Follow-up of Wilms tumor: comparison of CT with other imaging procedures

In a retrospective review, computed tomography (CT) was compared to a "routine" combination of other diagnostic imaging procedures used for follow-up evaluations of 13 children being treated for Wilms tumor. The examined variables were diagnostic accuracy, expense, and duration of examination. Results from 13 patients indicated that CT most accurately answers diagnostic queries pertinent to follow-up evaluation of Wilms tumor: the presence and extent of bilateral renal tumors, local recurrence, contralateral renal hypertrophy, and metastasis to liver or lungs, For diagnosing pulmonary metastases, CT was superior to conventional chest radiography both in sensitivity (4/4 vs. 2/4) and specificity (9/9 vs. 6/9). In depiction of liver metastases, CT (3/3) was superior to liver scintigraphy (2/3). The extent of bilateral Wilms tumors was better defined by CT than by urography. In no instances were the alternative diagnostic imaging studies found to be more accurate than CT for detection of recurrent tumor. Average cost for a CT examination ($344) is considerably less than the cost for a routine combination of the other imaging studies ($594). Examination time and diagnostic radiation does are also reduced using CT. Pending larger comparison studies, CT is recommended as the primary diagnostic method for follow-up evaluation of patients with Wilms tumor.
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