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CT of the kidneys: what size are renal cell carcinomas when they cause symptoms or signs?
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Oncology, Radiology and Clinical Immunology, Radiology. (Magnusson)
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Oncology, Radiology and Clinical Immunology, Radiology. (Magnusson)
2007 (English)In: Scandinavian Journal of Urology and Nephrology, ISSN 0036-5599, E-ISSN 1651-2065, Vol. 41, no 6, 490-495 p.Article in journal (Refereed) Published
Abstract [en]

Objective. To investigate the size of renal cell carcinomas (RCCs) when they cause macroscopic hematuria or other symptoms and/or signs. Material and methods. A retrospective review of 232 patients (136 males, 96 females; mean age 68±11 years; age range 40–90 years) with a diagnosis of RCC was undertaken. Patients were grouped according to the presenting symptoms and/or signs caused by the RCCs. Tumor size was measured on CT images. Results. Of the RCCs, 29% were found incidentally and 71% caused symptoms and/or signs. The incidentally found RCCs measured 4.9±2.6 cm (range 2–12 cm) and RCCs causing symptoms and signs measured 8.9±3.2 cm (range 3–18 cm); this size difference was significant (p<0.001). None of the RCCs causing macroscopic hematuria were <4 cm in size and only 3/165 (2%) of the symptomatic RCCs were <4 cm in size. Discussion. If small (<4 cm) RCCs do not cause symptoms, patients with them will not be referred for CT or any other imaging modality. Therefore, if a 2-cm RCC is found in a patient presenting with macroscopic hematuria, it is unlikely that this small RCC caused the hematuria and another cause of the hematuria must be ruled out.

Place, publisher, year, edition, pages
2007. Vol. 41, no 6, 490-495 p.
Keyword [en]
CT, Hematuria, Incidental discovery, Renal cell carcinoma, Symptoms and signs
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:uu:diva-17184DOI: 10.1080/00365590701428210ISI: 000251281000004PubMedID: 17853020OAI: oai:DiVA.org:uu-17184DiVA: diva2:44955
Available from: 2008-06-17 Created: 2008-06-17 Last updated: 2017-12-08Bibliographically approved
In thesis
1. CT Urography: Efforts to Reduce the Radiation Dose
Open this publication in new window or tab >>CT Urography: Efforts to Reduce the Radiation Dose
2011 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Computed tomography urography (CTU) is today the imaging method used to investigate patients with suspected urinary tract malignancy, replacing the old imaging method intravenous pyelography (IVP) about a decade ago. The downside of this shift was that the effective radiation dose to the examined patient was eight times higher for CTU compared to IVP. Based on four different studies, the present thesis focused on efforts to reduce the CTU radiation dose.

 

In study I, the number of cysts and solid lesions in the separate scan phases was evaluated in 57 patients undergoing four-phase CTU 1997-98. The number of scans was reduced from four to three when the nephrographic scan was abolished following study I.

Study II registered the diameter of renal cell carcinoma (RCC) and the presenting symptoms in the total number of patients (n=232) diagnosed with RCC between 1997 and 2003. The results from study II showed that the critical size for RCCs to cause macroscopic hematuria was ≥ 4 cm. Study III was a dose-escalation study aimed to decide the minimal possible tube load in the unenhanced and excretory phase scans if the low dose images are reviewed together with normal dose corticomedullary phase images. Study III showed that it is possible to reduce the mean effective dose in three phase CTU from 16.2 mSv to 9.4 mSv with a combined low and normal dose CTU protocol. Study IV investigated the changes in the CTU protocol between 1997 and 2008, and the development of the effective radiation dose. Study IV clarified how the CTU protocol has changed between 1997 and 2008 and as a result the mean effective radiation dose to patients undergoing CTU in 2008 is only 39% of the effective dose in 1997.

 

In conclusion, the findings from the studies included in this thesis have contributed to a reduced radiation dose to patients undergoing CTU. The mean effective dose from CTU is at present only three times higher compared to that from the IVP.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2011. 73 p.
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 646
Keyword
Urinary tract malignancy, renal cell carcinoma, urography, x-ray computed tomography, radiation dosage, dose escalation, hematuria/diagnosis
National Category
Radiology, Nuclear Medicine and Medical Imaging
Research subject
Radiology
Identifiers
urn:nbn:se:uu:diva-146332 (URN)978-91-554-8009-7 (ISBN)
Public defence
2011-04-01, Enghoffsalen, Ing 50, Akademiska Sjukhuset, Uppsala, 09:15 (Swedish)
Opponent
Supervisors
Available from: 2011-03-11 Created: 2011-02-16 Last updated: 2017-02-20Bibliographically approved

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Dahlman, PärBrekkan, EinarMagnusson, Anders

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