Helical CT Evaluation of Renal Mass Lesions: A Prospective Study
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Professor of Nephrology, **** Professor of Radiology, **** Associate Professor of
Radiology; Departments of of renal masses was 98.5% vs 97% of USG (Table I
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REPORT
JIACM 2007; 8(3): 262-4
Helical CT Evaluation of Renal Mass Lesions: A Prospective Study
RPS Bajwa*, P Sandhu**, BS Aulakh***, JS Sandhu****, K Saggar*****, A Ahluwalia******
Abstract
Objective: To study the diagnostic accuracy of helical CT in characterisation of renal mass lesions (excluding the simple renal cysts) and to study the pattern of renal mass lesions in a tertiary care institute in North India. Methods: All consecutive patients of renal mass lesions – other than simple cysts – were prospectively studied and the CT findings were compared with the final diagnosis. Results: This study included 70 patients (44 males; 26 females) in the age range of 4 to 84 years. Neoplastic lesions were observed in 39 (55.7%) cases and inflammatory lesions in 23 (32.9%). The remaining 8 patients had urinoma and complicated cyst in 3 each and renal injury in two. Renal cell carcinoma was observed in 32 cases, Wilm’s tumour in 3, transitional cell carcinoma in 2, and 1 each of lymphoma and angiomyolipoma. The inflammatory renal mass lesions observed were focal pyelonephritis in 12, emphysematous pyelonephritis and renal abscess in 5 each and xanthogranulomatous pyelonephritis in 1. Helical CT was accurate in characterising 98.5% of renal mass lesions and staging 92.4% of renal cell carcinomas. Conclusions: Helical CT is highly sensitive in characterisation of renal masses. Although malignancy remains the commonest renal mass lesion, inflammatory lesions also constitute a significant proportion. Key words: Renal cell carcinoma, Inflammatory renal lesions.
Introduction
The commonest space occupying renal lesion is a simple cyst with an incidence of 25% to 50% after the age of 50 years. Benign renal masses outnumber the malignant ones. Renal cell carcinoma is the most common tumour of the kidney comprising 3% of all malignancies found in adults1. The diagnosis of incidental renal carcinoma has now increased from 7 to 13% in the early 1970s to 48 - 60%2. In the past, surgical exploration of all space occupying renal l s o sw sh l o l g t r .R c n l ,s q e t a r d o o i a ein a ed biaoy eety eunil ailgcl investigations can distinguish the nature of renal masses with a diagnostic accuracy comparable to that of surgery. We studied the pattern of renal mass lesions and compared t eh l c lC f n i g w t t ef n lc i i a a dh s o o i a h eia T idns ih h ia lncl n itlgcl danss igoi.
masses that adhered to the criteria of simple cyst were not included in this study. The institutional ethical and the medical university thesis evaluation committee cleared the suy td. Helical CT was performed on Siemens Somatom AR Star. Oral, rectal, and intravenous contrast was given to each patient. A topogram was acquired with the patient supine in a state of suspended respiration. Initial plain scans were obtained to determine the location of the mass and pertinent vascular structures. Thereafter, 80 ml of non-ionic contrast was injected manually as a single bolus through 18-gauge catheter. Spiral CT scans with collimation of 10 mm and table speed of 15 mm per second, i.e., a pitch of 1.5 was done. Images were reconstructed at 8 mm intervals, i.e., with 20% overlap. Thinner images were reconstructed at 4 mm wherever indicated. Reconstructed images were viewed in detail. For permanent record, the relevant images of each case were recorded on 14” x 17” special laser film by Dry View Kodak camera. Axial CT images so obtained were studied in detail on soft tissue and bone window. The morphology, size, shape, enhancement pattern, character ( o i o c s i ) c l i i a i ni a y l c lo d s a ts r a o sld r ytc, acfcto f n, oa r itn ped f the mass was studied. The CT staging of the malignant mass
Material and methods
This study was carried out at Dayanand Medical College and Hospital Ludhiana, a tertiary care centre in North India. S v n yc n e u i ep t e t o r n lm s l s o s( l n c l y eet osctv ains f ea as ein ciial suspected or incidentally detected on other imaging studies) referred for CT evaluation were included. Renal
* Resident in Radiology, ** Professor of Radiology, *** Professor of Urology, **** Professor of Nephrology, ***** Professor of Radiology, ****** Associate Professor of Radiology; Departments of Radio Diagnosis, Urology and Nephrology, Dayanand Medical College and Hospital, Ludhiana - 141 001, Punjab, India.
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