Computed tomography angiogram: accuracy in renal surgery.

OBJECTIVES: To determine the sensitivity and specificity of computed tomography angiogram (CTA) in detecting number and location of renal arteries and veins as well as crossing vessels causing uretero-pelvic junction obstruction (UPJO), and to determine if this can be used in decision-making algorithms for treatment of UPJO. METHODS: A prospective study was carried out in patients undergoing open, laparoscopic and robotic renal surgery from April 2005 until October 2006. All patients were imaged using CTA with 1.25 collimation of arterial and venous phases. Each multi-detector CTA was then read by one radiologist and his results were compared prospectively with the actual intra-operative findings. RESULTS: Overall, 118 patients were included. CTA had 93% sensitivity, 77% specificity and 90% overall accuracy for detecting a single renal artery, and 76% sensitivity, 92% specificity and 90% overall accuracy for detecting two or more renal arteries (Pearson chi(2) = 0.001). There was 95% sensitivity, 84% specificity and 85% overall accuracy for detecting the number of renal veins. CTA had 100% overall accuracy in detecting early dividing renal artery (defined as less than 1.5 cm branching from origin), and 83.3% sensitivity, specificity and overall accuracy in detecting crossing vessels at UPJ. The percentage of surgeons stating CTA to be helpful as pre-operative diagnostic tool was 85%. CONCLUSION: Computed tomography angiogram is simple, quick and can provide an accurate pre-operative renal vascular anatomy in terms of number and location of renal vessels, early dividing renal arteries and crossing vessels at UPJ.

Radiological response in Saudi patients undergoing transarterial chemoembolization for hepatocellular carcinoma.

BACKGROUND: Hepatocellular carcinoma (HCC) is the second commonest cancer affecting males and the eighth most common one affecting females in Saudi Arabia. Transarterial chemoembolization (TACE) is currently considered the first line therapy for multifocal HCC in selected patients. OBJECTIVE: To evaluate HCC response to TACE based on triphasic computerized tomography (CT) of the liver obtained 6 weeks after the procedure. MATERIALS AND METHODS: A retrospective chart review of 15 patients who underwent TACE in King Khalid University Hospital for unresectable HCC. Patients were staged according to the Child-Pugh, Okuda, and CLIP scoring systems. The first triphasic CT of the liver after TACE was evaluated for Lipiodol uptake and interval change in tumor burden. RESULTS: The mean age was 63 years (40-82), 10 were males (66.7%), and five were females. About 11 patients had cirrhosis (73.3%). Eight patients (53.3%) were Child-Pugh class A while seven (46.7%) were Child-Pugh class B. One patient died and two were lost to follow up. Four patients had a complete response to TACE (26.7%), two had a partial response (13.3%), five showed no change (33.3%) and none showed progression of disease. Tumoral Lipiodol uptake in five patients was> 75% (33.3%), in two 75-50% (13.3%) while in four patients it was < 50% (26.7%). CONCLUSION: Our results show that TACE is an effective method of reducing the tumor burden in selected patients with unresectable HCC.