scholarly journals Role of multi detector computed tomography (MDCT) in evaluation of renal masses

Author(s):  
M. A. Karthikeyan ◽  
Poonam Vohra

Background: Due to rapid pace in development of imaging techniques and increasing number of investigations being done, more number of renal masses are discovered incidentally during evaluation of unrelated or unspecific symptoms. Hence it is vital to differentiate neoplastic and non-neoplastic masses. Among the neoplastic masses, there is a need to differentiate benign and malignant masses so that appropriate treatment strategies like nephron sparing surgery, radio frequency ablation etc. can be planned at an early stage and avoiding unnecessary radical treatments for improved patients survival.Methods: A Cross-sectional Observational study was done in 35 patients. Patients of either sex in any age group who had presented with suspected renal mass by clinical signs and symptoms (palpable renal angle mass, renal angle pain, hematuria) confirmed on USG examination or an incidental Renal mass diagnosed on USG/CT examination were included in our study.Results: Ultrasound is the initial imaging modality of choice since it is inexpensive, easy to perform and no radiation exposure. On USG, the renal lesions are classified as solid or cystic. Anechoic, thin walled cyst without any septations or solid components is usually Bosniak I cyst (simple cyst) and does not need any further evaluation. Rest of the cystic and solid lesions cannot be characterized by ultrasound and hence need further evaluation.Conclusions: Multidetector Computed Tomography is the imaging modality of choice for further evaluation and characterization. CT is done in four phases viz., unenhanced, corticomedullary, nephrographic and excretory phase especially in cases of malignancy while in benign conditions like angiomyolipoma and abscess, evaluation with unenhanced and single phase post contrast in portovenous phase is sufficient.

2015 ◽  
Vol 2 (3) ◽  
pp. 105-113 ◽  
Author(s):  
Tsitskari Maria ◽  
Christos Georgiades

Renal cell carcinoma (RCC) is the most common type of kidney cancer in adults. Nephron sparing resection (partial nephrectomy) has been the “gold standard” for the treatment of resectable disease. With the widespread use of cross sectional imaging techniques, more cases of renal cell cancers are detected at an early stage, i.e. stage 1A or 1B.  This has provided an impetus for expanding the nephron sparing options and especially, percutaneous ablative techniques.  Percutaneous ablation for RCC is now performed as a standard therapeutic nephron-sparing option in patients who are poor candidates for resection or when there is a need to preserve renal function due to comorbid conditions, multiple renal cell carcinomas, and/or heritable renal cancer syndromes. During the last few years, percutaneous cryoablation has been gaining acceptance as a curative treatment option for small renal cancers. Clinical studies to date indicate that cryoablation is a safe and effective therapeutic method with acceptable short and long term outcomes and with a low risk, in the appropriate setting.  In addition it seems to offer some advantages over radio frequency ablation (RFA) and other thermal ablation techniques for renal masses.


2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Sang Wha Kim ◽  
Adams Hei Long Yuen ◽  
Cherry Tsz Ching Poon ◽  
Joon Oh Hwang ◽  
Chang Jun Lee ◽  
...  

AbstractDue to their important phylogenetic position among extant vertebrates, sharks are an invaluable group in evolutionary developmental biology studies. A thorough understanding of shark anatomy is essential to facilitate these studies and documentation of this iconic taxon. With the increasing availability of cross-sectional imaging techniques, the complicated anatomy of both cartilaginous and soft tissues can be analyzed non-invasively, quickly, and accurately. The aim of this study is to provide a detailed anatomical description of the normal banded houndshark (Triakis scyllium) using computed tomography (CT) and magnetic resonance imaging (MRI) along with cryosection images. Three banded houndsharks were scanned using a 64-detector row spiral CT scanner and a 3 T MRI scanner. All images were digitally stored and assessed using open-source Digital Imaging and Communications in Medicine viewer software in the transverse, sagittal, and dorsal dimensions. The banded houndshark cadavers were then cryosectioned at approximately 1-cm intervals. Corresponding transverse cryosection images were chosen to identify the best anatomical correlations for transverse CT and MRI images. The resulting images provided excellent detail of the major anatomical structures of the banded houndshark. The illustrations in the present study could be considered as a useful reference for interpretation of normal and pathological imaging studies of sharks.


2013 ◽  
Vol 2013 ◽  
pp. 1-3 ◽  
Author(s):  
Junaid Nabi ◽  
Danish Rafiq ◽  
Fatema N. Authoy ◽  
Ghulam Nabi Sofi

Introduction. Adrenal myelolipoma is a rare tumor that is benign in nature, usually asymptomatic, unilateral, and nonsecreting. It is composed of variable mixture of mature adipose tissue and hematopoietic elements and develops within the adrenal gland. With the widespread use of cross-sectional imaging modalities such as ultrasonography and computed tomography, the incidental detection of these tumors is increasing in frequency.Case Presentation. We report a case of adrenal myelolipoma in a 63-year-old Kashmiri male, who presented with pain in the right upper abdomen. Physical examination was unremarkable. Ultrasound abdomen showed the presence of a hyperechoic mass in the right suprarenal region with undefined margins. Contrast-enhanced computed tomography (CECT) scan of abdomen revealed a well-defined, round lesion in the right suprarenal region with heterogeneous attenuation suggesting the possibility of myelolipoma. The patient was subjected to right adrenalectomy and his postoperative course was uneventful. The histopathological evaluation of the mass confirmed the initial diagnosis of adrenal myelolipoma.Conclusion. Although mostly discovered as an “incidentaloma”, the diagnosis of adrenal myelolipoma warrants thorough diagnostic study. Imaging techniques such as ultrasonography and CT scans as well as biochemical studies are useful for indicating the best treatment taking into account the size of the mass and possible hormone production. Surgical resection is advocated through extraperitoneal approach as it minimizes postoperative complications and leads to quicker recovery.


2019 ◽  
Vol 47 ◽  
Author(s):  
Viviane Motta dos Santos Moretto ◽  
Luciana Maria Curtio Soares ◽  
Esthefanie Nunes ◽  
Uiara Hanna Araújo Barreto ◽  
Valéria Régia Franco Sousa ◽  
...  

Background: Cerebral cavernous hemangioma is a rare neoplasm of vascular origin in the brain, characterized by abnormally dilated vascular channels surrounded by endothelium without muscle or elastic fibers. Presumptive diagnosis is performed by magnetic resonance or computed tomography (CT) scanning and can be confirmed by histopathology. The prognosis of intracranial cavernous hemangioma is poor, with progression of clinical signs culminating in spontaneous death or euthanasia. The purpose of this paper is to report a case of cerebral cavernous hemangioma in a dog, presenting the clinical findings, tomographic changes, and pathological findings.Case: This case involved a 2-year-old medium sized mixed breed female dog presenting with apathy, hyporexia, ataxia, bradycardia, dyspnea, and seizure episodes for three days. Hemogram and serum biochemistry of renal and hepatic function and urinalysis did not reveal any visible changes. CT scanning was also performed. The scans revealed a hyperdense nodule of 15.9 x 14 mm, with well defined borders, and a hypodense halo without post-contrast enhancement and mass effect in the right parietal lobe was observed in both transverse and coronal sections. Based on the image presented in the CT scans, the nodule was defined as a hemorrhagic brain lesion. The animal died after a seizure. The right telencephalon was subjected to necropsy, which revealed a reddish-black wel-defined nodule 1.7 cm in diameter extending from the height of the piriform lobe to the olfactory trine at the groove level and extending towards the lateral ventricle, with slight compression and deformation of the thalamus but no other macroscopic alterations in the other organs. The histopathology indicated that this nodular area in the encephalus contained moderate, well-delimited but unencapsulated cellularity, composed of large vascular spaces paved with endothelial cells filled with erythrocytes, some containing eosinophilic fibrillar material (fibrin) and others with organized thrombus containing occasional neutrophil aggregates. The endothelial cells had cytoplasm with indistinct borders, elongated nuclei, scanty crust-like chromatin, and cellular pleomorphism ranging from discrete to moderate, without mitotic figures.Discussion: The histological findings characterized the morphological changes in the brain as cavernous hemangioma, and the growth and compression of this neoplasm were considered the cause of the clinical signs of this dog. The main complaint was seizures, although ataxia and lethargy were also noted. These clinical signs are often related to changes in the anterior brain and brainstem. The literature does not list computed tomography as a complementary diagnostic method in cases of cerebral cavernous hemangioma in dogs, but CT scanning was useful in confirming cerebral hemorrhage. The main differential diagnosis for cerebral cavernous hemangioma would be a hamartoma, but what differentiates them histologically is the presence of normal interstices between the blood vessels, since no intervening neural tissue occurs in the case of cerebral hemangioma. Therefore, even in the absence of immunohistochemistry to more confidently confirm a cavernous hemangioma, the clinical signs, CT scans and especially the pathological findings were consistent with a case of cerebral cavernous hemangioma, a benign neoplasm with a poor prognosis due to the severe neurological changes it causes and its difficult treatment.


2018 ◽  
Vol 22 (1) ◽  
Author(s):  
Nompumelelo E. Mlambo ◽  
Nondumiso N.M. Dlamini ◽  
Ronald J. Urry

Background: The incidence of renal cell carcinoma (RCC) is increasing globally owing to the increased use of cross-sectional imaging. Computed tomography (CT) scan is the modality of choice in the diagnosis and pre-operative assessment of RCC. Nephrectomy is the standard treatment for RCC and pre-surgery biopsy is not routinely practised. The accuracy of CT diagnosis and staging in a South African population has not been established.Objectives: To determine the accuracy of CT scan in the diagnosis and pre-operative staging of RCC at Grey’s Hospital.Methods: A retrospective chart review was performed; CT scan reports and histopathological results of adult patients who underwent nephrectomy for presumed RCC on CT scan between January 2010 and December 2016 were compared.Results: Fifty patients met the inclusion criteria for the study. CT significantly overestimated the size of renal masses by 0.7 cm (p = 0.045) on average. The positive predictive value of CT for RCC was 81%. Cystic tumours and those 4 cm and smaller were more likely to be benign. CT demonstrated good specificity for extra-renal extension, vascular invasion and lymph node involvement, but poor sensitivity.Conclusion: In our South African study population, CT is accurate at diagnosing RCC, but false-positives do occur. Non-enhancing or poorly enhancing, cystic, fat-containing and small lesions (4 cm or smaller) are more likely to be benign and ultrasound-guided biopsy should be considered to avoid unnecessary surgery. CT assessment of extra-renal extension and vascular invasion is challenging and additional imaging modalities such as magnetic resonance imaging (MRI) venogram, duplex Doppler ultrasound or Positron emission tomography–computed tomography (PET/CT) may be beneficial.


2012 ◽  
Vol 35 (3) ◽  
pp. 129-143 ◽  
Author(s):  
Woonggyu Jung ◽  
Stephen A. Boppart

In pathology, histological examination of the “gold standard” to diagnose various diseases. It has contributed significantly toward identifying the abnormalities in tissues and cells, but has inherent drawbacks when used for fast and accurate diagnosis. These limitations include the lack ofin vivoobservation in real time and sampling errors due to limited number and area coverage of tissue sections. Its diagnostic yield also varies depending on the ability of the physician and the effectiveness of any image guidance technique that may be used for tissue screening during excisional biopsy. In order to overcome these current limitations of histology-based diagnostics, there are significant needs for either complementary or alternative imaging techniques which perform non-destructive, high resolution, and rapid tissue screening. Optical coherence tomography (OCT) is an emerging imaging modality which allows real-time cross-sectional imaging with high resolutions that approach those of histology. OCT could be a very promising technique which has the potential to be used as an adjunct to histological tissue observation when it is not practical to take specimens for histological processing, when large areas of tissue need investigating, or when rapid microscopic imaging is needed. This review will describe the use of OCT as an image guidance tool for fast tissue screening and directed histological tissue sectioning in pathology.


2019 ◽  
Vol 36 (1) ◽  
pp. 37-44
Author(s):  
Jessica T. Prince

This review explores the classification and evaluation of suspicious renal lesions across several radiologic imaging modalities. Diagnostic medical sonography (DMS), computed tomography (CT), magnetic resonance imaging (MRI), and contrast-enhanced ultrasound (CEUS) are the primary modalities used to investigate questionable lesions found within the kidneys. Renal masses may range from completely benign to malignant. They are classified based on many different features and characteristics. These lesions may be simple cystic, complex cystic, or solid in nature. Masses may also exhibit varying degrees of vascularity, septations, and calcifications. The discussed imaging modalities have varying strengths, limitations, and implications for use. Imaging techniques may be used independently or in conjunction to best diagnose and treat a patient with a suspicious renal mass. The aim of this review was to describe the diagnostic value of the imaging modalities (DMS, CT, MRI, and CEUS) and their role in the evaluation of suspicious renal lesions.


2017 ◽  
Vol 62 (No. 10) ◽  
pp. 579-582
Author(s):  
F. Del Signore ◽  
R. Terragni ◽  
A. Carloni ◽  
L. Stehlik ◽  
P. Proks ◽  
...  

The goal of this study was to describe the ultrasonographic and computed tomographic appearance of a penile foreign body in a dog for the first time. We describe an unusual penile localisation of a grass seed awn in an 11-year-old mixed-breed dog referred for a computed tomography study after a severe haemorrhage from the penis. A fistulous tract was observed after plain and post-contrast whole-body computed tomography acquisition; the foreign body was localised with ultrasound and removed under ultrasonographic guidance, with the complete healing of the penile lesion. Grass awns are common foreign bodies in dogs and cats and are commonly localised in the ear canal, subcutaneous tissue, interdigital space, eyelid, conjunctiva and nasal or oral cavity. These foreign bodies pose a threat due to their peculiar structure, which facilitates their easy access to the affected area and their transit through the body. Clinical signs are often non-specific, and imaging modalities such as ultrasonography and computed tomography are useful techniques for localisation. Our report demonstrates that the combination of computed tomography and ultrasound techniques was crucial for the exact localisation and mini-invasive retrieval of the grass seed.


2021 ◽  
Vol 10 (38) ◽  
pp. 3413-3418
Author(s):  
Fatma Fayez Badr ◽  
Mohammed Abdulaziz Barayan ◽  
Fatima Mohammed Jadu ◽  
Hanadi Mohammed Khalifa

BACKGROUND Cone beam computed tomography (CBCT) was first introduced in 2008 and has since seen a tremendous growth in both private dental clinics and dental institutions. This has led to the normalization of CBCT use by general dentists. Therefore, it is essential to assess how and why general and specialist dentists use CBCT. The purpose of this study was to assess the knowledge, practice and attitude towards CBCT among general and specialist dentists working in the kingdom of Saudi Arabia. METHODS In this cross-sectional study, a questionnaire was electronically distributed via email and social media from October 2018 to September 2020. The self-administered questionnaire was divided into five segments: demographics, knowledge, current practice, training and attitude. RESULTS A total of 221 dentists filled the questionnaire including 85 general dentists and 135 post graduate students or specialists. The majority of dentists (81.9 %) demonstrated poor knowledge. Orthodontists and endodontists were most aware of CBCT terms. Most dentists (71.5 %) have a CBCT unit in their practice. Only 34.8 % received CBCT training, the majority of which was theoretical. A positive attitude was noted in 83.2 % of dentists by agreeing to a statement regarding CBCT justification. CONCLUSIONS Poor CBCT knowledge was evident in majority of dentists despite having CBCT in their practice. Dentists are highly aware of the importance of CBCT justification and professional interpretation; however, they lack basic knowledge and training related to this imaging modality. This highlights an institutional gap that policy makers should address in order to ensure the highest quality of patient care. KEY WORDS Cone Beam Computed Tomography; CBCT; Survey


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