ROLE OF MULTI-DETECTOR COMPUTED TOMOGRAPHY (MDCT) IN EVALUATION OF RENAL MASSES ASSUMING HISTOPATHOLOGY AS GOLD STANDARD

Abstract

Aim: To study role of MDCT in evaluation of renal masses, characterization of Benign and malignant lesions and to find out the Sensitivity, Specificity and Accuracy to differentiate a benign from malignant lesion.

Material & methods: 48 patients having 50 renal masses from Nephrology, Urology and Pediatrics department were included in this hospital based descriptive type of observational study. All patient underwent MDCT and Histopathological examination. MDCT was performed on Philips Ingenia 128 slice multi detector scanner and the final diagnosis was made by histopathology. Statistical analysis was applied to find out the sensitivity, specificity, PPV, NPV and Accuracy. P-value < 0.05 was taken as significant.

Results: In our study out of total 48 cases with 50 renal masses (in 2 cases masses were bilateral accounting 4 masses in them) among 31 males and 17 females (age range from 3 to 69 years), there were 46 (92%) malignant and 4 (8%) benign renal masses. Renal cell carcinoma (n=31) accounted for 62% of all renal masses and 67.3% of malignant renal masses, Transitional cell carcinoma (n=02), Wilm's tumor (n=07), Metastases (n=03), lymphoma (n=03), Angiomyolipoma (n=03) and Oncocytoma (n=01). The most common calcified renal mass was renal cell carcinoma. Calcification was seen in 7 out of 31 cases of RCC (22.5%). Malignant renal masses showed more amount of necrosis when compared to the benign renal masses (58% in RCC and 100% in Wilms' tumor).Renal vein invasion was seen in 35.4% cases of RCC and in 2 out of 7 (28.7%) cases of Wilms' tumor whereas none of the benign renal masses showed renal vein invasion. 2 out of 31 (6.5%) cases of RCC showed inferior vena caval thrombosis. MDCT was able to differentiate a benign from malignant lesion with Sensitivity of 100%, Specificity of 80%, and Accuracy of 98%.

Conclusion: MDCT with good reformatting techniques has excellent accuracy in the detection and characterization of renal masses and to differentiate a benign from malignant lesion.

Keywords: Multi-detector computed tomography (MDCT), Masses, Renal cell carcinoma (RCC).