ACCURACY OF MULTIPHASE HELICAL TOMOGRAPHY IN DETECTION AND CHARACTERISATION OF SUSPECTED RENAL MASSES USING HISTOPATHOLOGICAL FINDINGS AS GOLD STANDARD

Tariq Saeed Siddiqui, Asima Tariq, Bushra Rehman, Tahir Saeed Siddiqui, Aisha Asim

Abstract


Background: The introduction of multiphase helical computed tomography has created many
important advances in the detection and characterisation of renal masses. Renal cell carcinoma (RCC)
is the seventh most common cancer and makes up 80–85% of all primary renal cancer in adults. If it is
found and treated early, the chances of survival from kidney cancer are high. This cross-sectional
comparative was carried out at department of CMH/MH Rawalpindi from 1st February 2007 to 25
March 2008 to evaluate accuracy of multiphase helical tomography in detection and characterisation of
suspected renal masses using histopathological findings as gold standard. Methods: Thirty patients
with suspicion of having renal masses were scanned with multiphase CT scanning and 5 mm thick
contiguous section were obtained from kidneys before and after injection of intravenous contrast
material. The corticomedullary phase images were obtained after a delay of 25 seconds and
nephrographic phase images, after a delay of 120 seconds after initiation of contrast medium injection.
The numbers of lesions detected in all three phases were determined. The mass was then characterised
by evaluation of its features and by its degree of contrast enhancement. Results of CT scan were
compared with histopathology. Results: At review of unenhanced, corticomedullary and nephrographic
phase images, 26, 29 and 30 lesions, respectively, were identified. One malignant lesion was not
identified and 3 malignant lesions falsely appeared benign in the corticomedullary phase. All lesions
were detected in the nephrographic phase and only 1 malignant lesion falsely appeared benign. The
corticomedullary phase had a sensitivity of 86.2% and nephrographic phase 96.6% in malignant lesion
detection. Conclusion: Enhancement of renal neoplasm is time dependent and is better in
nephrographic phase. Small, hypovascular tumours and those placed in medulla may be missed or
inadequately characterised if nephrographic phase scanning is not done.
Keywords: Computed tomography, renal masses, corticomedullary phase, nephrographic phase

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References


Harris JP, Nelson RC. Abdominal imaging with multidetector

computed tomography; state of the art. J Comput Assist

Tomogr 2004;28(Suppl):517–9.

Schoepf UJ, Becker C, Bruning R, Hong C, Rust GF,

Helmberger, et al. Computed tomography of the abdomen

with multidetector array CT. Radiology 1999;39:652–61.

Yuh BI, Cohan RH. Different phases of renal enhancement.

Role in detecting and characterizing renal masses during

helical CT. AJR Am J Roentgenol. 1999;173(3):747‒55.

Israel GM, Bosniak MA, How I do it: evaluating renal

masses. Radiology 2005;236(2):441–50.

Rana SM, Zafar R, Burney MR. Renal cell carcinoma in a

horseshoe kidney. Pak. Armed Forces Med J 2002;52:219–

Yuh BI, Cohan RH. Helical CT for detection and

charecterization of renal masses. Semin ultrasound CTMR

;18:82–90.

Hertz BR, Einstein DM, Paushter DM. Spiral CT of the

abdomen: artifacts and potential pitfalls. AJR

;161:1185–90.

Birnbaum BA, Jacobs JE, Ramchandani P. Multiphasic renal

CT: comparison of renal mass enhancement during the

corticomedullary and nephrographic phases. Radiology

;200:753–8.

Szolar DH, Kammerhuber F, Altziebler S, Tillich M, Breinl

E, Fotter R, et al. Multiphasic helical CT of the kidney:

increased conspicuity for detection and characterization of

small (<3 Cm) renal masses. Radiology 1997;202:211–7.

kopka L, Fischer U. Zoeller G, Schimdt C, Ringer RH,

Grabbe E. Dual- phase helical CT of the kidney: value of the

corticomedullary and nephrographic phase for evaluation of

renal lesions and preoperative staging of renal cell

carcinoma. AJR Am J Roentgenol. 1997;169:1573–8.

Baumgartner BR, SmithRH, Newfield DM, Nelson RC.

Comparison of spiral and non spiral contrast enhanced CT of

the kidneys for the detection of focal abnormalities.

Presented at 13th annual meeting of the Society of

Uroradiology, Laguna Naiguel, Calif, January 9,1994.

Richard HC, Leonard SS, Melvyn K, James CB, Isaac RF.

Renal masses: Assessmant of Corticomedullary-Phase and

Nephrographic-Phase CT scans. Radiology 1995;196:445–

Silverman SG, Lee BY, Seltzer SE, Bloom DA, Corless CL,

Adams DF. Small (>3 Cm) renal masses: Correlation of

spiral CT features and pathologic findings. AJR

;163:597–605.

Shetty CM, Lakhkar BN, Devi BI, Lakshmi BI. Dual-Phase

helical CT of Kidney: Comparison of corticomedullary and

Nephrographic phases in detection and characterization of

renal masses. Ind J Radiol Imag 2004;14(3):285–90.


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