Accurate detection of renal leukemic involvement in children using 3‐D computed tomography modeling

Abstract

Background The rate of renal involvement in pediatric acute lymphoblastic leukemia (ALL) at diagnosis varies between reports because renal involvement is diagnosed on renal size larger than aged‐matched standards on conventional modalities. We propose a new method for precise renal involvement detection using 3‐D enhanced computed tomography (CT) reconstruction. Methods Twenty‐five children with ALL were evaluated utilizing 3‐D enhanced CT reconstruction to measure renal volume before and after induction therapy, renal mass lesions and renal axis at diagnosis. Renal involvement was defined as a marked decrease of renal volume or the presence of mass lesions. Results According to the 3D‐CT criteria, nine of 25 patients (36%) had renal involvement. All of them had bilateral mass lesions except for one who had diffuse nephromegaly alone. This method detected renal involvement more accurately than ultrasonography. When using conventional criteria based on the length of the renal axis, 19 of 25 (76%) had renal involvement, including many cases of false‐positive nephromegaly. Patients with renal involvement had significantly more extramedullary involvement according to the 3D‐CT‐based criteria. Conclusions The use of 3D‐CT reconstruction was accurate in detecting renal involvement in childhood ALL, most of which consisted of piled up mass lesions. Patients with renal involvement should be worked up for the detection of other extramedullary lesions.

Renal ultrasonographic abnormalities at initial presentation of children diagnosed with acute lymphoblastic leukemia and long-term renal functions and prognosis in survivors

“…In addition to this, different screening modalities such as intravenous pyelogram, ultrasound, and computerized tomography have been preferred in those. [ 4 , 9 , 14 ] The above circumstances might cause inadequate estimation of the frequency of renal abnormalities in ALL patients. Most commonly reported renal imaging abnormalities are bilateral, diffuse enlargement of kidneys, and/or hyperechoic pattern, and these findings have been accepted as a sign of renal leukemic involvement in the previous reports.…”

“…D’Angelo et al [ 10 ] demonstrated that prognosis of patients with NM at the time of diagnosis was worse with respect to the patients without NM. Neglia et al, Fujiki et al, and Taylor et al [ 5 , 8 , 14 ] did not consider NM as having an impact on prognosis in comparison to the presence of other well-defined prognostic criteria. Hann et al [ 4 ] showed that the NM was associated with worse survival in cases with better risk factors defined at the era of the study.…”

“…[ 3 ] There are very few imaging studies exclusively dedicated to the prevalence of renal abnormalities at the time of ALL diagnosis, and the frequency of renal radiological abnormalities was reported as 18-47%. [ 4 - 14 ] The most common findings are unilateral or bilateral enlargement of kidneys and/or increased renal echogenicity, of which it is impossible to reveal the etiology based on radiological findings, as renal biopsy is not routinely performed in the majority of cases, except in the autopsy series. In some reports, bilateral nephromegaly (NM) resolving after successful chemotherapy has been considered as a sign of renal leukemic involvement.…”