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Role of Multiphasic Computed Tomography in Prediction Histopathology of Renal Parenchymal Lesions

Iraqi Postgraduate Medical Journal, 2022, Volume 21, Issue 1, Pages 102-108
10.52573/ipmj.1970.174078

Abstract

BACKGROUND:
Renal masses have different histologic types and subtypes, aggressiveness and metastatic potential, depending on there changes in angiogenesis
OBJECTIVE:
Is to evaluate the role of multiphasic contrast enhanced CT scan in prediction histopathology of renal masses.
PATIENTS AND METHODS:
In this prospective study, 50 patients with renal mass were diagnosed by abdominal ultrasound underwent multiphasic contrast enhanced computed tomography prior to surgical treatment,CT parameters at each phase of contrast study and histopathology results were correlated.
RESULTS:
In this study( 26 female and 24 male with mean age of 55.1 ± 10.1) were evaluated, clear renal cell carcinoma was documented in 35 patients(70%), papillary renal cell carcinoma in 5 patients(10%), Wilm´s tumors in 3 patients(6%), chromophobe renal cell carcinoma in2patients(4%), angiomyolipoma in 2 patients(4%),while collecting duct renal cell carcinoma , lymphoma, and tubulocystic renal cell carcinoma were found in only one patient for each one. The correlation of mean mass density with the histopathological types revealed no statistically significant difference in noncontrast phase. Significant difference (P<0.001) was noted in the mean enhancement of mass between the types of RCC during corticomedullary phase, however it is insignificantly different than angiomyolipoma  AML (P>0.05).  clear cell RCC show maximum enhancement (152H.U at corticomedullary phase ) with rapid wash out while papillary subtype show delayed progressive enhancement with delayed wash out with relatively low level of peak enhancement (69H.U at nephrogenic phase ) AML and chromophobe RCC with other subtypes show moderately rising enhancement with presence of plateau   and evidence of delayed washout. From the remaining renal masses that were hypovascular with slow pattern of enhancement during dynamic examination one in old patient proved to be lymphoma and other in pediatric age proved histologically as Wilms tumor.
CONCLUSION:
Muliphasic contrast enhanced CT is reliable modality to differentiate clear cell cancer from other subtype by maximum enhancement and rapid wash out at corticomedullary phase while papillary subtype show delay progressive enhancement with delayed wash out
 
 
Keywords:

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