الفهرس 
Introduction.Only 14 pages are availabe for public view
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Abstract
The kidneys are paired, retroperitoneal, solid organs. They act as the organs of urinary excretion and play a central role in fluid and electrolyte balance. They are mobile and their positions change with respiration. They are supplied by the renal arteries that leave the aorta at right angle at the level of L2. Many neoplastic conditions affect the kidneys and result in change in their sizes and have mass effects or disrupt the normal renal outlines. These conditions include: (1) Benign masses: angiomyolipoma, adenoma, oncocytoma, reninoma, haemangioma, fibroma, lipoma, and myoma. (2) Malignant masses: renal cell carcinoma, Wilm’s tumor, transitional cell carcinoma, metastasis lymphoma, and sarcoma. Out of 30 patients included in this study, they were 19 males and 11 females, with mean age 64 years (range of 12 - 80 years). Prior to performing CT examination, all patients were subjected to the following: 1- Clinical examination (including the complaint of abdominal swellings, hematuria, dysuria, pyuria, weight loss or fever) and through physical examination (general and local examinations). 2- Laboratory investigation including urine analysis (for blood cells and pus) and serum analysis (for kidney functions: urea and creatinine) and liver functions, as well as other related investigations as serum sugar in diabetic patients. 3- 3-Preliminary imaging investigation (Ultrasonography, intravenous urography or both modalities) All patients underwent multiphasic CT scanning for the kidneys and urinary tract following a present scanning protocol that included unenhanced, corticomedullary phase, nephrographic phase, and excretory phase scanning. Out of 30 patients with renal masses, 19 renal mass were malignant and 11 were benign, these results were determined by true cut needle biopsy, total surgical nephrectomy, partial surgical nephrectomy, therapeutic tests, CT follow up, and other supportive investigation. By further analysis of age and sex distribution of malignant and benign renal masses we found that, malignancy was higher in patient group 51-60 years representing 90% of masses found in this group followed by those of ≥ 61years with malignant masses representing 62.5% of masses found in this age group. We could not relay on the size of masses as a feature for differentiating malignant from benign renal masses as malignancy was found in nearly all the size groups. Regarding the enhancement of renal masses, 19 masses representing 63.3% of the examined masses were heterogeneous of which all were found malignant showing sensitivity for malignancy of 100 % and specificity of 100%, 3 masses were homogenous representing 10 % of the examined masses with a sensitivity of 100% for benign, Among the examined 30 masses 13 masses representing 43.3% of the examined masses showed an ill-defined margin with a sensitivity of 100% for being malignant, while 17 masses representing 56.6% showed a well-defined margin. Of those masses with well-defined margins 11 were benign; however a well-defined margin didn’t exclude the presence of malignancy as 6 malignant masses representing 31.5% of the diagnosed malignant masses were found to have well-defined margins. Among the examined 30 masses, no calcification were detected in 16 masses representing 53.3%, nevertheless 6 masses were malignant representing 37.5 % of masses in this group and calcification were detected in 14 masses, 13 masses were benign will one mass were benign, Associated metastatic lymph nodes were found in 8 patients representing 26.6 % of the examined masses, with a sensitivity of 100% for malignancy, however, absence of associated metastatic lymph nodes did not exclude the presence of malignancy, and associated renal vein and IVC thrombosis were found in 4 patients representing 14 % of the examined masses, with a sensitivity of 100% for malignancy. Associated local fat infiltration were found in 6 patients representing 20% of the examined masses, with a sensitivity of 100% for malignancy, Final diagnosis of 30 renal masses achieved by different final methods (Total and partial surgical nephrectomy and histopathological examination, true cut needle biopsy, therapeutic tests and CT follow up), out of 30 renal masses, malignant were 19 cases, out of 19 malignant masses RCC were representing 84.2%, and 5 of benign masses were simple renal cyst representing 45.4% of Benign masses, these diagnoses were achieved by MDCT fining and associated investigations and follow up. In conclusion Multidetector computerized tomography is highly sensitive, specific and accurate modality in the evaluation of renal masses. MDCT can differentiate between malignant and benign masses, not only but also have high sensitivity in characterization of malignant and benign mass, so we recommend MDCT examination in all patients with suspected renal mass as routine investigation.