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Indeterminate renal masses: The role of dynamic pharmacoangiography
Indeterminate Renal Masses: The role of Dynamic Pharmacoangiography Mr V C Mishra, Mr A R Rao, Dr Mark Charig, Mr H G Motiwala, Mr 0 M A Karim Department of Urology and Department of Radiology, Wexham Park Hospital, Slough, UK
Introduction: The rapid evolution of non-invasive imaging modalities has greatly reduced the use of angiography in the evaluation of renal masses and CT scan today is the investigation of choice for that purpose. However, the interpretation of some lesions by CT scan could be inconclusive and angiography may be helpful in establishing a proper diagnosis. Dynamic Pharmacoangiography (DPA) using noradrenaline to constrict normal vessels without affecting the tumour vessels, is widely regarded as the final and definitive step. Though a small series, we present our experience of 8 patients in a district general hospital.
Materials
and Methods:
Between 1999 and 2002, eight patients underwent DPA in our radiology department for assessment of indeterminate masses on CT scan. Their case history along with the CT scan, angiographic findings and final histopathologic diagnosis was reviewed retrospectively and findings presented.
Results: All the eight underwent uneventful Dynamic Pharmacoangiographic studies. One Senior Consultant Radiologist who performed the study reported the films. Of the eight patients, one patient did not undergo surgery based on the DPA finding of benign disease and is well after 24 months of follow-up. Five patients underwent Radical Nephrectomy based on the findings of DPA out of which final histology matched only in two patients. The last two patients with DPA findings of malignant renal tumours refused surgery and were lost for follow-up.
Conclusion: Classic angiographic description of neovascularity, arteriovenous fistulae, pooling of contrast media, attenuation of capsular vessels and inability of noradrenaline to constrict vessels in a malignant tumour is described. However, it is often not present in all malignant tumours and diagnosis can be elusive. Arteriography may still have a role in evaluating a lesion for nephron sparing surgery in a solitary kidney and in association with angioinfarction of large tumours. Our study concludes that DPA is a useful tool in the diagnostic armamentarium, which should be used to complement other investigations rather than to provide the final definitive answer in the assessment of renal masses.
Introduction: The rapid evolution of non-invasive imaging modalities has greatly reduced the use of angiography in the evaluation of renal masses and CT scan today is the investigation of choice for that purpose. However, the interpretation of some lesions by CT scan could be inconclusive and angiography may be helpful in establishing a proper diagnosis. Dynamic Pharmacoangiography (DPA) using noradrenaline to constrict normal vessels without affecting the tumour vessels, is widely regarded as the final and definitive step. Though a small series, we present our experience of 8 patients in a district general hospital.
Materials
and Methods:
Between 1999 and 2002, eight patients underwent DPA in our radiology department for assessment of indeterminate masses on CT scan. Their case history along with the CT scan, angiographic findings and final histopathologic diagnosis was reviewed retrospectively and findings presented.
Results: All the eight underwent uneventful Dynamic Pharmacoangiographic studies. One Senior Consultant Radiologist who performed the study reported the films. Of the eight patients, one patient did not undergo surgery based on the DPA finding of benign disease and is well after 24 months of follow-up. Five patients underwent Radical Nephrectomy based on the findings of DPA out of which final histology matched only in two patients. The last two patients with DPA findings of malignant renal tumours refused surgery and were lost for follow-up.
Conclusion: Classic angiographic description of neovascularity, arteriovenous fistulae, pooling of contrast media, attenuation of capsular vessels and inability of noradrenaline to constrict vessels in a malignant tumour is described. However, it is often not present in all malignant tumours and diagnosis can be elusive. Arteriography may still have a role in evaluating a lesion for nephron sparing surgery in a solitary kidney and in association with angioinfarction of large tumours. Our study concludes that DPA is a useful tool in the diagnostic armamentarium, which should be used to complement other investigations rather than to provide the final definitive answer in the assessment of renal masses.