Comparison of Segmental Enhancement Inversion on Biphasic MDCT Between Small Renal Oncocytomas and Chromophobe Renal Cell Carcinomas

Abstract

The purpose of this article is to assess the usefulness of segmental enhancement inversion on biphasic MDCT in differentiating small (<4 cm) renal oncocytomas from chromophobe renal cell carcinomas (CRCCs). Eighty-two patients (40 men and 42 women) with a mean (±SD) age of 54±12 years (range, 21-75 years) with 27 renal oncocytomas and 55 CRCCs diagnosed by surgery who underwent contrast-enhanced biphasic CT between January 2000 and December 2011 were included. CT scans were interpreted by two radiologists who were blinded to the pathologic findings. The tumors were evaluated for size and segmental enhancement inversion. After independent evaluation, a consensus was reached by measuring the attenuation. Pathologic analysis determined the presence of fibrous septa, cystic change, hemorrhage, and necrosis. The Fisher exact test was used to evaluate the relationship between segmental enhancement inversion, tumor type, and specific pathologic changes. Interobserver concordance was evaluated with kappa statistics. There were no significant differences in size between renal oncocytomas and CRCCs (p=0.458). Segmental enhancement inversion was present in 23, 20, and 21 (25.6%) of the 82 tumors according to reader 1, reader 2, and the consensus, respectively. The agreement was almost perfect (κ=0.843; p<0.001). Segmental enhancement inversion was more common in renal oncocytomas (63% [17/27]) than in CRCCs (7.3% [4/55]; p<0.001). There were no significant relationships between the four pathologic changes and tumor type or segmental enhancement inversion (p=0.351 and p=0.126, respectively). Our study findings suggest that segmental enhancement inversion on biphasic MDCT may be useful in differentiating small renal oncocytomas from CRCCs.