CT imaging spectrum of infiltrative renal diseases

Ballard, David H.; Alba, Luis De; Migliaro, Matías; Previgliano, Carlos; Sangster, Guillermo

doi:10.1007/s00261-017-1193-5

Cited by 14 publications

(16 citation statements)

References 38 publications

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“…In humans, RCCs appear predominantly solid but often have areas of hemorrhage or necrosis [29]. Moreover, human RCCs show heterogeneous enhancement on CT [30], and tumor enhancement patterns are related to calcification, infection, necrosis, and vascular supply [31]. Although we did not assess the gross tumor pathology, the heterogeneous enhancement observed in dogs with RCC may be related to hemorrhage or necrosis.…”

Section: Discussionmentioning

confidence: 99%

“…To the best of our knowledge, there are no other reports on the CT examination of canine renal lymphoma. In humans, primary renal lymphoma, which is defined as lymphoma confined to the renal parenchyma with no lymphadenopathy, is rare and requires biopsy for diagnosis [30]. Renal lymphoma is usually homogenous and isodense or slightly hyperdense compared to the normal renal parenchyma on pre-contrast CT images; it may be hypovascular on arteriography or CT examination [10,32,33].…”

Section: Discussionmentioning

confidence: 99%

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Contrast-enhanced computed tomography findings of canine primary renal tumors including renal cell carcinoma, lymphoma, and hemangiosarcoma

et al. 2019

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In veterinary medicine, abdominal ultrasonography is used to rank the differential diagnosis of renal lesions. However, a conventional sonographic examination may show nonspecific findings. The purpose of this study was to assess the computed tomography (CT) findings of canine renal tumors, including renal cell carcinoma (RCC), lymphoma, and hemangiosarcoma (HSA). In this retrospective study, the following CT parameters were recorded for each dog: 1) extent of renal involvement of tumors, 2) enhancement pattern, 3) number of renal tumors, 4) renal tumor vessel enhancement in the corticomedullary phase, 5) presence of lymphadenopathy and lung metastasis, and 6) attenuation values of the renal tumors on the pre- and post-contrast corticomedullary, nephrographic, and excretory phase images. Fifteen dogs met the inclusion criteria, of which nine had RCCs, four had lymphomas, and two had HSAs. RCCs tended to show heterogeneous enhancement and unilateral renal involvement, and vessel enhancement was detected in the corticomedullary phase in dogs with RCC. Conversely, renal lymphomas showed homogeneous enhancement, bilateral renal involvement, and multiple masses; in these dogs, no vessel enhancement was detected in the corticomedullary phase, and the incidence of lymphadenopathy was low. However, in dogs with lymphadenopathy, the renal lymphoma was associated with regionally severe lymphadenopathy. Finally, renal HSAs tended to show heterogeneous enhancement with a non-enhanced area and unilateral renal involvement; in these dogs, vessel enhancement was detected in the nephrographic phase, with the enhancement expanding around the vessel. These findings had no significant differences. Further studies with a larger sample size are required to examine the association between CT and histopathological findings.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Contrast-enhanced computed tomography findings of canine primary renal tumors including renal cell carcinoma, lymphoma, and hemangiosarcoma

et al. 2019

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“…In contrast, infiltrative renal masses are considered unusual, and have been mostly studied to explore various differential diagnoses other than RCC, including invasive urothelial carcinoma, metastasis from other organs or lymphoma. [14][15][16][17][18][19][20] In RCC cases, previous studies have suggested that infiltrative features could be exceptionally observed in relation to atypical, but aggressive, subtypes, such as sarcomatoid, medullary or collecting duct carcinomas. 21,22 However, the potential limitations of these previous studies included the lack of a clear definition of infiltrative renal mass.…”

Section: Discussionmentioning

confidence: 99%

Infiltrative tumor interface with normal renal parenchyma in locally advanced renal cell carcinoma: Clinical relevance and pathological implications

et al. 2021

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Objectives: Locally advanced renal cell carcinoma is considered clinically aggressive, despite heterogeneity in survival outcomes. We investigated the clinical relevance and pathological implications of infiltrative tumor interface with normal renal parenchyma on preoperative imaging in locally advanced renal cell carcinoma. Methods: A total of 77 patients with locally advanced renal cell carcinoma (≥pT3a Nany M0) who underwent radical or partial nephrectomy (2008)(2009)(2010)(2011)(2012)(2013)(2014)(2015)(2016)(2017)(2018) were analyzed. Preoperative dynamic computed tomography images were reviewed to assess radiological infiltrative features. A radiological infiltrative feature was defined as an illdefined tumor interface with normal renal parenchyma. The tumor interfaces were analyzed histologically and compared with radiological findings. Results: The median tumor size was 6.4 cm. Lymphadenopathy was observed in four patients (5.2%). Clear cell renal cell carcinoma was diagnosed in 66 patients (86%) and Fuhrman grade was 3-4 in 38 patients (49%). A total of 30 patients (39%) showed radiological infiltrative features, which were significantly associated with larger tumor size and higher clinical T stage. The specificity and sensitivity of radiological infiltrative features in predicting pathological renal parenchymal infiltration were 90 and 64%, respectively. During a median follow-up period of 3.8 years, 27 patients (35%) developed cancer recurrences, and six patients (7.8%) died of renal cell carcinoma. Multivariable analysis showed that the presence of radiological infiltrative features was an independent risk factor for cancer recurrence. Cancer recurrence and cancer-specific mortality were significantly stratified by the presence or absence of radiological infiltrative features (P < 0.001 and P = 0.02, respectively). Conclusions: Locally advanced renal cell carcinoma can show radiological infiltrative features preoperatively, which are significantly associated with unfavorable prognosis. Radiological infiltrative features on preoperative imaging correspond with a high specificity to pathological renal parenchymal infiltration.

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“…Generally, renal lymphoma appears as multiple renal masses (60% of cases) and less frequently as solitary lesion or as diffuse parenchymal infiltration. In diffuse form, nephromegaly could be the only CT finding, with preservation of cortical profile and deformity of the calyces and pelvis; after contrast administration, infiltrative lymphomatous involvement appears hypodense compared with the normal parenchyma, with evidence of loss of corticomedullary differentiation [18].…”

Section: Differential Diagnosis With Lymphoma and Leukemiamentioning

confidence: 97%

“…Recently, the association of calyx dilation, pelvic contraction and cortical reduction has been described as the bear's paw sign, which represents a strong index of suspicion for the diagnosis of XGP. CT also allows to evaluate the possible presence of hydro-pyonephrosis, the thickening of the Gerota fascia (associated or not with streaks of perirenal fat), retroperitoneal and psoas involvement [18]. Malek and Elder [19] classified this disease into three stages according to the extent of tissue involvement (Table 1): stage I, confined to renal parenchyma only ( Fig.…”

Section: Xanthogranulomatous Pyelonephritis (Xgp)mentioning

confidence: 99%

Complicated pyelonephritis associated with chronic renal stone disease

et al. 2020

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Purpose This article reviews imaging manifestations of complicated pyelonephritis associated with chronic renal stones disease, in particular xanthogranulomatous pyelonephritis (XGP) and emphysematous pyelonephritis (EPN), as potential mimics of other renal diseases and malignances and provides helpful tips and differentiating features that may alert the radiologist to suspect a diagnosis of infection. Materials and methods A retrospective review of the records from 6 adult patients (5 females and 1 male, mean age 72,3 years) with diagnosis of XGP associated with chronic nephrolithiasis and 7 adult patients (6 females and 1 male, mean age 59,3 years) with diagnosis of EPN associated with chronic nephrolithiasis from January 2010 to January 2020 was carried out. Computed tomography urography (CTU) with at least an unenhanced scan, and the parenchymal and excretory phases after contrast medium administration performed at our Teaching Hospital were included. When available images related to conventional radiography, ultrasound (US) and magnetic resonance imaging of the same patients, the comparison with CTU images was carried out. Conclusion A possible diagnosis of XGP or EPN must always be taken into account when a pyelonephritis is associated with untreated kidney stones, especially whenever clinical presentation is atypical, current therapy is not effective and imaging shows features of dubious interpretation. Due to their rarity and atypical presentation, a multidisciplinary approach is required and an expert radiologist represents a key figure in the multidisciplinary team as he can help to differentiate between benign and malignant lesions and thus avoid unnecessary radical surgical procedures.

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CT imaging spectrum of infiltrative renal diseases

Cited by 14 publications

References 38 publications

Contrast-enhanced computed tomography findings of canine primary renal tumors including renal cell carcinoma, lymphoma, and hemangiosarcoma

Contrast-enhanced computed tomography findings of canine primary renal tumors including renal cell carcinoma, lymphoma, and hemangiosarcoma

Infiltrative tumor interface with normal renal parenchyma in locally advanced renal cell carcinoma: Clinical relevance and pathological implications

Complicated pyelonephritis associated with chronic renal stone disease

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