肾脏囊性占位.ppt

上传人:王** 文档编号:686221 上传时间:2023-12-09 格式:PPT 页数:35 大小:1.38MB
下载 相关 举报
肾脏囊性占位.ppt_第1页
第1页 / 共35页
肾脏囊性占位.ppt_第2页
第2页 / 共35页
肾脏囊性占位.ppt_第3页
第3页 / 共35页
肾脏囊性占位.ppt_第4页
第4页 / 共35页
肾脏囊性占位.ppt_第5页
第5页 / 共35页
肾脏囊性占位.ppt_第6页
第6页 / 共35页
肾脏囊性占位.ppt_第7页
第7页 / 共35页
肾脏囊性占位.ppt_第8页
第8页 / 共35页
肾脏囊性占位.ppt_第9页
第9页 / 共35页
肾脏囊性占位.ppt_第10页
第10页 / 共35页
亲,该文档总共35页,到这儿已超出免费预览范围,如果喜欢就下载吧!
资源描述

《肾脏囊性占位.ppt》由会员分享,可在线阅读,更多相关《肾脏囊性占位.ppt(35页珍藏版)》请在优知文库上搜索。

1、肾脏囊性占位IntroductionIgnore,Follow or ExciseRadiological InterpretationCalcificationHyperdense or High signalSeptationsEnhancementMultiloculatedNodularityWall thickeningRole of BiopsyDr Bosniaks opinionBosniak Classification of Renal Cystic Disease Even on gross examination a cystic renal cell carcinom

2、a(left)may be indistinguishable from a complicated cyst(right)Ignore,Follow or ExciseRenal cysts can be classified according to the Bosniak classification depending on their features.Type Icysts are simple cysts.Type IIare the minimally complicated cysts.Type I and II can be ignored.Type II Fare pro

3、bably benign,but need to be followed.Type III and IVboth are surgical lesions.Type IV is inevitably malignant and in the type III group about 80-90%turn out to be malignant as well.In our communication with the clinicians it is important,that we explain the significance of our findings and the meani

4、ng of the classification in terms of:Ignore(type I and II),Follow(type IIF)or Excise(type III and IV).So in this lecture we will only talk about Ignore,Follow or Excise.For those who want to see the original Bosniak classification,look at the table which is presented at the end of the lecture.Radiol

5、ogical Interpretation Although the final differentiation of cystic renal masses is based upon histologic diagnosis,there are imaging findings that tell you that a cyst is not a simple cyst and whether it is probably benign or malignant.The following imaging features indicate that a cyst is NOT simpl

6、e:-Calcification-Hyperdense/high signal-Septations-Multiple locules-Enhancement-Nodularity/wall thickening Differentiation is based upon histologic diagnosis,but Imaging is a reliable means for differentiating benign from malignant cystic lesions The table on the left summarises these imaging featur

7、es together with the management consequences:Ignore,Follow or Excise.When we look at these imaging features,we have to realise,that the most worrisome portion of a cystic mass should be used in deciding appropriate management.So when the findings are discordant either within one examination or using

8、 different radiological examinations,the lesion should be managed based upon the most aggressive imaging findings.When we look at the table on the left,we can say that we are pretty good with the first 3 parameters(calcification,hyperdens and septations),because we are correct in about 95%of the cas

9、es.The other four are even more easy,because when you have any of these(enhancement,multiloculated,nodularity or wall thickening),the lesion is almost always a surgical lesion.Regarding follow up,there are no rules at the moment.One could do a follow up at 6 months and if the lesion is stable then d

10、ouble the follow up time.We will now discuss all these imaging features in detail.Calcification The most important thing is a good description of the type of calcifications.We can ignore small amounts of calcification that are smooth,septal or if it is milk of calcium,which moves to the lowest point

11、 with positional changes.We have to make sure,that no enhancement(=All lesions that show enhancement and lesions with wall thickening or nodularity of the wall outside the calcifications should be excised.We can follow lesions with thick or nodular calcification without any enhancement.Benign calcif

12、ications:small punctate and milk of calcium.Ignore On the left we see a cystic lesion.There is a small punctate calcification that we can ignore.On the bottom of the cyst there is a layer of calcium typical for milk of calcium.This is also a benign calcification that we can ignore.LEFT:NECT with a s

13、mooth linear calcification and nodular calcification.RIGHT:Enhanced CT shows enhancement.Excise On the left a patient with nefrolithiasis.There is also a cystic lesion with linear and nodular calcification.If there were only these linear calcifications we could ignore the lesion.In case of nodular c

14、alcification we can follow it,if there is no enhancement.In this case however we see enhancement,so this lesion has to be excised.On CT hyperdense means:20 HU on a NECTOn MRI hyperintense means all that has higher signal intensity than water on a T1 weighted image.Hyperdensity or hyperintensity usua

15、lly indicates hemorrhage or high protein content of the cyst.Ignore all lesion with sharp margins;lesions On US they have to be clearly cysticFollow all lesions that are totally intrarenal,because you can not appreciate the wall and follow all lesions 3 cm,because there is at the moment not much exp

16、erience with these lesions.All these lesions must show no enhancement.Excise all lesions that are poorly defined or heterogenous or show enhancement.Also when ultrasound shows that the lesion is solid,the lesion should be excised.HyperdenseorHighsignalLEFT:NECT shows a lesion with a density of 27 HU.IgnoreRIGHT:MRI shows a intrarenal lesion that is hyperintense on T1:higher signal than water.Follow On the left we see a hyperdens cystic lesion on CT and a hyperintense lesion on a T1-weighted MR.B

展开阅读全文
相关资源
猜你喜欢
相关搜索

当前位置:首页 > 医学/心理学 > 儿科学

copyright@ 2008-2023 yzwku网站版权所有

经营许可证编号:宁ICP备2022001189号-2

本站为文档C2C交易模式,即用户上传的文档直接被用户下载,本站只是中间服务平台,本站所有文档下载所得的收益归上传人(含作者)所有。装配图网仅提供信息存储空间,仅对用户上传内容的表现方式做保护处理,对上载内容本身不做任何修改或编辑。若文档所含内容侵犯了您的版权或隐私,请立即通知装配图网,我们立即给予删除!