|Year : 2018 | Volume
| Issue : 4 | Page : 795-798
The diagnostic value of multi-slice spiral computed tomography in patients with renal carcinoma
Jie Liu, Shufang Yang, Haiying Jin, Xiang He, Peng Nie, Changfu Wang
Department of Radiology, Huaihe Hospital Henan University, Kaifeng, Henan Province, PR China
|Date of Web Publication||27-Jun-2018|
Department of Radiology, Huaihe Hospital, Henan University, Kaifeng, Henan Province 475000
Source of Support: None, Conflict of Interest: None
Objective: This study was aimed to investigate the characteristics of multi-slice spiral computed tomography (CT) image in kidney cancer patients and its clinical value in staging diagnosis of kidney cancer.
Materials and Methods: This study included 57 patients who were confirmed as kidney cancer through postoperative pathological examination; they were diagnosed within February 2014 and December 2016 in our hospital. The data obtained from multi-slice spiral CT plain scan and contrast-enhanced CT of these patients was retrospectively analyzed. Moreover, we determined the characteristics of multi-slice spiral CT image for kidney cancer and analyzed their consistency with pathological staging.
Results: CT plain scan showed that kidney lumps were mostly found in the prominent renal contour or renal parenchyma, and they were round-like or round in shape. Among the 57 included patients, the tumors of 43 cases showed regular edges, and 14 showed irregular edges. Among the 14 cases, 10 patients had tumors with lobulated edges and 5 with spinous tumor edge. Among all the 57 patients, CT plain scan showed there were 5 cases with slightly higher density, 24 cases with mixed density, 28 cases with equal density or slightly lower density. The range of tumor diameter was 2.1–12.6 cm; the tumor diameter was smaller than 3 cm in 11 cases, 3–7 cm in 34 cases, and larger than 7 cm in 12 cases. In terms of contrast enhancement, the arterial phase was obviously enhanced in 31 cases, moderately and irregularly enhanced in 18 cases, and slightly enhanced in 8 cases. Moreover, the renal parenchymal scan showed a rapid decline in the enhancement and a further decline in the enhancement of renal pelvic tumor; the three stages of enhancement could be expressed in terms of fast forwardness and fast backwardness. A total of 33, 4, 9, and 11 cases were classified as postoperative pathological Stage I, II, III, and IV, respectively; 35, 5, 7, and 10 cases were classified as CT scan Stage I, II, III, and IV, respectively; and 34, 5, 8, and 10 cases were classified as contrast-enhanced CT scan Stage I, II, III, and IV, respectively. No significant difference was observed in the frequency of CT scan, the enhanced stage and pathological stage (P > 0.05).
Conclusion: CT image of kidney cancer revealed the morphological and enhanced features of this tumor. The consistency between CT stage and pathological stage was high; thus, this method can be applied as a forecasting method for pathological staging.
Keywords: Computed tomography, diagnosis, kidney carcinoma
|How to cite this article:|
Liu J, Yang S, Jin H, He X, Nie P, Wang C. The diagnostic value of multi-slice spiral computed tomography in patients with renal carcinoma. J Can Res Ther 2018;14:795-8
|How to cite this URL:|
Liu J, Yang S, Jin H, He X, Nie P, Wang C. The diagnostic value of multi-slice spiral computed tomography in patients with renal carcinoma. J Can Res Ther [serial online] 2018 [cited 2019 Nov 17];14:795-8. Available from: http://www.cancerjournal.net/text.asp?2018/14/4/795/235091
| > Introduction|| |
Renal cancer is a malignant tumor originated from the renal parenchymal urinary epithelial system. It included various renal cell carcinoma subtypes originated from different parts of the urinary tract but excluded tumors and renal pelvic tumors derived from renal interstitium. Kidney cancer accounted for approximately 2%–3% of adult malignancies and 80%–90% of adult kidney malignancies., Epidemiological studies have shown that the incidence of kidney cancer worldwide significantly varied, which was higher in Europe, United States, and other developed countries than that of in developing countries. It was also higher in urban areas than that of in rural areas, and in men than that of in women, wherein the ratio of the male-to-female patient was approximately 2:1. The onset of this disease has been observed in all ages, but a high incidence was observed among individuals of 50–70-year-old. In China, it remained lack of a nationwide epidemiological data on the incidence of kidney cancer. Although a regional epidemiological study on kidney cancer has shown that the incidence of kidney cancer in China in recent years displayed an evidently upward tendency. Given that no obvious clinical symptom could be observed in early-stage kidney cancer, this disease was occasionally found when patients undergo other physical examinations. Symptoms included tumor diameters of generally smaller than 4 cm, and most of these tumors were renal cell carcinoma. Computer tomography (CT) examination has been one of the important methods for the diagnosing renal carcinoma. This study retrospectively analyzed the abdominal CT scanning results of 57 renal cancer patients and then, these results were analyzed and compared for postoperative pathological staging of renal cancer. Moreover, the value of multi-slice CT scan in staging diagnosis of renal cancer has been presented.
| > Materials and Methods|| |
Fifty-seven kidney cancer patients who were confirmed by a postoperative pathological examination conducted within February 2014 to December 2016 in our hospital were included in the study. The age range of the patients was 41–75 years old (mean age, 61.5 ± 12.8 years old); 39 (68.4%) of the patients were female and 18 (31.6%) were female. Tumors were located in the left kidney in 30 (52.6%) cases and in the right kidney in the other 27 (47.4%) cases. In terms of clinical manifestation, it observed gross hematuria or microscopic hematuria in 16 cases, low back pain or abdominal pain in 5 cases, abdominal mass in 7 cases, and two or more symptoms in 2 cases; physical examination or other examination in 28 cases. Pathologic examination confirmed that 33, 4, 9, and 11 cases were in the pathologic Stages I, II, III, and IV of postradical mastectomy, respectively [Table 1].
Computer tomography scanning
Scans were performed using a Siemens SOMATOM Definition AS 64-row 128-slice CT with iodohydrin as contrast agent. The patients were asked to lie in a scanning bed and then, the following scanning parameters were applied: Tube current, 220–260 mAs; tube voltage, 120–140 kV; pitch, 1–1.5; layer thickness, 5–7 mm; reconstruction interval, 1–2 mm; layer pitch, 2.5–3.5 mm; and bed movement speed, 5–10 mm/s. The plain scan was followed by contrast enhancement. Before contrast enhancement, 70–100 ml of iodide (contrast agent) was rapidly injected at a rate of 3 ml/s into a vein in the patients' elbow with a high-pressure syringe. Arterial phase scanning was performed for 25 s after the injection of the contrast agent, followed by real phase scanning after 60–90 s, and then renal pelvis scan after 3–5 min. The collected image information was forwarded to the workstation, and then, a multi-faceted reconstruction display was created on the multi-planar reconstruction and curved planar reformation.
Criteria in renal cancer staging through computer tomography scanning
Stage I: Tumor diameter ≤7 cm, confined to the renal capsule, no extracellular proliferation or lymph node metastasis, and no distant metastasis. Stage II: Tumor diameter >7 cm, no renal extracorporeal expansion or lymph node metastasis, and no distant metastasis. Stage III: Tumor diameter >7 cm, displayed a group of lymph node metastasis but without distant metastasis. Stage IV: Tumor diameter >7 cm, renal tumors extend to the renal fascia, and distant metastasis occurred. CT staging images of patients were independently read by CT diagnostic physicians; any discrepancy in staging was settled through discussion.
The statistical analysis was performed with STATA10.0 statistical software (http://www.stata.com). The measurement data were expressed with x¯ ± s and the comparison between groups was made based on the t-test of the sample mean. The enumeration data were expressed with a relative number, and the comparison between groups was made based on the Chi-square test. P < 0.05 meant a statistical difference.
| > Results|| |
Computer tomography plain scan performance of renal cancer
CT scan showed that renal lumps of the patients were prominent mostly in the renal contour or in renal parenchyma, and they were round-like or round in shape. Among the 57 cases, 43 showed tumors with regular edges, and 14 showed tumors with irregular edges. Among the 14 cases, 10 cases showed tumors with lobulated edges and 5 showed tumors with spinous edges. Moreover, among the 57 patients, 5 cases displayed a slightly high density, 24 with mixed densities, and 28 with equal or slightly low density as revealed by CT scan. The diameter of the tumors was 2.1–12.6 cm; tumor diameters were shorter than 3 cm in 11 cases, 3–7 cm in 34 cases, and larger than 7 cm in 12 cases [Figure 1].
|Figure 1: Computer tomography plain scan performance of renal cancer. (a) Right kidney cancer; (b) left kidney cancer; (c) left kidney cancer|
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Computed tomography contrast enhancement performance of kidney cancer
In terms of contrast enhancement, the arterial phase was obviously enhanced in 31 cases, moderately irregularly enhanced in 18 cases, and mildly enhanced in 8 cases. The renal parenchymal scan showed the rapid decline in the enhancement and a further decline in the enhancement of renal pelvic tumor; the three stages of scan enhancement could be expressed in terms of fast forwardness and fast backwardness [Figure 2].
|Figure 2: Computer tomography contrast enhancement performance of renal cancer. (a-c) Left kidney cancer of the same patients; (d-f) left kidney cancer of the same patients; (g-i) right kidney cancer of the same patients|
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Correspondence between computed tomography scan staging and pathological staging
A total of 33, 4, 9, and 11 cases were classified as Stage I, II, III, and IV, respectively by post-pathology classification, and 35, 5, 7, and 10 cases were classified as CT scanning Stage I, II, III, and I, respectively [Table 2]. Moreover, 34, 5, 8, and 10 cases were categorized into CT enhanced scanning Stage I, II, III, and IV stages, respectively [Table 3]. No significant difference was observed in the frequency of CT scan stage and pathological stage (P > 0.05), indicating that the results of CT staging and pathological staging were consistent.
|Table 2: Correspondence between computer tomography scan staging and pathological staging, n (%)|
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|Table 3: Correspondence between computer tomography enhanced scan staging and pathological staging, n (%)|
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| > Discussion|| |
Renal cancer has been a common type of genitourinary tumor, accounting for 85% of adult kidney malignancies and 3% of all malignancies. In 2004, kidney cancer was classified into 10 subtypes by the WHO; of which, renal clear cell carcinoma was most common, and followed by renal papillary cell carcinoma and kidney chromophobe cell carcinoma, accounting for 70%–80%, 14%–17%, and 4%–8% of all kidney cancer cases, respectively.
The main imaging methods currently applied in the clinical diagnosis of kidney cancer were MRI ,, and spiral CT., Given that CT was easy to operate and can be accurately phased, it has been extensively utilized in clinical applications to obtain important information for clinical treatments. CT scan was able to detect kidney cancer that caused changes in the renal pelvis and kidney calices, even in the absence of symptoms; CT scan was able to accurately measure tumor density and can be quickly and conveniently performed in clinics. Studies have reported that CT demonstrated an accuracy rate of 91% in the evaluation of kidney cancer invasion in renal vein and an accuracy rate of 87% in the evaluation of peripheral lymph node metastasis. In CT imaging, kidney cancer was generally manifested as a renal parenchymal lump, which could also extrude in renal parenchyma; the lump was round, round-like, or lobulated and with clear or blurred boundaries. The CT value of soft tissue mass with uneven density was generally >20 Hu, which was slightly higher, similar, or slightly lower than that of in normal renal parenchyma; an uneven internal density was related to hemorrhagic necrosis or tumor calcification. When CT enhanced scan was applied, the CT value of normal renal parenchyma was more or less 120 Hu; the CT value of tumor also increased but remained significantly lower than that of the normal renal parenchyma; the edge of tumor was more defined., When the CT value of the lump slightly changed after being examined with CT enhanced scan, then the lump was possibly a cyst, which could be confirmed based on the liquid density of CT before and after the injection of contrast agent. CT value was low for the focal necrosis in kidney cancer, renal cystadenocarcinoma, and renal artery embolization after injection of the contrast agent. CT examination was one of the important methods for diagnosing kidney cancer; its sensitivity and specificity were relatively high and confirmed by many studies. However, few studies have reported on the relationship between radiological staging and pathological staging with multi-slice CT scan. The consistency between CT radiological staging and pathological staging should be assessed. Therefore, we conducted a retrospective analysis of CT scan results and pathologic findings for 57 kidney cancer patients, who were confirmed through operation in our hospital. Moreover, we presented the characteristics of multi-slice CT images in kidney cancer patients and the clinical value of CT imaging in the diagnosis of kidney cancer. CT images of kidney cancer were speculated to display certain morphological and enhanced features. Excellent consistency between CT staging and pathological staging was observed; thus, CT images could be applied for forecasting in pathological staging.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Table 1], [Table 2], [Table 3]