Renal imaging: a comparison of radionuclide, ultrasound, and computed tomographic scanning in investigation of renal space-occupying lesions

Renal single photon emission computed tomography: should we do it?

Although single photon emission computed tomography (SPECT) imaging has established a place for itself in clinical nuclear medicine for heart and brain studies, its place in renal imaging is not yet clear. Renal SPECT has been subject to limitations imposed by the efficiency of imaging equipment, and has been confined to use with static imaging agents such as technetium-99m (99mTc) dimercaptosuccinate (DMSA). SPECT has been used to investigate space-occupying lesions and anatomical abnormalities, and for quantitative studies of renal uptake and volume. In these areas, it has provided little advantage over conventional imaging, but it has been helpful in individual cases. High-resolution SPECT is a promising new development, which may have applications in detecting and classifying renal scarring. It deserves careful evaluation.

Multiple-section radionuclide tomography of the kidney: a clinical evaluation

The clinical utility of radionuclide emission tomography of the kidney in comparison with conventional gamma-camera imaging has been assessed from scans of 60 patients suspected of having space-occupying lesions of the kidney. Nineteen patients had renal tumour, 17 had cysts and seven had renal pseudotumours; the remainder had no lesion. Objective trials using four observers showed only a slight, statistically insignificant advantage from the addition of tomographic sections to conventional images. However, in several individual cases tomography had aided diagnosis, particularly in obese patients, when an alternative non-invasive investigation (ultrasonography) was inconclusive. In seven patients a positive diagnosis of renal pseudotumour was made possible by tomography; definite identification of ectopic functioning cortical tissue at the location of a mass suspected after urography was considered to be a distinct diagnostic advantage gained from emission tomography of the kidney.

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.

Lymphangioma of kidney

Lymphangioma of kidney is a rare, symptomatic but benign tumour. A case is reported and the literature reviewed. Aetiology and its effect on the incidence, non-invasive investigation, treatment and pathology are discussed.