| Kidney cancer, also known as renal cell carcinoma (RCC), is the most common malignant tumor of adult kidneys. Surgery operation is the one of the primary means of treating renal cell carcinoma,and it is also the only way to cure kidney cancer. As a kind of mini-invasive surgery, with the advantage of less trauma and fewer complications, laparoscopic nephron sparing surgery (LNSS) can miximize to protect the kidney. Thus, it has been recognized by the urology field and widely applied in the clinical operations. Because LNSS for renal cell carcinoma is complex and difficult to handle, it is required to have accurate preoperative evaluation. However, traditional imaging methods in the application of LNSS preoperative evaluation have some limitations. MSCT can continuously collect data within a certain volume at a fast speed, and then conduct a variety of 3D post-processing based on the volume data. Therefore, the evaluation can be done by MSCT about anatomical structure of kidney vessels, kidney tumor and contralateral kidney. However, most domestic literatures are concentrated on the assessment of renal vascular anatomy, only a few are involved in the research of comprehensive Preoperative evaluation.Objective: studying the practical application of MSCT to the preoperative evaluation in laparoscopic nephron sparing surgery for renal cell carcinoma, and providing much more valuable information for choosing the appropriate clinical plans and taking the responding surgical measures.Subjects and Methods: Triphasic spiral CT scan was performed on 40 patients(including: 25 males and 15 females;range of age: 7~82 years old; average age: 57.2 years old)who have pathologically turned out to suffer from renal cell carcinoma at T1a stage during the period from June, 2009 to January, 2011. The subjects included 37 patients suffering from clear cell carcinoma RCC, 2 from papillary RCC, 1 from multilocular cystic RCC, 19 from Left kidney cancer, and 21 from right kidney cancer.All subjects had experienced the enhanced preoperative MSCT examination before the radical nephrectomy by the Siemens 64-slice spiral CT. And all of them had fasted for 6-8 hours before the examination and been scanned by taking the supine posture. The scan was done at one time during the period from the inhale to breath-hold, ranging from the top of the diaphragm to the iliac crest level. The venous channel was established through the antecubital vein by means of non-ionic contrast media ultavist or omnipaque, whose iodine content is 300mg/l and total dose is 80-100ml, and then was injected by automatic high pressure injector at a speed of 4.0ml/s. The data recorded after injection for cortical phase, parenchymal phase, renal pelvis secretory phase were respectively 29s,64s and 180s. The slice thickness was 5mm, and slice distance was also 5mm. The original scanning data was reconstructed with 1mm thickness and transmitted to the workstation (ADW4.2), and then conducted the post-processing of multiplanar reconstruction (MPR), maximum intensity projection (MIP), volume rendering (VR) . Through the axial images and a variety of post-processing images,the assessment indicators of Kidney cancer patients were observed: vascular anatomy of the kidney, kidney tumor-related conditions (size, location, depth of invasion of renal parenchyma, the syntagmatic relations between renal collecting system and the surrounding blood vessels.etc) and the contralateral kidney-related conditions (gross anatomy, functional state and comorbidities situations. etc). MSCT evaluation index data were compared with the data seen from general surgery and pathology in the operation, and were analyzed statistically by SPSS11.5 statistical analysis software. The paper aims at evaluating the consistency between the MSCT evaluation and the results from the corresponding gross pathology after operation and (or) from the surgery operation.Results: Firstly, after MSCT assessment on vascular anatomy to all the kidneys was compared with the intraoperative findings one by one in detail, MSCT evaluation was completely consistent with the intraoperative findings, and the accuracy was 100%. Total variance rate of renal artery anatomy was 62.5%. Secondly, MSCT measurements of tumor size were respectivley compared with the measured data from gross pathology, and conducted the statistical analysis by paired"t"test. The result was P > 0.05, indicating that the MSCT measurements and pathologic measurements were no statistical difference. MSCT assessments on tumor location were compared with gross pathology specimens and intraoperative findings, MSCT findings and the gross pathology specimens and intraoperative findings were exactly consistent, and the accuracy was 100%. MSCT assessments teams on the depth of tumor invasion of renal parenchyma, and on the syntagmatic relations betweeen the surrounding blood vessels and renal collecting system, were compared with group findings from gross pathology specimens and (or) from surgery operation. The statistics showed that the corresponding results were quite consistent (Kappa =0.949,0.872, 0.936) . Thirdly, the general anatomy of the contralateral kidney: One case in the research was found suffering from RCC in lower pole of right kidney and absent left kidney by MSCT enhanced examination. The other cases had no clear abnormalities and congenital variations in the CT gross anatomy examination on contralateral kidney, and the results were conformed to other relevant examination. The functional state of the contralateral kidney: Three cases were found abnormal in size, shape and degree of enhancement. In them, the first one was found that the contralateral kidney was obviously atrophic and small and its degree of enhancement was reduced. The second was found that the shape of kidney was irregular with multiple patchy low-density enhancement area, and its degree of enhancement was significantly uneven. The third was found that degree of enhancement was apparently reduced with the renal accumulation of water. The rest cases had no abnormalities in size, shape and degree of enhancement by CT examination. However, three of them were found suffering from mild renal impairment by other comprehensive examination. Therefore, the accuracy of CT examination in examining renal function abnormal was only 50% in this research. Contralateral kidney combined with diseases: In the 39 contralateral kidneys (one of them was conducted radical nephrectomy due to renal cell carcinoma), 17 were not found other diseases. 22 were comined with one or several diseases: mainly with the renal cyst (16 cases), kidney calculi (5 cases), renal artery calcification (6 cases), renal artery stenosis (2 cases), and hydronephrosis (1 case), etc.Conclusion: As a non-invasive,comprehensive, efficient and accurate imaging method, MSCT can combine the fast volume scanning with intravenous injection of contrast agent and the computer-aided image post-processing. With the"one-stop"examination, MSCT can conduct a comprehensive evaluation for preoperative laparoscopic nephron sparing surgery. It has high clinical value to guide doctors in making the appropriate choice for clinical surgical indications, assessing accurately the difficult of operation, and laying the detailed and feasible operational plan.
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