Abstract
ObjectiveTo discuss the dual energy spectral computer tomography (CT) imaging features of the pathological grading of clear cell renal cell carcinoma (ccRCC) and the correlation between spectral CT imaging features and pathology.Materials and methodsWe performed analyses of 62 patients with confirmed diagnosis of ccRCC. All patients underwent non-enhanced CT and dual-phase (cortex phase, CP and parenchyma phase, PP) contrast-enhanced CT with dual energy spectral mode. The subjects were pathologically divided into two groups: low-grade group (Fuhrman 1/2) and high-grade group (Fuhrman 3/4). The CT value of each lesion was measured on the monochromatic image at 70 keV. The normalized iodine concentrations (NIC) and the slope of the spectrum curve were calculated. The qualitative morphological parameters, including tumor shape, calcification, pseudocapsule, necrosis, and enhancement mode, were compared between the two groups. The quantitative data were compared using Student’s t-test, and the enumeration data were analyzed using the chi-square test between low-grade and high-grade ccRCC.Receiver operating characteristic curve was used to determine the sensitivity and specificity of the quantitative parameters in two groups.ResultsThe CT value, NIC, and mean slope of the low-grade group were increased compared with the high-grade group during CP (P = 0.001, P = 0.043, and P<0.001, respectively). The CT did not differ significantly during PP (P = 0.134); however, the NIC and mean slope varied considerably in the low grade compared with the high-grade group (P = 0.048, P = 0.017, respectively). The CT threshold value, NIC, and slope had high sensitivity and specificity in differentiating low-grade ccRCC from high-grade ccRCC. The tumor shape, pseudocapsule, and necrosis differed significantly between the two groups (P<0.05).ConclusionsDual energy spectral CT with the quantitative analysis of iodine concentration and qualitative analysis of morphological characteristics increases the accuracy of diagnosing the pathological grade of ccRCC.
Highlights
Renal cell carcinoma (RCC) is the most common primary malignant tumor of the kidney and accounts for approximately 85–90% of malignant kidney tumors
The computer tomography (CT) value, normalized iodine concentrations (NIC), and mean slope of the low-grade group were increased compared with the high-grade group during cortex phase (CP) (P = 0.001, P = 0.043, and P
The CT did not differ significantly during parenchyma phase (PP) (P = 0.134); the NIC and mean slope varied considerably in the low grade compared with the high-grade group (P = 0.048, P = 0.017, respectively)
Summary
Renal cell carcinoma (RCC) is the most common primary malignant tumor of the kidney and accounts for approximately 85–90% of malignant kidney tumors. Clear cell renal cell carcinoma (ccRCC) is the most common subtype of RCC, accounting for approximately 70% of cases[1]. Given the high morbidity and mortality of ccRCC[2], an earlier diagnosis and treatment is essential for improving patient survival and quality of life. CcRCC is divided into 1–4 grades according to Fuhrman nuclear grade. To increase the reproducibility and reduce the intra-/inter-observer variability, 4-tiered Fuhrman grading system can be merged into simplified 2-tiered system: grade 1and 2 as low grade (well-differentiated tumors), and grade 3 and 4 as high grade (poorly differentiated tumors), which performed to the prognostic ability of the traditional[4]. To evaluate the malignant degree of RCC and to select the operation scheme, preoperative pathological classification of RCC is of vital importance
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