Patterns of recurrence in renal cell carcinoma: manifestations on helical CT

Local recurrence of renal cell carcinoma after partial nephrectomy: applicability of the apparent diffusion coefficient of MRI as an imaging marker - a multicentre study

Purpose

The goal of the study was an assessment of the diagnostic performance of diffusion-weighted images (DWI) and apparent diffusion coefficient (ADC) of magnetic resonance imaging (MRI) in distinguishing local recurrence (LR) of renal cell carcinoma (RCC) from benign conditions after partial nephrectomy.

Material and methods

Thirty-nine patients after partial nephrectomy for solid RCC were enrolled in the study. Patients were followed up using MRI, which included DWI sequence (b = 800 s/mm²). All patients with MRI features of LR were included in the main group (n = 14) and patients without such features – into the group of comparison (n = 25). Apparent diffusion coefficient (ADC) values of suspicious lesions were recorded. In all patients with signs of locally recurrent RCC, surgical treatment was performed followed by pathologic analysis.

Results

The mean ADC values of recurrent RCC demonstrated significantly higher numbers compared to benign fibrous tissues and were 1.64 ± 0.15 × 10^-3 mm²/s vs. 1.02 ± 0.26 × 10^-3 mm²/s (p < 0.001). The mean ADC values of RCCs’ LR and benign post-op changes in renal scar substantially differed from mean ADC values of healthy kidneys’ parenchyma; the latter was 2.58 ± 0.05 × 10^-3 mm²/s (p < 0.001). In ROC analysis, the use of ADC with a threshold value of 1.28 × 10^-3 mm²/s allowed us to differentiate local recurrence of RCC from benign postoperative changes with 100% sensitivity, 80% specificity, and accuracy: AUC = 0.980 (p < 0.001).

Conclusions

The apparent diffusion coefficient of DWI of MRI can be used as a potential imaging marker for the diagnosis of local recurrence of RCC.

Recurrent renal cell carcinoma following nephrectomy and ablation therapy: Radiology perspective

Renal cell carcinoma (RCC) is the most common renal malignancy, accounting for approximately 2% of adult malignancies and 4% of new cancer cases in the United States every year. Imaging guided ablative therapy, including radiofrequency (RF) ablation, cryotherapy and microwave has gained popularity over the last decade in treatment of small tumors. Antiangiogenic therapy has set itself to be the standard of care for many patients with metastasis these days. With hope for more research, survival rates of metastatic RCC may increase from a current 2-year survival rate of approximately 20%. Variation in imaging surveillance protocol in terms of frequency, modality, and duration is noted among guidelines developed by several organizations. In this review article, we will discuss follow-up imaging protocols, patterns of RCC recurrence following different modalities of treatment, imaging appearance, as well as usual and unusual sites of metastatic disease.

[MDCT patterns of presentation of pancreatic metastases from renal cell carcinoma]

OBJECTIVE

To determine the frequency of pancreatic metastasis from renal cell carcinoma in patients studied with MDCT during 2007 and to describe the patterns of presentation on MDCT.

MATERIAL AND METHODS

We retrospectively studied 133 patients with renal cell carcinoma who underwent MDCT between January and December 2007. Forty-nine patients presented disseminated disease. We analyzed the frequency, location, and patterns of presentation of pancreatic metastases.

RESULTS

Pancreatic involvement was identified in six patients. Four patients had isolated pancreatic nodules and two presented multiple nodules. A total of nine pancreatic lesions ranging between 8mm and 40 mm were detected. All nodules had increased uptake of contrast material in the arterial phase except for one in a patient with multiple nodules, due to necrosis. Two cases were associated with pancreatic duct dilation. Histology was obtained in only one patient.

CONCLUSION

Pancreatic involvement of renal cell carcinoma was detected in 4.5% of patients, ranking fifth in frequency in patients with disseminated disease. The arterial phase is necessary to detect pancreatic involvement of renal cell carcinoma. The pattern of presentation is nearly constant, helping differentiate pancreatic metastasis from primary pancreatic adenocarcinoma.

Multidetector computed tomography in the study of pancreatic metastases

PURPOSE

The aim of this study was to explore the diagnostic performance of multidetector computed tomography (MDCT) in characterising pancreatic metastases.

MATERIALS AND METHODS

CT examinations of 17 patients affected by pancreatic metastases were retrospectively reviewed. The primary malignancy was renal cell carcinoma (RCC) in eight cases, uterine leiomyosarcoma in two, lung carcinoma in four and breast carcinoma in three. CT images were assessed for lesion number, size and morphology.

RESULTS

Pancreatic lesions were solitary in seven cases and multiple in ten. Lesion size ranged between 8 and 40 mm. Metastases from RCC were hyperattenuating in the arterial phase, metastases from breast cancer and lung cancer were hypoattenuating and metastases from uterine leiomyosarcoma were inhomogeneous. Precise lesion characterisation was obtained by using CT examination in 12 cases. In the remaining five patients, all with solitary metastases from RCC, a precise diagnosis was not possible because the lesions could not be differentiated from a neuroendocrine tumour.

CONCLUSIONS

MDCT allowed pancreatic metastases characterisation in 70.5% of cases. The lesions were the manifestation of widely disseminated neoplastic disease, with the exception of metastases from RCC, which were exclusively located in the pancreas.

Adrenal mass imaging with multidetector CT: pathologic conditions, pearls, and pitfalls

The adrenal gland is involved by a range of neoplasms, including primary and metastatic malignant tumors; however, the most common tumor detected is the incidental benign adenoma. Although computed tomographic (CT) findings will not always yield a definitive diagnosis, attention to these findings provides a road map to guide image interpretation. Adenomas typically demonstrate rapid washout, which is defined as an absolute percentage washout (APW) of more than 60% and a relative percentage washout (RPW) of more than 40% on delayed images. Adrenocortical carcinoma typically has an RPW of less than 40%; however, large size and heterogeneity are more reliable indicators of the diagnosis than are washout values. Washout characteristics of pheochromocytoma are variable; in conjunction with high levels of dynamic enhancement, pheochromocytomas may mimic adenoma (ie, APW > 60%, RPW > 40%). Myelolipomas appear as well-defined masses with variable quantities of fat and soft tissue. After contrast material administration, metastases usually demonstrate slower washout on delayed images (APW < 60%, RPW < 40%) than do adenomas, although hypervascular metastases may enhance similarly to pheochromocytoma. Finally, a number of nonadrenal pathologic conditions have been reported to mimic adrenal masses at CT.

Sternal metastasis as an initial presentation of renal cell carcinoma: a case report

Renal cell carcinoma accounts for 85% of all solid renal tumors in adults. Nearly one quarter of patients has distant metastasis at presentation while another 50% develop metastasis during follow-up. A small percentage of these are solitary metastasis. We report here a case of solitary bone sternal metastasis as an initial presentation of clear-cell renal cell carcinoma in a 56-year-old woman. The prognosis for patients with metastasized renal cell carcinoma is poor; treatment of metastasis is usually palliative and designed to provide comfort and pain relief. Palliative nephrectomy may be considered for control of symptoms. Radical nephrectomy associated with metastatic bone tumor resection is being tested to improve functional status and survival, especially when metastasis involves supporting bones.

Radiologic evaluation of small renal masses (II): posttreatment management

The increase in the detection of small renal masses (SRMs) and their best knowledge leads to a change in the therapeutic management of these lesions. The use of a less aggressive surgical technique or even an expectant attitude is the current tendency, in order to preserve as much renal function as possible. Imaging techniques are essential in the followup of these lesions. It allows us to know the postsurgical changes and possible complications due to treatment and the presence of local recurrence and metastases. Furthermore, a close radiological followup of SRM related to ablative treatments is mandatory. The purpose of this article is to reveal the imaging features of complications due to surgical or ablative treatments, local recurrence and metastasis, as well as their followup.

Detection, staging and surveillance in renal cell carcinoma

This article discusses the computed tomography (CT) and magnetic resonance (MR) scanning techniques used for the detection and staging of renal cell carcinoma and their pitfalls. Comparison between the Robson and recent modifications to the TNM classifications is also addressed. The accuracy of CT and MR in the staging of renal cell carcinoma and the role of positron emission tomography (PET) scanning is outlined and finally the surveillance of patients who have had curative treatment of renal cell carcinoma is briefly addressed.

An Unusual Case of Thymic Carcinoma With Endobronchial Metastases Manifesting as Centrilobular Opacities

We report a case of a 75-year-old man having unusual manifestation of thymic carcinoma associated with endobronchial metastases. To our knowledge, endobronchial metastases secondary to thymic carcinoma has not been reported in the literature. On high-resolution computed tomograms, the tree-in-bud centrilobular opacities caused by metastatic cells accumulating within the small bronchioles is indistinguishable from that caused by inflammatory process. Thus, in patients with thymic carcinoma and persistent tree-in-bud centrilobular opacities, endobronchial metastatic disease should be considered.

CT/MRI in staging renal cell carcinoma

Renal cell carcinoma (RCC) is the eighth most common malignancy. It accounts for approximately 3% of newly diagnosed cancers and has been reported to occur in 11 out of 100000 individuals. The incidence of RCC has increased by 40% in the USA from 1974 to 1990. There appears to be a true increase in the incidence of RCC over and above that attributable to the increased number detected by abdominal cross-sectional imaging. This increase has been accompanied by improved 5-year survival as the tumors detected by imaging are diagnosed at an earlier stage when they are still resectable. The male to female ratio is approximately 2:1; the majority present in the fifth to seventh decade of life and the racial distribution is equal. The majority of cases occur sporadically, but predisposing factors can sometimes be identified. RCC occurs in about 36% of patients with von Hippel–Lindau disease and invasive RCC is three to six times more common among long-term dialysis patients than in the general population.

Staging Renal Cell Carcinoma With Helical CT: The Revised 1997 AJCC and UICC TNM Criteria

The TNM staging system for renal cell carcinoma, revised in 1997 by the UICC and AJCC, has important implications for tumor prognosis and surgical planning. Multislice helical CT of the kidneys plays a vital role in the detection, characterization, and staging of renal cell carcinoma, and for surgical planning. Radiologists should be familiar with state-of-the-art helical CT techniques, the revised TNM staging criteria, and the varied appearances of renal tumors, tumor cell types, and the wide variety of metastatic disease that occurs in advanced cases.