Evaluation Of Renal Tumors And Function Of Hydronephrotic Kidneys: MSCT Perfusion Study

Part â… : The study on the correlation between MSCT appearance and expressions of VEGF, MVD in renal cell carcinomaObjective: To study the correlation between MSCT features and expressions of vascular endothelial growth factor (VEGF), microvascular density (MVD) in renal cell carcinoma (RCC). Methods: 47 cases of RCC (male 31, female 16, ages varies from 43-67, average 52.8) were examined by MSCT (plain scan and enhancement scan) and proved by surgery and pathology. The contrast medium was given at the flow rate of 3.5ml/s from forearm superficial vein. Total dose is 50ml. Expressions of VEGF in 47 cases of RCC and the normal tissues adjacent to RCC were examined by immunohistochemical techniques of streptavidin-biotin-peroxidase (SP). The vascular development was measured by MVD immunostained with anti-factor â…§-related antigen monoclonal antibody. Results: (1) 47 cases with RCC included 28 cases of clear cell renal cell carcinoma, 10 cases of granular cell carcinoma, 4 cases of mixed type and 5 cases of papillary renal cell carcinoma; (2) The expressions of VEGF,MVD were related to and increased with the pathological grades of RCC (P<0.05); (3) The expressions of VEGF were found significantly correlated with MVD in RCC (r=0.67 P<0.01) ; (4) The positive expressions of VEGF, MVD were significantly correlated with tumor size, intratumor necrosis, cystic degeneration, enhancement extent, lymph nodes metastases, invasion of renal vein or inferior vena cava, invasion of adjacent organs or distant metastases on MSCT scan(P<0.01). Conclusion: (1) The features of MSCT could reflect the histopathology of RCC. (2) Some MSCT features were closely correlated with MVD and expressions of VEGF in RCC, which could be a noninvasive method in evaluating the biological behavior and malignance, and predicting aggressiveness andmetastasis.Part â…¡ : Relative study between MSCT perfusing imaging and molecular pathology in renal tumorsObjective: To correlate the functional CT parameters of renal tumor with pathological findings and tumor angiogenesis, to discuss the value of MSCT perfusion imaging in diagnosis of renal tumor. Methods: 58 patients (male 39,female 19,ages varies from 43-67, average 52.3) with newly diagnosed renal tumors underwent perfusion imaging with MSCT. At first routine plain CT scan were performed to localize central slices of tumors, CT perfusion imaging were performed later using a multislice scanner. We obtained two contiguous 10mm slices through the lesion using continuous scanning at 120KVp and 60mA. 50ml iodinated contrast medium was infused via an arm vein at 3.5ml/s. Data were transferred to ADW4.0 workstation and analyzed using perfusion 2 software. The maps of renal blood volume, blood flow, permeability surface and mean transit time were obtained. Regions of interest (ROI) were drawn in the part of the lesions and the region of normal adjacent to renal tumor. Results: 58 patients with renal tumor included 47 cases of the renal cell carcinoma (RCC), 6 cases of the renal pelvic carcinoma (RPC), 5 cases of the renal agiomyolipoma (RAML). The mean BF, BV and PS were significant different among the 3 grades of the RCC. The mean BF, BV and PS of G3 were larger than that of G1. The mean BF, BV and PS of the normal renal cortex were lager than that of the RCC. The mean MTT of the normal renal cortex was larger than that of the RCC. The perfusion of RCC was much higher than that of other two renal tumors. A significant inverse correlation (r=0.673, P<0.01) was observed between the mean MTT and the expressions of VEGF. Additionally, the mean BF, BV and PS of RCC had a significant positive correlative with the value of MVD and the expressions of VEGF. Conclusion: MSCT perfusion imaging is a functional image technique that is capable of quantitative assessment to tumor angiogenesis. blood perfusion and vascular permeability and it also can provide information of incremental benefit in diagnosis, in staging of RCC. There is some value of MSCT perfusion imaging in differentiate diagnosis of the renal tumors.Part â…¢: Value of MSCT perfusion in the half functional assessment of hydronephrotic kidney: an experimental studyObjective: To evaluate the usefulness of MSCT perfusion in assessment of half renal function of hydronephrotic kidney by measuring perfusion parameters of hydronephrotic model with MSCT perfusion techniques. Methods: Twenty healthy adult male rabbits aged more than 8 weeks with experimentally induced partial obstruction of right ureter underwent sequential MSCT perfusion. SPECT and CDF1 before and 4 weeks after the establishment of hydronephrotic model. The animals were euthanized 2 hours after the last imaging evaluation. The hydronephrotic kidneys were then removed and fixed in 10% formaldehyde solution. The specimen was paraffin-embedded and cross-sectioned, stained with eosin and hematoxylin. and examined at microscopy. Results: Pelvicalyceal dilatation and renal parenchymal thinning were seen on CT. BF and BV values in both renal cortex and medulla were significantly lower than those in the control group (with P values <0.01). No significant change in MTT was found and PS of renal cortex was slightly lower than that before obstruction but not significantly while PS of renal medulla was significantly lower than that in the control group (with P values <0.01). Color duplex flow imaging (CDF1) showed a significant lower peak systolic velocity (PSV) in both renal arteries and veins than that before the obstruction (P<0.05) and a more significant decline in end diastolic velocity (EDV) (P<0.01) . There was a significant higher resistive index (RI) in the renal and intrarenal arteries 4 weeks after the obstruction (P<0.01) . On SPECT, glomerular filtration rate (GFR) of the obstructed kidneys were much lower than those before the obstruction (P<0.001), T_b were much longer (P<0.001) and T_1/2 were much longer which have no practical significant in measuration. Histologically, the specimen of obstructed kidneys showed cystic dilated renal tubules with some atrophic renal tubules. The tubular epithelial cells were flat. Lobular structure of some of the glomerulum still remained. Intertubular distance widened because of interstitial fibrosis. Cloudy swelling of the tubular epithelium and prolate nucleus were found. Conclusion: BF and BV are perfusion parameters that have the most significant decline in the post-obstructive renal cortical and medullar. MSCT perfusion parameters were consistent with the renal hemodynamic changes reflected by PSV, EDV and RI measured by CDFI. MSCT with perfusion technique can not only provide anatomic images of high temporal and spatial resolution measured with which the renal function highly accord with that with CDFI, but also overcome the shortcomings of nuclear medicine study which cannot provide accurate renal anatomic information and must use many special instruments. The advent of MSCT perfusion added new methods to the evaluation of renal function. With advance in the software, MSCT perfusion will be of great value in the clinical practice of renal function assessment.Part â…£: Predictability of MSCT perfusion in the restorability of renal function of hydronephrotic kidneysObjective: To evaluate the predictability of MSCT perfusion in the restorability of renal function of hydronephrotic kidneys with unilateral partial ureteric obstructed rabbit model as to explore a method to predict the restorability of renal function of hydronephrotic kidneys and to investigate the changes of MSCT perfusion parameters during the course of the restore of renal function. Methods: Establish a unilateral partial ureteric obstructed rabbit hydronephrotic model. Hydronephrotic rabbits were grouped as control, 2, 4 and 8 week (G_2w, G_4w and G_8w) after obstruction and the later 3 groups of rabbits were reared for further 4 weeks after the obstruction was released. BUN, Cr and ACE level of all the later 3 groups before the obstruction and 4 weeks after the obstruction were measured and compared with that of the control. MSCT perfusion scanning, CDFI and SPECT examinations were performed and the specimen was made into histological slices with HE staining. Results: BUN and Cr were normal in G_2w, G_4w and G_8w. ACE of G_2w and G_4w were higher than that of control; there was no significant difference between ACE of control and G_8w and between ACE of G_2w, and G_8w after obstruction was released and that of control. GFR of G_2w, G_4w and were lower than that of control while there was no significant difference between total GFR of G_2w, G_4w and G_8w before and after obstruction was released. There was slightly restore of right renal GFR after obstruction was released in G_2w. EDV of intrarenal arteries of G_4w and G_8w after obstruction was released were significantly lower than that of control while there was no significant difference between EDV of intrarenal and renal arteries of G_2w after obstruction was released and that of control. BF and BV value of renal cortex and medulla of G_2w after obstruction was released restored in substance and approached that of control while there was no significant restore in that of G_4w and G_8w after obstruction was released. Histologically, there was a positive correlation between the duration of obstruction and the seriousness of pathologic changes. Conclusion: MSCT perfusion can provide information not only morphologically but also about renal perfusion of hydronephrotic kidneys. The combined use of CDFI and MSCT perfusion may be the "gold standard" to predict the restorability of impaired renal function of hydronephrotic kidneys.