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Small renal masses (≤ 4 cm): differentiation of oncocytoma from renal clear cell carcinoma using ratio of lesion to cortex attenuation and aorta-lesion attenuation difference (ALAD) on contrast-enhanced CT.
- Source :
-
La Radiologia medica [Radiol Med] 2020 Dec; Vol. 125 (12), pp. 1280-1287. Date of Electronic Publication: 2020 May 08. - Publication Year :
- 2020
-
Abstract
- Purpose: We investigate the use of ratio of lesion to cortex (L/C) attenuation and aorta-lesion attenuation difference (ALAD) on multiphase contrast-enhanced CT to help distinguish oncocytoma from clear cell RCC in small renal masses (diameter < 4 cm).<br />Methods: We retrospectively identified 76 patients that undergo CT before surgery for a suspicious small renal mass between January 2014 and December 2018 with pathological diagnosis of 21 oncocytomas (ROs), 25 clear cell RCCs, 7 chromophobe RCCs, 7 papillary RCCs, 7 multilocular cystic RCCs, 7 angiomyolipomas and 2 leiomyomas. CT attenuation values were obtained for the tumor, the normal renal cortex and the aorta, placing a circular region of interest (ROI) in the same slice by two radiologists, independently.<br />Results: In the corticomedullary phase, ROs showed isodense enhancement to the renal cortex (ratio L/C 0.92 ± 0.12), while clear cell RCCs appeared hypodense to the renal cortex (ratio L/C 0.69 ± 0.20; p < 0.01) with an accuracy of 80% for diagnosing RO. In nephrographic phase, the ratio L/C attenuation was lower than the corticomedullary phase in ROs (0.78 ± 0.11) showing an early washout pattern, while the ratio L/C was similar to the corticomedullary phase in clear cell RCCs (0.69 ± 0.13; p = 0.025, with an accuracy of 65% for diagnosing RO). The ratio L/C attenuation showed considerable overlap between ROs and clear cell RCCs in the excretory phase (p = 0.27). Mean ALAD values in the nephrographic phase were 21.95 ± 16.24 for ROs and 36.96 ± 30.53 for clear cell RCCs (p = 0.049).<br />Conclusion: The ratio L/C attenuation in corticomedullary phase may be useful to differentiate RO from clear cell RCC.
- Subjects :
- Adenoma, Oxyphilic pathology
Adult
Aged
Angiomyolipoma diagnostic imaging
Carcinoma, Papillary diagnostic imaging
Carcinoma, Papillary pathology
Carcinoma, Renal Cell pathology
Contrast Media
Diagnosis, Differential
Female
Humans
Kidney Neoplasms pathology
Leiomyoma diagnostic imaging
Male
Middle Aged
Preoperative Period
Radiographic Image Enhancement
Retrospective Studies
Tumor Burden
Adenoma, Oxyphilic diagnostic imaging
Aorta diagnostic imaging
Carcinoma, Renal Cell diagnostic imaging
Kidney Cortex diagnostic imaging
Kidney Neoplasms diagnostic imaging
Tomography, X-Ray Computed methods
Subjects
Details
- Language :
- English
- ISSN :
- 1826-6983
- Volume :
- 125
- Issue :
- 12
- Database :
- MEDLINE
- Journal :
- La Radiologia medica
- Publication Type :
- Academic Journal
- Accession number :
- 32385827
- Full Text :
- https://doi.org/10.1007/s11547-020-01199-7