Comparison of ultrasonography, computerized tomography and angiography in dialysis patients with renal cell carcinoma.

Seventeen dialysis patients with renal cell carcinoma were examined preoperatively by ultrasonography, computerized tomography (CT) and angiography. Ultrasonography, CT and angiography correctly predicted the diagnosis of renal cell carcinoma in 17 (100%) and 12 (71%) of 17, and 11 (69%) of 16 patients, respectively. All renal tumors of more than 3.0 cm in diameter were detected by the three diagnostic procedures. However, ultrasonography, CT and angiography detected renal tumors of less than 3.0 cm in 12 (100%) and 7 (58%) of 12 patients and 6 (55%) of 11 patients, respectively. Seven renal cell carcinomas were associated with acquired cystic disease of the kidney (ACDK). All renal tumors were found by ultrasonography. However, CT predicted the correct diagnosis in 3 (43%) of 7 patients with ACDK and in 9 (90%) of 10 patients without ACDK, and angiography was correct in 3 (50%) of 6 patients with ACDK and 8 (80%) of 10 patients without ACDK. Our results indicate that ultrasonography is an effective procedure to detect renal cell carcinomas in dialysis patients.     

Comparative value of ultrasonography, computerized tomography, angiography and excretory urography in the staging of renal cell carcinoma

From 1982 to 1985, 225 patients with renal cell carcinoma were treated by nephrectomy. To evaluate the diagnostic significance of ultrasonography in predicting tumor stage the results of ultrasonography, computerized tomography, renal angiography and excretory urography were compared to the histopathological findings. Since local tumor extension has a considerable impact on the operation strategy evaluation of the T classification was of particular interest. All 4 diagnostic procedures were performed in 73 of the 225 patients. The T stage was determined correctly by ultrasonography in 77.8 per cent of the patients, while the tumor was not identifiable in only 0.6 per cent. Computerized tomography was almost as reliable as ultrasonography (the T stage was predicted correctly in 72.3 per cent of the examinations). In contrast, the tumor was staged correctly by angiography in only 57.2 per cent of the patients and by excretory urography in only 59.2 per cent. From these results ultrasonography appears to be an effective, noninvasive, inexpensive and safe procedure to evaluate the T stage of renal tumors.     

Comparison of spiral CT scan and arteriography for evaluation of renal and visceral arteries

Renal and visceral artery images obtained concurrently with spiral CT and conventional arteriography were compared for 32 patients. Indications for imaging were occlusive disease (n=12), aneurysmal disease (n=9), and renal or visceral artery disease (n=11). Conventional arteriography enabled visualization of 64 renal arteries and 15 accessory renal arteries. Lateral aortograms obtained in 15 patients enabled visualization of 14 superior mesenteric (SMA) and 14 celiac arteries. Spiral CT enabled visualization of 60 renal arteries, 12 accessory renal arteries, 27 SMAs, and 22 celiac arteries. Calcification or a disparity in timing of contrast material injection and scanning prevented visualization of the celiac artery in 10 patients and the SMA in four patients. With conventional arteriography as the standard for comparison, spiral CT had a sensitivity of 67% and a specificity of 95% for depiction of at least 75% stenosis in the main renal artery. By means of the Pearson correlation coefficient, significant correlation (p < 0.001) was confirmed between spiral CT and arteriography for evaluation of stenosis of the main renal artery, SMA, and celiac artery. This early experience suggests that spiral CT may be useful in evaluation of renal and visceral arteries and their relationship to aortic disease.Presented at the Twentieth Annual Meeting of the Peripheral Vascular Surgery Society, New Orleans, La., June 10, 1995.     

Echography in vena cava invasion from renal tumors

The last 4 cases of our case series of renal cell carcinoma (RCC) with caval or cavo-atrial invasion were studied by ultrasonography (US), computerized tomography (CT scan), arteriography (AG) and venocavography (VC) (inferior and/or superior). A comparison is made with these different methods, with particular emphasis on (US). The authors' conclusions are that ultrasound may replace anterograde inferior cavography in the evaluation of thrombotic extension and, in addition, it seems to be capable of eliminating the false-positives or -negatives of this method. AG and VC are no longer necessary to determine the cavo-atrial extension of a tumor thrombus from RCC when US and CT scan are available and are correctly integrated.     

Diagnostic importance of CT in early stage renal cell carcinoma

Our experience of finding a small renal cell carcinoma by CT suggested the diagnostic importance of CT in the early stage of the tumor. The patient was a forty-year-old woman who had suffered several times from pyelonephritis. She consulted us for detailed examination. IVP showed only slight deformity like a calyceal diverticulum at the upper pole of the left kidney. Ultrasonic tomography failed to expose the region. Enhanced CT revealed a small space occupying lesion like a simple renal cyst at the region, though plain CT revealed no abnormal findings. From the comparison of these two CT, she was diagnosed to have renal cell carcinoma which was confirmed by renal arteriography. Subsequently, transabdominal left nephrectomy was performed. Pathological diagnosis was renal cell carcinoma (clear cell type). The tumor size was very small, 1.5 cm in diameter. Comparison of plain and enhanced CT were considered important to diagnose a small tumor, and CT is now the most useful examination to detect early stage renal cell carcinoma.     

A renal trauma: evaluation by dynamic CT

To document the severity and degree of renal injury multiple studies may be necessary, including excretory urography, nephrotomography, arteriography and ultrasonographic examination. Even these extensive studies fail at times to provide sufficient information for treatment of the injury. However, the parenchymal injuries and extrarenal hematomas are depicted more accurately by computed tomography (CT). Moreover, dynamic CT can assess parenchymal enhancement during the capillary phase. Therefore, dynamic CT is useful in assessing the renal contusion and hematoma. In addition, it appears to be highly reliable and relatively noninvasive means of diagnosing renal trauma.     

Utility of CT angiography for evaluation of living kidney donors

We reviewed our initial experience with helical computed tomography (CT) angiography in the evaluation of living kidney donors which, until now, has necessitated arteriography. Nineteen donors (12 women, 7 men) have had their renal anatomy evaluated solely by CT angiography preoperatively.All scans demonstrated normal collecting systems and single ureters. Five donors (26%) had supernumerary renal arteries. Fourteen donors had single, 4 donors had two, and 1 donor had three renal arteries. Helical CT demonstrated small polar vessels in several donors. Two donors (10%) had supernumerary renal veins. Accuracy of vascular anatomy defined on CT was 90% when confirmed at operation. Anatomically all CT findings were consistent with operative findings except in 1 donor who was found to have a 0.8 cm lesion near the renal hilum.At our institution, the total charges for selective renal arteriography are $3845 and for helical CT with three-dimensional (3-D) reconstruction are $1546. The amount of contrast dye (approximately 100 mL) is equivalent. Patients uniformly reported that the CT scan was a convenient and painless procedure.The accuracy of helical CT angiography is equivalent to arteriography in assessing renal vascular anatomy (with the additional benefit of imaging venous and parenchymal anatomy). Charges for helical CT are 59% less. There is greater patient acceptance and potentially less morbidity associated with the non-invasive nature of helical CT. We believe that CT angiography is the radiologic procedure of choice for the assessment of renal anatomy in potential living kidney donors.     

螺旋CT扫描在肾癌术前分期中的应用价值

目的探讨螺旋CT检查在肾癌术前临床分期中的应用价值。方法回顾性分析经手术病理证实的93例肾癌患者资料。男63例，女30例。年龄15～78岁，平均55岁。术前均采用螺旋CT平扫加多期增强扫描。将CT分期与病理分期结果进行比较分析。结果93例患者CT分期Ⅰ期55例、Ⅱ期17例、Ⅲ期6例、Ⅳ期15例；手术病理分期Ⅰ期44例、Ⅱ期28例、Ⅲ期8例、Ⅳ期13例。线性趋势检验结果提示2种分期方法密切相关（P〈0．01），Pearson积矩相关系数rp=0．91，呈正相关关系，但这种关联不是简单的直线关系。螺旋CT对肾癌术前分期的敏感性、特异性和准确性分别为77．4％、92．5％和88．7％。结论螺旋CT能很好地显示肾癌的影像学特征，并进行准确的临床分期，应列为肾癌术前的常规检查项目。     

A case of cystic renal cell carcinoma: clinical usefulness of CT arteriography

We report a case of cystic renal cell carcinoma (CRCC). In general, computed tomography (CT) and magnetic resonance imaging (MRI) are sufficient for diagnosing renal cell carcinoma (RCC). However, we often have difficulty in diagnosing CRCC based on these modalities alone. In the present case, to assess the contrast-enhancement of the cyst wall and the septum, we evaluated the usefulness of CT arteriography (CTA) by selective injection of contrast material into the renal artery. We believe that CTA could be a valid option for preoperative radiological differentiation of CRCC.     

囊性肾癌的CT诊断

为了进一步提高囊性肾癌的诊断水平，对１９８８～１９９３年收治１１例经手术病理证实的囊性肾癌患者，均作了增强薄层ＣＴ扫描，８例作了超声。所有病灶囊壁不规则增厚，部分有壁结节、增厚分隔及钙化外软组织，实质部分有中度、明显早期强化。结果认为囊壁及分隔不规则增厚、结节和早期强化是ＣＴ诊断囊性肾癌的重要依据，增强薄层ＣＴ扫描是显示病灶形态特征和定性的有效方法。     

The diagnosis and local staging of renal cancer--an appraisal

The standard pattern of investigation for renal masses usually involves excretion urography, ultrasonography and angiography. This study was undertaken to determine whether computed tomography (CT) and fine needle aspiration cytology could provide information that might allow this pattern to be modified. Diagnostic information was obtained by needle aspiration cytology in 25 patients who were shown at operation to have a neoplasm. The diagnosis was correct in 22 cases (88%). By comparison, arteriography was accurate in 22 out of 24 (92%), and computed tomography provided the correct diagnosis in 19 out of 21 (90%). Staging was performed surgically and histologically in 21 patients, and when this was compared with the results of CT staging there was complete agreement in 13 cases (62%). A literature review revealed an average staging accuracy for CT of 81% while arteriography was accurate in only 57%. Thus CT appears to be as good as arteriography for diagnosis and potentially better for local staging. It is also less invasive, rapid and cost effective and could supersede arteriography as the primary diagnostic and staging investigation in patients with a solid renal mass.     

Is adrenalectomy always advisable in tumor nephrectomy?

Since the addition of ultrasonography and computerized tomography to the diagnostic tools used for the recognition of renal tumor masses, detection of renal cell carcinomas has been much earlier and more reliable than formerly. Between July 1981 and June 1990, 335 patients without distal metastases underwent radical nephrectomy for renal cell carcinoma. In only 2.6% of the patients were adrenal metastases found, exclusively with stage pT3 tumors. The results of this review suggest that the adrenal gland need not be removed with the radical nephrectomy specimen in the case of tumors staged T1 or T2 if the adrenal CT scan is normal.     

Magnetic resonance imaging in the staging of renal cell carcinoma

Correct diagnosis and accurate staging of renal cell carcinoma are critical in the evaluation of prognosis and subsequent treatment planning. Between October 1989 and April 1993, 25 patients with histologically proven renal cell carcinoma (RCC) were studied, comparing magnetic resonance imaging (MRI), computerized tomography (CT), operative findings and histopathological results. Two patients with pT3 tumours were understaged by both methods as T2. Three other patients staged as T4 by CT and T3 by MRI were actually pT3. N and V status were accurately detected by both imaging modalities. One patient with biopsy-proven liver metastasis missed by CT was correctly diagnosed by MRI. We conclude that MRI is complementary to CT and is especially helpful in patients with advanced stage and large sized tumours.     

小肾癌的影像学诊断比较分析（附35例报告）

目的：探讨影像学检查在小肾癌诊断中的应用价值。方法：回顾性分析我科35例术后经病理确诊为小肾癌患者的B超、IVU、CT、MRI等影像学资料,比较分析各影像学检查的优缺点。结果：35例小肾癌病例,常规行B超、IVU检查,并结合CT或MRI检查。其中,B超诊断肾癌23例,准确率65．7％。IVU提示有肾盂肾盏受压等间接征象5例（14．3％）。21例行CT检查,诊断肾癌20例,准确率95．2％。14例行MRI检查,诊断肾癌13例,准确率92．9％。结论：综合应用B超、IVU、CT和MRI检查对于小肾癌的早期诊断具有重要意义,尤以CT检查更具价值。     

THE DIAGNOSIS AND LOCAL STAGING OF RENAL CANCER — AN APPRAISAL

The standard pattern of investigation for renal masses usually involves excretion urography, ultrasonography and angiography. This study was undertaken to determine whether computed tomography (CT) and fine needle aspiration cytology could provide information that might allow this pattern to be modified. Diagnostic information was obtained by needle aspiration cytology in 25 patients who were shown at operation to have a neoplasm. The diagnosis was correct in 22 cases (88%). By comparison, arteriography was accurate in 22 out of 24 (92%), and computed tomography provided the correct diagnosis in 19 out of 21 (90%). Staging was performed surgically and histologically in 21 patients, and when this was compared with the results of CT staging there was complete agreement in 13 cases (62%). A literature review revealed an average staging accuracy for CT of 81% while arteriography was accurate in only 57%. Thus CT appears to be as good as arteriography for diagnosis and potentially better for local staging. It is also less invasive, rapid and cost effective and could supersede arteriography as the primary diagnostic and staging investigation in patients with a solid renal mass.     

肾动脉水平以下腹主动脉瘤的诊断和治疗(附261例报告)

为提高腹主动脉瘤手术的安全性，对１９６０年１月～１９９７年１２月２６１例肾动脉水平以下腹主动脉瘤的处理进行了分析。１９７０年以前手术切除７３例，其中５０例经主动脉造影确诊。１９８７年以来的１７８例由Ｂ超和ＣＴ确诊，５例行动脉造影或数字减影造影（ＤＳＡ）、５例经磁共振血管成像明确了动脉瘤上界和肾动脉的关系。结果：患者均行动脉瘤切除人造血管移植，手术死亡率３．８％，５年存活率７４．４１％。腹主动脉瘤诊断中最为关键的是确定动脉瘤上界与肾动脉间的距离，若Ｂ超与ＣＴ不能肯定，主动脉造影或ＤＳＡ极有帮助。提示：手术操作和麻醉技术的改进使腹主动脉瘤修补术变得更为迅速、安全和方便。     

小肾癌的影像学诊断(附43例报告)

目的 评价影像学检查在小肾癌诊断中的应用价值。方法 回顾性分析43例经手术及病理证实为小肾癌（直径≤3cm）患者的B超、IVU、CT、MRI等影像学资料。结果 43例小肾癌中，B超诊断恶性肿瘤28例，诊断准确率65．1％。29例行IVU，7例有间接征象（24．1％）。CT诊断恶性肿瘤42例，诊断准确率97．7％。14例MRI检查诊断恶性肿瘤13例，诊断准确率92．9％。结论 影像学检查中CT及CT增强扫描对小肾癌的定性、定位诊断有重要价值。     

Splenosis presenting as a left renal mass indistinguishable from renal cell carcinoma

Splenosis following splenic trauma is a common but underdiagnosed entity before surgical exploration. In all previously reported cases the ectopic splenic tissue was distinctly separate from the kidney. To our knowledge we report the first known case in which the splenic tissue was located in direct apposition with the kidney. Using conventional imaging techniques, including renal ultrasonography, abdominal computerized tomography and selective renal arteriography, this ectopic splenic tissue appeared to be part of the left kidney and was indistinguishable from renal cell carcinoma. The pathophysiology, clinical presentation and diagnostic studies of splenosis are reviewed.     

食管癌CT模拟定位

目的　探讨食管癌CT模拟定位的临床价值。方法　对 48例行单纯放疗的食管癌患者 ,比较CT模拟定位和常规模拟定位的等中心位置、射野大小及剂量分布情况。结果　CT模拟定位和常规模拟定位的等中心点位置不相同 ;射野均大于常规模拟定位 (P <0 .0 1) ,90 %等剂量线更能够适形 ,包括靶区。结论　CT模拟定位可以准确提供食管癌病变情况 ,并为放射治疗的合理实施提供了重要的保证     

Clinical role of F-18 fluorodeoxyglucose positron emission tomography for detection and management of renal cell carcinoma

PURPOSE: We evaluate the accuracy of F-18 fluorodeoxyglucose (FDG)-positron emission tomography (PET) for staging and management of renal cell carcinoma. MATERIALS AND METHODS: FDG-PET was performed in 25 patients with known or suspected primary renal tumors and/or metastatic disease and compared with conventional imaging techniques, including computerized tomography (CT). Histopathological confirmation was obtained in 18 patients and confirmation of the disease was by followup in the remainder. The impact of FDG-PET on disease management was also assessed. RESULTS: Of the 17 patients with known or suspected primary tumors FDG-PET was true positive in 15, true negative in 1 and false-negative in 1. Comparative CT was true positive in 16 patients and false-positive in 1. The accuracy of FDG-PET and CT was similar (94%). All patients would have undergone radical nephrectomy after conventional imaging findings but FDG-PET results altered treatment decisions for 6 (35%), of whom 3 underwent partial nephrectomy and 3 avoided surgery due to confirmation of benign pathology or detection of unsuspected metastatic disease. Of the 8 cases referred for evaluation of local recurrence and/or metastatic disease FDG-PET changed treatment decisions in 4 (50%), with disease up staged in 3 and recurrence excluded in 1. Compared with CT, FDG-PET was able to detect local recurrence and distant metastases more accurately and differentiated recurrence from radiation necrosis. CONCLUSIONS: FDG-PET accurately detected local disease spread and metastatic disease in patients with renal cell carcinoma and altered treatment in 40%. FDG-PET may have a role in the diagnostic evaluation of patients with renal cell carcinoma preoperatively and staging of metastatic disease.