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Published on: December 4, 2016
Magnetic resonance imaging characteristics and changes in hemostatic agents after partial nephrectomy
Erdem Kisa1, Hilal Sahin2, Ozgür Cakmak3
1Department of Urology, Tepecik Training and Research Hospital, Güney Mahallesi, 1140/1. Sk. No:1, Yenişehir, Konak, 35180, Izmir, Turkey. drerdemkisa@hotmail.com.
Purpose:
To evaluate the characteristics of images generated by magnetic resonance imaging (MRI) and changes in the mass-like lesion (MLL) during the follow-up of patients who underwent partial nephrectomy (PN) with the intra-operative use of hemostatic agents (HAs).
Methods:
The records of patients who had undergone PN in our clinic due to renal mass between January 2013 and August 2018 were retrospectively reviewed. Our study included 47 patients who were administered one or more HAs during the PN and who received diffusion and dynamic MRI at the post-operative 2nd/4th Queryand 12th month.
Results:
MLL is defined as T2 heterogeneous, intermediate-signal intensity bolster-related mass with a pseudocapsule in the renal parenchymal defect. When we looked at the morphological changes of MLL, the mean largest axial dimensions of masses were 27.3 (range 12.2-44.7) mm in the first follow-up period (2nd/4th months) and 21.2 (range 11-44.7) mm in the 12th month follow-up period. The average change in size of MLL was - 0.66 mm/month. We did not see any significant relationship between observation of MLL in the post-operative follow-up MRI images and the use of HAs such as Surgicel®, Spongostan®, and autologous fatty tissue as well as the amount of the agents used in PN operations (p = 0.405, p = 0.159, respectively).
Conclusions:
The distinction of MLL causing bolster-related mass and granulomatosis tissue from relapse/recurrence can be made based on the change in mass size observed in the MR images and image characteristics.
Insights
Mass-like lesions (MLL) after partial nephrectomy (PN) with hemostatic agents (HAs) shrink over time on MRI. This imaging follow-up helps distinguish MLL from tumor recurrence.
Area of Science:
- Radiology
- Urologic Oncology
- Surgical Innovation
Background:
- Partial nephrectomy (PN) is a standard treatment for renal masses.
- Intra-operative hemostatic agents (HAs) are frequently used during PN to control bleeding.
- Post-operative imaging may reveal mass-like lesions (MLL) that require careful evaluation.
Purpose of the Study:
- To characterize magnetic resonance imaging (MRI) findings of MLL after PN.
- To assess the changes in MLL size during post-operative follow-up.
- To evaluate the relationship between HA use and MLL development.
Main Methods:
- Retrospective review of 47 patients who underwent PN with HA use.
- Analysis of diffusion and dynamic MRI scans at 2-4 and 12 months post-operatively.
- Morphological assessment of MLL, including size and signal characteristics.
Main Results:
- MLLs were defined as heterogeneous, intermediate-signal intensity masses with a pseudocapsule.
- MLLs demonstrated a decrease in size over the follow-up period (mean change -0.66 mm/month).
- No significant correlation was found between HA type/amount and MLL observation.
Conclusions:
- MLLs following PN with HAs typically show size reduction on serial MRI.
- Imaging characteristics and size changes aid in differentiating MLL from tumor recurrence.
- The use of specific hemostatic agents does not appear to influence MLL formation.
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