Imaging Pearls ❯ Kidney ❯ CIN
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- “ The historically inflated risk of CIN reflects logistic and intellectual pitfalls that continue to confound the study of this disease. Recent advances have clarified that the incidence of CIN is much lower than previously thought, but there are lingering questions. We suggest that CIN is likely real but is rare and offer directions for future study.”
The Challenges in Assessing Contrast-Induced Nephropathy: Where Are We Now-
Davenport MS et al.
AJR 2014;202:784-789 - “ In conclusion it is an exciting time for the study of CIN. Although most recent investigations agree that CIN is an overdiagnosed illness confounded by countless alternative nephrotoxic events and physiologic variation, there are data indicating that for at least patients with severe renal insufficiency, IV LOCM and IOCM are potential nephrotoxins that merit continued scrutiny.”
The Challenges in Assessing Contrast-Induced Nephropathy: Where Are We Now-
Davenport MS et al.
AJR 2014;202:784-789
- Risk Factors for Contrast Induced Nephrotoxicity
- Diabetes
- Preexisting renal insufficiency
- Dehydration
- Cardiovascular disease
- Advanced age
- Hypertension
- Hyperuricemia
- Risk Factors for Contrast Induced Nephrotoxicity
- Multiple myeloma
- Certain drug therapies especially chemotherapeutic drugs and long term use of nonsteroidal anti-inflammatory drugs
- "High risk patients may have less likelihood of developing contrast induced nephrotoxicity when iodixanol (Visipaque) is used rather than the low osmolar, nonionic contrast medium iohexol."
Nephrotoxic Effects in High Risk Patients Undergoing Angiography
Aspelin R et al.
N Engl J Med 2003;348:491-499
- "When protocols involving multiple scans are designed, an effort should be made to obtain as much diagnostic information as necessary with a sufficient but not unnecessary amount of radiation whenever possible."
Patient Radiation Dose at CT Urography and Conventional Urography
Nawfel RD et al.
Radiology 2004; 232:126-132
- "Measurements made from curved planar images are typically inaccurate because of the geometric distortion that occurs at increasing distances from the centerline."
Value of Curved Planar Reformations in MDCT of Abdominal Pathology
Desser TS et al.
AJR 2004;182:1477-1484
- "Bladder cancer tends to show peak enhancement with the 60-second scanning delay. Multidetector row helical CT is useful in the detection and staging of bladder cancer."
Bladder Cancer: Analysis of Multidetector Row Helical CT Enhancement Pattern and Accuracy in Tumor Detection and Perivesical Staging
Kim et al.
Radiology 2004; 231:725-731
- "Sensitivity and specificity in the diagnosis of perivesical invasion were 89% and 95% respectively, in 67 patients and increased to 92% and 98% respectively, in 44 patients with a time interval of 7 or more days between TURP and CT."
Bladder Cancer: Analysis of Multidetector Row Helical CT Enhancement Pattern and Accuracy in Tumor Detection and Perivesical Staging
Kim et al.
Radiology 2004; 231:725-731
- "The cancer detection rate and positive predictive value for cancer detection was 97% and 95% respectively, in 67 patients and increased to 100% and 100% in 44 patients with a time interval of 7 or more days between TURP and CT."
Bladder Cancer: Analysis of Multidetector Row Helical CT Enhancement Pattern and Accuracy in Tumor Detection and Perivesical Staging
Kim et al.
Radiology 2004; 231:725-731
- Bladder Cancer Enhancement
Attenuation Value 40 second scanning delay 60 second scanning delay 100 second scanning delay Mean plus standard deviation 75 ± 14 106 ± 14 84 ± 14 range 55-107 78-129 55-119
Radiology 2004; 231:725-731
- "Multidetector row CT can help assess well the renal vasculature and the urinary tract of living renal donors."
Living Donor Kidneys: Usefulness of Multi-Detector Row CT for Comprehensive Evaluation
Kim JK et al.
Radiology 2003; 229:869-876
- "Detection rate of CT angiography was 98% for arteries and 98% for veins."
Living Donor Kidneys: Usefulness of Multi-Detector Row CT (4 row) for Comprehensive Evaluation
Kim JK et al.
Radiology 2003; 229:869-876
- "MDCT angiography is highly accurate for detecting vascular anomalies and providing anatomic information for laparoscopic living donor nephrectomy."
Multidetector CT angiography for preoperative evaluation of living laparoscopic kidney donors.
Kawamoto S, Montgomery RA, Lawler LP, Horton KM, Fishman EK AJR 2003 Jun;180(6):1633-8.
- "Our study found a 9.9% prevalence of ovarian varices in the general population. Our findings suggest that half (57%)the patients with ovarian varices have pelvic congestion syndrome and that most (77%) of them benefit from ovarian vein embolization or ligation."
Ovarian Varices in Healthy Female Kidney Donors: Incidence , Morbidity and Clinical Outcome
Belenky A et al.
AJR 2002; 179:625-627
- Renal Cell Carcinoma: Facts
- 85% of all renal cancers in adults
- 30,000 new cases diagnosed in the US each year
- M>F by 2-1
- Peak incidence is age 50-70
- Tumors are adenocarcinomas
- Renal Cell Carcinoma: Risk Factors
- Acquired cystic renal disease
- Chronic renal failure
- Von Hippel Lindau disease
- Smoking
- Hereditary renal cell carcinoma
- "The prevalence of a hemodynamically significant stenosis isolated to an accessory renal artery was 1.5% in our study. Thus, failure to detect accessory renal arteries should not unduly affect the utility of a non-invasive test for detecting renovascular hypertension."
Is It Necessary to Study Accessory Arteries When Screening the Renal Arteries for Renovascular Hypertension
Bude RO et al.
Radiology 2003;226:411-416
- "There is no statistically significant difference between 3D MR angiography and multidetector row CT angiography in the detection of hemodynamically significant arerial stenosis of the aortoiliac and renal arteries."
Aortoiliac and Renal Arteries: Prospective
Intraindividual Comparison of Contrast Enhanced three Dimensional MR Angiography and Multidetector Row CT Angiography
Willmann JK et al.
Radiology 2003;226:798-811
- "Patient acceptance was best for CT angiography."
Aortoiliac and Renal Arteries: Prospective
Intraindividual Comparison of Contrast Enhanced three Dimensional MR Angiography and Multidetector Row CT Angiography
Willmann JK et al.
Radiology 2003;226:798-811
- CT Urography: Protocol
- Unenhanced CT from kidneys to bladder
- Nephrographic phase from diaphragm to iliac crests with 110 sec delay
- Excretory phase at 8 minutes from kidneys thru bladder
- Multidetector Row CT Urography in the Evaluation of Hematuria
Joffe SA et al
RadioGraphics 2003;23:1441-1456
- Papillary Necrosis: Etiologies
- Diabetes
- Analgesic abuse
- Sickle cell disease
- Renal vein thrombosis
- Obstructive uropathy
- "Multidetector row CT can help assess well the renal vasculature and the urinary tract of living renal donors."
Living Donor Kidneys: Usefulness of Multi-Detector Row CT for Comprehensive Evaluation
Kim JK et al.
Radiology 2003; 229:869-876
- "Detection rate of CT angiography was 98% for arteries and 98% for veins."
Living Donor Kidneys: Usefulness of Multi-Detector Row CT (4 row) for Comprehensive Evaluation
Kim JK et al.
Radiology 2003; 229:869-876
- "At our institution, CT urography virtually replaced conventional urography in the evaluation of patients with hematuria and has proven successful in depicting a wide range of diseases affecting the urinary tract."
Multidetector CT Urography with Abdominal Compression and Three Dimensional Reconstruction
Chow LC et al.
AJR 2001;177:849-855
- "CT Angiography produced interpretable multiplanar images of the renal artery, even with a a metallic stent in place, and was adequate for determining stent patency. Compared with catheter angiography, the intrastent luminal diameter was underestimated in most patients who underwent CT Angiography."
Thin-Section Multidetector CT Angiography of Renal Artery Stents
Behar JV et al.
AJR 2002;178:1155-1159
- "The diameter of the renal artery stent lumen measured on catheter angiography (mean, 5.9 +/- 1.3 mm) was greater than that on CT angiography (mean stent lumen diameter for direct axial plane was 4.6 +/- 1.0 mm)."
Thin-Section Multidetector CT Angiography of Renal Artery Stents
Behar JV et al.
AJR 2002;178:1155-1159
- von Hippel-Lindau Disease: Facts
- Autosomal dominant familial tumor syndrome
- High penetrance with variable expression
- Prevalence of one in 50,000
- Defect in short arm of chromosome 3
- von Hippel-Lindau Disease: organ involvement
- Kidney
- Adrenal
- Pancreas
- Brain
- Spinal cord
- Retina
- von Hippel-Lindau Disease: Renal Pathology
- Renal cysts- occur in 50-75% of patients and are usually multiple and bilateral
- Renal cell carcinoma-occur in 28-45% of patients and occur at a younger age (30-36 yrs). The lesions are often multiple and bilateral and may be hypovascular or cystic lesions with mural nodules
- von Hippel-Lindau Disease: Adrenal Pathology
- Pheochromocytoma
- Occur in up to 30% of families with VHL
- They are bilateral in up to 50% of patients with a malignancy rate of around 10%
- Up to 18% are extraadrenal in location
- von Hippel-Lindau Disease: Pancreatic Pathology
- Occur in up to 77% of patients
- Lesions include
- Simple pancreatic cysts
- Serous cystadenomas
- Neuroendocrine tumors
- Pancreatic carcinoma
- von Hippel-Lindau Disease: Uncommon Pathology
- Liver cysts
- Cystadenomas of the epididymis and broad ligament
- "In evaluating Robson stage I of renal cell carcinoma, we were able to diagnose fat infiltration on 1-mm scans with 96% sensitivity, 93% specificity, and 95% accuracy; the positive and negative predictive values were, respectively, 100% and 93%."
High-Resolution Multidetector CT in the Preoperative Evaluation of Patients with Renal Cell Carcinoma
Catalano C et al.
AJR 2003; 180:1271-1277
- "On portal venous phase contrast enhanced CT scans, attenuation greater than 70HU or moderate or marked internal heterogeneity favor a diagnosis of renal cell carcinoma oer a diagnosis of high attenuation renal cyst."
Distinction of Renal Cell carcinomas from High Attenuation Renal Cysts at Portal Venous Phase Contrast Enhanced CT
Suh M et al
Radiology 2003; 228:330-334
- Sickle Cell Disease:Organ Involement
- Bone
- Brain
- Lungs
- Liver
- Spleen
- Kidney
- Sickle Cell Disease: Subgroups
- SS disease (homozygous Hb SS)
- SC disease
- S-thal
- Sickle Cell trait is associated with a rare renal tumor- medullary carcinoma.
- Sickle Cell Disease: Renal Involvement
- Glomerulosclerosis leading to
- Proteinuria
- Nephrotic syndrome
- Renal failure
- "The attenuation coefficient of a cystic renal lesion increased by no more than 10H among the unenhanced, corticomedullary, and parenchymal phase scans."
Analysis of Changes in Attenuation of Proven Renal Cysts on Different Scanning Phases of Triphasic MDCT
Chung EP et al.
AJR 2004; 182:405-410
- "This study shows that cystic lesions typically reveal a change in attenuation of less than 10HU between the scanning phases of a triphasic MDCT, affirming Bosniaks initial assertion that 10HU is a reasonable cutoff for determining enhancement in renal lesions."
- "This study shows that cystic lesions typically reveal a change in attenuation of less than 10HU between the scanning phases of a triphasic MDCT, affirming Bosniaks initial assertion that 10HU is a reasonable cutoff for determining enhancement in renal lesions."
Analysis of Changes in Attenuation of Proven Renal Cysts on Different Scanning Phases of Triphasic MDCT
Chung EP et al.
AJR 2004; 182:405-410