Abstract | OBJECTIVE: MATERIALS AND METHODS: Our study cohort included all pathologically proven solid renal masses that underwent pretreatment four-phase MDCT at our institution from 2001 to 2012. Both retrospective qualitative analysis (blinded dual-radiologist evaluation of morphologic features: enhancement pattern, lesion contour, neovascularity, and calcification) and quantitative analysis (mean absolute and relative attenuation and changes in attenuation across phases) were performed. ANOVA with post-hoc analysis, Pearson chi-square tests, and ROC analysis were used. RESULTS: One hundred fifty-six consecutive patients (99 men, 57 women) with a mean age of 62.7 years (range, 26-91 years) had 165 solid renal masses (median size, 3.0 cm): 86 clear cell RCCs, 36 papillary RCCs, 10 chromophobe RCCs, 23 oncocytomas, and 10 lipid-poor angiomyolipomas. Kappa for interradiologist agreement regarding morphologic features was 0.33-0.76. There were significant associations between histologic subtype and enhancement pattern (p < 0.001), lesion contour (p < 0.014), and neovascularity (p < 0.001). Clear cell RCC had the highest mean relative corticomedullary attenuation (p < 0.02). Clear cell RCC had greater deenhancement than oncocytoma (p < 0.001); deenhancement less than 50 HU or relative corticomedullary attenuation greater than 0% differentiated clear cell RCC from oncocytoma with a positive predictive value of 90%. Lipid-poor angiomyolipoma had the highest mean absolute unenhanced attenuation (p < 0.01); absolute unenhanced attenuation greater than 45 HU and relative corticomedullary attenuation less than 10% differentiated lipid-poor angiomyolipoma from clear cell RCC with a negative predictive value of 97%. CONCLUSION: Four-phase MDCT renal attenuation profiles enable differentiation of clear cell RCC from other solid renal cortical masses, most notably papillary RCC and lipid-poor angiomyolipoma.
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Authors | Stephanie A Lee-Felker, Ely R Felker, Nelly Tan, Daniel J A Margolis, Jonathan R Young, James Sayre, Steven S Raman |
Journal | AJR. American journal of roentgenology
(AJR Am J Roentgenol)
Vol. 203
Issue 5
Pg. W516-24
(Nov 2014)
ISSN: 1546-3141 [Electronic] United States |
PMID | 25341166
(Publication Type: Journal Article)
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Topics |
- Adult
- Aged
- Aged, 80 and over
- Algorithms
- Carcinoma, Renal Cell
(diagnostic imaging)
- Cohort Studies
- Diagnosis, Differential
- Female
- Humans
- Kidney Neoplasms
(diagnostic imaging)
- Male
- Middle Aged
- Multidetector Computed Tomography
(methods)
- Observer Variation
- Radiographic Image Enhancement
(methods)
- Radiographic Image Interpretation, Computer-Assisted
(methods)
- Reproducibility of Results
- Sensitivity and Specificity
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