging of solid renal masses. Material and Methods: Study was conducted in GCS medical college, Ahmedabad and includes 28 patients(15 males and 13 females patients) over a period of 6 months from April 2019 to September 2019. Multiphasic MDCT was done by using 16 slice Siemens CT scanner machine including standard scan protocol include unenhanced, cortico-medullary phase, nephrogenic phase and excretory phase. Result: A total 31 masses were detected in 28 patients, 25 patients had unilateral mass and 3 patients had bilateral renal masses. The different pathologies including RCC (64.5%), Wilms tumor(6.5%) , Lymphoma (12.9) , Angiomyolipoma(9.6%) and TCC (6.5%) were detected. Local spread ,lymphnode metastasis , vascular involvement and distant metastasis were assessed in different pathologies. In RCC cases, Rapid enhancement was seen in CMP (Average HU 80 +/-50), rapid decrease of enhancement was observed in NP (Average HU 70 +/-20) & rapid washout of contrast in EP (Average HU 50 +/-20) compared to TCC cases in which faint enhancement was observed in CMP (Average HU 40 +/-25),then increase enhancement in NP (Average HU 60 +/-10) & then washout of contrast in EP(Average HU 35 +/-15).Clear cell RCC are Hypervascular lesions so it shows rapid enhancement in CMP (Average HU 100 +/-45) & washout in EP (Average HU 60 +/-25) while papillary and chromophobe RCC are homogenously hypo vascular with average HU 50 and 75 respectively. Conclusion: MDCT is one of the most effective modality in diagnosis of primary renal mass lesions, its extension, vascular involvement, staging &