Angiography in diagnosis of renal tumors: current concepts

Comparison of excretory urography, angiography, ultrasound and computed tomography for T category staging of renal cell carcinoma

The diagnostic significance of excretory urography, renal angiography, ultrasound and computed tomography for predicting the stage of tumours was evaluated by comparing their results with peroperative and histopathological findings. Thirty-nine out of 178 patients operated on for renal cell carcinoma from 1981 to 1988 were subjected to all four diagnostic procedures. The T stage was determined correctly by computed tomography in 80% of the cases, by ultrasound in 74.5%, by renal angiography in 64% and by excretory urography in 56.5%. Excretory urography did not give any significant additional information on the T category compared with the other imaging methods. Angiography is still of value in that it gives preoperative information on the collateral circulation and the number of renal arteries and their location.

Comparative value of ultrasonography, computerized tomography, angiography and excretory urography in the staging of renal cell carcinoma

From 1982 to 1985, 225 patients with renal cell carcinoma were treated by nephrectomy. To evaluate the diagnostic significance of ultrasonography in predicting tumor stage the results of ultrasonography, computerized tomography, renal angiography and excretory urography were compared to the histopathological findings. Since local tumor extension has a considerable impact on the operation strategy evaluation of the T classification was of particular interest. All 4 diagnostic procedures were performed in 73 of the 225 patients. The T stage was determined correctly by ultrasonography in 77.8 per cent of the patients, while the tumor was not identifiable in only 0.6 per cent. Computerized tomography was almost as reliable as ultrasonography (the T stage was predicted correctly in 72.3 per cent of the examinations). In contrast, the tumor was staged correctly by angiography in only 57.2 per cent of the patients and by excretory urography in only 59.2 per cent. From these results ultrasonography appears to be an effective, noninvasive, inexpensive and safe procedure to evaluate the T stage of renal tumors.

Tomographic renal cortical scintigraphy: correlation with intravenous urography, computed tomography, ultrasonography, angiography, and nuclear magnetic resonance imaging

This study evaluates single-photon renal tomoscintigraphy (SPECT) in the evaluation of renal masses and correlates this modality, where indicated, with computed tomography (CT), ultrasonography (US), angiography (ANGIO) and nuclear magnetic resonance imaging (NMR). Eight patients with renal cortical lesions detected on intravenous urography (IVP) were evaluated by SPECT and planar nuclear imaging using Tc-99m glucoheptonate (GH). Three of these patients were felt particularly likely to have renal tumors and were additionally evaluated with US, CT, ANGIO and NMR. The five patients with nodules on IVP that were not particularly suggestive of malignancy had functioning, benign, renal tissue accounting for their IVP lesions. Four of five were found by planar-GH nuclear imaging, five/five by SPECT-GH. In addition, SPECT-GH allowed better "confidence" in the normal renal tissue diagnosis in three/five cases. Of the three renal lesions that were highly suggestive of malignancy, two were hypernephromas and one was hypertrophied functioning cortical tissue. All three were correctly identified prospectively on SPECT-GH; however, one hypernephroma was missed on planar-GH. NMR, CT, and ANGIO detected only one of two hypernephromas prospectively (US detected both); all four modalities incorrectly diagnosed the hypertrophied tissue suggestive of malignancy.