CT导引下穿刺注射无水乙醇治疗肾囊肿

目的　评估CT导引经皮穿刺肾囊肿注射无水乙醇治疗的临床经验。方法　 4 4 5例 5 10个肾囊肿于CT导引下经皮穿刺肾囊肿抽液后注射无水乙醇治疗 ,4 4 5例中 385例为单发肾囊肿 ,5 3例多发肾囊肿 ,7例多囊肾。囊肿直径为 1.9～ 13.5cm。用 18～ 2 1G抽吸针穿刺抽吸 ,抽出囊液量为 3～780ml。注入 99.7%乙醇 ,乙醇量以抽出囊液的 2 5 %为合适。结果　本组 396例 (42 7个囊肿 )用CT扫描或超声检查随访 ,随访时间为 3个月到 1年以上 ,单发肾囊肿疗效为 97% ,其中囊腔消失为 82 % ,多发肾囊肿疗效为 95 % ,其中囊腔消失为 79% ,多囊肾疗效为 6 7%。并发症为局部疼痛 (2 8例 ) ,血尿 (4例 ) ,无严重并发症出现。结论　CT导引经皮穿刺肾囊肿乙醇治疗对单发肾囊肿和多发囊肿是一种有价值的治疗方法     

Renal imaging in long-term dialysis patients: a comparison of CT and sonography

Patients undergoing long-term dialysis are subject to cyst formation, hemorrhage, and neoplasia in their native kidneys. Detection of these complications with incremental dynamic CT and detection with sonography were compared prospectively in 41 patients (79 kidneys) who had been undergoing dialysis intermittently for 3 or more years. Acquired cystic kidney disease (five or more cysts per kidney) was identified in 59% of kidneys by use of CT and in 18% by use of sonography. CT showed a complete renal contour definition in all cases, sonography did so in only 57%. Three solid renal tumors (2- to 4-cm diameter) were identified with both techniques with no false-negative evaluations. Four benign hemorrhagic cysts were identified with combined CT (hyperdense mass) and sonography (benign cysts). CT provided the best anatomic image quality and was more accurate for detection of acquired cystic kidney disease. CT and sonography were equivalent for detection of solid tumors. Our results suggest that dynamic contrast-enhanced CT scanning with the supplemental use of sonography is the best imaging regimen for the evaluation of suspected acquired cystic kidney disease and its potential complications.     

High-density renal cysts in autosomal dominant polycystic kidney disease demonstrated by CT

Unenhanced abdominal CT scans of 35 patients with autosomal dominant polycystic kidney disease (ADPKD) showed multiple high-density (58-84 HU) renal cysts in 42.9% of patients, occasional high-density cysts in 25.7%, and no high-density cysts in 31.4%. These high-density cysts were usually subcapsular and were more frequent in patients with markedly enlarged kidneys and flank pain at the time of CT. Several were found to contain altered blood on pathological analysis. Follow-up CT often showed a reduction in cyst densities, although some cysts developed mural calcification and calcification of their contents. High-density cysts are probably produced by cyst hemorrhage. This may occur randomly as part of the natural history of the disease or may result from minor trauma to the enlarged kidneys. Renal carcinomas occur rarely in ADPKD and may occasionally be hyperdense. However, high-density cysts may usually be distinguished from carcinomas on CT by their smooth contours, sharp interfaces with renal parenchyma, homogeneity, and lack of contrast enhancement.     

Renal failure and cystic kidney diseases

Cystic kidney diseases often are discovered at the time of initial work-up of renal failure through ultrasound or family history, or incidentally at the time of an imaging test. Hereditary diseases include autosomal dominant or recessive polycystic kidney disease (PKD), tuberous sclerosis (TS) and medullary cystic kidney disease (MCKD). Autosomal dominant PKD is characterized by large renal cysts developing in young adults. Renal failure is progressive and becomes severe around 50-60 years of age. Atypical cysts (hemorrhagic or hyperdense) are frequent on CT and MRI examinations. Imaging plays a valuable role in the management of acute complications such as cyst hemorrhage or infection. Autosomal recessive PKD is often detected in neonates, infants or young adults. It is characterized by renal enlargement due to the presence of small cysts and liver disease (fibrosis and biliary ductal dilatation). Late manifestation or slow progression of autosomal recessive PKD may be more difficult to distinguish from autosomal dominant PKD. These cystic kidney diseases should not be confused with non-hereditary incidental multiple renal cysts. In tuberous sclerosis, renal cysts are associated with angiomyolipomas and sometimes pulmonary lymphangioleiomyomatosis. Renal failure is inconstant. Other hereditary cystic kidney diseases, including MCKD and nephronophtisis, are usually associated with renal failure. Non-hereditary cystic kidney diseases include multicystic renal dysplasia (due to complete pelvi-ureteric atresia or hydronephrosis), acquired multicystic kidney disease (chronic renal failure, chronic hemodialysis) and varied cystic kidney diseases (multicystic renal disease, glomerulocystic kidney disease, microcystic kidney disease).     

Unilateral renal cystic disease: CT findings

Unilateral renal cystic disease (URCD) is characterized by replacement of most of one kidney by multiple cysts scattered diffusely throughout the parenchyma without the formation of a distinct, encapsulated renal mass. There are no cysts in the opposite kidney or liver. The condition is nonfamilial and does not cause renal functional impairment. We describe the clinical and radiologic findings in two patients with URCD and discuss how the disorder usually can be distinguished from other renal cystic diseases using CT. Absence of a family history of renal cystic disease and the normality of the other kidney help distinguish URCD from autosomal dominant polycystic kidney disease. The diffuse nature of the cysts in URCD and the absence of a distinct encapsulated renal mass help distinguish URCD from cystic renal neoplasms.     

成人型多囊肾及并发症的MSCT诊断及优势

目的 探讨MSCT诊断ADPKD并发症的优势及临床应用价值.方法 回顾性分析18例多囊肾患者的CT表现,观察多囊肾肾实质、周围脏器及肾周筋膜的变化,确定有无并发症及病变范围.结果 18例患者中,无任何症状1例,高血压症状并肝脏多发囊肿,表现双肾及肝脏多发大小不等囊肿,或并出血、结石、钙化者共8例,其中1例脾脏见一小囊肿;腹部包块、疼痛及尿路感染症状者9例,双肾体积明显增大,轮廓呈球形突出,但仍有肾形,显示肾实质明显受压,肾盂肾盏变形,并见弧形和不规则型高密度影,肾筋膜增厚,肾周脂肪间隙模糊,呈不均匀密度增高影.结论 多螺旋CT能清楚显示肾周脂肪和筋膜,是病灶检出和定位的有效方法.对临床早期发现病变、制定治疗方案、预防并发症及预后的判断具有重要的价值.     

Renal cystic diseases

Renal cystic disease comprises a mixed group of heritable, developmental, and acquired disorders. Because of their diverse etiology, histology, and clinical presentation, no single scheme of classification has gained acceptance. Conditions include autosomal dominant polycystic kidney disease, acquired renal cystic disease, medullary sponge kidney, autosomal recessive polycystic kidney disease, multicystic dysplastic kidney, medullary cystic disease, tuberous sclerosis, cysts of the renal sinus, and von Hippel-Lindau's disease. An awareness of the pathology of each cystic disease is helpful in the understanding of the corresponding radiological images. Imaging techniques used in evaluating renal cystic disease include intravenous urography, sonography, CT, MRI, nuclear medicine, and renal angiography. Many types of cystic disease show similar imaging features. Meticulous attention to subtle radiological findings is therefore essential for reaching a correct diagnosis. Imaging features requiring analysis include whether the cysts are unilateral or bilateral, renal size and functional status, cyst distribution in the kidneys, and the presence of hemorrhagic and calcified renal cysts, solid renal masses, renal sinus cysts, and cysts in adjacent organs. Radiological findings should be carefully correlated with clinical features such as patient age, family history, symptoms, physical findings, and renal functional status before a diagnosis is attempted. Received 10 October 1996; Revision received 30 January 1997; Accepted 4 February 1997     

Unilateral renal cystic disease

Unilateral renal cystic disease (URCD) is a distinct entity that is one of the renal cystic diseases. URCD consists of a cluster of multiple cysts in part or most of one kidney with no association of cystic disease in the contralateral kidney. URCD is a nonfamilial, nonprogressive disorder and is not related with autosomal dominant polycystic kidney disease (ADPKD). We report a case of URCD with six-year CT follow-up. Confinement of the cystic disease to one kidney with an absence of cysts in other organs such as liver or pancreas distinguish URCD from ADPKD. Absence of an encapsulated mass and intervening normal renal parenchyma between the cysts can differentiate URCD from cystic renal tumors.     

Natural history of acquired renal cystic disease in dialysis patients: a prospective longitudinal CT study

Patients with end-stage kidney disease, particularly those treated with dialysis, develop proliferative processes in their native kidneys that result in the formation of multiple acquired renal cysts, renal adenomas, and carcinomas. Data about these abnormalities have been acquired mainly from retrospective studies. We undertook a longitudinal prospective study in which the native kidneys of 30 dialysis patients were surveyed by serial CT during a 7-year period to study the natural history of acquired renal cystic disease and the frequency of associated complications. Acquired cysts were seen in 87% of patients at the end of the study compared with 57% at the study's onset, and a significant increase was seen in mean renal volume with time. Five patients (17%) developed large hemorrhagic renal cysts and four (13%) developed large perinephric hematomas. Renal cell carcinomas developed in two patients (7%) without renal symptoms. One carcinoma invaded the renal capsule, but did not cause metastases. The other carcinoma was widely metastatic. Our findings are consistent with those of earlier studies documenting an increased prevalence of renal cell carcinoma in dialysis patients as compared with the general population. However, our conclusions are limited because the study sample is small and no control population was studied. We conclude that acquired renal cystic disease in dialysis patients is a progressive disorder often associated with cyst hemorrhage. Dialysis patients may also have an increased prevalence of renal cell carcinoma.     

Simple renal cysts in children: diagnosis and follow-up with US

To assess the sonographic frequency of simple renal cysts in children, the authors retrospectively reviewed the results of abdominal sonographic studies of 16,102 children performed over a 5-year period between January 1, 1985, and December 31, 1989. Patients with abnormal renal function, dysplastic kidneys, or a family history of polycystic kidney disease were excluded from the study. The authors' review of the sonograms revealed 37 simple cysts in 35 patients (0.22%); the cysts were evenly distributed by age and sex and measured from 0.3 to 7.0 cm in maximum diameter. Sixteen cysts (43%) were in the upper pole of the right kidney. Follow-up sonographic studies of 23 cysts in 22 patients for up to 5 years showed no change in size in 17 cysts (74%). The largest cyst was drained percutaneously; all other cysts were managed conservatively. No patient showed deterioration of renal function. Therefore, the authors concluded that in a pediatric patient demonstrating normal renal function, no further intervention is necessary when a simple renal cyst is identified at sonography.     

The radiology of cystic liver tumours

Six patients with cystic liver tumours are presented. The definitive diagnosis of such cystic lesions may be difficult and needle aspiration or biopsy or even operation may be necessary. Clinical and biochemical features may be helpful and in five of the six patients presented, the liver function tests were abnormal. In two patients, diagnostic imaging could not distinguish the tumour from a benign cyst. The differential diagnosis of such cystic liver tumours includes simple cyst, polycystic liver disease, hydatid, liver abscess, haematoma and biloma.     

Single-session alcohol sclerotherapy in symptomatic benign hepatic cysts performed with a time of exposure to alcohol of 10 min: initial results

The aim of this study was to evaluate the 1-year results of single-session sclerotherapy of symptomatic benign non-parasitic liver cysts performed with maximum 10 min time of ethanol exposure. During the period 1995–1999, 15 symptomatic liver cysts in nine patients — eight women and one man — were treated with 10 min time of exposure to ethanol. Ultrasound-guided puncture combined with fluoroscopy was used for catheter placement. Alcohol sclerotherapy was performed with a maximum volume of ethanol 96% of 10% of the cyst volume, never exceeding 100 ml. At follow-up the patients were examined with liver function tests, ultrasound or CT examination, clinical examination, and interview by a gastrointestinal surgeon. Ten cysts in seven patients (six women and one man; age range 44–61 years, median age 58 years), who had a follow-up of at least 1 year, were included. The original cyst volumes were 30–4110 ml (median 392 ml). After a follow-up period of 12–47 months (median 23 months), cyst volumes were 0–523 ml (median 21.5 ml) with a reduction of the median cyst volume by 95% (p<0,005). All patients experienced relief of their clinical symptoms. Except for pain, no complications were observed. Sclerotherapy using only one session and maximum 10 min time of exposure to ethanol represents an effective treatment of symptomatic liver cysts.     

Hyperdense renal masses: a CT manifestation of hemorrhagic renal cysts

Eleven patients with sharply circumscribed round to ovoid renal cysts measuring 70-90 H on CT are reported. The cysts were hyperdense on unenhanced scans, measuring 30-60 H greater than the adjacent parenchyma, and either hypodense, isodense, or hyperdense on enhanced scans. Four patients had polycystic kidney disease; of the other 7 patients, the cysts were cortical in 6 and parapelvic in 1. Eight patients had a solitary cyst and 3 had multiple cysts. Sonography demonstrated internal echoes and/or lack of increased through-transmission in 6 patients. Pathological analysis was available in 6 cases and indicated a benign, hemorrhagic renal cyst. This hyperdense CT appearance is characteristic of some hemorrhagic renal cysts, though differentiation between benign and malignant cysts requires cyst puncture and/or surgery.     

Localized cystic disease of the kidney

OBJECTIVE: Localized cystic disease of the kidney is a benign nonsurgical condition. Its imaging and clinical features are characterized and differentiated from autosomal dominant polycystic kidney disease, multilocular cystic nephroma, and cystic neoplasm. MATERIALS AND METHODS: Localized cystic disease was diagnosed in 18 patients on the basis of a review of imaging studies, clinical histories, and pathologic proof in four of the 18 patients. Average age at diagnosis was 54 years (age range, 24-83 years). Fifteen of the patients (83%) were men. CT was performed on 18 patients, sonography on nine, excretory urography on six, arteriography on four, and MR imaging on two. RESULTS: Localized cystic disease was unilateral in all patients and characterized by multiple cysts of various sizes separated by normal (or atrophic) renal tissue in a conglomerate mass suggestive of cystic neoplasm. In some patients, involvement of the entire kidney, which was suggestive of unilateral autosomal dominant polycystic kidney disease, was seen. No cysts were seen in the contralateral kidney in 14 patients, and only one or two scattered small cysts were present in four patients. Clinical presentations included hematuria, flank pain, palpable abdominal mass, and localized cystic disease as an incidental finding. None of the patients had a family history of autosomal dominant polycystic kidney disease. Ten patients underwent follow-up (follow-up range, 1-12 years); nine patients underwent imaging follow-up and one patient underwent clinical follow-up, which showed stability of disease. Four patients underwent nephrectomy for suspected renal neoplasm. CONCLUSION: Familiarity with localized cystic disease of the kidney and its imaging findings is important to avoid unnecessary surgery and to differentiate the disease from autosomal dominant polycystic kidney disease.     

Seminal vesicle cysts: association with adult polycystic kidney disease

Adult polycystic kidney disease (APKD) is associated with cyst formation in the kidney, liver, pancreas, esophagus, ovary, uterus, and brain. Four patients with APKD (aged 45-65 years) with computed tomographic evidence of seminal vesicle cysts are described. All seminal vesicles contained cystic masses with attenuation values of 0-30 HU. Seminal vesicle thickness was 3-4 cm (normal, 1.5 cm). High-attenuation walls separated the cysts, which were 3-35 mm in diameter. All patients had typical renal stigmata of APKD. None had cysts elsewhere, except one patient with hepatic cysts. Postmortem examination in one patient confirmed the seminal vesicle cysts as well as APKD. It is likely that a basement membrane defect allows cyst formation in multiple organs, presumably including the seminal vesicles. Because of the association of seminal vesicle cysts with ipsilateral urogenital anomalies, and because only 60% of patients with APKD have a relevant familial history, the kidneys of patients with cross-sectional imaging evidence of seminal vesicle cysts should also be studied.     

肾囊性病的CT影象研究

This report presented 61 cases of renal cystic masses including renal parenchymal cyst 57 cases; parapelvic cyst 2; cystic hypernephroma 1 and calyceal diverticulum 1 case. All were confirmed by CT guided puncture and aspiration. The CT features of various renal cysts. complications and some special manifestations as well as differential diagnosis were discussed. Pertinent analysis of the CT features are necessary for correct diagnosis and proper management.     

Imaging of renal cystic diseases

The improved understanding of hereditary cystic diseases is changing the nomenclature used to describe these diseases. Detailed family studies of the inheritance of these conditions become possible as the genes involved, or their DNA markers, are identified. At the same time, ultrasonography allows cystic disease to be detected very early in life in some patients. The new information necessitates changes in the terminology, which was based previously on the patient's age at clinical presentation. Thus, because ultrasonography now sometimes identifies the cysts of adult polycystic kidney disease in utero or in neonates, the term autosomal dominant polycystic kidney disease is now more appropriate. Similarly, the term autosomal recessive polycystic kidney disease is replacing infantile polycystic kidney disease. Despite the success of ultrasonography in identifying the cysts of these and other inherited conditions very early, it is important to appreciate that precise definition of the type and heredity of the condition concerned requires detailed pathologic and genetic studies. The other renal cystic disease receiving considerable attention in the recent literature is acquired cystic disease, about which more data are accumulating. With increasing numbers of patients on long-term dialysis, the condition and its complications, especially renal adenocarcinoma but also hemorrhage, continue to cause concern. The evidence for an increased incidence of renal cell carcinoma has strengthened over recent years, and the debate on the need for CT screening of patients on long-term dialysis continues.     

Comparison of MRI segmentation techniques for measuring liver cyst volumes in autosomal dominant polycystic kidney disease

PurposeTo compare MRI segmentation methods for measuring liver cyst volumes in autosomal dominant polycystic kidney disease (ADPKD).MethodsLiver cyst volumes in 42 ADPKD patients were measured using region growing, thresholding and cyst diameter techniques. Manual segmentation was the reference standard.ResultsRoot mean square deviation was 113, 155, and 500 for cyst diameter, thresholding and region growing respectively. Thresholding error for cyst volumes below 500 ml was 550% vs 17% for cyst volumes above 500 ml (p < 0.001).ConclusionFor measuring volume of a small number of cysts, cyst diameter and manual segmentation methods are recommended. For severe disease with numerous, large hepatic cysts, thresholding is an acceptable alternative.     

Sclerotherapy of renal cysts using acetic acid: a comparison with ethanol sclerotherapy

This study compared percutaneous sclerotherapy using 50% acetic acid with that using 99% ethanol for patients with simple renal cysts. The study included 72 simple renal cysts in 64 patients (male/female ratio = 31/33; age range, 31-75 years). Under fluoroscopic guidance, the cyst fluid was aspirated completely. Sclerotherapy was then performed using 50% acetic acid for 32 cysts and 99% ethanol for 40 cysts. The volumes of each renal cyst before and after sclerotherapy were compared using ultrasonography or CT. Medical records were reviewed to analyse any complications. The mean follow-up period was 21.5 months (range, 3-75 months). The mean remnant volume of the cyst after sclerotherapy was 2.6% of the initial volume in the acetic acid group and 14.0% in the ethanol group. The rates of complete remission, partial remission and treatment failure were 90.6%, 9.4% and 0%, respectively, in the acetic acid group, and 60.0%, 30.0% and 10.0%, respectively, in the ethanol group. There were no complications related to sclerotherapy in either group. In conclusion, acetic acid is a safe and effective sclerosing agent, with clinical results superior to those of ethanol, and is an alternative to ethanol for sclerotherapy of renal cysts.     

骨包虫病3例报告

分析了3例骨包病囊肿MRI影像特点，治疗过程和国内的有关报道，骨包虫病为多囊型结构，具有膨胀性生长的特征，CT上可见病变为多个小囊性结构构成，病变未见明显的包膜。MRI上T1加权像病变呈低信号，病变内部结构信号更低，T2加权像病变呈高信号，病变内部为更清的多个高信号影，脊柱受累占骨包虫病的465，手术是治疗骨包虫病的主要方法，同时病灶清除术后复发率非常高。