Angionephrography in the diagnosis of renal cell carcinoma

Han, M C; Chung, K B; Yeon, K M

Abstract

The significancy of renal areriography in the diagnosis and menagement of patients with renal cell carcinomahas been well established since dos Santos introduced translumbar aortography in 1929. Selective renalarteriography with epinephrine injection is excellent diagnostic tool in differentiation of intrarenal masses,especially between renal cell carcinoma and simple renal cyst. The arteriographic findings of 21 cases ofconfirmed renal cell carcinoma, with their clinical findings, are reviewed. The brief results are as follows; 1.Incidence of renal cell carcinoma is more common in male; male to female ratio is 15:6, and the peak age incidenceis 6th to 7th decades(67%). 2. Numerous metastatic nodules are demonstrated in chest PA film in total 5 cases ofpatients. In IVP studies, 90% of cases are showing various abnormal findings such as calyceal deformity,nonfunctioning, delayed functioning and displacement of kidney. 3. The characteristic arteriographic finding isdemonstration of abnormal tumor vessels(96%), and the other important finding were hypervascularity (86%),vascular displacement(76%), vascular pooling (67%), intrarenal A-V shunt (57%) and arterial encasement(57%) inorder. The collateral veins such as ovarian vein and retroperitoneal veins are demonstrated in 3 cases andintraluminal filling defects in the inferior vena cava or renal vein are noted in total 3 cases of patient, In onecase, there is no evidence of tumor vessels, and preoperative angiographic diagnosis was simple renal cyst. 4.Epinephrine study were performed in 12 cases of patient. Mild to marked enhancement of tumor vessels afterepinephrine injection is demonstrated in 6 cases, and in other 4 cases, the epinephrine effects are quesstionable.But in 2 cases, well demonstrated tumor vessels in no epinephrine study are disappeared in epinephrine study dueto constriction of proximal normal intrarenal arteries. 5. Selective renal arteriography is one of the mosteffective and accurate procedure in the diagnosis of renal cell carcinoma.