Wilms' tumor CT: Difference between revisions

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{{CMG}}
{{CMG}};{{AE}}{{SSW}}
{{Wilms' tumor}}
{{Wilms' tumor}}


==Overview==
==Overview==
CT scan may be helpful in the diagnosis of wilms' tumor.
Abdominal [[CT scan]] may be helpful in the diagnosis of Wilms tumor.Findings on [[CT scan]] which can be suggestive of  Wilms tumor include soft-tissue density masses,  areas of [[calcification]] (~10%) and fat-density regions. [[CT]] is better than [[ultrasonography]] in detecting small lesions of tumor. [[CT scan]] of the chest can be helpful to diagnose [[Metastasis|lung metastasis]].


==CT scan==
==CT scan==
* Abdominal CT scan may be helpful in the diagnosis of wilms tumor.  
* Abdominal CT scan may be helpful in the diagnosis of Wilms tumor. Findings on CT scan suggestive of Wilms tumor include:<ref name="pmid4080660">{{cite journal |vauthors=Cahan LD |title=Failure of encephalo-duro-arterio-synangiosis procedure in moyamoya disease |journal=Pediatr Neurosci |volume=12 |issue=1 |pages=58–62 |date=1985 |pmid=4080660 |doi= |url=}}</ref><ref name="radio">Wilms tumour. Dr Tim Luijkx and Dr Frank Gaillard et al. Radiopaedia.org 2015.http://radiopaedia.org/articles/wilms-tumour </ref><ref name="pmid10813321">{{cite journal |vauthors=Gow KW, Roberts IF, Jamieson DH, Bray H, Magee JF, Murphy JJ |title=Local staging of Wilms' tumor--computerized tomography correlation with histological findings |journal=J. Pediatr. Surg. |volume=35 |issue=5 |pages=677–9 |date=May 2000 |pmid=10813321 |doi=10.1053/jpsu.2000.5941 |url=}}</ref>
* Findings on CT scan suggestive of/diagnostic of wilms tumor include:
** Heterogeneous soft-tissue density masses
** Heterogeneous soft-tissue density masses
**These masses have frequent areas of calcification (~10%) and fat-density regions
**These masses have frequent areas of [[calcification]] (~10%) and fat-density regions
* Contrast-enhanced CT or magnetic resonance imaging (MRI) is recommended to further evaluate the nature and extent of the mass. CT or MRI also may detect small lesions of tumor or nephrogenic rests in the opposite kidney, which were not detected by ultrasonography. The Children’s Oncology Group (COG) evaluated the diagnostic performance of CT and MRI for local staging of pediatric renal tumors and found that they have similar ability to detect lymph node metastasis and capsular penetration [56]. MRI detected more contralateral synchronous lesions; however, these were rare. The investigators concluded either modality can be used for initial locoregional staging of pediatric renal tumors based on institutional expertise, need for anesthesia, risks of radiation exposure, and cost concerns. At our institution, we typically use CT at the time of initial diagnosis; MRI or CT may be used for follow up imaging depending on the patient’s specific circumstances.  In a separate study, COG investigated the role of preoperative CT scans in detecting tumor rupture and found that ascites beyond the cul-de-sac was the best indicator of rupture; however, the sensitivity of CT to detect tumor rupture was poor (54 to 70 percent) [57].
**[[Lymph node]] [[metastasis]]
*  
**Invasion of surrounding organs
* Wilms tumours are heterogeneous soft-tissue density masses with frequent areas of calcification (~10%) and fat-density regions.
**[[Thrombus]] in or occlusion of the [[renal vein]] and/or the [[inferior vena cava]]
* Enhancement is also patchy, and allows for better delineation of the relationship between the mass and kidney.
**Abdominal [[Lymph node|lymph nodes]] and contralateral involvement
* 20% of cases have lung metastases at time of diagnosis.<ref name="radio">Wilms tumour. Dr Tim Luijkx and Dr Frank Gaillard et al. Radiopaedia.org 2015.http://radiopaedia.org/articles/wilms-tumour </ref>
**Estimate tumor size and volume and to plan surgical management
**Determine stage based on tumor size and structures involved


* CT scan shows a renal mass which often shows one or more of the following:  
*Chest CT scan can be helpful to diagnose [[lung]] [[metastasis]].
** areas of hemorrhage
 
** invasion of surrounding organs
[[File:Wilms-tumour CT.jpg|center|thumb|300x300px|CT abdomen showing Wilms tumor
** thrombus in or occlusion of the renal vein and/or the inferior vena cava
Source:Radiopedia
** abdominal lymph nodes and contralateral involvement
Case courtesy of Dr Jeremy Jones,<ref><nowiki>https://radiopaedia.org/cases/8084</nowiki></ref>
* A preoperative CT scan helps to better estimate tumor size and volume and to plan surgical management more successfully.
]]
* It is a useful tool to determine stage based on tumor size and structures involved.<ref>Pshak TJ, Cho DS, Hayes KL, Vemulakonda VM. Correlation between CT-estimated tumor volume, pathologic tumor volume, and final pathologic specimen weight in children with Wilms' tumor.


J Pediatr Urol. 2014 Feb;10(1):148-54. doi: 10.1016/j.jpurol.2013.08.001. Epub 2013 Sep 12. </ref><ref>McDonald K, Duffy P, Chowdhury T, McHugh K. Added value of abdominal cross-sectional imaging (CT or MRI) in staging of Wilms' tumours. Clin Radiol. 2013 Jan;68(1):16-20. doi: 10.1016/j.crad.2012.05.006. Epub 2012 Aug 11. </ref>
[[Image:Wilms Tumor CTScan.gif|frame|left|[[Computed tomography|CT Scan]] of 11 cm '''Wilms' tumor''' of left kidney in 13 month old patient.]]
<br clear="left" />
<br clear="left" />
[[File:Wilms-tumour- coronal view .jpg|center|thumb|300x300px|Wilms tumor - coronal view
source: radiopedia<ref>Case courtesy of Dr Jeremy Jones, <a href="https://radiopaedia.org/">Radiopaedia.org</a>. From the case <a href="https://radiopaedia.org/cases/8084">rID: 8084</a></ref>
Case courtesy of Dr Jeremy Jones
]]
[[File:Wilms-tumour-4.jpg|center|thumb|300x300px|Wilms tumor - axial view
source: Radiopedia - Case courtesy of Dr G Balachandran.<ref>Case courtesy of Dr G Balachandran, <a href="https://radiopaedia.org/">Radiopaedia.org</a>. From the case <a href="https://radiopaedia.org/cases/10250">rID: 10250</a></ref>
]]


==References==
==References==

Latest revision as of 15:24, 16 July 2018


Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1];Associate Editor(s)-in-Chief: Sargun Singh Walia M.B.B.S.[2]

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Overview

Abdominal CT scan may be helpful in the diagnosis of Wilms tumor.Findings on CT scan which can be suggestive of Wilms tumor include soft-tissue density masses, areas of calcification (~10%) and fat-density regions. CT is better than ultrasonography in detecting small lesions of tumor. CT scan of the chest can be helpful to diagnose lung metastasis.

CT scan

  • Abdominal CT scan may be helpful in the diagnosis of Wilms tumor. Findings on CT scan suggestive of Wilms tumor include:[1][2][3]
    • Heterogeneous soft-tissue density masses
    • These masses have frequent areas of calcification (~10%) and fat-density regions
    • Lymph node metastasis
    • Invasion of surrounding organs
    • Thrombus in or occlusion of the renal vein and/or the inferior vena cava
    • Abdominal lymph nodes and contralateral involvement
    • Estimate tumor size and volume and to plan surgical management
    • Determine stage based on tumor size and structures involved
CT abdomen showing Wilms tumor Source:Radiopedia Case courtesy of Dr Jeremy Jones,[4]


Wilms tumor - coronal view source: radiopedia[5] Case courtesy of Dr Jeremy Jones
Wilms tumor - axial view source: Radiopedia - Case courtesy of Dr G Balachandran.[6]

References

  1. ↑ Cahan LD (1985). "Failure of encephalo-duro-arterio-synangiosis procedure in moyamoya disease". Pediatr Neurosci. 12 (1): 58–62. PMID 4080660.
  2. ↑ Wilms tumour. Dr Tim Luijkx and Dr Frank Gaillard et al. Radiopaedia.org 2015.http://radiopaedia.org/articles/wilms-tumour
  3. ↑ Gow KW, Roberts IF, Jamieson DH, Bray H, Magee JF, Murphy JJ (May 2000). "Local staging of Wilms' tumor--computerized tomography correlation with histological findings". J. Pediatr. Surg. 35 (5): 677–9. doi:10.1053/jpsu.2000.5941. PMID 10813321.
  4. ↑ https://radiopaedia.org/cases/8084
  5. ↑ Case courtesy of Dr Jeremy Jones, <a href="https://radiopaedia.org/">Radiopaedia.org</a>. From the case <a href="https://radiopaedia.org/cases/8084">rID: 8084</a>
  6. ↑ Case courtesy of Dr G Balachandran, <a href="https://radiopaedia.org/">Radiopaedia.org</a>. From the case <a href="https://radiopaedia.org/cases/10250">rID: 10250</a>

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