How to Miss a Renal Mass: Guide to Pitfalls and Solutions. MDCT of the Kidneys: Decisions, Decisions, Decisions. Pitfalls in Renal Imaging
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1 How to Miss a Renal Mass: Guide to Pitfalls and Solutions Elliot K. Fishman M.D. Johns Hopkins Hospital The most common reason for a missed diagnosis in radiology is a perceptual error, or an error in which the radiologist fails to observe or recognize an abnormality. Medicolegal Issues in Genitourinary Radiology Berlin JW RSNA Categorical Course in Diag Radiol: Genitourinary Radiology 2006;pp An extremely common cause of perceptual error in genitourinary radiology (and other areas of diagnostic radiology as well) is improper technique. Medicolegal Issues in Genitourinary Radiology Berlin JW RSNA Categorical Course in Diag Radiol: Genitourinary Radiology 2006;pp MDCT of the Kidneys: Decisions, Decisions, Decisions contrast injection protocol (rate, volume, etc.) scan parameter selection (collimation, pitch, etc.) phase(s) of acquisition acquired (arterial or corticomedullary, nephrographic and excretory phases) use of post-processing techniques including 3D imaging Pitfalls in Renal Imaging What are the sources of pitfalls, pratfalls and misdiagnosis of CT of the kidneys? Phase of data acquisition Image display format Rendering technique use for display CT Symposium 1
2 Pitfalls in Renal Imaging Phase of data acquisition Image display format Rendering technique use for display Phase of Acquisition: Non-Contrast CT Ideal for detection of renal calculi Ideal for defining CT attenuation of a suspected renal lesion pre-contrast to help determine whether a lesion is a high density renal cyst Can specifically allow diagnosis of high density renal cyst Phase of Acquisition: Non-Contrast CT But non-contrast CT will miss Small renal tumors especially when not changing renal contour Acute pyelonephritis Vascular pathology including AVM CT Symposium 2
3 Subtle Renal Cell Carcinoma Subtle Renal Cell Carcinoma CT Symposium 3
4 TCC-Subtle on Arterial Phase CT Symposium 4
5 1 cm Renal Cell Carcinoma only seen in Arterial Phase CT Symposium 5
6 CT Symposium 6
7 Renal AVM CT Symposium 7
8 Pitfalls in Renal Imaging Phase of data acquisition Image display format Rendering technique use for display CT Symposium 8
9 Image Display Techniques 2 cm Renal Cell Carcinoma Axial Multiplanar (especially coronal) 3D volume rendering and MIP 2 cm Renal Cell Carcinoma VRT MIP Conclusion Optimal lesion detection of renal masses requires a carefully designed workflow pattern from data acquisition to data display to post processing in order to optimize lesion detection and classification CT Symposium 9
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