Novos paradigmas na avaliação por imagem dos tumores parenquimatosos renais

Abstract

New paradigms in the imaging evaluation of renal parenchymal tumorsNovos paradigmas na avaliação por imagem dos tumores parenquimatosos renais EditorialFor a long time, imaging methods have played a secondary role in the diagnosis and therapeutic planning in cases of renal parenchymal tumors, considering that excretory urography could only detect large lesions causing bulging of the renal contour or distortion of the calyceal system, generally in symptomatic patients with advanced disease.In this scenario, the arrival of ultrasonography (US) has represented a landmark, considering that small lesion started being incidentally diagnosed (incidentalomas), resulting in a significant improvement in survival rates, since patients diagnosed with incidental tumors with < 4 cm (T1 stage) present 95% probability of ten-year survival(1) . In the last years, the higher availability of Doppler and ultrasonographic contrast agents has contributed to increase the US applicability in the detection, therapeutic planning and post-treatment follow-up of focal renal lesions.On its turn, computed tomography (CT) with intravenous iodinated contrast enhancement has become the method of choice in the evaluation of the greatest majority of focal renal lesions, because, besides allowing a better characterization of lesions detected by US, this method also allows an accurate pretherapeutic staging of these lesions. The current technologies, with multidetector helical CT (MDCT or multislice CT) utilizing dedicated protocols with four-phase studies (precontrast, corticomedullary, nephrographic and excretory phases) have increasingly widened the CT applicability, with shorter acquisition times, higher spatial resolution and possibility of 3D and multiplanar images reconstruction (2) . Finally, magnetic resonance imaging (MRI), with exceptional contrast resolution and digital subtraction capability, has brought a positive contribution to the evaluation of focal renal lesions particularly in patients presenting allergy to iodinated contrast agents, along with characterizing lesions indeterminate at CT (3) .

Sinais de hipervascularização em imagens de ressonância magnética em metástases ósseas de carcinoma de células renais

“…Although these signs have been described in studies with small samples, their high frequency allows the authors to affirm that the presence of hypervascularization within or surrounding bone lesions must suggest the evaluation of the kidney as the primary site of the neoplasm. In cases where the primary tumor is already known and a surgical treatment is indicated, the surgeon must be warned about the presence of these large, newly formed vessels (14) , to prevent eventual intraoperative complications (hemorrhage).…”