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3-DIMENSIONAL VOLUME RENDERED COMPUTERIZED TOMOGRAPHY FOR PREOPERATIVE EVALUATION AND INTRAOPERATIVE TREATMENT OF PATIENTS UNDERGOING NEPHRON SPARING SURGERY

1999; Lippincott Williams & Wilkins; Volume: 161; Issue: 4 Linguagem: Inglês

10.1016/s0022-5347(01)61599-4

1527-3792

Deirdre M. Coll, Robert G. Uzzo, Brian R. Herts, W J Davros, S. Wirth, Andrew C. Novick,

Renal and Vascular Pathologies

No AccessJournal of UrologyClinical Urology: Original Articles1 Apr 19993-DIMENSIONAL VOLUME RENDERED COMPUTERIZED TOMOGRAPHY FOR PREOPERATIVE EVALUATION AND INTRAOPERATIVE TREATMENT OF PATIENTS UNDERGOING NEPHRON SPARING SURGERY DEIRDRE M. COLL, ROBERT G. UZZO, BRIAN R. HERTS, WILLIAM J. DAVROS, SUSAN L. WIRTH, and ANDREW C. NOVICK DEIRDRE M. COLLDEIRDRE M. COLL More articles by this author , ROBERT G. UZZOROBERT G. UZZO More articles by this author , BRIAN R. HERTSBRIAN R. HERTS More articles by this author , WILLIAM J. DAVROSWILLIAM J. DAVROS More articles by this author , SUSAN L. WIRTHSUSAN L. WIRTH More articles by this author , and ANDREW C. NOVICKANDREW C. NOVICK More articles by this author View All Author Informationhttps://doi.org/10.1016/S0022-5347(01)61599-4AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: Computerized tomography (CT) is the diagnostic and staging modality of choice for renal neoplasms. Existing imaging modalities are limited by a 2-dimensional (D) format. Recent advances in computer technology now allow the production of high quality 3-D images from helical CT. Nephron sparing surgery requires a detailed understanding of renal anatomy. Preoperative evaluation must delineate the relationship of the tumor to adjacent normal structures and demonstrate the vascular supply to the tumor for the surgeon to conserve as much normal parenchyma as possible. We propose that helical CT combined with 3-D volume rendering provides all of the information required for preoperative evaluation and intraoperative management of nephron sparing surgery cases. We prospectively evaluated the role of 3-D volume rendering CT in 60 patients undergoing nephron sparing surgery for renal cell carcinoma at the Cleveland Clinic Foundation. Materials and Methods: Triphasic spiral CT was performed preoperatively in 60 consecutive patients undergoing nephron sparing surgery for renal neoplasms. A 3 to 5-minute videotape was prepared using volume rendering software which demonstrated the position of the kidney, location and depth of extension of the tumor(s), renal artery(ies) and vein(s), and relationship of the tumor to the collecting system. These videotapes were viewed by a radiologist and urologist in the operating room at surgery, and immediately correlated with surgical findings. Corresponding renal arteriograms of 19 patients were retrospectively compared to 3-D volume rendering CT and operative findings. Results: A total of 97 renal masses were identified in 60 cases evaluated with 3-D volume rendering CT before nephron sparing surgery. There were no complications related to the 3-D protocol and 3-D rendering was successful in all patients. The number and location of lesions identified by 3-D volume rendering CT were accurate in all cases, while enhancement and diagnostic characteristics were consistent with pathological findings in 95 of 97 tumors (98%). Of 77 renal arteries identified at surgery 74 were detected by 3-D volume rendering CT (96%). Helical CT missed 3 small accessory arteries, including 1 in a cross fused ectopic kidney. All major venous branches and anomalies were identified, including 3 circumaortic left renal veins. Of 69 renal veins identified at surgery 64 were detected by 3-D volume rendering CT (93%). All 5 renal veins missed by CT were small, short, duplicated right branches of the main renal vein. Renal fusion and malrotation anomalies were correctly identified in all 4 patients. Conclusions: The 3-D volume rendering CT accurately depicts the renal parenchymal and vascular anatomy in a format familiar to most surgeons. The data integrate essential information from angiography, venography, excretory urography and conventional 2-D CT into a single imaging modality, and can obviate the need for more invasive imaging. Additionally, the use of videotape in an intraoperative setting provides concise, accurate and immediate 3-D information to the surgeon, and it has become the preferred means of data display for these procedures at our center. References 1 : Differential diagnosis and evaluation of the incidentally discovered renal mass. Sem. Urol. Oncol.1995; 13: 246. Google Scholar 2 : Incidental detection of renal tumours by abdominal ultrasonography. Eur. Urol.1990; 18: 94. 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Link, Google Scholar From the Departments of Urology and Radiology, Cleveland Clinic Foundation, Cleveland, Ohio(Herts, Davros) Financial interest and/or other relationship with Siemens Medical Systems.© 1999 by American Urological Association, Inc.FiguresReferencesRelatedDetailsCited ByGershman B, Psutka S, Matsumoto J, King B, Kawashima A, Morris J and Leibovich B (2018) Use of Personalized Printed 3-Dimensional Kidney Models for Simulation before Nephron Sparing Surgery: Methodology and Examples from a Case SeriesUrology Practice, VOL. 3, NO. 2, (124-133), Online publication date: 1-Mar-2016.Chawla S, Crispen P, Hanlon A, Greenberg R, Chen D and Uzzo R (2018) The Natural History of Observed Enhancing Renal Masses: Meta-Analysis and Review of the World LiteratureJournal of Urology, VOL. 175, NO. 2, (425-431), Online publication date: 1-Feb-2006.TAKIUCHI H, MORI Y, SHIMA H, TANOOKA M, HIRAYAMA S and NAKAO N (2018) KIDNEY DISPLACEMENT SIMULATOR FOR RETROPERITONEAL LAPAROSCOPIC NEPHRECTOMYJournal of Urology, VOL. 174, NO. 6, (2111-2114), Online publication date: 1-Dec-2005.EL FETTOUH H, HERTS B, NIMEH T, WIRTH S, CAPLIN A, SANDS M, RAMANI A, KAOUK J, GOLDFARB D and GILL I (2018) Prospective Comparison of 3-Dimensional Volume Rendered Computerized Tomography and Conventional Renal Arteriography for Surgical Planning in Patients Undergoing Laparoscopic Donor NephrectomyJournal of Urology, VOL. 170, NO. 1, (57-60), Online publication date: 1-Jul-2003.GILL I, MATIN S, DESAI M, KAOUK J, STEINBERG A, MASCHA E, THORNTON J, SHERIEF M, STRZEMPKOWSKI B and NOVICK A (2018) Comparative Analysis of Laparoscopic Versus Open Partial Nephrectomy for Renal Tumors in 200 PatientsJournal of Urology, VOL. 170, NO. 1, (64-68), Online publication date: 1-Jul-2003.MARUKAWA K, HORIGUCHI J, SHIGETA M, NAKAMOTO T, USUI T and ITO K (2018) Three-Dimensional Navigator For Retroperitoneal Laparoscopic Nephrectomy Using Multidetector Row Computerized TomographyJournal of Urology, VOL. 168, NO. 5, (1933-1936), Online publication date: 1-Nov-2002.UZZO R, CHERULLO E, MYLES J and NOVICK A (2018) Renal Cell Carcinoma Invading the Urinary Collecting System: Implications for StagingJournal of Urology, VOL. 167, NO. 6, (2392-2396), Online publication date: 1-Jun-2002.UZZO R and NOVICK A (2018) NEPHRON SPARING SURGERY FOR RENAL TUMORS: INDICATIONS, TECHNIQUES AND OUTCOMESJournal of Urology, VOL. 166, NO. 1, (6-18), Online publication date: 1-Jul-2001.CHERULLO E, ROSS J, KAY R and NOVICK A (2018) RENAL NEOPLASMS IN ADULT SURVIVORS OF CHILDHOOD WILMS TUMORJournal of Urology, VOL. 165, NO. 6 Part 1, (2013-2017), Online publication date: 1-Jun-2001.RENDON R, STANIETZKY N, PANZARELLA T, ROBINETTE M, KLOTZ L, THURSTON W and JEWETT M (2018) THE NATURAL HISTORY OF SMALL RENAL MASSESJournal of Urology, VOL. 164, NO. 4, (1143-1147), Online publication date: 1-Oct-2000. Volume 161Issue 4April 1999Page: 1097-1102 Advertisement Copyright & Permissions© 1999 by American Urological Association, Inc.MetricsAuthor Information DEIRDRE M. COLL More articles by this author ROBERT G. UZZO More articles by this author BRIAN R. HERTS More articles by this author WILLIAM J. DAVROS More articles by this author SUSAN L. WIRTH More articles by this author ANDREW C. NOVICK More articles by this author Expand All Advertisement PDF DownloadLoading ...