Accuracy and Reliability of the CT for Detection of The Renal Masses

Abstract

Background: With the advances in the diagnostic parameters, CT with the use of various software allowing manipulation and increase in the spatial resolutions lead to a considerable reduction in time needed for scanning. Aims & Objectives:The present observational study was conducted to learn the enhancement pattern and attenuation pattern of renal masses during different phases (Cortico-medullary, nephrographic, and unenhanced phases, and to evaluate renal parenchymal enhancement characteristics during these phases, Also, comparison of findings from CT and pathological diagnosis was done. Materials and Methods: For enhancement pattern and attenuation values of real masses during various phases namely nephrographic, corticomedullary, and unenhanced phase multidetector CT was used for better assessment. Subjects with the complaint of flank pain/fullness, and/or hematuria, and also subjects with the incidental detection of renal masses ultrasonographically and were referred for CT abdomen. 20 subjects with confirmed presence of renal masses on CT were finally included. Results: Mean size of the masses detected in the kidney was found to be 5.423±3.4877 with the range of 2cm to 19cms. 11 lesions were benign whereas 9 lesions detected were found to be malignant. For enhancement pattern, it was homogenous in 6 whereas, heterogeneous in remaining 5. Among 9 malignant lesions, only 2 lesions were homogenous and 7 lesions were heterogeneous. For margins of the tumors, well-defined margins were seen in 9 of the benign lesion, and only 2 benign lesions had ill-defined margins. In malignant lesions, only 2 lesions had well-defined margins and ill-defined margins were seen in the rest 7 lesions. This difference in the margins of the benign and malignant tumors was statistically significant. In the corticomedullary phase and nephrographic phase, HU values for malignant renal masses respectively were 96.64 and 73.26. Enhancement was lower in the nephrographic phase compared to the corticomedullary phase.Conclusion:For differentiating benign tumors from malignant tumors, and their characterization, attenuation values, and the enhancement patterns serve as an important tool in this regard. Regarding enhancement patterns of benign tumors, no statistically significant difference was seen nephrographic and corticomedullary phases. For malignant renal masses, enhancement was greater in the corticomedullary phase compared to the nephrographic phase. The present trial concludes that renal masses should be evaluated in all phases including unenhanced, corticomedullary, and nephrographic phases for appropriate characterization and detection of the renal masses.