What is the role of angiography in 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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Answer

With the availability of noninvasive procedures such as Doppler imaging and MRA, angiography is now rarely used in the diagnosis and staging of Wilms tumors. Tortuous tumor vessels of a spider-leg nature may be seen, and large tumors may have collateral circulation from adjacent lumber vessels. The extent of neovascularity helps in planning the preoperative assessment of the tumor.

Rosch et al used sequential angiography to evaluate 6 children with solid abdominal malignancies with sequential angiography [44] and found that angiography was valuable for demonstrating the tumor, as well as its location, extent, vascular characteristics, regression, and recurrence. Wilms tumors and neuroblastomas responded well to irradiation and chemotherapy by substantially shrinking, with regression or disappearance of its neovasculature. Resection of the tumors revealed that these effects were due to tumor necrosis, hemorrhage, and/or cystic degeneration.

Albert and Petty reported a case of spontaneous renal hemorrhage [45] that appeared to be polyarteritis nodosa on arteriography but turned out to be a malignant process. This case stresses the overlapping angiographic appearances of the 2 disease processes and emphasizes the need for tissue diagnosis because radiographic findings may not be as specific as reported.


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