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<p><b>OBJECTIVE</b>To study the CT findings of cystic nephroma (CN) and multilocular cystic renal cell carcinoma (MCRCC) and to improve the accuracy of preoperative diagnosis of these two diseases.</p><p><b>METHODS</b>The CT findings of nine CN cases and 19 MCRCC cases confirmed by pathology were blindly reviewed and compared with their pathological results. Fisher's exact test and independent-samples T test were applied to statistically analyze some of the CT features of the CN and MCRCC lesions.</p><p><b>RESULTS</b>The thickness of cystic walls and partitions in the nine CN cases ranged from 0.5 to 5 mm. Cystic walls and partitions were slightly thicker in some parts without visible mural nodules. Varying amounts of solid tissue could be found in all the 19 MCRCC tumors, and the cystic walls and partitions were found partially thickened ranging from 3 mm to 13 mm. Eight cases were with mural nodules (nodule diameter: 4.5-16 mm). Nine cases of CN tumors were lobulated and 7 protruded into the renal sinus. Three out of the 19 MCRCC presented shallow lobulation, and 7 tumors protruded into the renal sinus. The CT contrast-enhancement scanning displayed moderate delayed enhancement in the cystic walls and partitions in 8 cases. The enhanced scanning revealed that all the nine cases showed enhancement of the cystic walls and partitions, while 8 cases of them had mild to moderate delayed enhancement. The cystic walls, partitions and nodules were enhanced in 19 MRCC cases, among them 17 cases displayed obvious enhancement in the cortical phase. Among the differences of CT findings between MC and MRCC, the shallow lobulation, protruding into the renal sinus, mural nodules, cystic wall and partition thickness, and net growth in the cortical and nephrographic phase were statistically significantly different (P<0.05 for all).</p><p><b>CONCLUSIONS</b>CT scan can provide significant evidence for CN and MCRCC diagnosis. CN cases usually present relatively thin and even cystic walls and partitions without mural nodules and with shallow lobulation and protruding into the renal sinus. The enhancement is mild to moderate, dynamic and delayed, while the opposite CT findings may indicate a higher possibility of MCRCC.</p>
Subject(s)
Humans , Adenocarcinoma, Clear Cell , Diagnostic Imaging , Carcinoma, Renal Cell , Diagnostic Imaging , Diagnosis, Differential , Kidney , Diagnostic Imaging , Kidney Diseases, Cystic , Diagnostic Imaging , Kidney Neoplasms , Diagnostic Imaging , Tomography, X-Ray ComputedABSTRACT
Objective To analyze the correlation between renal blood flow (BF)of CT perfusion and effective renal plasma flow (ERPF)of radionuclide labeled microspheres.Methods CT perfusion was applied to 26 cases of renal cell carcinoma (RCC)in order to obtain the average unit BF of the target layer of the uninjured lateral kidney.For the renal image of the uninjured lateral kidney in the nephrographic phase (NP),we used the value of maximal renal cross-sectional area times the value of renal maximal height as the standardized volume.The product of this standardized volume and average unit BF could be used as an approximation of total re-nal blood flow,which was a standardized renal BF value.Meanwhile,we took radionuclide labeled microspheres into practice to ob-tain an ERPF value of the corresponding uninjured lateral kidney.The correlation between standard renal BF and ERPF was obtained by using Pearson chi-square test.Results The standard renal BF values of the uninjured lateral kidney for the group of 26 cases of RCC ranged from 620.59 to 820.76 mL·min-1 ·g-1 ·cm3 (mean=718.87 ±58.40 mL·min-1 ·g-1 ·cm3 ),and the values of ERPF tested by radionuclide labeled microspheres ranged from 244 to 41 1 mL/min (mean= 320.54 ± 55.71 mL/min).The two groups were positively correlated (r=0.754,P <0.01).Conclusion CT perfusion imaging of the kidney,to some extent,has the potential to replace renal functional examination of radionuclide labeled microspheres.
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Objective To investigate the value of contrast enhanced ultrasonography in evaluating cystic renal mass. Methods According to the imaging diagnosing standard, 29 cystic renal mass lesions were studied with contrast enhanced ultrasonography(CEUS), unenhanced ultrasonography (US), contrast enhanced CT(CECT) and then correlated their results with final histopathological results. The data were tested by receiver operating characteristic(ROC) curve. Results The area under ROC curve of CEUS and US was 0. 721, 0. 997, respectively. There was significant difference between the 2 groups (P=0. 003). The area under ROC curve of CEUS and CECT was 0. 997, 0. 997,respectively. There was no significant difference between the 2 groups (P= 1. 000). Conclusions CEUS is better than US and similar to CECT in evaluating cystic renal mass. CEUS with the Bosniak classification is useful for evaluating cystic renal mass.
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BACKGROUND: The biomechanical studies about calcium sulfate cement vertebroplasty are only limited to the single fracture vertebra, not performed in spinal compression fracture unit with posterior transpedicular screw fixation. Furthermore, performing experimental study in the whole function spine unit (FSU) conforms to actual clinical situation. OBJECTIVE: To assess the biomechanical properties of calcium sulfate vertebroplasty combined with posterior transpedicular screw fixation in treatment of thoracolumbar compression fractures. DESIGN, TIME AND SETTING: A controlled experiment was performed at the Biomechanical Laboratory of Shanghai University in March 2009. MATERIALS: Fifteen fresh thoracolumbar spines were harvested from male calves and made into T_(11)-L_1 FSU, then divided into 3 groups randomly: normal control group, posterior transpedicular screw fixation group and transpedicular screw fixation plus vertebroplasty group. METHODS: T_(12) flexion-compression fracture models were made in all specimens of posterior transpedicular screw fixation group and transpedicular screw fixation plus vertebroplasty group, undergoing reduction and posterior transpedicular screw fixation, and calcium sulfate vertebroplasty combined with posterior transpedicular screw fixation respectively. MAIN OUTCOME MEASURES: All specimens were placed on the WE-10A universal testing machine for mechanical test. Load-straining, load-displacing, rigidity, strength and torsion of the FSU were performed in axial compression, flexion, extension and lateral bending states. The experimental outcomes were collected and compared by statistic analysis. RESULTS: The load-strain and loed-displacement showed a linear relationship. Straining values in vertebral body and intervertebral disc of calcium sulfate vertebroplasty plus posterior transpedicular screw fixation group were 14% and 12% less than that of posterior transpedicular screw fixation group, 21% and 13% less than that of normal control group. The thoracolumbar displacement in calcium sulfate vertebroplasty Plus posterior transpedicular screw fixation group decreased 25% and 37% as compared with other 2 groups respectively. Compared with normal control and posterior transpedicular screw fixation group, the thoracolumbar stiffness in calcium sulfate vertebroplasty plus posterior transpedicular screw fixation group increased 53% and 44% respectively. The strength in vertebral body and intervertebral disc of calcium sulfate vertebroplasty plus posterior transpedicular screw fixation group were 14% and 24% higher than that of posterior transpedicular screw fixation group, 13% and 20% higher than that of normal control group. The maximal twisting strength of FSU in calcium sulfate vertebroplasty plus posterior transpedicular screw fixation group were 18% and 30% higher than that of other 2 groups, the twisting stiffness were 30% and 40% higher than that of other 2 groups. The data above were significant differences statistically (P < 0.05). CONCLUSION: Posterior transpedicular screw fixation combined with calcium sulfate vertebroplasty show superior biomechanical properties for treatment of thoracolumbar compression fractures, which exhibits not only strong strength and stiffness, but also stable FSU, thus could decrease the stress loading of the internal fixation, the incidences of screw breakage and avoid the altitude loss of vertebral body.
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[Objective]To evaluate the clinical value in treatment of subtrochanteric fracture of the femur by dynamic condylar screw(DCS).[Method]This study retrospectively reviewed 29 patients who suffered from subtrochanteric fracture of the femur.There were 18 males,11 females,with an average age of 52.2 years.Seven cases were caused by traffic accident,8 cases caused by falling from hight,14 cases caused by pedestrian injury.According to Seinsheimer classification,there were 5 cases of typeⅡ(2 of typeⅡB,3 of typeⅡC),12 cases of typeⅢ(7 of type ⅢA,5 of type ⅢB),5 cases of type Ⅳ,7 cases of type Ⅴ.All patients accepted the treatment with traction reduction and dynamic condylar screw fixation and were fellowed up for 9～24 months(average 16 months).Outcoms were assessed by Sanders traumatic hip rating scale and postoperative complications were analyzed.[Result]All patients obtained bone union in average 3.5 months(3～5 months),Only one case who had obtained bone union suffered subtrochanteric refracture 16 months after operation because of plate breakage.All patients were encouraged to early exercise and walk by nonweight-bearing.There was no postoperative infection,deep venous thrombosis,internal fixation loosening,limb shortening and varus deformity.According to sanders traumatic hip rating scale,18 cases were excellent,10 cases were good,1case was fair.The excellent and good rate was 96.5%.[Conclusion]In treatment of subtrochanteric fracture of the femur,DCS not only maintain satisfying reduction with reliable fixation,but also prevent femoral shortening,rotation and varus deformity,thus get good curative effect,fast recovery,satisfying function and so on.So it is one of the best choices to heal subtrochanteric fracture.