Preoperative radiographic parameters predict long-term renal impairment following partial nephrectomy.

PURPOSE: We analyzed radiographic parameters describing anatomic features of renal tumors to identify preoperative characteristics that could help predict long-term decline in renal function following partial nephrectomy. METHODS: We retrospectively reviewed the records of 194 consecutive patients who underwent partial nephrectomy from January 2006 to March 2009 and analyzed a cohort of 53 patients for whom complete clinical, radiographic, and operative information was available. Computed tomography images were reviewed by a single radiologist. Radiographic criteria for describing renal tumor size and location included diameter, volume, endophytic properties, proximity to collecting system, anterior/posterior location, location relative to polar lines, and R.E.N.A.L. nephrometry score. Postoperative estimated glomerular filtration rate was calculated using the MDRD study group equation with serum creatinine at last follow-up. RESULTS: The median preoperative and postoperative GFR values were 75 (IQR 65-97) and 66 (IQR 55-84) mL/min/1.73 m(2), respectively. At a median follow-up of 38 months, the median percentage decrease in GFR was 12%. On univariate analyses, tumor diameter (P = 0.002), tumor volume (P < 0.0001), nearness of tumor to collecting system (P = 0.017), and location relative to polar lines (P = 0.017) were associated with percentage decrease in GFR. Furthermore, higher R.E.N.A.L. nephrometry score was also associated with poorer renal functional outcomes following partial nephrectomy (P = 0.019). CONCLUSIONS: Anatomic features of renal tumors defined by preoperative radiographic characteristics correlate with the degree of renal functional decline after partial nephrectomy. Identification of these parameters may assist in patient counseling and clinical decision making following partial nephrectomy. Validation in larger prospective studies is necessary.

Hepatocellular carcinoma: clinical and radiological findings in patients with chronic B viral hepatitis and chronic C viral hepatitis.

AIM: To compare clinical and radiological findings of newly diagnosed hepatocellular carcinomas (HCCs) in patients with chronic hepatitis B virus (HBV) and chronic hepatitis C virus (HCV) infections. MATERIALS AND METHODS: Dynamic contrast-enhanced CT images in 532 patients with newly diagnosed HCC were retrospectively reviewed. Of these patients, 418 had chronic HBV infections and 114 had chronic HCV infections. The number, size, shape (nodular vs. non-nodular) and enhancement pattern (typical vs. atypical) of hepatic lesions were assessed. The presence of portal vein thrombosis and bile duct invasion were determined. RESULTS: The mean age of the HBV group (54.31 [range 27-85], median 54) was younger than that of the HCV group (64.21 [range 30-86], median 64) (P < 0.001). Lesions in patients with HBV were more likely to be multifocal (>5; P < 0.001); larger than 5 cm (P = 0.023); non-nodular shape (P < 0.001); atypical enhancement pattern (P = 0.047), association with portal vein thrombosis (P = 0.004); association with bile duct invasion (P < 0.001). CONCLUSIONS: Clinical and radiological findings of HCC differ between patients with HBV and HCV infections.

Extension of air into the right perirenal space after duodenal perforation: CT findings.

PURPOSE: To determine the extraperitoneal distribution of air following perforation of the second portion of the duodenum. MATERIALS AND METHODS: Institutional review board approval was obtained for this HIPAA-compliant study. The requirement for written informed consent was waived. Two reviewers who were aware of the presence of duodenal perforation after duodenal endoscopy retrospectively reviewed computed tomographic (CT) images in eight patients (one man, seven women; mean age, 68 years; age range, 27-88 years) to assess and categorize the location of extraluminal air. RESULTS: Extraluminal air was detected in the following locations: right anterior pararenal space (n = 8), right perirenal space (n = 7), right posterior pararenal space (n = 4), right properitoneal compartment (n = 4), bare area of the liver (n = 6), right extraperitoneal pelvis (n = 7), hepatoduodenal ligament (n = 3), mesentery (n = 2), mediastinum (n = 4), portal venous system (n = 1), and peritoneal cavity (n = 1). CONCLUSION: Air extended posteriorly into the right perirenal space in seven (88%) of eight patients following perforation of the second portion of the duodenum. Duodenal perforation introduces potential for direct communication between the right anterior pararenal space and the right perirenal space. SUPPLEMENTAL MATERIAL: http://radiology.rsnajnls.org/cgi/content/full/2503080605/DC1.

Imaging diagnosis of cystic pancreatic lesions: pseudocyst versus nonpseudocyst.

Although the clinical, radiologic, and pathologic features of cystic pancreatic lesions are well known, preoperative diagnosis is difficult. Differentiation between a pancreatic pseudocyst and a cystic pancreatic neoplasm is crucial in determining the proper treatment. Careful evaluation of the patient's clinical history is important for accurate diagnosis of a pseudocyst. Clinical scenarios include a pseudocyst developing after acute pancreatitis and a pseudocyst superimposed on chronic pancreatitis. However, a pseudocyst in a patient with no clinical history of pancreatitis poses a diagnostic problem. The differential diagnosis of a neoplastic cystic lesion of the pancreas includes serous cystadenoma, mucinous cystic neoplasms, intraductal papillary mucinous tumor, and solid and papillary epithelial neoplasm. Definitive diagnosis is often possible when the lesion has a typical radiologic appearance, but in many cases characterization with imaging alone is impossible. Thin-section computed tomography with multiplanar reformation, magnetic resonance cholangiopancreatography, and endoscopic ultrasonography have emerged as modalities that can provide additional diagnostic information. Familiarity with the range of imaging appearances and awareness of the diagnostic strengths and limitations of each imaging modality are important for accurate diagnosis and management of cystic pancreatic lesions.