Search

The purpose of this study was to investigate whether cystic renal masses are better characterized on thin axial and multiplanar reconstructed MDCT images than on 5-mm images.The records of 70 complex cystic renal masses in 59 patients (45 men, 14 women; mean age, 68 +/- 13 years) who underwent 64-MDCT at two medical centers were studied. Twenty-three of the masses were confirmed on the basis of the histologic findings and 47 in 2-4 years of follow-up. Images were reviewed in two sessions by two radiologists with 12 and 2 years of experience. In the first session, 5-mm axial images were analyzed, and in the second, thin axial images and multiplanar reconstructions. To assess intraobserver variability, analysis was repeated after 1 month. Statistical analysis was performed with Wilcoxon's signed rank test, receiver operating characteristic analysis, and weighted kappa statistics.Radiologists 1 and 2 detected thicker cystic walls (p0.001, p0.005) and septa (p0.03, p0.05) and fewer septa (p0.005, p0.002) on 5-mm axial images and assigned significantly different Bosniak categories than they did in analysis of the volume data (p0.04, p0.05). Variability was reduced in thin axial and multiplanar views. No significant differences were found in characterization of lesions as benign or malignant in review of 5-mm axial images and volume data sets. The areas under the receiver operating characteristic curve were 0.89 for 5-mm images and 0.96 for volume data sets for radiologist 1 and 0.87 and 0.90 for radiologist 2.Analysis of volume data sets is associated with less intraobserver and interobserver variability than review of 5-mm axial images. Wall thickness and the number and thickness of septa may differ, resulting in assignment of different Bosniak categories. Diagnostic performance in characterizing lesions as benign or malignant, however, is not statistically different for the thick and thin images.

The North American Symptomatic Carotid Endarterectomy Trial has confirmed the benefit of carotid endarterectomy in comparison to medical treatment in stroke prevention in symptomatic patients having a carotid stenosis of 70% or more. The Asymptomatic Carotid Atherosclerosis Study has concluded that the benefit of surgical treatment remains significant in asymptomatic patients with 60% (or more) stenosis of the ipsilateral internal carotid artery, when mortality rate remains inferior to 3%. In these two trials, angiography has been used to quantify the stenosis. Though this test is carrying some neurological and renal risks, replacing the angiography stenosis grading for a non or less invasive test, seems to be permissible.In our retroprospective study, the assessments of the carotid stenosis by several non-invasive tests findings were compared to the angiography results. Nineteen carotid arteries of fifteen patients, both symptomatic and asymptomatic, having a carotid stenosis at least 60% or more and being detected by the Doppler ultrasound were explored either by magnetic resonance angiography (MRA), spiral computed tomography angiography (SCTA) and angiography.The ultrasonography and angiography findings were well correlated (r=0,88; p0.002) according to the Spearman test. The assessments of the MRA were better correlated to the angiography than to the SCTA (respectively r=0.91, p0.0001 and r=0,68, p0.001). Using both ultrasonography and MRA as a confirmatory test, the rate of injustified carotid endarterectomy was 25%. And this rate rose up to 33% when the ultrasonography was used with the SCTA. It is noteworthy that negative predictive value of ARM was 100%. To reduce the mortality rate, several surgical teams managed the carotid stenosis without angiography.MRA could replace angiography, on condition that the rate of unjustified carotid endarterectomy lowers and becomes acceptable. Far reaching complementary studies are necessary to confirm the fiability of those non-invasive tests. In order to raise the benefit to carotid endarterectomy, the research studies should turn to the predictive score determination of a surgical international risk and towards the "High benefit" patients groups after endarterectomy.