• Korean Journal of Radiology
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• 제24권10호
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• pp.1017-1027
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• 2023

Objective: The assessment of cortical integrity following renal injuries with planar Tc-99m dimercaptosuccinic acid (DMSA) scintigraphy depends on measuring relatively decreased cortical uptake (i.e., split renal function [SRF]). We analyzed the additive values of the volumetric and quantitative analyses of the residual cortical integrity using single-photon emission computed tomography (SPECT) compared to the planar scintigraphy. Materials and Methods: This prospective study included 47 patients (male:female, 32:15; age, 47 ± 22 years) who had non-operatively managed renal injuries and underwent DMSA planar and SPECT imaging 3-6 months after the index injury. In addition to planar SRF, SPECT SRF, cortical volume, and absolute cortical uptake were measured for the injured kidney and both kidneys together. The correlations of planar SRF with SPECT SRF and those of SRF with volumetric/quantitative parameters obtained with SPECT were analyzed. The association of SPECT parameters with renal function, grades of renal injuries, and the risk of renal failure was also analyzed. Results: SPECT SRF was significantly lower than planar SRF, with particularly higher biases in severe renal injuries. Planar and SPECT SRF (dichotomized with a cutoff of 45%) showed 19%-36% of discrepancies with volumetric and quantitative DMSA indices (when dichotomized as either high or low). Absolute cortical uptake of the injured kidney best correlated with glomerular filtration rate (GFR) at follow-up (ρ = 0.687, P < 0.001) with significant stepwise decreases by GFR strata (90 and 60 mL/min/1.73 m²). Total renal cortical uptake was significantly lower in patients with moderate-to-high risk of renal failure than those with low risk. However, SRF did not reflect GFR decrease below 60 mL/min/1.73 m² or the risk of renal failure, regardless of planar or SPECT (count- or volume-based SRF) imaging. Conclusion: Quantitative measurements of renal cortical integrity assessed with DMSA SPECT can provide more clinically relevant and comprehensive information than planar imaging or SRF alone.

• Asian Pacific Journal of Cancer Prevention
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• 제15권18호
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• pp.7821-7824
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• 2014

Background: We investigated the correlation between standardized uptake value (SUVmax), tumor size and Fuhrman grade in patients with renal cell carcinoma (RC). Materials and Methods: We retrospectively analyzed the data of 54 patients with clear cell renal cell carcinoma histopathologically diagnosed who underwent fluorine-18 fluoro-2 deoxyglucose positron emission tomography/computed tomography (F-18 FDG PET/CT) between January 2005 and March 2014. Results: Avarage tumor sizes were $5.64{\pm}1.85$, $6.85{\pm}2.24$ and $7.98{\pm}2.45$ in low, medium and high SUVmax groups, respectively. The Spearman's correlation coefficient between the tumor size and SUVmax was 0.385 (p=0.004) and between the Fuhrman grade and SUVmax was 0.578 (p<0.001). Conclusions: SUVmax appears highly correlated with tumor size and Fuhrman grade in patients with histopathologically confirmed clear cell RC. Multicenter studies are needed to provide larger series for more accurate results.

• Clinical and Experimental Pediatrics
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• 제54권5호
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• pp.212-218
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• 2011

Purpose: The diagnosis of acute pyelonephritis (APN) is often difficult, as its clinical and biological manifestations are non-specific in children. If not treated quickly and adequately, however, APN may cause irreversible renal damage, possibly leading to hypertension and chronic renal failure. We were suspecting the diagnostic value of $^{99m}Tc$-dimercaptosuccinic acid (DMSA) scan by experiences and so compared the results of DMSA scan to those of multi-detector row computed tomography (MDCT). Methods: We retrospectively selected and analyzed 81 patients who were diagnosed as APN by MDCT during evaluation of their acute abdomen in emergency room and then received DMSA scan also for the diagnostic work-up of APN after admission. We evaluated the results of imaging studies and compared the diagnostic value of each method by age groups, <2 years (n=45) and ${\geq}$2 years (n=36). Results: Among total 81 patients with MDCT-proven APN, DMSA scan was diagnostic only in 55 children (68%), while the remaining 26 children (32%) showed false negative normal findings. These 26 patients were predominantly male and most of them, 19 (73.1%) were <2 years of age. Conclusion: DMSA scan holds obvious limitation compared to MDCT in depicting acute inflammatory lesions of kidney in children with APN, especially in early childhood less than 2 years of age. MDCT showed hidden lesions of APN, those were undetectable through DMSA scan in children.

• 한국임상수의학회지
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• 제37권4호
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• pp.231-234
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• 2020

An 11-year-old, 4.3 kg, mixed breed, intact female dog exhibiting vomiting and a reduced appetite was presented. On physical examination, palpation of the right kidney elicited discomfort. Blood analysis revealed leukocytosis with neutrophilia, and elevation of alkaline phosphatase and blood urea nitrogen. Escherichia coli was detected in urine culture, whereas urine analysis showed absence of glucose. Radiography and ultrasonography suggested that there was gas in the right renal parenchyma, and computed tomography was performed while the dog was awake to investigate the suspected gas in the right kidney. After unilateral ureteronephrectomy, a histological diagnosis of right emphysematous pyelonephritis (EPN) was made. EPN refers to a severe necrotizing infection of the renal parenchyma with gas accumulation in the tissue. It is rare in both human and veterinary medicine, and almost all EPN patients have uncontrolled diabetes mellitus. This case report describes the imaging-based diagnosis of a rare occurrence of unilateral EPN in a non-diabetic dog.

• Journal of Trauma and Injury
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• 제30권4호
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• pp.192-196
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• 2017

Purpose: Blunt injury accounts for 80-95% of renal injury trauma in the United States. The majority of blunt renal injuries are low grade and 80-85% of these injuries can be managed conservatively. However, there is a debate on the management of patients with high-grade renal injury. We reviewed our experience of renal trauma at our trauma center to assess management strategy for high-grade blunt renal injury. Methods: We reviewed blunt renal injury cases admitted at a single trauma center between August 2007 and December 2015. Computed tomography (CT) scan was used to diagnose renal injuries and high-grade (according to the American Association for the Surgery of Trauma [AAST] organ injury scale III-V) renal injury patients were included in the analysis. Results: During the eight-year study period, there were 62 AAST grade III-V patients. 5 cases underwent nephrectomy and 57 underwent non-operative management (NOM). There was no difference in outcome between the operative group and the NOM group. In the NOM group, 24 cases underwent angioembolization with a 91% success rate. The Incidence of urological complications correlated with increasing grade. Conclusions: Conservative management of high-grade blunt renal injury was considered preferable to operative management, with an increased renal salvage rate. However, high-grade injuries have higher complication rates, and therefore, close observation is recommended after conservative management.

• 대한수의학회지
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• 제41권3호
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• pp.421-427
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• 2001

개에서 실험적으로 편측성 신수종증을 유발한 후, 이오헥솔-에탄올 용액을 신장동맥내로 주입하여 신수종증이 유발된 신장으로의 혈류를 차단하는 신동맥 색전술을 실시하고, 선택적 동맥촬영술, 조영증강 전산화 단층촬영, 이용하여 색전술이 실시된 신수종증의 신장과 반대편 정상신장을 평가하고자 본 실험을 실시하였다. 실험적 수신증은 2두의 비글견의 편측 근위 요관을 이중결찰하여 유발하였으며 개에서 요관 결찰 17일째에 편측성 수신증이 유발되었음을 확인할 수 있었다. 신장동맥 색전술은 2두의 신수종증이 유발된 신장측의 신장동맥에 대퇴동맥을 통하여 선택적으로 카테터를 삽입한 후 이오헥솔-에탄올 용액을 주입하였으며, 시술 중 심전도, 산소포화도, 체온, 맥박, 호흡수는 모두 정상범위에 있었다. 신장동맥 색전술 후 사망한 개체는 없었으며, 색전물질의 유출로 인한 부작용도 관찰할 수 없었다. 색전술 직후 그리고 14일째에 실시한 선택적 동맥촬영술을 통하여 색전술을 시행한 2두의 개의 신장동맥에서 재맥관화가 발생하지 않았음을 확인할 수 있었다. 실험군의 2두와 대조군의 1두에서 실시한 전산화단층촬영상에서는 색전술 실시 후 14일째에 실험군과 대조군의 신장의 신우부가 확장되고 확장된 신장에 의해 비장이 복측으로 변위된 것을 확인할 수 있었으며, 색전술 실시 후 두 달째의 소견에서는 색전된 신장의 크기가 감소한 것을 확인할 수 있었다. 조영제 증강 전산화단층촬영에서는 색전술을 실시하지 않은 신장피질의 신호강도가 증가하는 것을 관찰할 수 있었으나, 색전술을 실시한 신장피질의 신호강도는 증가하지 않았다. 따라서, 조영 증강 전산화 단층촬영은 개의 수신증에 실시한 신장동맥 색전술 후의 신장동맥의 재맥관화를 평가할 수 있는 유용한 검사법으로 사료된다.

• Journal of Trauma and Injury
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• 제23권1호
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• pp.29-37
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• 2010

Purpose: Controversy exists regarding whether pediatric blunt abdominal trauma patients with microscopic hematuria should undergo radiographic evaluation. Adult patients have indications such as shock and deceleration injury. This study was conducted to suggest indications for the use of CT to detect significant renal injury in pediatric blunt abdominal trauma patients with microscopic hematuria. Methods: From January 2005 to December 2009, patients less than 18 years of age with blunt abdominal trauma and microscopic hematuria who had undergone CT were included in this retrospective study. We analyzed the correlation between microscopic hematuria, shock, deceleration injury, and American Association for the Surgery of Trauma (AAST) renal injury grade. Patients were divided into two groups: the insignificant renal injury group (AAST grade 1) and the significant renal injury group (AAST grades 2-5). We compared age, gender, mechanism of injury, degree of microscopic hematuria, evidence of shock, presence of deceleration injury, and associated injuries between the two groups. We analyzed the effect of each of the above each factors on renal injury by using a logistic regression analysis. Results: Forty-three children were included, and the median age was 15 years. Five children had a significant renal injury. No significant differences, except age and microscopic hematuria (more than 30 red blood cells per high power field (RBC/HPF), p = 0.005) existed between the insignificant and the significant injury groups. A positive correlation existed between renal injury and microscopic hematuria (rho = 0.406, p = 0.007), but renal injury was not correlated with shock and deceleration injury. In the multivariate regression analysis, microscopic hematuria was the only factor correlated with renal injury (p = 0.042). Conclusion: If a microscopic hematuria of more than 30 RBC/HPF exists, the use of CT should be considerd, regardless of shock and deceleration injury to detect significant renal injury in pediatric blunt abdominal trauma patients.

• 대한영상의학회지
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• 제82권5호
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• pp.1292-1296
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• 2021

신장의 유상피 혈관근지방종은 혈관근지방종의 드문 변이형으로 현저한 유상피세포로 구성되어 있다. 유상피 혈관근지방종은 일반적으로 종양 내부의 출혈과 다양한 정도의 괴사 혹은 낭성 변화를 동반한 크기가 큰 불균일한 연조직 종괴로 나타난다. 우리는 64세 여성에서 발견된 신세포암으로 오인된 다방성 낭종 형태의 신장의 유상피 혈관근지방종에 대해 발표하려 한다. 낭종 내 다량의 출혈, 조영 전 검사에서 고음영의 벽과 격막, 그리고 비대된 종괴 내혈관들이 신세포암을 감별하는 데 있어 도움이 될 수 있다.

• Journal of Trauma and Injury
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• 제19권2호
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• pp.192-195
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• 2006

Degenerative vascular disease, previous arterial surgery, long-term ureteral stenting, pelvis surgery, and radiotheraphy are reported as causes of artery-to-collecting-system communication.. Artery-to-collecting-system- communication associated with blunt trauma is rare, but potentially fatal. The diagnosis is very difficult and requires a high degree of suspicion. We were able to make the diagnosis based on the characteristic finding of contrast-enhanced computed tomography (CT) obtained in the early phase, equivalent to the finding obtained in the corticomedullary phase of the kidney. We report a case of artery to collecting system communication due to blunt abdominal trauma following a fall, which was treated by embolization.

• Journal of Trauma and Injury
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• 제35권3호
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• pp.181-188
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• 2022

Purpose: Inferior vena cava (IVC) collapse is related to hypovolemia. Sonography has been used to measure the IVC diameter, but there is variation depending on the skill of the operator and it is difficult to obtain accurate measurements in patients who have a large amount of intestinal gas or are obese. As a modality to obtain accurate measurements, we measured the diameters of the IVC and aorta on trauma computed tomography scans and investigated the correlation between the IVC to aorta ratio and the shock index in blunt trauma patients. Methods: We retrospectively analyzed the medical records of 588 trauma patients who were transferred to the regional trauma center (level 1) of Wonkang University Hospital from March 2020 to February 2021. We included trauma patients 18 years or older who met the trauma activation criteria and underwent trauma computed tomography scans with intravenous contrast within 40 minutes of admission. The shock index was calculated from vital signs before trauma computed tomography scan, and measurements of the anteroposterior diameter of the IVC (AP), the transverse diameter of the IVC (T), and aorta were made 10 mm above the right renal vein in the venous phase. Results: Overall, 271 patients were included in this study, of whom 150 had a shock index ≤0.7 and 121 had a shock index >0.7. The T to AP ratio and AP to aorta ratio were significantly different between groups. Cutoffs were identified for the T to AP ratio and AP to aorta ratio (2.37 and 0.62, respectively) that produced clinically useful sensitivity and specificity for predicting a shock index >0.7, demonstrating moderate accuracy (T to AP ratio: area under the curve, 0.71; sensitivity, 59%; specificity, 87% and AP to aorta ratio: area under the curve, 0.70; sensitivity, 55%; specificity, 91%). Conclusions: The T to AP ratio and AP to aorta ratio are useful for predicting hemorrhagic shock in trauma patients.