Which modalities are preferred for Wilms tumor imaging?

Updated: Mar 04, 2019
  • Author: Ali Nawaz Khan, MBBS, FRCS, FRCP, FRCR; Chief Editor: Eugene C Lin, MD  more...
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Although modern imaging techniques such as color Doppler sonography, helical or multidetector-row CT, and MRI have substantially improved the potential to image Wilms tumors, definitive diagnosis is still based on histology. Children presenting with abdominal masses initially undergo ultrasonography scanning, usually in combination with chest radiography. Initial diagnosis of a Wilms tumor is generally based on ultrasonography supplemented with Doppler ultrasound because inferior vena cava (IVC) tumoral thrombi are occasionally missed on CT; missing these thrombi can lead to a fatal outcome at surgery. [8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19]  If a Wilms tumor is suspected or if the primary tumor is histologically confirmed, it should be staged by using CT or MRI. The tumors may be large, and their size may make it difficult to identify its renal origin on sonograms. Therefore, CT and MRI may be useful for distinguishing between renal tumors and adrenal tumors. Radiologists prefer chest CT over chest radiography to stage the spread of disease to the thorax.

In a study of ultrasound and laboratory findings in Wilms tumor survivors with a solitary kidney, signs of kidney damage were seen in 22 of 53 (41.5%) patients on ultrasonography. The most frequently detected abnormalities were hyperechoic rings around renal pyramids (28.3% of patients). Hypertrophy of the solitary kidney occurred in 71,7% of cases. [20]

Conventional radiography is inexpensive and noninvasive; however, it has low sensitivity and specificity. A chest radiograph may miss lung metastases. Regarding CT and MRI, sedation or general anesthesia may be required. MRI is expensive and has certain contraindications; for example, claustrophobia may be a problem. Neither CT nor MRI is tissue specific, and tissue diagnosis may be required. Bone scintigraphic studies are highly sensitive but lack specificity.

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