Title: Role of ultrasound and CT scan in evaluation of Renal Masses
Authors: Dr Mukhtar Ahmad, Dr Dipesh Yadav
DOI: https://dx.doi.org/10.18535/jmscr/v6i1.123
Abstract
Background: The term renal “mass” includes a large variant of expansile entities which are aggregates of non functioning renal parenchyma. The non neoplastic renal masses can be grouped as renal cystic disease, inflammatory masses, vascular masses, angiomyolipomas and others. The neoplastic masses can be either benign which includes adenoma, hemangiomaetc or malignant like renal cell carcinoma, renal pelvic carcinoma and Wilm’s tumour.1
The ultrasonography (US) and computed tomography (CT) in diagnostic imaging, the accuracy in renal mass detection has approached close to 100%.CT is to be superior to intravenous urography, ultrasonography and angiography for detection of renal and retroperitoneal details and in staging of renal neoplasms.02 On the other hand, ultrasound combined with cyst aspiration has an important role to play in these cyst-like renal masses which are indeterminate on CT.03
Materials and Methods: The study had been carried out in the Department of Radiodiagnosis, Rajiv Gandhi Cancer Institute and Research Centre in the period March 2012 to July 2013.
A total number of fifty (50) patients with suspected renal mass were studied, irrespective of age and sex. In all the patients taken up for the study, a detailed clinical history was taken with emphasis on duration of symptoms and specific complaints like fever, pain abdomen and hematuria. The patients were examined for any palpable lump abdomen. Routine and other relevant laboratory investigations were done e.g. Blood Urea, Serum Creatinine, Urine routine, microscopic examination, Culture and for malignant cells.
All patients with renal symptoms like hematuria, flank pain, clinically palpable renal lump or with renal mass in ultrasound, CT fulfilling the specified inclusion and exclusion criteria from March 2012 to May 2013 were enrolled into this study.
Inclusion Criteria: Patients with renal lesion on USG, CT and on other imaging modalities.
Exclusion Criteria:
- Pregnant females
- History of contrast hypersensitivity.
- Impaired renal functions.
- Bosniak category I cysts
Results: Out of 50 cases, eight were diagnosed radiologically & HPE was not required. 42 cases underwent HPE, out of these 37 cases were correctly diagnosed radiologically as malignant & remaining five cases were either misdiagnosed or radiologically diagnosed as indeterminate masses. Radiological correlation with HPE was done to see the nature of the lesion (Benign versus Malignant).In our study out of 50 cases, 10 cases were Benign & 40 were Malignant. Ten Benign cases include Oncocytoma (1), Abcess (1), APKD (3), Parapelvic cyst (1), Angiomyolipoma (1), Psuedo tumour (2) and Bosniak type (II) cyst (1). Eight (8) cases were correctly diagnosed radilogically as Benign and HPE was not carried out whereas two cases who were underwent HPE were proved to be Oncocytoma & abcess. Out of the 10 cases, one case was falsenegatively diagnosed as RCC which proved to be Oncocytoma on HPE. In our study specificity was found to be 90% (Table no. 20).%In our study 37 cases were diagnosed radiologically as malignant lesions out 40 malignant cases, sensitivity of imaging was formed to be 94.8.
Statistical Analysis: Statistical testing was conducted with the statistical package for the Social Science System Version SPSS 17.0. Nominal categorical data between the groups were compared using Chi-squared test or Fisher’s exact test as appropriate
Conclusion: Ultrasound remains the modality of choice for initial screening in cases of Adult Polycystic Kidney disease, Parapelvic cyst. CT is indicated only when an associated renal complication such as intra cyst haemorrhage, infection or tumour is suspected. Ultrasound has a definite role in determining the nature of renal cell carcinomas.
US is equally sensitive to CT in detecting venous invasion into renal vein or inferior venacava, in cases of renal cell carcinoma.
Keyword: Renal masses, Ultrasonography, CT scan.
