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Abstract
Background and objectives: The use of non-invasive techniques to predict the histological type of renal masses can avoid a renal mass biopsy, thus being of great clinical interest. The aim of our study was to assess if quantitative multiphasic multidetector computed tomography (MDCT) enhancement patterns of renal masses (malignant and benign) may be useful to enable lesion differentiation by their enhancement characteristics. Materials and Methods: A total of 154 renal tumors were retrospectively analyzed with a four-phase MDCT protocol. We studied attenuation values using the values within the most avidly enhancing portion of the tumor (2D analysis) and within the whole tumor volume (3D analysis). A region of interest (ROI) was also placed in the adjacent uninvolved renal cortex to calculate the relative tumor enhancement ratio. Results: Significant differences were noted in enhancement and de-enhancement (diminution of attenuation measurements between the postcontrast phases) values by histology. The highest areas under the receiver operating characteristic curves (AUCs) of 0.976 (95% CI: 0.924–0.995) and 0.827 (95% CI: 0.752–0.887), respectively, were demonstrated between clear cell renal cell carcinoma (ccRCC) and papillary RCC (pRCC)/oncocytoma. The 3D analysis allowed the differentiation of ccRCC from chromophobe RCC (chrRCC) with a AUC of 0.643 (95% CI: 0.555–0.724). Wash-out values proved useful only for discrimination between ccRCC and oncocytoma (43.34 vs 64.10, p < 0.001). However, the relative tumor enhancement ratio (corticomedullary (CM) and nephrographic phases) proved useful for discrimination between ccRCC, pRCC, and chrRCC, with the values from the CM phase having higher AUCs of 0.973 (95% CI: 0.929–0.993) and 0.799 (95% CI: 0.721–0.864), respectively. Conclusions: Our observations point out that imaging features may contribute to providing prognostic information helpful in the management strategy of renal masses.
Highlights
The incidence of renal cell carcinoma (RCC) varies widely from region to region, with the highest rates being observed in the Czech Republic and North America [1]
Our findings show that the relative tumor enhancement ratio was significantly in the CM phase between clear cell renal cell carcinoma (ccRCC) and papillary RCC (pRCC) (0.97 vs. 0.02, p < 0.001), and chromophobe RCC (chrRCC), respectively (0.97 vs. 0.36, p < 0.001), and in the NP phase between ccRCCs and pRCCs (0.57 vs. 0.01, p = 0.003), and chrRCCs, respectively (0.57 vs. 0.34, p = 0.024)
Like the studies conducted by Bird et al [17] and Zhang et al [18], we found that after contrast administration, oncocytoma showed the highest enhancement change, and among the subtypes of RCC, ccRCC displayed the highest enhancement, whereas chrRCC enhanced moderately and pRCC
Summary
The incidence of renal cell carcinoma (RCC) varies widely from region to region, with the highest rates being observed in the Czech Republic and North America [1]. 2016 World Health Organization classification of RCCs [2], the major subtypes are clear cell RCC (ccRCC), papillary RCC (pRCC), and chromophobe RCC (chrRCC), which comprise 65–70%, 15–20%, and 5–7% of all RCCs, respectively. Enhancement patterns of renal masses (malignant and benign) may be useful to enable lesion differentiation by their enhancement characteristics. The highest areas under the receiver operating characteristic curves (AUCs) of 0.976 (95% CI: 0.924–0.995) and 0.827 (95% CI: 0.752–0.887), respectively, were demonstrated between clear cell renal cell carcinoma (ccRCC) and papillary RCC (pRCC)/oncocytoma. The relative tumor enhancement ratio (corticomedullary (CM) and nephrographic phases) proved useful for discrimination between ccRCC, pRCC, and chrRCC, with the values from the CM phase having higher AUCs of 0.973 (95% CI: 0.929–0.993) and 0.799 (95% CI: 0.721–0.864), respectively
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