OBJECTIVETo investigate the differences between tumor sizes measured by preoperative computed tomography (CT) imaging and pathologic examination of surgical specimens in Chinese patients who received extirpative surgery for renal tumors.

METHODSFrom September 2008 to September 2010, 204 patients with renal tumors treated in the Renji Hospital were enrolled in this study, and their clinicopathological data were collected and analyzed. The paired Student's t-test was used to compare the mean radiological tumor maximum diameter and the mean pathological tumor maximum diameter. All cases in which post-operative down-staging or up-staging occurred due to the discrepancy between radiological and pathological tumor maximum diameters were identified. In addition, the relationship between radiological and pathological tumor maximum diameters and histological subtypes was analyzed.

RESULTSOverall, the radiological mean maximum diameter of tumors on CT was 48.3 mm and the pathological mean maximum diameter was 47.0 mm. On average, CT overestimated pathological size by 1.3 mm (P = 0.018). CT overestimated pathological tumor size in 111 (54.4%) patients, underestimated in 71 (34.8%) patients and equal pathological size in 22 (10.8%) patients. Among the 190 patients with pT1 or pT2 tumors, there was a discrepancy between clinical and pathological staging in 35 (18.4%) patients. Of these, 29 (15.3%) patients were down-staged post-operatively and 6 (3.2%) were up-staged. When subjects were categorized according to radiographic tumor size associated with clinical stage, statistically significant difference (average of 1.76 mm) was observed between radiographic and pathologic maximum diameters ranging 41-70 mm (P = 0.035). For clear cell carcinoma, mean radiographic tumor maximum diameter was significantly larger than the pathologic maximum diameter by 1.69 mm (P = 0.003).

CONCLUSIONSThere is a statistically significant but small difference (1.3 mm) between mean radiological and mean pathological tumor maximum diameters. For some patients, this difference leads to a discrepancy between clinical and pathological staging, which may have implications on pre-operative clinical decision and prognosis prediction.

Diagnostic Imaging ; Humans ; Kidney ; diagnostic imaging ; pathology ; Kidney Neoplasms ; diagnostic imaging ; pathology ; Prognosis ; Retrospective Studies ; Tomography, X-Ray Computed

OBJECTIVE: To explore the feasibility of rapid and accurate three-dimensional (3D) image reconstruction using Uromedix-3D software for urological surgery. METHODS: The original renal thin-slice enhancement CT data were obtained from patients with kidney lesions treated in our hospital between December, 2015 and October, 2018. The self-developed Uromedix- 3D system was used to reconstruct the normal kidney structures, blood vessels, collecting systems and the lesions. The spatial anatomic relationships of the structures were measured and digitized for surgical planning. RESULTS: 3D reconstruction of the kidneys was performed in a total of 173 cases, and the mean time for reconstruction was 31.24±2.012 min. Of these cases, 147 (84.9%) had renal tumors, and 2 had renal tumors with tumor thrombus. In addition to renal tumors, the Uromedix-3D system was also used for reconstructing other lesions including UPJO, kidney stones and retroperitoneal masses. Renal artery reconstruction was performed in 170 cases, which allowed observation of the precise terminal branches (up to 7th grade arterial branch) of the artery; 109 (64%) cases showed the 5th grade arterial branch or above. Renal artery variations were detected in 37 cases, including accessory renal artery (24 cases) and multiple renal arteries (13 cases). The renal veins were reconstructed in 164 cases, and second grade or above (up to the 4th grade) vein branches were observed in 138 (84%) cases. CONCLUSIONS Uromedix-3D system can accurately and efficiently reconstruct the 3D structure of human kidneys and the renal lesions based on enhanced CT data. The reconstructed 3D model allows objective assessment of the spatial anatomical relationship of the lesions to provide assistance in surgical planning.
Humans ; Imaging, Three-Dimensional ; Kidney ; Kidney Calculi ; diagnostic imaging ; surgery ; Kidney Neoplasms ; diagnostic imaging ; surgery ; Tomography, X-Ray Computed

OBJECTIVETo investigate the value of real-time contrast-enhanced ultrasound (CEUS) in the diagnosis and differential diagnosis of renal solid renal lesions (RSLs).

METHODSWe retrospectively analyzed 140 cases of 152 RSLs with a mean diameter 3.1∓1.9 cm. CEUS was performed and the perfusion characteristics were analyzed using contrast pulse sequences (CPS) technique. CEUS findings were compared with biopsy histopathologic findings.

RESULTSA total of 137 malignant lesions (including 127 renal clear cell carcinomas, 8 renal papillary carcinomas and 2 chromophobe cell carcinomas) and 15 benign lesions (13 angiomyolipomas and 2 renal oncocytomas) were detected. Of the 137 malignant lesions, 98 (71.5%) showed contrast agent fast perfusion and hyper-enhancement or iso-enhancement in cortical phase, 104 (75.9%) showed hypo-enhancement in later corticalmedullary and late phase, and 125 (91.2%) showed rim-like enhancement. Tumors with a diameter ≤2 cm presented with homogeneous enhancement, and those ranging from 2 to 4 cm showed heterogeneous enhancement with a honeycomb feature; tumors greater than 4 cm featured heterogeneous enhancement with large no-enhancement necrotic areas. Of the benign lesions, 13 angiomyolipomas and 2 renal oncocytomas showed slow wash-in and slow wash-out mode. The diagnostic specificity, accuracy and positive predictive value of CEUS for RSLs were 94.9%, 96.1%, and 73.7%, as compared to 72.3%, 71.1%, and 19.1% with conventional US, respectively (P<0.001). The sensitivity and negative predictive value of CEUS were 93.3% and 99.2%, respectively, significantly higher than those of conventional US (60% and 94.3%, P=0.084, and 0.062, respectively).

CONCLUSIONReal-time CEUS can provide valuable information for improving the diagnosis and differential diagnosis of RSLs.

Adenoma, Oxyphilic ; diagnostic imaging ; Carcinoma, Renal Cell ; diagnostic imaging ; Contrast Media ; Diagnosis, Differential ; Humans ; Kidney Diseases ; diagnostic imaging ; Kidney Neoplasms ; diagnostic imaging ; Retrospective Studies ; Sensitivity and Specificity ; Ultrasonography

Adult ; Female ; Humans ; Kidney Neoplasms ; diagnostic imaging ; metabolism ; Neuroectodermal Tumors ; diagnostic imaging ; metabolism ; Radiography ; Young Adult

Angiomyolipoma ; diagnostic imaging ; etiology ; Brain ; diagnostic imaging ; Female ; Humans ; Kidney Neoplasms ; diagnostic imaging ; etiology ; Lung Neoplasms ; diagnostic imaging ; etiology ; Lymphangioleiomyomatosis ; diagnostic imaging ; etiology ; Magnetic Resonance Imaging ; Middle Aged ; Pedigree ; Tomography, X-Ray Computed ; Tuberous Sclerosis ; complications ; diagnostic imaging

OBJECTIVETo study the CT findings of cystic nephroma (CN) and multilocular cystic renal cell carcinoma (MCRCC) and to improve the accuracy of preoperative diagnosis of these two diseases.

METHODSThe CT findings of nine CN cases and 19 MCRCC cases confirmed by pathology were blindly reviewed and compared with their pathological results. Fisher's exact test and independent-samples T test were applied to statistically analyze some of the CT features of the CN and MCRCC lesions.

RESULTSThe thickness of cystic walls and partitions in the nine CN cases ranged from 0.5 to 5 mm. Cystic walls and partitions were slightly thicker in some parts without visible mural nodules. Varying amounts of solid tissue could be found in all the 19 MCRCC tumors, and the cystic walls and partitions were found partially thickened ranging from 3 mm to 13 mm. Eight cases were with mural nodules (nodule diameter: 4.5-16 mm). Nine cases of CN tumors were lobulated and 7 protruded into the renal sinus. Three out of the 19 MCRCC presented shallow lobulation, and 7 tumors protruded into the renal sinus. The CT contrast-enhancement scanning displayed moderate delayed enhancement in the cystic walls and partitions in 8 cases. The enhanced scanning revealed that all the nine cases showed enhancement of the cystic walls and partitions, while 8 cases of them had mild to moderate delayed enhancement. The cystic walls, partitions and nodules were enhanced in 19 MRCC cases, among them 17 cases displayed obvious enhancement in the cortical phase. Among the differences of CT findings between MC and MRCC, the shallow lobulation, protruding into the renal sinus, mural nodules, cystic wall and partition thickness, and net growth in the cortical and nephrographic phase were statistically significantly different (P<0.05 for all).

CONCLUSIONSCT scan can provide significant evidence for CN and MCRCC diagnosis. CN cases usually present relatively thin and even cystic walls and partitions without mural nodules and with shallow lobulation and protruding into the renal sinus. The enhancement is mild to moderate, dynamic and delayed, while the opposite CT findings may indicate a higher possibility of MCRCC.

Adenocarcinoma, Clear Cell ; diagnostic imaging ; Carcinoma, Renal Cell ; diagnostic imaging ; Diagnosis, Differential ; Humans ; Kidney ; diagnostic imaging ; Kidney Diseases, Cystic ; diagnostic imaging ; Kidney Neoplasms ; diagnostic imaging ; Tomography, X-Ray Computed

BACKGROUNDThere are relatively few reports focusing on clinical and multi-slice CT (MSCT) imaging findings of mucinous tubular and spindle cell carcinoma (MTSCC). Our study aimed to characterize the clinical and MSCT imaging features of MTSCC.

METHODSThe imaging findings in 17 patients with MTSCC by MSCT were retrospectively studied. MSCT was undertaken to investigate tumor location, size, density, cystic or solid appearance, calcification, capsule sign, enhancement pattern, and retroperitoneal lymph node metastasis.

RESULTSTumors (mean diameter, (3.9 ± 1.7) cm) were solitary (17/17), solid (16/17) with cystic components (5/17), had no calcifications (14/17), had a poorly defined margin (14/17), were centered in the medulla (15/17), compressed the renal pelvis (7/17), and neither lymph node nor distant metastasis was found. The attenuation of MTSCC tumors was equal to that of the renal cortex or medulla on unenhanced CT (32.3 ± 2.6, 36.3 ± 4.6, 33.2 ± 3.9, respectively, P > 0.05), while tumor enhancement after administration of a contrast agent was lower than that of normal renal cortex and medulla during all phases (P < 0.05).

CONCLUSIONMTSCC tends to be a solitary, isodense mass with poorly defined margin arising from the renal medulla with enhancement less than the cortex and medulla during all phases.

Adenocarcinoma, Mucinous ; diagnosis ; diagnostic imaging ; Adult ; Carcinoma ; diagnosis ; diagnostic imaging ; Carcinoma, Renal Cell ; diagnosis ; diagnostic imaging ; Female ; Humans ; Kidney Neoplasms ; diagnosis ; diagnostic imaging ; Male ; Middle Aged ; Radiography

OBJECTIVETo study the sonographic features and patterns of cystic renal carcinomas.

METHODSThirteen cases of cystic renal carcinoma confirmed by operation and pathology were examined by ultrasonography, and the cystic walls, septa and solid mural nodules were studied.

RESULTSSolid mural nodules of some cases and irregular thickening of the cystic walls and septa were characteristic findings for the ultrasonic diagnosis of cystic renal carcinomas. According to their pathologic mechanisms and sonographic features, cystic renal carcinomas were classified into 3 patterns: unilocular cystic mass, multiloculated cystic mass and cystic-solid mass.

CONCLUSIONSTypical cystic renal carcinomas can be well diagnosed, while atypical cases may be misdiagnosed as benign renal cysts by ultrasonography. Color Doppler ultrasonography and needle aspiration guided by ultrasonography are helpful in the diagnosis of these atypical cases.

Adult ; Aged ; Biopsy, Needle ; Carcinoma, Renal Cell ; diagnostic imaging ; Diagnosis, Differential ; Female ; Humans ; Kidney Diseases, Cystic ; diagnostic imaging ; Kidney Neoplasms ; diagnostic imaging ; Male ; Middle Aged ; Ultrasonography, Doppler, Color

Paraganglioma is a rare neuroendocrine tumor arising from the undifferentiated cells of the primitive neural crest. We report a case of malignant paraganglioma originating from the left kidney. The 55-year-old female patient was admitted for intractable cough for a month and the presence of a solid mass in the left lung detected by computer tomography (CT). Sonography revealed a mass in the left kidney after admission. Complete surgical resection of the tumor was performed and the diagnosis of malignant paraganglioma originating from the left kidney was established pathologically. During the follow-up for 12 months, the patient showed a good general condition and sonography revealed no evidence of recurrence. Based on these findings, we discussed the diagnosis of this disease using medical imaging modalities.
Female ; Humans ; Kidney Neoplasms ; diagnostic imaging ; pathology ; surgery ; Lung Neoplasms ; diagnostic imaging ; secondary ; Middle Aged ; Paraganglioma ; pathology ; secondary ; surgery ; Radiography

Adult ; Aged ; Angiomyolipoma ; diagnosis ; diagnostic imaging ; Carcinoma, Renal Cell ; diagnosis ; diagnostic imaging ; Diagnosis, Differential ; Female ; Fibroma ; diagnosis ; diagnostic imaging ; Humans ; Kidney Neoplasms ; diagnosis ; diagnostic imaging ; Leiomyosarcoma ; diagnosis ; diagnostic imaging ; Male ; Mesenchymoma ; diagnosis ; diagnostic imaging ; Middle Aged ; Tomography, Spiral Computed ; methods