Sonography and Contrast Enhancement MDCT in the Evaluation of Complicated Autosomal Dominant Polycystic Kidney Disease
Journal Title: Archives of Renal Diseases and Management - Year 2015, Vol 1, Issue 1
Abstract
Objectives: Our study is finalized to assess the role of Sonography and MDCT in the diagnostic work-up of patients with complicated Autosomal Dominant Polycystic Kidney Disease (ADPKD). Methods: Thirty-five patients with ADPKD underwent Sonography, un-enhanced and contrast-enhancement MDCT for flank pain, haematuria and fever. Sonographic evaluation was made with patients in the supine position, full bladder, by making the patient with deep inalations, and other bedsores were used (side, prone) using other types of acoustic windows. MDCT studies were performed with volumetric acquisition technique (un-enhanced and contrast enhancement), and the relative images were evaluated at the appropriate work-station using MPR, cMIP, MIP thin and thick, and Volume Rendering (VRT) reconstructions. Two different Radiologists, with experience in genitourinary imaging, analysed image quality. Results: All patients of our study had complicated cystic formations. The diameter of all cysts was valuated by Sonography and MDCT. Correlation between cystic diameters and Sonography/MDCT measurements was assessed using Pearson correlation test: tests were considered significant at P < 0.05. Cyst haemorrhage was present in all thirty-five patients, seen as high-density cysts, which were mostly bilateral. Sonography showed that these cysts had: sharply outlined contours (n = 7), sharp interfaces with adjacent renal parenchyma (n = 13), imperceptible walls (n = 9), and homogeneous density (n = 6), and all them did not enhance following e.v. contrast administration. The MDCT study also revealed, in addition to Sonographic results, the presence of: cyst infection (n = 13) cases, air within the infected cyst (n = 4), thickening and enhancement of peri- and paranephric fasciae (n = 5), abscesses in the posterior paranephric space and adjoining psoas muscle (n = 3), and cyst wall calcifications (n = 9). In 1 case MDCT revealed a soft tissue density enhancing mass in one of the cysts; this proved to be a renal cell carcinoma by the biopsy. We also identified renal calculi in 5 patients. Conclusions: Although Sonography provides valuable, preliminary diagnostic information, suggesting the initial diagnosis, the most complete characterization of complicated ADPKD is provided by MDCT. MDCT can produce high quality images of the kidneys and the cysts; it can visualize the entire abdomen cavity, and an accurate assessment of the number, size and extent of renal cysts, and also in other organs, is usually well demonstrated.
Authors and Affiliations
Messina Francesco, Loria Francesco, Frosina Luciano, Morano Enrico
Keywords
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- EP ID EP343338
- DOI 10.17352/2455-5495.000002
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