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Preoperative Evaluation of Renal Cell Carcinoma with Multidetector Spiral CT

Author: LaiYanBo
Tutor: GuoYuLin
School: Ningxia Medical University
Course: Medical Imaging and Nuclear Medicine
Keywords: Kidney Renal cell carcinoma Computer X-ray tomography Three-dimensional CT Radical nephrectomy Nephron-sparing surgery
CLC: R737.11
Type: Master's thesis
Year: 2009
Downloads: 20
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Abstract

Purpose of renal cell carcinoma of the multi-phase enhanced scan is not diagnostic test evaluation phase; analysis at different phases of image diagnostic value of clinical staging of renal cell carcinoma, and of multislice spiral CT (MDCT) in renal cell carcinoma preoperative assessment in diagnostic value. The method has been pathologically confirmed 47 cases of renal cell carcinoma (both CCRCC) as the case group, and 39 patients with renal cell carcinoma cases confusing for the control group. Preoperative underwent plain (UP), corticomedullary phase (CMP), the substance of period (NP) collection system period (EP) multi-phase dynamic enhanced CT. Evaluation of renal cell carcinoma by diagnostic analysis of the ROC curve of the case and control groups multitemporal enhance the diagnostic value of renal cell carcinoma; observed tumor enhancement mode, application kurskal-wallis H-test analysis of the case group of asymptomatic and symptomatic patients The significant difference observed different time to enhance the diagnostic value of the scanned image of the staging of renal cell carcinoma; application MPR, VR and MIP restructuring process pathology group image, preoperative assessment the consistency test analysis by Kappa preoperative imaging tests to determine the surgical program with the final implementation of a consistent difference in surgery program. Results of three independent groups (1) scan and corticomedullary period; (2) scan with parenchymal phase; (3) unenhanced, corticomedullary and parenchymal phase; ROC area under the curve were 89%, 92%, 94%. The sensitivity for the diagnosis of renal cell carcinoma were 84%, 90%, 100%. Specificity constant 84%; asymptomatic and symptomatic plain and three-enhanced CT value was no significant difference (p gt; 0.05), not the same white CT values ??were significantly different (p lt; 0.05); MDCT multi-phase scan of the kidneys staging accuracy were stage Ⅰ 100% Phase II 90.9% of cases, of Ⅲ of 79.2% 100% of the Phase IV. The degree of consistency of the overall compliance rate was 87.2%; Kappa consistency test, Kappa = 0.29, P = 0.042 <0.05 between the two there was significant difference MDCT scan after comprehensive evaluation of surgical resection program with actual surgical removal of the program results not ideal. Conclusion 1. Asymptomatic Robson staging more symptoms stage low trend, there is no sufficient evidence to prove that those who are asymptomatic with there was significant difference between the symptoms, less than normal because of the number of cases, the need to further expand sample size to verify. 2. Enhanced three multitemporal scanning corticomedullary renal cell carcinoma, a higher the parenchymal phase show signs lesion and diagnostic help. Renal cell carcinoma unenhanced combined with enhanced three scans, parenchymal phase images in the preoperative diagnostic imaging has important diagnostic value. 4. MDCT multi-phase scan can better judge the kidney cancer preoperative staging on the clinical surgical select important guiding significance. Resectability make a more accurate assessment of kidney cancer surgery. MDCT scan after surgical resection of the comprehensive evaluation program with the degree of consistency of the results of the the actual surgical excision programs is not ideal, mainly because the number of cases is too few, may be due to the higher NSS risk and will increase the local recurrence rate delays in treatment, caused by the surgeon this choice of surgical procedure to reduce the need to further expand the sample size to verify, in a follow-up study,. MDCT thin layer of volumetric scanning and MPR, VR and MIP recombinant techniques are non-invasive and effective imaging technique, can be effective in the pre-operative renal masses to be assessed.

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