Title: Comparative Study of Ultrasonography- Doppler and Computed Tomography in Cases of Renal Mass
Authors: Dr Shefali Baba Meshram, Dr Ritesh S Satardey
DOI: https://dx.doi.org/10.18535/jmscr/v7i1.76
Abstract
Introduction: Ultrasound, Color Doppler and computerized Tomography can reliably diagnose benign and malignant mass lesions affecting kidneys. The common benign renal lesions include simple renal cyst, angiomyolipoma, oncocytoma, cystic nephroma and inflammatory lesions like renal abscess. The common malignant renal lesions include renal cell carcinoma in adults and wilms tumor in pediatric age group. Though the imaging can be useful in diagnosis final diagnosis is dependent upon histopathology particularly in malignant lesions such as renal cell carcinoma and Wilms tumor. We conducted this study to compare Ultrasonography-Doppler and Computed Tomography as imaging modality in the diagnosis of renal masses and to correlate the Ultrasonography-Doppler and Computed Tomography findings of renal masses with Histopathology wherever possible.
Materials and Methods: This was a prospective cohort study conducted in the department of radiology of a tertiary care medical college situated in an urban area. One hundred and two (102) patients of all age groups and both sexes and diagnosed to be having renal mass on the basis of imaging in either ultrasound or CT were included in this study on the basis of a predefined inclusion and exclusion criteria. Ultrasound and Doppler examination and CT scan was done in all the cases. USG- Doppler and CT scan findings were compared with histopathology diagnosis. The sensitivity, specificity, positive predictive value and negative predictive value of the various modalities were determined.
Results: Out of 102 cases included in this study there were 63 (61.76%) males and 39 (38.24%) females with a M:F ratio of 1:0.61 and most of the patients belonged to the age group of 40-49 years (27.45%). The most common lesion found in the patients was renal cyst (40.20%) followed by renal cell carcinoma (27.45%) and abscess (9.80%). RCC was the most common malignant renal mass (28 out of 40 i.e. 70%). The accuracy of USG doppler for diagnosis of RCC and AML was 98.07%. The accuracy of CT scan for diagnosis of abscess, AML, simple cyst, cystic nephroma, renal lymphoma, RCC, TCC and Wilms tumor was 100%. There were two false negative cases of SCC on CT scan. The analysis of CT characteristics for pre-operative evaluation of RCC showed that Computerized tomography was having sensitivity of 75% for determination of adjacent organ involvement. For all other parameters CT was found to be 100% sensitive.
Conclusion: For the diagnosis of renal masses both USG-Doppler and CT scan were found to be equally accurate except in cases of angiomyolipoma, renal cell carcinoma and squamous cell carcinoma where CT was found to be more accurate for diagnosis. On the basis of imaging features of various renal masses on USG-Doppler and CT scan, it is possible to differentiate and diagnose most of the renal masses thus aiding in their management.
Keywords: Renal Masses, Ultrasound, Doppler, Computerized Tomography, Positive Predictive Value.
