Solid renal masses: use of spiral Computed tomography for Differentiation between benign and malignant lesions

Abstract

objective: To determine whether CT images on the basis of their morphologic features and enhancement patterns. could help accurately distinguish benign renal masses from malignant .
patients and Methods : Between April 2006 and February 2009, 80 consecutive patients (age range, 1–65 years; 50 male, 30 female) suspected to have renal mass by physical examination ,underwent ultrasound examination to evaluate the mass ,whether cystic or solid. Only patients with solid renal mass documented with US were included in the study then preoperative renal CT. All CT studies evaluated the mass about the pattern and degree of enhancement, lesion contour, presence of neovascularity, and calcifications .
Results: Of the 80 renal masses (median size, 3.4 cm; range, 1.1–20.0 cm) included in this study, 30 (37 %) were benign and 50 (63 %) were malignant. of benign 14 (47%)patients have abscess and 16(54 %) have angiomyolipoma , while malignant tumor classified as clear cell renal cell carcinomas (RCCs) 28 (56 %) , papillary lesions 16 (32 %) and 6 (12 %) Wilm's tumors. abscess most commonly classified as hypodense with peripheral enhancement while Clear cell RCC most commonly manifested with a mixed enhancement pattern of both hypervascular soft-tissue components and low-attenuation areas that corresponded to necrotic or cystic changes ,whereas the homogeneous and peripheral enhancing patterns were more predictive of less aggressive papillary . Clear cell RCCs tended to be hypervascular and angiomyolipomas tended to enhance moderately, and papillary lesions were mostly hypovascular. Conclusion: Certain imaging features and the degree of enhancement may be helpful in differentiation of renal masses .