Image characteristics of renal cysts with high density / 中华泌尿外科杂志

Objective To discuss the imaging characteristics of renal cyst of high density.Methods Nine cases (5 women and 4 men; mean age,48 years; age range,31-79 years) with high density renal mass(>30 HU) were reviewed.For all patients,the symptom was intermittent lumbar pain in 2 patients,gross hematuria with lumbar pain in 1 patient,gross hematuria without pain in 1 patient.The other 5 patients were detected during routine physical examination without symptom.Preoperative examination included CT,MRI and DSA.Results All the patients had solitary and unilateral high density renal cysts,which size ranged from 2 to 5 cm in diameter.The cysts displayed predominantly hypoechoic or irregular internal echoes on sonography.Excretory urography showed an unenhanced round mass without further distinguishing characteristics.Their cystic features were con-firmed on nonenhanced and contrast-enhanced CT scans.MRI showed a round mass with long T1 and long T2 signal.Angiography revealed lack of vessels around the mass.All patients were operated by partial nephreetomy.There was no recurrence in all patients during the follow-up for 1-5 years.Conclusion Renal cyst of high density has many special features of imageology.

Ablation of Symptomatic Cysts Using Absolute Ethanol in 11 Patients with Autosomal-Dominant Polycystic Kidney Disease

OBJECTIVE: To evaluate the effects of cyst ablation with absolute ethanol in autosomal-dominant polycystic kidney disease (ADPKD) patients with symptomatic cysts. MATERIALS AND METHODS: Using absolute ethanol, cyst ablation was performed in 11 patients with documented ADPKD who suffered cyst pain refractory to medical treatment. An ethanol solution was instilled into the largest symptomatic cysts through a catheter. We assessed the therapeutic efficacy of the procedure by tracking subjective pain relief during a 3 to 24-month follow-up period after ablation. RESULTS: At follow-up, we found that the duration of subjective pain relief was 12 to 24 months in seven patients, 4 to11 months in one, and less than 3 months in three. CONCLUSION: Selective ablation of a symptomatic cyst may be a valid option in managing chronic pain caused by one or a few large cysts in ADPKD patients.

Tetracycline Hydrochloride Sclerotherapy: Renal, Hepatic, Ovarian, and Perivesical cysts

PURPOSE: To assess the efficacy and resulting complications of tetracycline sclerotherapy in renal, hepatic, ovarian, and perivesical cysts. MATERIALS AND METHODS: We retrospectively reviewed 23 cases of benign cysts (16 renal, 4 hepatic, 2 ovarian, and 1 perivesical) in 22 patients in whom the condition was diagnosed or confirmed by either ultrasound, CT, or cytology, and who underwent percutaneous tetracycline sclerotherapy. Using a 21-gauge Chiba needle, the target cyst was punctured under ultrasound guidance. Prior to the injection of 1500 mg of tetracycline diluted in 5 ml of normal saline, almost all the cystic content was aspirated, and at the end of the procedure the tetra-cycline was left in the cyst. During a period of between 3 and 22 months, 18 of the 23 cases were followed up. RESULT: In six of the 18 cases followed up, the cysts either decreased in size by 10%, or collapsed completely. In seven cases a collapse of over 50% was noted, and in the remaining five the cyst recurred. In one of these, complete collapse occurred after retreatment at ten months, and the patient with a perivesical cyst underwent surgery six months after recurrence. Thus, treatment was effective (a collapse of at least 50%) in 13 of 18 cases (72.2%). This total of 13 comprised ten of 12 renal cysts (83.3%), two of two ovarian (100%), and one of three hepatic (33.3%). Percutaneous therapy was unsuccessful in five cases (two hepatic cysts, one renal, one para-pelvic and one perivesical). Complications occurring during the procedure or follow-up period included discomfort or mild pain, vomiting, and transient fever, though these subsided within 24 hours. In one patient with severe pain, this subsided after four days. CONCLUSION: As single-shot injection of tetracycline provides safe and effective treatment for renal and ovarian cysts, but for hepatic cysts is unsuccessful.

Usefulness of the Bosniak Classification in Cystic Renal Mass on CT

PURPOSE: To assess the clinical usefulness of the Bosniak classification system for characterizing cysticrenal masses by computed tomography (CT). MATERIALS AND METHODS: The CT scans of 28 patients with 32pathologically proven cystic renal masses (17benign, 15 malignant) were reviewed retrospectively by tworadiologists, who reached a consensus. Both unenhanced and enhanced CT scans were obtained using thin sectionswith 5-mm or 7-mm collination in 26 and four patients, respectively. Renal masses were categorized using theBosniak classification system; category I and II masses were considered benign, and category IV, malignant. Massesin category IIF or III were considered malignant when their wall thickness was more than 3 mm, their inner wallwas irregular or nodular, their septae were irregular, nodular or thick (more than 2-3 mm), calcification wasextensive, nodular or thick (more than 2-3 mm), and/or solid portions were enhanced more than 10-20 Hounsfieldunit. They were then correlated with their pathologic findings. RESULTS: For cystic renal masses, the finalpathologic results were as follows : all seven category I lesions were benign, as were seven of eight category IIlesions ; seven of 11 category III lesions were malignant, as were all seven category IV lesions. Distinguishingcategory II and III lesions by the Bosniak classification was difficult in two cases. One malignant tumor wasinterpreted as benign, and two benign tumors as malignant. With regard to prediction of the malignancy of 32cystic renal masses, as seen on CT, sensitivity, specificity, and accuracy were 93%, 88%, and 91%, respectively. CONCLUSION: Overall, the Bosniak classification system is useful for the evaluation and management of cystic renalmasses; however, with regard to the distinction between category II lesions requiring conservative management andsurgical category III lesions, some difficulties still remain.

Acetic Acid Sclerotheraphy of Renal Cysts

PURPOSE: Sclerotherapy for renal cysts was performed, using 50% acetic acid as new sclerosing agent. Wereport the methods and results of this procedure. MATERIALS AND METHODS: Fifteen patients underwent sclerotherapyfor renal cyst, using 50% acetic acid. Because four patients were lost to follow-up, only 11 of the 15 wereincluded in this study. The renal cysts, including one infected case, were diagnosed by ultrasonograpy (n=10) ormagnetic resonance imaging (n=1). The patient group consisted of four men and seven women (mean age, 59 years;range, 23-77). At first, the cyst was completely aspirated, and 25 volume% of aspirated volume was replaced with50% sterile acetic acid through the drainage catheter. During the following 20 minutes, the patient changedposition, and the acetic acid was then removed from the cyst. Finally, the drainage catheter was removed, aftercleaning the cyst with saline. After treatment of infection by antibiotics and catheter drainage for 7 days,sclerotherapy in the infected case followed the same procedure. In order to observe changes in the size of renalcysts and recurrence, all patients were followed up by ultrasound between 2 and 8 months. We defined response totherapy as follows: complete regression as under 5 volume%, partial regression as 5-50 volume% and no response asmore than 50 volume% of initial cyst volume. RESULTS: No clinically significant complication occured during theprocedures or follow-up periods. All cysts regressed completely during follow-up of 8 months. Complete regressionoccurred as follows : two cysts at 2 months, seven cysts at 4 months, two cysts at 6 months. Two cysts showedresidues at the last follow-up, at 4 and 6 months, respectiivery. The volume of residual cysts decreased to under5 volume% of initial volume, however. Completely regressed cysts did not recurr during follow-up. CONCLUSION: Acetic acid sclerotherapy for renal cysts showed good results, regardless of the dilntion of sclersoing agent withresidual cyst fluid, and no significant complications. the procedure, therefore, appears to provide effectivetherapy for renal cysts.

The Value of Intrarenal Resistive Index in Autosomal Dominant Polycystic Kidney Disease

PURPOSE: The purpose of this study was to determine the value of the intrarenal resistive index (RI),measured by Doppler sonography, in order to assess intrarenal vascular resistance in autosomal dominant polycystickidney disease (ADPKD) patients. MATERIALS AND METHODS: In 26 patients with ADPKD, RI was measured by Dopplersonography and correlated with the presence of hypertension, renal function (creatinine clearance) and anatomicalrenal severity index (RSI), thus indicating renal morphologic abnormalities during B-mode sonography . RESULTS:RI was significantly higher in 18 hypertensive ADPKD patients (0.64+/-0.65) (Mean+/-1SD; range: 0.52-0.74) than ineight normotensive patients (0.59+/-0.50) ( 0.48-0.64) (p<0.05). Statistically significant inverse correlation wasfound between RI values and creatinine clearance (r=-0.45, p<0.05), and statistically significant correlation wasfound between RI values and RSI, indicating the degree of renal parenchymal involvement. CONCLUSION: RIcorrelates with the development of hypertension, renal function and renal morphologic abnormality scoring by RSIduring B-mode Doppler sonography, and measured in this way may thus be used to assess renal vaseular resistance inADPRD patients.

Acquired Cystic Kindey Disease in Dialysis and Renal Transplant Patients: Ultrasonography and CT Analysis

PURPOSE: To evaluate by US and CT the incidence and complications of acquired cystic kidney disease (ACKD) in dialysis and renal transplant patients and to compare the effectiveness of US and CT in the diagnosis of this entity. MATERIALS AND METHODS: This study was prospectively performed in 70 dialysis patients and 13 renal transplant patients, and excluded any with multiple renal cysts or polycystic kidney disease, on as seen on initial films. US were obtained in all patients, and CT scans were randomly obtained in 27 who had been on dialysis for 3 years or more; all these US and CT scans were analyzed, with particular emphasis on whether or not cysts were present. In order to correlate the numbers of cysts with duration of dialysis, all patients were assigned to one of three groups, according to the number of cysts found (group 1, 0; group 2, 1-4; group 3, >4).Only group 3 was diagnosed as suffering from ACKD. In order to compare the cyst-detection capability of US with that of CT, 27 dialysis patients who had undergone US and CT were divided into four groups according to the numberof cysts found (grade 1, 0; grade 2, 1-4; grade 3, 5-10; grade 4, >10). RESULTS: Seventy dialysis patients were divided according to the results of US, as follows : group 1, 20%; group 2, 47.1%; group 3, 32.9%. The mean duration of dialysis in group 1 (31.9 months) was statistically different from that in group 2 (50.6 months) and in group 3 (95.8 months) (p<0.000). Thirteen renal transplant patients were divided as follows : group1, 61.5%; group 2, 38.5%; group 3, 0%. In dialysis patients with ACKD, complications noted were renal cell carcinoma(n=1), hemorrhagic cysts(n=2), and hematomas(n=2) Among the 27 dialysis patients who underwent CT, this and US showed an equal grade of cystic change in 53.7%, while CT showed a higher grade in 46.3%. The detection rate of ACKD in these 27 patients was 46% on US and 63% on CT. CONCLUSION: A prolongation of dialysis corresponded to an increased incidence of ACKD; renal neoplasm and hemorrhage may occur in dialysis patients, but ACKD and its complications did not develop in renal transplant patients. In long-term dyalysis patients, regular follow-up studies of kidneys using US or CT are therefore needed. CT was superior to US in diagnosing ACKD.

Renal Cell Carcinoma in Adult Polycystic Kidney Disease: A Case Report

The authors report a case of a renal cell carcinoma occurring in an adult suffering from polycystic kidney disease and diagnosed by radiologic examination. The patient presented with palpable flank mass, hematuria and weight loss. Ultrasonography, CT, MRI and angiography were performed preoperetively. Although severe renal architectural distortion and destruction caused by polycystic disease had masked evidence of malignancy, this was diagnosed after examination of the solid component of the mass lesion, and its hypervascular character, as seen on the three types of radiologic image. Malignancy was confirmed through nephrectomy and pathological examination.