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2015 ; 5
(5
): 691-9
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Comparison between computed tomography multislice and high-field magnetic
resonance in the diagnostic evaluation of patients with renal masses
#MMPMID26682139
Baldari D
; Capece S
; Mainenti PP
; Tucci AG
; Klain M
; Cozzolino I
; Salvatore M
; Maurea S
Quant Imaging Med Surg
2015[Oct]; 5
(5
): 691-9
PMID26682139
show ga
BACKGROUND: Renal masses are a common finding in diagnostic imaging; these
lesions usually are solid or cystic, benign or malignant, and the correct
diagnosis may be difficult. The aim of our study was the comparison of
multi-slice computed tomography (MSCT) and high-field magnetic resonance (MR) in
the diagnostic evaluation of renal masses. METHODS: We studied 29 patients, 16
men and 13 women aged 8-85 years (mean 61±17 years) with histo-cytological
diagnosis of renal masses (n=31), of which the majority (74%; n=23) was
represented by malignant lesions [renal cell carcinoma (Ca) =16, chromophobe
renal cell Ca =2, squamous cell Ca =1, urothelial Ca =2, lymphoma =1, Wilms tumor
=1]; the remaining 8 masses (26%) were benign (pyelonephritis =2, simple cyst =1,
hematic cyst =1, lipoma =1 and oncocytoma =3). All patients underwent MSCT and MR
(3.0 Tesla) before and after contrast injection; the images were evaluated in
double-blind by two expert radiologists. The results of the images were then
compared with the histo-cytological data to calculate the values of diagnostic
accuracy for both methods in the identification and characterization of renal
masses. The benign or malignant nature of the lesions was established according
to the regularity of the margins, presence or absence of significant contrast
enhancement, infiltration of perirenal fat and vascular invasion. The concordance
of the results of the two imaging techniques was then calculated using the
coefficient Kappa Cohen. RESULTS: For both identification and characterization of
renal masses, MSCT and MR showed comparable values of diagnostic accuracy with a
significant concordance (k=1); in particular, the diagnostic accuracy of MSCT/MR
was 100%/100% for lesion identification, 90%/90% for lesion characterization in
terms of benign or malignant nature, 97%/97% for the evaluation of lesion edges,
90%/90% for the assessment of lesion contrast enhancement, 93%/93% for the
evaluation of peri-renal fat infiltration and 96%/96% for the evaluation of
vascular infiltration. Only in three cases of oncocytoma the two imaging methods
were both inaccurate for diagnosis of benignity classifying the lesions as
probably malignant on the basis of the absence of central scar and of dynamic
contrast enhancement pattern. CONCLUSIONS: The results of our study show
comparable diagnostic accuracy of computed tomography (CT) and MR for the
identification and characterization of expansive renal lesions. High-field MR is,
therefore, a valid alternative to MSCT in the evaluation of renal masses avoiding
exposure to ionizing radiation.