European Journal of Radiology 63 (2007) 295–301 Computed tomography of renal cell carcinoma in patients with terminal renal impairment Jiˇ r´ ı Ferda a,* , Milan Hora b , Ondˇ rej Hes c , Tom´ aˇ s Reischig d , Boris Kreuzberg a , Hynek M´ ırka a , Eva Ferdov´ a a , Krist ´ yna Ohl´ ıdalov´ a a , Jan Baxa a , Tom´ aˇ s Urge b a Department of Radiology, Charles University Hospital Plzeˇ n, Alej Svobody 80, CZ-306 40 Plze ˇ n, Czech Republic b Department of Urology, Charles University Hospital Plzeˇ n, Dr. Edvarda Beneˇ se 13, CZ-306 40 Plze ˇ n, Czech Republic c Institut of Pathology, Charles University Hospital Plzeˇ n, Alej Svobody 80, CZ-306 40 Plze ˇ n, Czech Republic d Department of Internal Medicine, Nephrology Unit, Charles University Hospital Plzeˇ n, Alej Svobody 80, CZ-306 40 Plze ˇ n, Czech Republic Received 12 January 2007; accepted 19 January 2007 Abstract Purpose: An increased incidence of renal tumors has been observed in patients with end-stage-renal-disease (ESRD). The very strong association with acquired renal cystic disease (ACRD) and increased incidence of the renal tumors (conventional renal cell carcinoma (CRCC), papillary renal cell carcinoma (PRCC) or papillary renal cell adenoma (PRCA)) was reported. This study discusses the role of computed tomography (CT) in detecting renal tumors in patients with renal impairment: pre-dialysis, those receiving dialysis or with renal allograft transplants. Materials and methods: Ten patients (nine male, one female) with renal cell tumors were enrolled into a retrospective study; two were new dialysis patients, three on long-term dialysis, and five were renal transplant recipients with history of dialysis. All patients underwent helical CT, a total of 11 procedures were performed. Sixteen-row detector system was used five times, and a 64-row detector system for the six examinations. All patients underwent nephrectomy of kidney with suspected tumor, 15 nephrectomies were performed, and 1 kidney was assessed during autopsy. CT findings were compared with macroscopic and microscopic assessments of the kidney specimen in 16 cases. Results: Very advanced renal parenchyma atrophy with small cysts corresponding to ESRD was found in nine patients, chronic pyelonephritis in remained one. A spontaneously ruptured tumor was detected incidentally in one case, patient died 2 years later. In the present study, 6.25% (1/16) were multiple PRCA, 12.5% (2/16) were solitary PRCC, 12.5% tumors (2/16) were solitary conventional renal cell carcinomas (CRCC’s), 12.5% tumors (2/16) were multiple conventional renal cell carcinomas (CRCC’s), 25% (4/16) were CRCC’s combined with multiple papillary renal cell carcinomas with adenomas (PRCC’s and PRCA’s), and 25% (4/16) of the tumors were multiple PRCC’s combined with PRCA’s without coexisting CRCC’s. Bilateral renal tumors were found in our study in 60% (6/10) confirmed in six cases, one kidney left on follow-up due to the small tumors. Conclusions: With the use of a multi-detector row system, it is possible to detect smaller foci suspected to originate in multiple tumors, especially when up to 3-mm thin multi-planar reconstructions are used. Two cases demonstrated the possibility the development of RCC in impaired kidneys may start before dialysis initiation. © 2007 Elsevier Ireland Ltd. All rights reserved. Keywords: Computed tomography; Renal impairment; Hemodialysis; Kidney; Renal cell carcinoma 1. Introduction An increased incidence of renal tumors has been reported in patients with end-stage-renal-disease (ESRD) [1,2]. Renal cell Abbreviations: Tx, renal allograft transplantation; CRCC, conventional renal cell carcinoma; PRCC, papillary renal cell carcinoma; PRCA, papillary renal cell adenoma * Corresponding author. Tel.: +420 377103436; fax: +420 377103438. E-mail address: ferda@fnplzen.cz (J. Ferda). carcinoma (RCC) presents with a frequency three to six times higher in patients receiving dialysis than in the general pop- ulation [1,2]. Observations provide histological evidence that renal cell neoplasms are prone to develop in relatively young renal failure patients when their uremia is treated by long-term dialysis. The studies further indicate that the stimulus for neo- plastic growth accompanies with cystic transformation of the kidneys [2,3]. A very strong association with acquired renal cys- tic disease (ACRD) and an increased incidence of papillary renal tumors was observed in many studies. ARCD develops in about 0720-048X/$ – see front matter © 2007 Elsevier Ireland Ltd. All rights reserved. doi:10.1016/j.ejrad.2007.01.027