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HELICAL COMPUTERIZED TOMOGRAPHY (CT) IN DETECTING SPORADIC MULTIFOCAL RENAL CELL CARCINOMA: IMAGING AND PATHOLOGY CORRELATIONS
372
373
EFFICACY OF 3-DIMENSIONAL COMPUTED TOMOGRAPHY IN THE DIFFERENTIAL DIAGNOSIS OF CYSTIC RENAL MASS
EVALUATION OF CYSTIC RENAL MASSES WITH CONTRAST ENHANCED US. COMPARISON WITH CT
Min G.E., Bang J.K., Song C., Hong B., Hong J.H., Kim C.S., Ahn H.
Sanguedolce F.1, Schiavina R.1, Franceschelli A.1, Valentino M.2, Bertolotto M., Barozzi L.2, Martorana G.1
Asan Medical Centre, Dept. of Urology, Seoul, South Korea
1
Introduction & Objectives: :HHYDOXDWHGWKHXVHIXOQHVVRIGLPHQVLRQDO FRPSXWHG WRPRJUDSK\ ' &7 LQ WKH GLᚎHUHQWLDO GLDJQRVLV RI F\VWLF UHQDO mass. Material & Methods: Between March 1997 and June 2007, total 104 patients ZLWK %RVQLDN FODVV ൖ ൗ ,9 F\VWLF renal masses managed surgically were reviewed. From the preoperative ' &7 VFDQV HQKDQFHPHQW GLᚎHUHQFHV LQ +RXQVᚏHOG XQLWV +8 EHWZHHQ precontrast phase (PCP) and corticomedullary phase (CMP) were measured DWWKHKLJKHVWHQKDQFHPHQWDUHDWRFRUUHODWHZLWKWKHSDWKRORJLFDOᚏQGLQJV Results: 5HQDOFHOOFDUFLQRPD 5&& ZDVGLDJQRVHGLQ SDWLHQWV PRVW FRPPRQO\ RI WKH FOHDU FHOO KLVWRORJ\ $FFRUGLQJ WR WKH %RVQLDN FODVV IURP FODVV ൖൖI IURP FODVV ,,, (86.4%) from class IV were diagnosed of RCC. Between RCC and benign F\VWVPHDQ+8PHDVXUHGIURPWKH3&3DQG&03ZDVLQ5&& DQG LQ EHQLJQ F\VWV 8VLQJ WKH GLᚎHUHQFH LQ WKH +8 EHWZHHQ the PCP and CMP, the area under the receiver-operating characteristics 52& FXUYHZDV ZLWKWKHVHQVLWLYLW\DQGWKHVSHFLᚏFLW\DW DQG ZKHQWKHGLᚎHUHQFHZDVRYHU+80RUHRYHUIRUWKHPDVVHVWKDW continue to enhance into the early excretory phase (EEP), enhancement +8 FRXOG EH PHDVXUHG DW WKH ((3 DQG WKH GLᚎHUHQFH IURP WKH 3&3 RYHU +8 GHPRQVWUDWHG KLJKHVW VHQVLWLYLW\ DQG VSHFLᚏFLW\ DQG respectively) with the area under the ROC curve of 0.962. Conclusions: (QKDQFHPHQW GLᚎHUHQFHV PHDVXUHG IURP ' &7 EHWZHHQ precontrast and maximal enhancement phases (>45HU in PCP/CMP or !+8LQ3&3((3 DUHUHOLDEOHDQGXVHIXOLQWKHGLᚎHUHQWLDOGLDJQRVLVDQG decision-making for surgical treatment of cystic renal mass.
S. Orsola-Malpighi Hospital, “Alma Mater Studiorum” Bologna University, Dept. of Urology, Bologna, Italy, 2S. Orsola-Malpighi Hospital, “Alma Mater Studiorum” Bologna University, Dept. of Radiology, Bologna, Italy, Catinara Hospital, Dept. of Radiology, Trieste, Italy Introduction & Objectives: To assess the diagnostic performance of contrast enhanced XOWUDVRXQG &(86 LQHYDOXDWLRQRIDW\SLFDOF\VWLFUHQDOPDVVHVE\XVLQJDFODVVLᚏFDWLRQ EDVHGRQ%RVQLDNFODVVLᚏFDWLRQV\VWHPDGDSWHGWR86LPDJLQJ'HGLFDWHGKHOLFDO&7 DQGHVWDEOLVKHG%RVQLDNFODVVLᚏFDWLRQFULWHULDZHUHXVHGDVUHIHUHQFHSURFHGXUH Material & Methods: 79 consecutive patients with 87 atypical cystic renal masses at &7 XQGHUZHQW &(86 7ZHQW\IRXU PDVVHV ZHUH UHVHFWHG WKH UHPDLQLQJ OHVLRQV were followed up for periods ranging from 8 months to 4 years. Images and digital cine clips of all lesions were retrospectively evaluated by blind readers. Basing on CT DSSHDUDQFHWKHOHVLRQVZHUHDVVLJQHGD%RVQLDNFODVVLᚏFDWLRQ6LPLODUFULWHULDPRGLᚏHG for US imaging were used to score atypical cysts at CEUS. For each lesion, the QXPEHURIVHSWDWKLFNQHVVRIZDOODQGVHSWDSUHVHQFHRIFDOFLᚏFDWLRQVDQGFRQWUDVW enhancement were evaluated with both techniques. The scores of resected masses were correlated with pathology reports.
Results: $W&7OHVLRQVZHUHVFRUHGDVFDWHJRU\,, Q ,,) Q ,,, Q DQG ,9 Q $OOW\SH,9DQGW\SH,,,OHVLRQVZHUHVXUJLFDOO\UHPRYHG$OOFDWHJRU\ IV and 9/11 category III lesions of the surgical group were malignant. All class II and IIF cysts were stable after a follow up periods ranging from 8 months to 4 years. In 72/87 (82.7%) lesions CT and CEUS scores were equivalent, while in 15 lesions (17.2%), WKHUHZHUHGLᚎHUHQFHV&(86GHSLFWHGPRUHVHSWDWKDQ&7RUXSJUDGHGZDOOWKLFNQHVV resulting in Bosniak score upgrade in 12 lesions from category II to IIF. A category III lesion at CT was scored as category IV at CEUS. A category IIF and a category III lesion at CT were scored as category III and IIF at CEUS, respectively. Conclusions: &(86 VKRZV VLPLODU ᚏQGLQJV DV &7 LQ PRVW RI FRPSOH[ F\VWLF UHQDO OHVLRQV &RPSOH[ F\VWLF UHQDO PDVVHV DUH FKDUDFWHULVHG HᚎHFWLYHO\ ZLWK &(86 WKLV technique could be considered alternative to CT in the follow up of complex cysts and LQSDWLHQWVZLWKUHQDOLQVXᚑFLHQF\
374 HELICAL COMPUTERIZED TOMOGRAPHY (CT) IN DETECTING SPORADIC MULTIFOCAL RENAL CELL CARCINOMA: IMAGING AND PATHOLOGY CORRELATIONS Porcaro A.B.1, Migliorini F.1, Cesaro G.2, Monaco C.1, Zecchini Antoniolli S.1, Balzarro M.1, Pomari E.2, Pianon R.1, Ghimenton C., Sava T.4, Romano M.5, Comunale L.6 Azienda Ospedaliera - Ospedale Maggiore, Dept. of Urology, Verona, Italy, 2Azienda Ospedaliera Ospedale Maggiore, Dept. of Radiology, Verona, Italy, Azienda Ospedaliera - Ospedale Maggiore, Dept. of Pathology, Verona, Italy, 4Azienda Ospedaliera - Ospedale Maggiore, Dept. of Medical Oncology, Verona, Italy, 5Azienda Ospedaliera - Ospedale Maggiore, Dept. of Radiation Oncology, Verona, Italy, 6Azienda Ospedaliera - Ospedale Maggiore, Dept. of Urology, Verona, Italy 1
Introduction & Objectives: Multifocal renal cell carcinoma (MRCC) has been well described in FDVHVRIKHUHGLWDU\UHQDOFDQFHU+RZHYHUWKHFRQWHPSRUDU\XURORJLFOLWHUDWXUHRᚎHUVRQO\OLPLWHG data on sporadic MRCC where incidence ranges between 5 to 25 %. Actually, Helical CT detection RI05&&LVDKDUGWDVNLQGHHGFOLQLFDORFFXOWPXOWLIRFDOLW\UDQJHVEHWZHHQWR2EMHFWLYH of this report was to evaluate the clinical incidence of MRCC in a contemporary and consecutive series in order to assess the role of Helical CT in detecting preoperatively clinical multifocality as well the frequency of clinically occult multifocality. Material & Methods: From January 2004 to December, 116 consecutive kidney units (KU) were surgically treated for renal cell carcinoma (RCC). Volumetric multislice helical CT was performed SUHRSHUDWLYHO\LQDOOSDWLHQWVDFFRUGLQJWRDSUHGHᚏQLWHSURWRFROLQRUGHUWRGHWHFWPXOWLIRFDOLW\7KH VXUJLFDOVSHFLPHQZDVLQYHVWLJDWHGE\WKH8URSDWKRORJLVWDFFRUGLQJWRWKHSUHGHᚏQLWHSURWRFROLQ RUGHUWRDVVHVVPXOWLIRFDOLW\5HQDOWXPRXUVZHUHFODVVLᚏHGDFFRUGLQJWRWKHODVW:+2FODVVLᚏFDWLRQ The size of primary unifocal and multifocal renal tumours were compared by the median statistical test of Mood. It was investigated in the literature the clinical incidence and CT sensitivity in detecting MRCC which was compared with our experience in order to assess statistical inference. Results: &OLQLFDOPXOWLIRFDOLW\ZDVGHWHFWHGLQ.87KHSUHYDOHQFHRGGVRQGLVHDVHLQWKH SRSXODWLRQZDV+HOLFDO&7VFDQGHWHFWHGPXOWLIRFDOLW\LQ .8DQGLWVVHQVLWLYLW\ZDV 3DWKRORJ\GHWHFWHGFOLQLFDORFFXOWPXOWLIRFDOLW\LQ.8 DQGLQ PXOWLIRFDO.8 $YHUDJHSULPDU\WXPRUVL]HZDV UDQJHದFP IRUXQLIRFDOWXPRXUVDQGFP LQ PXOWLIRFDO WXPRXUV WKLV GLᚎHUHQFH UHVXOWHG VWDWLVWLFDOO\ VLJQLᚏFDQW S $V UHSRUWHG IURP WKHOLWHUDWXUHWKHRYHUDOOLQFLGHQFHRI05&&LVRYHUDOORFFXOWPXOWLIRFDOLW\ DQGRYHUDOO LPDJLQJ VHQVLWLYLW\ 7KH GLᚎHUHQFH RI +HOLFDO &7 VHQVLWLYLW\ DV GHWHFWHG E\ RXU H[SHULHQFH DQG FRPSDUHG ZLWK WKDW UHSRUWHG IURP WKH OLWHUDWXUH UHVXOWHG VWDWLVWLFDOO\ VLJQLᚏFDQW (p=0,01). Conclusions: ,QRXUH[SHULHQFHKHOLFDO&7ZDVHᚎHFWLYHLQLPSURYLQJSUHRSHUDWLYHGHWHFWLRQRI sporadic primary MRCC as well as in lowering clinical occult multifocality. Preoperative detection of FOLQLFDOPXOWLIRFDOLW\PD\KHOSLQSODQQLQJHᚎHFWLYHSUHRSHUDWLYHVXUJLFDOWUHDWPHQWDVZHOODVORZHULQJ local recurrence after nephron sparing surgery. Technical and methodological improvements in performing Helical CT will improve it sensibility in detecting renal masses lower than 0,5 cm.
Eur Urol Suppl 2008;7(3):164
375 CCR GRADE PREDICTION USING CONTRASTED COMPUTED TOMOGRAPHY Villalobos-Gollas M., Leon-Vilchis F., Mendez-Probst C., Castillejos-Molina R. ,QVWLWXWR1DFLRQDOGH&LHQFLDV0«GLFDV\1XWULFLµQಯ6DOYDGRU=XELUDQರ'HSWRI Urology, Mexico City, Mexico Introduction & Objectives: Nuclear grade (Fuhrman) is an independent prognostic factor in renal cell carcinoma (RCC). Contrasted CT is one of the most important tools in the diagnosis and staging of (RCC). The amount of enhancement on contrasted CT to predict high grade tumours can be useful. Our objective was to identify if tumour enhancement was associated to RCC grade. Material & Methods: Medical charts of all patients with histologic diagnosis of RCC and a preoperative contrasted CT on a patient archive communication system (PACS) were analyzed. All CT were performed on a 64-slice Siemens CT. 9DULDEOHVDQDO\]HGGXULQJFRQWUDVWDQGQRQFRQWUDVW&7ZHUH+RXQVᚏHOGXQLWV (HU) of renal parenchyma and tumour. During contrast CT special attention was payed to both the points of highest enhancement and to average enhancement of the whole tumour at the point of greatest necrosis (WTH), if applicable. Pathological variables as well as size and stage were analyzed. Student’s T test was used for statistical analysis, using commercially available software. Results: SDWLHQWVZHUHLQFOXGHG$YHUDJHWXPRXUHQKDQFHPHQWZDV DQG+8IRUORZJUDGH )XKUPDQDQG DQGKLJKJUDGH )XKUPDQDQG tumours, respectively (p=0.022). When considering the average enhancement :7+ ORZ DQG KLJKJUDGH WXPRXUV HQKDQFHG DQG +8 S +LJKJUDGHWXPRXUVZHUHDOVRODUJHUWKDQORZJUDGHWXPRXUV FPYV cm, p=0.009). Conclusions: High-grade RCC was associated to lower enhancement on contrast CT. Lower average enhancement may correlate to the degree of necrosis and could be a useful tool in prediction of higher nuclear grade and ZRUVH SURJQRVLV /DUJHU SURVSHFWLYH VWXGLHV DUH QHFHVVDU\ WR FRQᚏUP WKLV association.
373
EFFICACY OF 3-DIMENSIONAL COMPUTED TOMOGRAPHY IN THE DIFFERENTIAL DIAGNOSIS OF CYSTIC RENAL MASS
EVALUATION OF CYSTIC RENAL MASSES WITH CONTRAST ENHANCED US. COMPARISON WITH CT
Min G.E., Bang J.K., Song C., Hong B., Hong J.H., Kim C.S., Ahn H.
Sanguedolce F.1, Schiavina R.1, Franceschelli A.1, Valentino M.2, Bertolotto M., Barozzi L.2, Martorana G.1
Asan Medical Centre, Dept. of Urology, Seoul, South Korea
1
Introduction & Objectives: :HHYDOXDWHGWKHXVHIXOQHVVRIGLPHQVLRQDO FRPSXWHG WRPRJUDSK\ ' &7 LQ WKH GLᚎHUHQWLDO GLDJQRVLV RI F\VWLF UHQDO mass. Material & Methods: Between March 1997 and June 2007, total 104 patients ZLWK %RVQLDN FODVV ൖ ൗ ,9 F\VWLF renal masses managed surgically were reviewed. From the preoperative ' &7 VFDQV HQKDQFHPHQW GLᚎHUHQFHV LQ +RXQVᚏHOG XQLWV +8 EHWZHHQ precontrast phase (PCP) and corticomedullary phase (CMP) were measured DWWKHKLJKHVWHQKDQFHPHQWDUHDWRFRUUHODWHZLWKWKHSDWKRORJLFDOᚏQGLQJV Results: 5HQDOFHOOFDUFLQRPD 5&& ZDVGLDJQRVHGLQ SDWLHQWV PRVW FRPPRQO\ RI WKH FOHDU FHOO KLVWRORJ\ $FFRUGLQJ WR WKH %RVQLDN FODVV IURP FODVV ൖൖI IURP FODVV ,,, (86.4%) from class IV were diagnosed of RCC. Between RCC and benign F\VWVPHDQ+8PHDVXUHGIURPWKH3&3DQG&03ZDVLQ5&& DQG LQ EHQLJQ F\VWV 8VLQJ WKH GLᚎHUHQFH LQ WKH +8 EHWZHHQ the PCP and CMP, the area under the receiver-operating characteristics 52& FXUYHZDV ZLWKWKHVHQVLWLYLW\DQGWKHVSHFLᚏFLW\DW DQG ZKHQWKHGLᚎHUHQFHZDVRYHU+80RUHRYHUIRUWKHPDVVHVWKDW continue to enhance into the early excretory phase (EEP), enhancement +8 FRXOG EH PHDVXUHG DW WKH ((3 DQG WKH GLᚎHUHQFH IURP WKH 3&3 RYHU +8 GHPRQVWUDWHG KLJKHVW VHQVLWLYLW\ DQG VSHFLᚏFLW\ DQG respectively) with the area under the ROC curve of 0.962. Conclusions: (QKDQFHPHQW GLᚎHUHQFHV PHDVXUHG IURP ' &7 EHWZHHQ precontrast and maximal enhancement phases (>45HU in PCP/CMP or !+8LQ3&3((3 DUHUHOLDEOHDQGXVHIXOLQWKHGLᚎHUHQWLDOGLDJQRVLVDQG decision-making for surgical treatment of cystic renal mass.
S. Orsola-Malpighi Hospital, “Alma Mater Studiorum” Bologna University, Dept. of Urology, Bologna, Italy, 2S. Orsola-Malpighi Hospital, “Alma Mater Studiorum” Bologna University, Dept. of Radiology, Bologna, Italy, Catinara Hospital, Dept. of Radiology, Trieste, Italy Introduction & Objectives: To assess the diagnostic performance of contrast enhanced XOWUDVRXQG &(86 LQHYDOXDWLRQRIDW\SLFDOF\VWLFUHQDOPDVVHVE\XVLQJDFODVVLᚏFDWLRQ EDVHGRQ%RVQLDNFODVVLᚏFDWLRQV\VWHPDGDSWHGWR86LPDJLQJ'HGLFDWHGKHOLFDO&7 DQGHVWDEOLVKHG%RVQLDNFODVVLᚏFDWLRQFULWHULDZHUHXVHGDVUHIHUHQFHSURFHGXUH Material & Methods: 79 consecutive patients with 87 atypical cystic renal masses at &7 XQGHUZHQW &(86 7ZHQW\IRXU PDVVHV ZHUH UHVHFWHG WKH UHPDLQLQJ OHVLRQV were followed up for periods ranging from 8 months to 4 years. Images and digital cine clips of all lesions were retrospectively evaluated by blind readers. Basing on CT DSSHDUDQFHWKHOHVLRQVZHUHDVVLJQHGD%RVQLDNFODVVLᚏFDWLRQ6LPLODUFULWHULDPRGLᚏHG for US imaging were used to score atypical cysts at CEUS. For each lesion, the QXPEHURIVHSWDWKLFNQHVVRIZDOODQGVHSWDSUHVHQFHRIFDOFLᚏFDWLRQVDQGFRQWUDVW enhancement were evaluated with both techniques. The scores of resected masses were correlated with pathology reports.
Results: $W&7OHVLRQVZHUHVFRUHGDVFDWHJRU\,, Q ,,) Q ,,, Q DQG ,9 Q $OOW\SH,9DQGW\SH,,,OHVLRQVZHUHVXUJLFDOO\UHPRYHG$OOFDWHJRU\ IV and 9/11 category III lesions of the surgical group were malignant. All class II and IIF cysts were stable after a follow up periods ranging from 8 months to 4 years. In 72/87 (82.7%) lesions CT and CEUS scores were equivalent, while in 15 lesions (17.2%), WKHUHZHUHGLᚎHUHQFHV&(86GHSLFWHGPRUHVHSWDWKDQ&7RUXSJUDGHGZDOOWKLFNQHVV resulting in Bosniak score upgrade in 12 lesions from category II to IIF. A category III lesion at CT was scored as category IV at CEUS. A category IIF and a category III lesion at CT were scored as category III and IIF at CEUS, respectively. Conclusions: &(86 VKRZV VLPLODU ᚏQGLQJV DV &7 LQ PRVW RI FRPSOH[ F\VWLF UHQDO OHVLRQV &RPSOH[ F\VWLF UHQDO PDVVHV DUH FKDUDFWHULVHG HᚎHFWLYHO\ ZLWK &(86 WKLV technique could be considered alternative to CT in the follow up of complex cysts and LQSDWLHQWVZLWKUHQDOLQVXᚑFLHQF\
374 HELICAL COMPUTERIZED TOMOGRAPHY (CT) IN DETECTING SPORADIC MULTIFOCAL RENAL CELL CARCINOMA: IMAGING AND PATHOLOGY CORRELATIONS Porcaro A.B.1, Migliorini F.1, Cesaro G.2, Monaco C.1, Zecchini Antoniolli S.1, Balzarro M.1, Pomari E.2, Pianon R.1, Ghimenton C., Sava T.4, Romano M.5, Comunale L.6 Azienda Ospedaliera - Ospedale Maggiore, Dept. of Urology, Verona, Italy, 2Azienda Ospedaliera Ospedale Maggiore, Dept. of Radiology, Verona, Italy, Azienda Ospedaliera - Ospedale Maggiore, Dept. of Pathology, Verona, Italy, 4Azienda Ospedaliera - Ospedale Maggiore, Dept. of Medical Oncology, Verona, Italy, 5Azienda Ospedaliera - Ospedale Maggiore, Dept. of Radiation Oncology, Verona, Italy, 6Azienda Ospedaliera - Ospedale Maggiore, Dept. of Urology, Verona, Italy 1
Introduction & Objectives: Multifocal renal cell carcinoma (MRCC) has been well described in FDVHVRIKHUHGLWDU\UHQDOFDQFHU+RZHYHUWKHFRQWHPSRUDU\XURORJLFOLWHUDWXUHRᚎHUVRQO\OLPLWHG data on sporadic MRCC where incidence ranges between 5 to 25 %. Actually, Helical CT detection RI05&&LVDKDUGWDVNLQGHHGFOLQLFDORFFXOWPXOWLIRFDOLW\UDQJHVEHWZHHQWR2EMHFWLYH of this report was to evaluate the clinical incidence of MRCC in a contemporary and consecutive series in order to assess the role of Helical CT in detecting preoperatively clinical multifocality as well the frequency of clinically occult multifocality. Material & Methods: From January 2004 to December, 116 consecutive kidney units (KU) were surgically treated for renal cell carcinoma (RCC). Volumetric multislice helical CT was performed SUHRSHUDWLYHO\LQDOOSDWLHQWVDFFRUGLQJWRDSUHGHᚏQLWHSURWRFROLQRUGHUWRGHWHFWPXOWLIRFDOLW\7KH VXUJLFDOVSHFLPHQZDVLQYHVWLJDWHGE\WKH8URSDWKRORJLVWDFFRUGLQJWRWKHSUHGHᚏQLWHSURWRFROLQ RUGHUWRDVVHVVPXOWLIRFDOLW\5HQDOWXPRXUVZHUHFODVVLᚏHGDFFRUGLQJWRWKHODVW:+2FODVVLᚏFDWLRQ The size of primary unifocal and multifocal renal tumours were compared by the median statistical test of Mood. It was investigated in the literature the clinical incidence and CT sensitivity in detecting MRCC which was compared with our experience in order to assess statistical inference. Results: &OLQLFDOPXOWLIRFDOLW\ZDVGHWHFWHGLQ.87KHSUHYDOHQFHRGGVRQGLVHDVHLQWKH SRSXODWLRQZDV+HOLFDO&7VFDQGHWHFWHGPXOWLIRFDOLW\LQ .8DQGLWVVHQVLWLYLW\ZDV 3DWKRORJ\GHWHFWHGFOLQLFDORFFXOWPXOWLIRFDOLW\LQ.8 DQGLQ PXOWLIRFDO.8 $YHUDJHSULPDU\WXPRUVL]HZDV UDQJHದFP IRUXQLIRFDOWXPRXUVDQGFP LQ PXOWLIRFDO WXPRXUV WKLV GLᚎHUHQFH UHVXOWHG VWDWLVWLFDOO\ VLJQLᚏFDQW S $V UHSRUWHG IURP WKHOLWHUDWXUHWKHRYHUDOOLQFLGHQFHRI05&&LVRYHUDOORFFXOWPXOWLIRFDOLW\ DQGRYHUDOO LPDJLQJ VHQVLWLYLW\ 7KH GLᚎHUHQFH RI +HOLFDO &7 VHQVLWLYLW\ DV GHWHFWHG E\ RXU H[SHULHQFH DQG FRPSDUHG ZLWK WKDW UHSRUWHG IURP WKH OLWHUDWXUH UHVXOWHG VWDWLVWLFDOO\ VLJQLᚏFDQW (p=0,01). Conclusions: ,QRXUH[SHULHQFHKHOLFDO&7ZDVHᚎHFWLYHLQLPSURYLQJSUHRSHUDWLYHGHWHFWLRQRI sporadic primary MRCC as well as in lowering clinical occult multifocality. Preoperative detection of FOLQLFDOPXOWLIRFDOLW\PD\KHOSLQSODQQLQJHᚎHFWLYHSUHRSHUDWLYHVXUJLFDOWUHDWPHQWDVZHOODVORZHULQJ local recurrence after nephron sparing surgery. Technical and methodological improvements in performing Helical CT will improve it sensibility in detecting renal masses lower than 0,5 cm.
Eur Urol Suppl 2008;7(3):164
375 CCR GRADE PREDICTION USING CONTRASTED COMPUTED TOMOGRAPHY Villalobos-Gollas M., Leon-Vilchis F., Mendez-Probst C., Castillejos-Molina R. ,QVWLWXWR1DFLRQDOGH&LHQFLDV0«GLFDV\1XWULFLµQಯ6DOYDGRU=XELUDQರ'HSWRI Urology, Mexico City, Mexico Introduction & Objectives: Nuclear grade (Fuhrman) is an independent prognostic factor in renal cell carcinoma (RCC). Contrasted CT is one of the most important tools in the diagnosis and staging of (RCC). The amount of enhancement on contrasted CT to predict high grade tumours can be useful. Our objective was to identify if tumour enhancement was associated to RCC grade. Material & Methods: Medical charts of all patients with histologic diagnosis of RCC and a preoperative contrasted CT on a patient archive communication system (PACS) were analyzed. All CT were performed on a 64-slice Siemens CT. 9DULDEOHVDQDO\]HGGXULQJFRQWUDVWDQGQRQFRQWUDVW&7ZHUH+RXQVᚏHOGXQLWV (HU) of renal parenchyma and tumour. During contrast CT special attention was payed to both the points of highest enhancement and to average enhancement of the whole tumour at the point of greatest necrosis (WTH), if applicable. Pathological variables as well as size and stage were analyzed. Student’s T test was used for statistical analysis, using commercially available software. Results: SDWLHQWVZHUHLQFOXGHG$YHUDJHWXPRXUHQKDQFHPHQWZDV DQG+8IRUORZJUDGH )XKUPDQDQG DQGKLJKJUDGH )XKUPDQDQG tumours, respectively (p=0.022). When considering the average enhancement :7+ ORZ DQG KLJKJUDGH WXPRXUV HQKDQFHG DQG +8 S +LJKJUDGHWXPRXUVZHUHDOVRODUJHUWKDQORZJUDGHWXPRXUV FPYV cm, p=0.009). Conclusions: High-grade RCC was associated to lower enhancement on contrast CT. Lower average enhancement may correlate to the degree of necrosis and could be a useful tool in prediction of higher nuclear grade and ZRUVH SURJQRVLV /DUJHU SURVSHFWLYH VWXGLHV DUH QHFHVVDU\ WR FRQᚏUP WKLV association.