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Diagnostic potential of multidetector computed tomography for characterizing small renal masses.

ABSTRACT: To assess the potential of CT for characterizing small renal tumors.76 patients with <4 cm renal tumors underwent CT examination. The following parameters were assessed: presence of calcifications, densitometry on unenhanced and enhanced scans, washout percentage, urinary tract infiltration, star-shaped scar, and paradoxical effect.Calcifications were found in 7/56 (12.5%) carcinomas. Clear cell carcinomas were as follows: mean density 183.5 HU (arterial phase), 136 HU (portal phase), and 94 HU (delayed phase), washout 34.3%; chromophobe carcinomas were as follows: mean density 135 HU (arterial phase), 161 HU (portal phase), and 148 HU (delayed phase), washout 28%; papillary carcinomas were as follows: mean density 50.3 HU (arterial phase), 60 HU (portal phase), and 58.1 HU (delayed phase), washout 2.7%. In 2/56 (3.6%) cases urinary tract infiltration was found. Oncocytomas were as follows: mean density 126.5 HU (arterial phase), 147.5 HU (portal phase), and 115.5 HU (delayed phase), washout 28.6%. On unenhanced scans, angiomyolipomas were as follows: density values <30 HU in 12/12 (100%) of cases and on enhanced scans: mean density 78 HU (arterial phase), 128 HU (portal phase), and 80 HU (delayed phase), washout 50%.Intralesional calcifications and urinary tract infiltration are suggestive for malignancy, with the evidence of adipose tissue for angiomyolipomas and a modest increase in density with a reduced washout for papillary carcinomas. The intralesional density on enhanced scans, peak enhancement, and washout do not seem significant for differentiating clear cell, chromophobe carcinomas, angiomyolipomas, and oncocytomas.

SUBMITTER: Mancini ME

PROVIDER: S-EPMC4407528 | biostudies-other | 2015

REPOSITORIES: biostudies-other

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Project description:BackgroundAlthough small bowel bleeding is relatively rare, it is a potentially fatal disease, and its diagnosis still faces challenges. Technetium 99m-labeled red blood cell computed single photon emission computed tomography/computed tomography (99mTc-RBC SPECT/CT) and contrast-enhanced multidetector computed tomography (MDCT) are common imaging methods for diagnosing small bowel bleeding, but there have been no studies comparing their diagnostic efficacy for this purpose. This study aims to compare the diagnostic value of 99mTc-RBC SPECT/CT and contrast-enhanced MDCT for small bowel bleeding.MethodsA total of 44 patients (30 males and 14 females, median age of 64 years) definitively diagnosed with small bowel bleeding and 15 non-small bowel bleeding patients (8 males and 7 females, median age of 66 years) were consecutively included in this study. All patients underwent 99mTc-RBC SPECT/CT and contrast-enhanced MDCT examinations at Beijing Friendship Hospital of Capital Medical University between January 2020 to September 2023. The definitive diagnosis had been made through surgery or colonoscopy, or through patient history, patient management, and clinical follow-up. We collected clinical data of the participants. 99mTc-RBC SPECT/CT and contrast-enhanced MDCT were reviewed in a blinded fashion for accuracy of detection of active bleeding as well as the active small bowel bleeding location.ResultsAmong the 59 patients, the accuracy, sensitivity, and specificity of 99mTc-RBC SPECT were 27.3%, 93.3%, and 92.3%; for 99mTc-RBC SPECT/CT they were 76.3%, 40.5%, and 93.3%; whereas for contrast-enhanced MDCT they were 45.8%, 27.3%, and 100%, respectively. The diagnostic accuracy of 99mTc-RBC SPECT/CT for jejunal and ileal bleeding was high, at 100% and 86.4%, respectively. Meanwhile, 99mTc-RBC SPECT/CT had a higher accuracy in diagnosing more causes of small bowel bleeding. In 59 patients, the combination of 99mTc-RBC SPECT/CT and contrast-enhanced MDCT accurately diagnosed small bowel bleeding and provided precise localization in 50 patients, resulting in the accuracy, sensitivity, and specificity of 84.7%, 79.5%, and 100.0%, respectively.Conclusions99mTc-RBC SPECT/CT has high diagnostic value in diagnosing small bowel bleeding and is superior to 99mTc-RBC SPECT and contrast-enhanced MDCT. The combination of 99mTc-RBC SPECT/CT and contrast-enhanced MDCT can further improve the diagnostic accuracy of diagnosis, and can accurately guide the diagnosis and treatment of small bowel bleeding.

Project description:Renal masses are a common finding in diagnostic imaging; these lesions usually are solid or cystic, benign or malignant, and the correct diagnosis may be difficult. The aim of our study was the comparison of multi-slice computed tomography (MSCT) and high-field magnetic resonance (MR) in the diagnostic evaluation of renal masses.We studied 29 patients, 16 men and 13 women aged 8-85 years (mean 61±17 years) with histo-cytological diagnosis of renal masses (n=31), of which the majority (74%; n=23) was represented by malignant lesions [renal cell carcinoma (Ca) =16, chromophobe renal cell Ca =2, squamous cell Ca =1, urothelial Ca =2, lymphoma =1, Wilms tumor =1]; the remaining 8 masses (26%) were benign (pyelonephritis =2, simple cyst =1, hematic cyst =1, lipoma =1 and oncocytoma =3). All patients underwent MSCT and MR (3.0 Tesla) before and after contrast injection; the images were evaluated in double-blind by two expert radiologists. The results of the images were then compared with the histo-cytological data to calculate the values of diagnostic accuracy for both methods in the identification and characterization of renal masses. The benign or malignant nature of the lesions was established according to the regularity of the margins, presence or absence of significant contrast enhancement, infiltration of perirenal fat and vascular invasion. The concordance of the results of the two imaging techniques was then calculated using the coefficient Kappa Cohen.For both identification and characterization of renal masses, MSCT and MR showed comparable values of diagnostic accuracy with a significant concordance (k=1); in particular, the diagnostic accuracy of MSCT/MR was 100%/100% for lesion identification, 90%/90% for lesion characterization in terms of benign or malignant nature, 97%/97% for the evaluation of lesion edges, 90%/90% for the assessment of lesion contrast enhancement, 93%/93% for the evaluation of peri-renal fat infiltration and 96%/96% for the evaluation of vascular infiltration. Only in three cases of oncocytoma the two imaging methods were both inaccurate for diagnosis of benignity classifying the lesions as probably malignant on the basis of the absence of central scar and of dynamic contrast enhancement pattern.The results of our study show comparable diagnostic accuracy of computed tomography (CT) and MR for the identification and characterization of expansive renal lesions. High-field MR is, therefore, a valid alternative to MSCT in the evaluation of renal masses avoiding exposure to ionizing radiation.

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Diagnostic potential of multidetector computed tomography for characterizing small renal masses.

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