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Nguyen T, Gupta A, Bhatt S. Multimodality imaging of renal lymphoma and its mimics. Insights Imaging 2022; 13:131. [PMID: 35962930 PMCID: PMC9375790 DOI: 10.1186/s13244-022-01260-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 06/26/2022] [Indexed: 11/10/2022] Open
Abstract
Lymphomatous involvement of the genitourinary system, particularly the kidneys, is commonly detected on autopsies; yet on conventional diagnostic imaging renal lymphoma is significantly underestimated and underreported, in part due to its variable imaging appearance and overlapping features with other conditions. We present a spectrum of typical and atypical appearances of renal lymphoma using multimodality imaging, while reviewing the roles of imaging in the detection, diagnosis, staging, and surveillance of patients with lymphoma. We also illustrate a breadth of benign and malignant entities with similar imaging features confounding the diagnosis of renal lymphoma, emphasizing the role of percutaneous image-guided biopsy. Understanding the spectrum of appearances of renal lymphoma and recognizing the overlapping entities will help radiologists improve diagnostic confidence and accuracy.
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Affiliation(s)
- Trinh Nguyen
- MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, 77030, USA.
| | - Akshya Gupta
- University of Rochester Medical Center, Rochester, NY, USA
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2
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Abstract
With the ever increasing trend of using cross-section imaging in today's era, incidental detection of small solid renal masses has dramatically multiplied. Coincidentally, the number of asymptomatic benign lesions being detected has also increased. The role of radiologists is not only to identify these lesions, but also go a one step further and accurately characterize various renal masses. Earlier detection of small renal cell carcinomas means identifying at the initial stage which has an impact on prognosis, patient management and healthcare costs. In this review article we share our experience with the typical and atypical solid renal masses encountered in adults in routine daily practice.
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Affiliation(s)
- Mahesh Kumar Mittal
- Department of Radiodiagnosis, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Binit Sureka
- Department of Radiology, Institute of Liver and Biliary Sciences, New Delhi, India
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3
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Sweet DE, Ward RD, Wang Y, Tanaka H, Campbell SC, Remer EM. Infiltrative Renal Malignancies: Imaging Features, Prognostic Implications, and Mimics. Radiographics 2021; 41:487-508. [PMID: 33449838 DOI: 10.1148/rg.2021200123] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Infiltrative renal malignancies are a subset of renal masses that are morphologically characterized by a poorly defined interface with the renal parenchyma. Infiltrative renal malignancies are less common but more aggressive than more typical renal malignancies and carry an overall worse prognosis. Although an infiltrative renal process often represents a malignant neoplasm, infiltrative masses include a wide spectrum of diseases including primary renal cortical, medullary, and pelvic tumors; lymphoproliferative processes; metastases; and various infectious, inflammatory, immune-mediated, and vascular mimics. The imaging features of these masses are often nonspecific, but with the appropriate history, laboratory results, and clinical context, the radiologist can help narrow the diagnosis and guide further treatment. An invited commentary by Lee is available online.Online supplemental material is available for this article. ©RSNA, 2021.
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Affiliation(s)
- David E Sweet
- From the Imaging Institute (D.E.S., R.D.W., E.M.R.) and Glickman Urological and Kidney Institute (Y.W., H.T., S.C.C., E.M.R.), Cleveland Clinic, 9500 Euclid Ave, L10, Cleveland, OH 44195; Department of Urology, First Hospital of Jilin University, Changchun, China (Y.W.); and Department of Urology, Tokyo Medical and Dental University, Tokyo, Japan (H.T.)
| | - Ryan D Ward
- From the Imaging Institute (D.E.S., R.D.W., E.M.R.) and Glickman Urological and Kidney Institute (Y.W., H.T., S.C.C., E.M.R.), Cleveland Clinic, 9500 Euclid Ave, L10, Cleveland, OH 44195; Department of Urology, First Hospital of Jilin University, Changchun, China (Y.W.); and Department of Urology, Tokyo Medical and Dental University, Tokyo, Japan (H.T.)
| | - Yanbo Wang
- From the Imaging Institute (D.E.S., R.D.W., E.M.R.) and Glickman Urological and Kidney Institute (Y.W., H.T., S.C.C., E.M.R.), Cleveland Clinic, 9500 Euclid Ave, L10, Cleveland, OH 44195; Department of Urology, First Hospital of Jilin University, Changchun, China (Y.W.); and Department of Urology, Tokyo Medical and Dental University, Tokyo, Japan (H.T.)
| | - Hajime Tanaka
- From the Imaging Institute (D.E.S., R.D.W., E.M.R.) and Glickman Urological and Kidney Institute (Y.W., H.T., S.C.C., E.M.R.), Cleveland Clinic, 9500 Euclid Ave, L10, Cleveland, OH 44195; Department of Urology, First Hospital of Jilin University, Changchun, China (Y.W.); and Department of Urology, Tokyo Medical and Dental University, Tokyo, Japan (H.T.)
| | - Steven C Campbell
- From the Imaging Institute (D.E.S., R.D.W., E.M.R.) and Glickman Urological and Kidney Institute (Y.W., H.T., S.C.C., E.M.R.), Cleveland Clinic, 9500 Euclid Ave, L10, Cleveland, OH 44195; Department of Urology, First Hospital of Jilin University, Changchun, China (Y.W.); and Department of Urology, Tokyo Medical and Dental University, Tokyo, Japan (H.T.)
| | - Erick M Remer
- From the Imaging Institute (D.E.S., R.D.W., E.M.R.) and Glickman Urological and Kidney Institute (Y.W., H.T., S.C.C., E.M.R.), Cleveland Clinic, 9500 Euclid Ave, L10, Cleveland, OH 44195; Department of Urology, First Hospital of Jilin University, Changchun, China (Y.W.); and Department of Urology, Tokyo Medical and Dental University, Tokyo, Japan (H.T.)
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Obayemi JE, Zhao K, Guzzo TJ, Abt PL. Management of Large Allograft Mass Following Living Donor Kidney Transplantation. Am J Kidney Dis 2020; 76:A16-A17. [PMID: 32829779 DOI: 10.1053/j.ajkd.2020.05.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Accepted: 05/08/2020] [Indexed: 11/11/2022]
Affiliation(s)
- Joy E Obayemi
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA.
| | - Kai Zhao
- Division of Transplant Surgery, Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Thomas J Guzzo
- Division of Urology, Department of Surgery (TJG), Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Peter L Abt
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
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Bokhari SRA, Inayat F, Bokhari MR, Mansoor A. Primary renal lymphoma: a comprehensive review of the pathophysiology, clinical presentation, imaging features, management and prognosis. BMJ Case Rep 2020; 13:13/6/e235076. [PMID: 32554453 DOI: 10.1136/bcr-2020-235076] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Primary renal lymphoma (PRL) is defined as a non-Hodgkin's lymphoma restricted to kidneys with the absence of extensive nodal disease. It is an exceedingly rare clinicopathological entity, accounting for 0.7% of extranodal lymphomas. Published medical literature regarding the natural history and clinical outcomes of PRL remains limited. We describe a case of a young patient who presented with left shoulder pain, continuous fever, and unexplained weight loss as atypical initial manifestations of bilateral PRL, confirmed with the standard set of investigations. Furthermore, this article reviews the literature and discusses various aspects of PRL, including pathophysiology, presentation patterns, imaging and pathological characteristics, management, and prognosis. This paper serves to provide an update and aims to enhance the understanding of PRL. Timely diagnosis and treatment are imperative to achieve improved outcomes. Clinicians should maintain a high index of suspicion in order to prevent morbidity and mortality associated with this serious disease.
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Upper urinary tract urothelial carcinoma on multidetector CT: spectrum of disease. Abdom Radiol (NY) 2019; 44:3874-3885. [PMID: 31440804 DOI: 10.1007/s00261-019-02173-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Urothelial carcinoma of the upper urinary tract (UUT) is a relatively uncommon genitourinary malignancy, accounting for about 5-7% of urothelial tumors. The significant features of this tumor are multifocality and high rate of recurrence. Computed tomography urography (CTU) has replaced excretory urography (EU) and retrograde pyelography (RP) for imaging of upper tract urothelial carcinoma. While many studies have confirmed high sensitivity (88-100%) and specificity (93-100%) of CTU, an optimized CT protocol is of critical importance in screening, staging, and post-operative follow-up of patients (Chlapoutakis, Eur J Radiol 73(2):334-338, 2010; Caoli and Cohan, Abdom Radiol (NY) 41(6):1100-1107, 2016). The key element of the CT protocol is to have adequate distension of the collecting system with excreted contrast, to detect subtle lesions at an early stage. In this article, we discuss the background of upper urinary tract TTC, pathogenesis, CT protocol and the role of imaging in evaluation of this malignancy, staging, as well as different imaging appearances.
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Tanaka T, Akiyoshi H, Nishida H, Mie K, Lin LS, Iimori Y, Okamoto M. Contrast-enhanced computed tomography findings of canine primary renal tumors including renal cell carcinoma, lymphoma, and hemangiosarcoma. PLoS One 2019; 14:e0225211. [PMID: 31756212 PMCID: PMC6874336 DOI: 10.1371/journal.pone.0225211] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Accepted: 10/30/2019] [Indexed: 12/02/2022] Open
Abstract
In veterinary medicine, abdominal ultrasonography is used to rank the differential diagnosis of renal lesions. However, a conventional sonographic examination may show nonspecific findings. The purpose of this study was to assess the computed tomography (CT) findings of canine renal tumors, including renal cell carcinoma (RCC), lymphoma, and hemangiosarcoma (HSA). In this retrospective study, the following CT parameters were recorded for each dog: 1) extent of renal involvement of tumors, 2) enhancement pattern, 3) number of renal tumors, 4) renal tumor vessel enhancement in the corticomedullary phase, 5) presence of lymphadenopathy and lung metastasis, and 6) attenuation values of the renal tumors on the pre- and post-contrast corticomedullary, nephrographic, and excretory phase images. Fifteen dogs met the inclusion criteria, of which nine had RCCs, four had lymphomas, and two had HSAs. RCCs tended to show heterogeneous enhancement and unilateral renal involvement, and vessel enhancement was detected in the corticomedullary phase in dogs with RCC. Conversely, renal lymphomas showed homogeneous enhancement, bilateral renal involvement, and multiple masses; in these dogs, no vessel enhancement was detected in the corticomedullary phase, and the incidence of lymphadenopathy was low. However, in dogs with lymphadenopathy, the renal lymphoma was associated with regionally severe lymphadenopathy. Finally, renal HSAs tended to show heterogeneous enhancement with a non-enhanced area and unilateral renal involvement; in these dogs, vessel enhancement was detected in the nephrographic phase, with the enhancement expanding around the vessel. These findings had no significant differences. Further studies with a larger sample size are required to examine the association between CT and histopathological findings.
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Affiliation(s)
- Toshiyuki Tanaka
- Laboratory of Veterinary Surgery, Osaka Prefecture University, Department of Graduate School of Life and Environmental Sciences, Osaka, Japan
- Kinki Animal Medical Training Institute and Veterinary Clinic, Osaka, Japan
| | - Hideo Akiyoshi
- Laboratory of Veterinary Surgery, Osaka Prefecture University, Department of Graduate School of Life and Environmental Sciences, Osaka, Japan
- * E-mail:
| | - Hidetaka Nishida
- Laboratory of Veterinary Surgery, Osaka Prefecture University, Department of Graduate School of Life and Environmental Sciences, Osaka, Japan
| | - Keiichiro Mie
- Laboratory of Veterinary Surgery, Osaka Prefecture University, Department of Graduate School of Life and Environmental Sciences, Osaka, Japan
| | - Lee-Shuan Lin
- Laboratory of Veterinary Diagnostic Imaging, College of Veterinary Medicine, Department of Veterinary Medicine, National Pingtung University of Science and Technology, Neipu, Taiwan
| | - Yasumasa Iimori
- Laboratory of Veterinary Surgery, Osaka Prefecture University, Department of Graduate School of Life and Environmental Sciences, Osaka, Japan
| | - Mari Okamoto
- Laboratory of Veterinary Surgery, Osaka Prefecture University, Department of Graduate School of Life and Environmental Sciences, Osaka, Japan
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Taylor A, Finotello R, Vilar-Saavedra P, Couto CG, Benigni L, Lara-Garcia A. Clinical characteristics and outcome of dogs with presumed primary renal lymphoma. J Small Anim Pract 2019; 60:663-670. [PMID: 31364180 DOI: 10.1111/jsap.13059] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Revised: 05/28/2019] [Accepted: 06/17/2019] [Indexed: 12/30/2022]
Abstract
OBJECTIVES To characterise the presentation, clinicopathologic data and outcome of 29 dogs with presumed primary renal lymphoma. MATERIALS AND METHODS Retrospective analysis of medical records of dogs with suspected primary renal lymphoma from 11 institutions. RESULTS All dogs were substage b, and lethargy and gastrointestinal signs were common presenting complaints, as were azotaemia (n=25; 86%) and erythrocytosis (n=15; 51%) on biochemical testing. Ultrasonography typically revealed bilateral renal lesions (n=23; 79%), renomegaly (n=22; 76%) and abdominal lymphadenopathy (n=14; 48%). Chemotherapy was the only treatment in 23 dogs, of which 11 responded, all considered partial responses. For all dogs the median progression-free survival and median overall survival times were 10 days (range: 1 to 126) and 12 days (range: 1 to 212), respectively, and for dogs that responded to chemotherapy 41 days (range: 10 to 126) and 47 days (range: 10 to 212), respectively. CLINICAL SIGNIFICANCE Primary renal lymphoma in dogs appears to be associated with a poor prognosis and short-lived response to chemotherapy.
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Affiliation(s)
- A Taylor
- Royal Veterinary College, University of London, Hertfordshire, AL9 7TA, UK
| | - R Finotello
- Institute of Veterinary Science, University of Liverpool, Liverpool, L69 3GH, UK
| | - P Vilar-Saavedra
- College of Veterinary Medicine, Michigan State University, East Lansing, Michigan, 48824, USA
| | - C G Couto
- Couto Veterinary Consultants, Hilliard, Ohio, 43026, USA
| | - L Benigni
- Youliv4 Veterinary Imaging, London, N11 1RH, UK
| | - A Lara-Garcia
- Royal Veterinary College, University of London, Hertfordshire, AL9 7TA, UK
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9
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Ding X, Ma X, Jia Y, Li H, Wang Y. Intrarenal urothelial cancers confused as infiltrative renal masses: Report of 22 cases and literature review. Oncol Lett 2018; 16:1912-1916. [PMID: 30008883 PMCID: PMC6036454 DOI: 10.3892/ol.2018.8867] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Accepted: 05/22/2018] [Indexed: 12/13/2022] Open
Abstract
Distinguishing infiltrative renal masses (IRMs) from intrarenal urothelial cancers (IUCs) is critically important, but may be challenging for any radiologist or urologist. The present study aimed to summarize the clinical, imaging and pathological characteristics of IRM, which were postoperatively confirmed as IUC. The analysis was performed using the records of 22 patients who were preoperatively diagnosed with IRM but the results of percutaneous biopsies or postoperative pathological analyses led to diagnoses of urothelial cancers (UCs) from January 2011 to December 2017. The demographic data, computed tomography (CT) imaging features and pathological characteristics were evaluated. The present study also reviewed the literature concerning the IRM and IUC. The mean age of patients was 62 years and 86.4% of them were >55 years. The sex and tumor side distributions were equal. Hematuria and/or flank pain were observed in 86.4% of patients. All patients exhibited endophytic solid renal masses with unclear tumor boundaries on CT images. The kidneys of 81.8% of patients maintained their normal shape while mild alternations were observed in 18.2% of cases. A total of 81.8% of patients maintained the reniform shape and 18.2% exhibited mild contour change. Of all patients, all tumors exhibited less or equal attenuation on unenhanced CT images and they were mildlyimproved on enhanced CT. A total of 6 cases were confirmed by biopsy, when patients underwent laparoscopic nephroureterectomy instead of radical nephrectomy. The remaining 16 patients underwent laparoscopic nephrectomy but the postoperative pathological diagnoses revealed the presence of UCs. All postoperatively confirmed cancers were stages T3 and T4 (62.5 and 37.5%, respectively). UCs should be suspected in middle aged or elderly middle-elderly patients presenting renal masses with endophytic solid unclear tumor boundary on unenhanced and slightly enhanced CT images, accompanied with hematuria and/or flank pain. Preoperative biopsy is preferred for complicated cases.
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Affiliation(s)
- Xiaobo Ding
- Department of Radiology, First Hospital of Jilin University, Changchun, Jilin 130021, P.R. China
| | - Xiaobo Ma
- Department of Pathology, First Hospital of Jilin University, Changchun, Jilin 130021, P.R. China
| | - Yatao Jia
- Department of Urology, First Hospital of Jilin University, Changchun, Jilin 130021, P.R. China
| | - Hongfei Li
- Department of Urology, First Hospital of Jilin University, Changchun, Jilin 130021, P.R. China
| | - Yanbo Wang
- Department of Urology, First Hospital of Jilin University, Changchun, Jilin 130021, P.R. China
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Katsinis B. A Challenging Case of Poorly Differentiated Transitional Cell Carcinoma of the Kidney. JOURNAL OF DIAGNOSTIC MEDICAL SONOGRAPHY 2018. [DOI: 10.1177/8756479318755687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
When describing carcinomas, poorly differentiated defines how little the tumor tissue resembles the normal tissue it came from. The origin of these types of tumors cannot be determined by histological findings alone. Imaging findings and patient history play a strong role in determining the source of the patient’s cancer. Imaging features of urothelial cancer of the renal pelvicaliceal system can be challenging for any sonographer or radiologist. When tumors are hyperechoic relative to nearby renal parenchyma, they may be obscured by the surrounding hyperechoic renal sinus fat, causing these carcinomas to be difficult to detect regardless of whether they are well defined or poorly differentiated. This case study delves into the difficulty in sonographically imaging a poorly differentiated transitional cell carcinoma without sonographic evidence of a primary circumscribed mass.
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11
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Ballard DH, De Alba L, Migliaro M, Previgliano CH, Sangster GP. CT imaging spectrum of infiltrative renal diseases. Abdom Radiol (NY) 2017; 42:2700-2709. [PMID: 28580537 DOI: 10.1007/s00261-017-1193-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Most renal lesions replace the renal parenchyma as a focal space-occupying mass with borders distinguishing the mass from normal parenchyma. However, some renal lesions exhibit interstitial infiltration-a process that permeates the renal parenchyma by using the normal renal architecture for growth. These infiltrative lesions frequently show nonspecific patterns that lead to little or no contour deformity and have ill-defined borders on CT, making detection and diagnosis challenging. The purpose of this pictorial essay is to describe the CT imaging findings of various conditions that may manifest as infiltrative renal lesions.
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Affiliation(s)
- David H Ballard
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S. Kingshighway Blvd, St. Louis, MO, 63110, USA
| | - Luis De Alba
- Department of Radiology, Louisiana State University Health Shreveport, 1501 Kings Hwy, Shreveport, LA, 71103, USA
| | - Matias Migliaro
- Department of Radiology, Hospital Santa Isabel de Hungria, 2854 Pedro del Castillo, Guaymallen, 5521, Mendoza, Argentina
| | - Carlos H Previgliano
- Department of Radiology, Louisiana State University Health Shreveport, 1501 Kings Hwy, Shreveport, LA, 71103, USA
| | - Guillermo P Sangster
- Department of Radiology, Louisiana State University Health Shreveport, 1501 Kings Hwy, Shreveport, LA, 71103, USA.
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Abstract
Renal medullary carcinoma (RMC) is a rare, highly aggressive tumor recognized as an independent pathological entity. African-descent adolescents and young adults with sickle cell hemoglobinopathy are the most affected groups. This rare subtype of renal cell carcinoma has its own morphogenetic and pathological characteristics. The major clinical manifestations include gross hematuria, abdominal or flank pain, and weight loss. The prognosis is very poor, with 95% of cases diagnosed at an advanced stage of the disease. In this review, we summarize the morphologic and dynamic characteristics of RMC under various imaging modalities such as ultrasound, computed tomography, and magnetic resonance. Differential diagnosis and management strategies are also discussed.
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13
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Li F, Bai M, Wu Y, He Y, Gu J, Xing J, Du L. Comparative Diagnostic Performance of Contrast-Enhanced ultrasound versus Baseline Ultrasound for Renal Pelvis Lesions. ULTRASOUND IN MEDICINE & BIOLOGY 2015; 41:3109-3119. [PMID: 26391561 DOI: 10.1016/j.ultrasmedbio.2015.07.034] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/30/2014] [Revised: 07/27/2015] [Accepted: 07/30/2015] [Indexed: 06/05/2023]
Abstract
The aim of this study was to assess the relative efficacy of contrast-enhanced ultrasound (CEUS) and baseline ultrasound (B-US) in diagnosing renal pelvic lesions. B-US findings on 58 suspected renal pelvis lesions were examined. The B-US and CEUS results were classified into five grades. Receiver operating characteristic curve analysis was used to compare the diagnostic efficacy of the two imaging modalities. CEUS characteristics of renal pelvis malignancies at different tumor stages and pathologic grades were examined. In the final diagnosis, 29 patients had malignant lesions (27 transitional cell carcinomas, 1 squamous cell carcinoma and 1 renal cell carcinoma) and 29 had benign lesions. On B-US, echogenicity and renal pelvis separation pattern in patients with malignant renal lesions overlapped those of patients with benign lesions. CEUS significantly increased the diagnostic grade of malignant lesions and decreased the grade of benign lesions (p = 0.000). The area under the receiver operating characteristic curve of CEUS was larger than that of B-US (p = 0.030). Enhancement shape and intensity in the wash-in phase markedly differed in lesions of higher tumor stage and higher pathologic grade, compared with lesions of lower stage and grade. In this study, compared with B-US, CEUS had significantly higher diagnostic efficacy in patients with renal pelvis lesions.
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Affiliation(s)
- Fan Li
- Department of Medical Ultrasound, Shanghai General Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Min Bai
- Department of Medical Ultrasound, Shanghai General Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Ying Wu
- Department of Medical Ultrasound, Shanghai General Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Yingqian He
- Department of Medical Ultrasound, Shanghai General Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Jiying Gu
- Department of Medical Ultrasound, Shanghai General Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Jinfang Xing
- Department of Medical Ultrasound, Shanghai General Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Lianfang Du
- Department of Medical Ultrasound, Shanghai General Hospital, Shanghai Jiao Tong University, Shanghai, China.
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15
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Taylor AJ, Lara-Garcia A, Benigni L. Ultrasonographic characteristics of canine renal lymphoma. Vet Radiol Ultrasound 2014; 55:441-6. [PMID: 24629062 DOI: 10.1111/vru.12152] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2013] [Accepted: 11/27/2013] [Indexed: 11/30/2022] Open
Abstract
There is little published information on the ultrasonographic appearance of canine renal lymphoma. The purpose of this retrospective study was to provide additional information regarding the ultrasonographic characteristics of canine renal lymphoma, suggest ultrasonographic description criteria, and evaluate the role of fine-needle aspirate cytology in the diagnosis of this disease. The ultrasonographic features of confirmed renal lymphoma were reviewed in ten dogs. Pyelectasia was found in all dogs. Other ultrasonographic findings were loss of corticomedullary distinction (9/10 dogs), renomegaly (8/10 dogs), renal deformity (6/10 dogs), hypoechoic lesion(s) (6/10 dogs), and hyperechoic lesion(s) (2/10 dogs). Hypoechoic lesions were described as masses, nodules, and indistinct areas. In 30% of the cases (3/10 dogs) ultrasound revealed only minor abnormalities, including grade 1 pyelectasia, mild renomegaly, and focal loss of corticomedullary definition. Bilateral lesions were seen in nine dogs (90%). Renal fine-needle aspirates were performed in 9/10 dogs, yielding a diagnosis in seven on first attempt (78%). Two dogs had been given a provisional cytological diagnosis of round cell neoplasia; in one dog lymphoma was confirmed by second aspirate and by tissue core biopsy in the other. In 1/10 dogs, lymphoma was found at necropsy. Findings indicated that ultrasonographic signs of canine renal lymphoma may be subtle, canine renal lymphoma should be included in the differential diagnosis when the above ultrasonographic features are observed, and fine-needle aspirate cytology is a useful method for diagnosing this disease.
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Affiliation(s)
- Angela J Taylor
- Department of Clinical Sciences and Service, The Royal Veterinary College, University of London
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16
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Taneja R, Bhargava P, Cuevas C, Dighe MK. Common and less-common renal masses and masslike conditions. Radiol Clin North Am 2012; 50:245-57, v-vi. [PMID: 22498441 DOI: 10.1016/j.rcl.2012.02.006] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
As an increasing number of imaging examinations are performed, a greater number of incidental renal lesions are detected. Apart from the usual cysts and solid renal cell carcinomas, a variety of unusual benign and malignant renal lesions exist. Imaging is invaluable in characterizing these lesions and is confirmatory in some benign lesions. Renal cell carcinoma remains the diagnosis of exclusion; however, assessment of the imaging pattern in the appropriate clinical context can improve diagnostic accuracy. The objective of this article is to familiarize the radiologist with the imaging appearance of unusual non-neoplastic and neoplastic lesions and correlate with histopathologic studies when available.
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Affiliation(s)
- Ranu Taneja
- Department of Radiology, Changi General Hospital, 2 Simei Street 3, Singapore 529889
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Prando A, Prando P, Prando D. Urothelial Cancer of the Renal Pelvicaliceal System: Unusual Imaging Manifestations. Radiographics 2010; 30:1553-66. [DOI: 10.1148/rg.306105501] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Symeonidou C, Standish R, Sahdev A, Katz RD, Morlese J, Malhotra A. Imaging and Histopathologic Features of HIV-related Renal Disease. Radiographics 2008; 28:1339-54. [DOI: 10.1148/rg.285075126] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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19
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Transitional Cell Neoplasm of the Upper Urinary Tract: Evaluation with MDCT. AJR Am J Roentgenol 2008; 191:416-22. [DOI: 10.2214/ajr.07.3649] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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20
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Dyer R, DiSantis DJ, McClennan BL. Simplified Imaging Approach for Evaluation of the Solid Renal Mass in Adults. Radiology 2008; 247:331-43. [DOI: 10.1148/radiol.2472061846] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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Leite NP, Kased N, Hanna RF, Brown MA, Pereira JM, Cunha R, Sirlin CB. Cross-sectional imaging of extranodal involvement in abdominopelvic lymphoproliferative malignancies. Radiographics 2008; 27:1613-34. [PMID: 18025507 DOI: 10.1148/rg.276065170] [Citation(s) in RCA: 85] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Extranodal lymphoproliferative diseases are common, and their prevalence is increasing. Non-Hodgkin lymphomas and Hodgkin disease, in particular, frequently involve extranodal structures in the abdomen and pelvis, including both the solid organs (liver, spleen, kidneys, and pancreas) and the hollow organs of the gastrointestinal tract. Because virtually any abdominopelvic tissue may be involved, many different imaging manifestations are possible, and lymphoproliferative diseases may mimic other disorders. Familiarity with the imaging manifestations that are diagnostically specific for extranodal lymphoproliferative diseases is important because imaging plays an important role in the noninvasive management of disease. However, a definitive diagnosis requires a biopsy (of bone marrow, a lymph node, or a mass), a peripheral blood analysis, and other laboratory tests. In patients with known disease, the goals of imaging are staging, evaluation of response to therapy, and identification of new or recurrent disease or of complications of therapy. In patients without known disease, imaging permits a provisional diagnosis.
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Affiliation(s)
- Nuno Pinto Leite
- Department of Radiology, Division of Body Imaging, University of California-San Diego, 200 W Arbor Dr, San Diego, CA 92103, USA
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Abstract
Ultrasonography and CT have allowed improved detection of renal mass lesions. Though ultrasonography is less sensitive in the characterization of the renal mass lesions, it is often the first imaging modality for evacuation of the kidneys. This article gives an overview of the benign and malignant renal mass lesions and the role of ultrasonography in their characterization.
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Affiliation(s)
- Raj Mohan Paspulati
- Department of Radiology, University Hospitals of Cleveland, Case Western Reserve University, 11100 Euclid Avenue, Cleveland, OH 44106, USA.
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Sheth S, Ali S, Fishman E. Imaging of renal lymphoma: patterns of disease with pathologic correlation. Radiographics 2006; 26:1151-68. [PMID: 16844939 DOI: 10.1148/rg.264055125] [Citation(s) in RCA: 160] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Extranodal spread of lymphoma often affects the genitourinary system, with the kidneys being the most commonly involved organs. Contrast material-enhanced computed tomography (CT) remains the modality of choice for the detection, diagnosis, staging, and monitoring of renal lymphoma. Magnetic resonance (MR) imaging is particularly useful in patients in whom intravenous administration of iodinated contrast material is contraindicated. Ultrasonography (US), although very valuable for diagnosing lymphoma in the testis or epididymis, is less sensitive than CT and MR imaging for detecting renal lymphoma. Typical imaging findings of renal lymphoma include multiple poorly enhancing or hypoechoic masses, retroperitoneal tumors directly invading the kidneys, bilateral renal enlargement, and perirenal soft-tissue masses. Cystic lesions and tumors predominantly affecting the renal sinus and collecting system are uncommon. Unless the renal lesions manifest in the setting of widespread lymphoma, percutaneous biopsy is indicated to differentiate lymphoma from metastases, hypovascular renal cell carcinoma, uroepithelial carcinoma, or atypical infection, with US routinely being used to guide the procedure. Current immunohistochemical techniques allow accurate diagnosis and characterization of renal lymphoma. Radiologists should be familiar with both typical and atypical manifestations of renal lymphoma and should recommend imaging-guided percutaneous biopsy for diagnostic confirmation to avoid unnecessary nephrectomy.
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Affiliation(s)
- Sheila Sheth
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University, 600 N Wolfe St, Baltimore, MD 21287, USA.
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25
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Blitman NM, Berkenblit RG, Rozenblit AM, Levin TL. Renal Medullary Carcinoma: CT and MRI Features. AJR Am J Roentgenol 2005; 185:268-72. [PMID: 15972435 DOI: 10.2214/ajr.185.1.01850268] [Citation(s) in RCA: 80] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE We review the cross-sectional imaging findings of six cases of pathologically proven renal medullary carcinoma in patients with sickle cell trait. MRI findings were available in three of the patients. To our knowledge, only one previous report has addressed MRI features of this rare disease. CONCLUSION In young patients with sickle cell trait, an infiltrative renal mass with associated retroperitoneal adenopathy and caliectasis are characteristic findings of renal medullary carcinoma on CT and MRI.
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Affiliation(s)
- Netta M Blitman
- Department of Radiology, Albert Einstein College of Medicine, Children's Hospital at Montefiore, 3400 Bainbridge Ave., Bronx, NY 10467, USA
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Mix TC, Stillman IE, McNamara A, Steinman TI. A 57-year-old woman with gross hematuria and bilateral renal masses: an unusual presentation of acute interstitial nephritis. Am J Kidney Dis 2002; 39:653-8. [PMID: 11877586 DOI: 10.1053/ajkd.2002.31421] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- T Christian Mix
- Department of Medicine (Renal Division), Beth Israel Deaconess Medical Center, Boston, MA 02215, USA
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Affiliation(s)
- R J Zagoria
- Department of Radiology, Wake Forest University School of Medicine, Medical Center Blvd., Winston-Salem, NC 27157-1088, USA
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28
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Abstract
Renal lymphoma is most often seen in conjunction with multisystemic, disseminated lymphoma or as tumor recurrence. Renal lymphoma may also be seen in immunocompromised patients or, rarely, as primary disease. Computed tomography (CT) is the most sensitive, efficient, and comprehensive examination for evaluation of the kidneys in patients with suspected renal lymphoma. Helical CT in particular improves detection and characterization of lymphomatous renal involvement by optimizing contrast dynamics and data acquisition and is the current modality of choice for accurate staging of lymphoma. Typical CT patterns in renal lymphoma include single and multiple masses, invasion from contiguous retroperitoneal disease, perirenal disease, and diffuse renal infiltration. Atypical CT patterns may also be encountered and provide a diagnostic challenge. These include spontaneous hemorrhage, necrosis, heterogeneous attenuation, cystic transformation, and calcification. Solid renal masses including renal cell carcinoma and metastases are the most commonly encountered entities that mimic renal lymphoma at CT and require biopsy for definitive diagnosis. CT (particularly helical CT) is useful in the evaluation of patients with suspected renal lymphoma, and familiarity with the spectrum of findings in renal lymphoma is important for accurate diagnosis.
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Affiliation(s)
- B A Urban
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Medical Institutions, Baltimore, MD 21287, USA
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29
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Pickhardt PJ, Lonergan GJ, Davis CJ, Kashitani N, Wagner BJ. From the archives of the AFIP. Infiltrative renal lesions: radiologic-pathologic correlation. Armed Forces Institute of Pathology. Radiographics 2000; 20:215-43. [PMID: 10682782 DOI: 10.1148/radiographics.20.1.g00ja08215] [Citation(s) in RCA: 104] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Most renal masses exhibit an expansile growth pattern characterized by radial tumor enlargement that displaces normal renal parenchyma and forms spherical, often exophytic, lesions. These expansile masses have pushing margins that impress adjacent normal renal parenchyma but do not infiltrate it; this behavior results in a well-defined, encapsulated appearance at both radiologic and gross pathologic examination. In contrast, certain disease processes involve the kidney in an infiltrative fashion by using the normal renal architecture as scaffolding for interstitial growth. These infiltrative renal lesions lack a sharp border of demarcation with the normal parenchyma and therefore demonstrate ill-defined zones of transition between the lesion and normal parenchyma. Although infiltrative lesions frequently enlarge the kidney, its reniform shape is usually maintained. Cross-sectional imaging can often help distinguish infiltrative from expansile growth patterns through analysis of the parenchymal interface between the process and the kidney, the effect of the lesion on the collecting system and renal sinus, and the overall renal morphology. A wide variety of neoplastic and inflammatory conditions characteristically involve the kidney by cellular infiltration. Although considerable overlap of the imaging features exists among the various infiltrative processes, the correct diagnosis may be suspected when the clinical data and associated radiologic findings are considered together.
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Affiliation(s)
- P J Pickhardt
- Department of Radiology, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, MO, USA
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30
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Abstract
Collecting duct carcinoma is an aggressive malignancy derived from the renal medulla. Imaging features suggestive of this diagnosis include a medullary origin, hypovascularity, and an infiltrative growth pattern. A case of collecting duct carcinoma with unsuspected contralateral renal agenesis is presented.
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Affiliation(s)
- P J Pickhardt
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri 63110, USA
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31
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Fukuya T, Honda H, Goto K, Ono M, Matsuura T, Kaneko K, Kuroiwa T, Yoshimitsu K, Irie H, Yoshida J, Naito S, Masuda K. Computed tomographic findings of Bellini duct carcinoma of the kidney. J Comput Assist Tomogr 1996; 20:399-403. [PMID: 8626899 DOI: 10.1097/00004728-199605000-00014] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
OBJECTIVE To analyze CT findings of Bellini duct carcinoma, a rare variant of renal cell carcinoma. MATERIALS AND METHODS The CT findings of five cases of Bellini duct carcinoma were reviewed and the findings were recorded. RESULTS In all cases the affected kidneys maintained the normal outer contours. In four cases the renal masses protruded into the central sinuses. Contrast enhancement was minimal in four cases. CONCLUSION Bellini duct carcinoma should be suspected in cases with these CT findings.
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Affiliation(s)
- T Fukuya
- Department of Radiology, Faculty of Medicine, Kyushu University, Fukuoka, Japan
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Oyen RH, Vandercruysse D, Baert A. Case report: renal involvement in primary Sjögren syndrome--a rare cause of renal pseudotumour. Clin Radiol 1995; 50:271-3. [PMID: 7729130 DOI: 10.1016/s0009-9260(05)83486-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Affiliation(s)
- R H Oyen
- Department of Radiology, University Hospitals, Catholic University of Leuven, Belgium
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Thrasher JB, Perez LM, Anderson EE. Clinical uroradiologic conference. Number 12. Sixty-one-year-old woman with multiple bilateral renal masses. Urology 1992; 40:542-4. [PMID: 1466109 DOI: 10.1016/0090-4295(92)90412-p] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- J B Thrasher
- Department of Surgery, Duke University Medical Center, Durham, North Carolina 27710
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34
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Computer-assisted tomography of the kidney. World J Urol 1992. [DOI: 10.1007/bf00213669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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