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Year : 2005  |  Volume : 15  |  Issue : 1  |  Page : 117-125
Spectrum of US and CT findings in renal neoplasms with pathologic correlation

Department of Radio-diagnosis, Department of Urology, All India Institute of Medical Sciences, New Delhi - 29, India

Correspondence Address:
S Vashist
Department of Radio-diagnosis, AIIMS, New Delhi - 29
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/0971-3026.28761

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Objective: The purpose of this study was to characterize the image morphology of renal neoplasms on US (including CDFI) and CT and to stage these tumors and correlate the imaging findings with operative and/or histopathological findings. Materials and methods: a total of 50 patients were studied. These included renal cell carcinoma (n=38), angiomyolipoma (n=5), renal metastases (n=3), oncocytoma (n=1), transitional cell carcinoma (n=1), multilocular cystic nephroma (n=1) and nephroblastomatosis with Wilms tumour (n=1). All patients were evaluated by US and CT. Imaging finding were correlated with both operative and histopathological findings in 31 patients. Diagnosis was confirmed by percutaneous biopsy in 14 patients. In 5 patients final diagnosis was made on classical imaging features. Results : Most renal cell carcinomas had a solid appearance. On US, the most common appearance of RCC was predominantly isoechoic to normal renal parenchyma (78%) followed by hypo & hyperechoic lesions. Only 1 patient had cystic RCC. Solid renal cell carcinomas showed presence of peripheral and intralesional vascularity. The peak systolic Doppler frequency shift ranged from 0.5 KHz to 3.6 KHz. On CT, most of the lesions of RCC were heterogeneous in attenuation with inhomogeneous contrast enhancement less than that of normal renal parenchyma. Calcification was seen in 51%, necrosis in 94%, and haemorrhage in 20% lesions of RCC. Cystic RCC had thick walls, internal septations and solid components, all showing enhancement. Most of the angiomyolipomas (n=4) were homogenously hyperechoic on US, showed peripheral vascularity with peak systolic Doppler frequency shift less than 2.5 kHz. On CT, AML most commonly appeared as well defined, heterogeneous mass lesions showing internal fat density and variable contrast enhancement. Metastatic renal lesions were seen as small, homogenously hypoechoic on US, hypo to isodense on CT and showed minimal or no contrast enhancement. One case of oncocytoma showed a well defined, homogenous mass with central echogenic stellate scar and calcification on US. CT showed homogenous contrast enhancement with central hypodense stellate scar. TCC appeared as an intermediate echogenic mass on US, located in the dilated renal pelvis and extending into the upper ureter. On CT the mass was located centrally having density greater than that of urine, showing minimal contrast enhancement with centrifugal extension and invasion of renal parenchyma. Multilocular cystic nephroma was seen as a well-defined lesion with multiple cystic spaces, separated by septae which were echogenic on US and showed mild to moderate enhancement on CT. Conclusion: US and CT show many of the key imaging features used to characterize most of the renal neoplasms. However, some lesions remain indeterminate and require percutaneous biopsy to confirm the diagnosis.

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