Differentiation of renal angiomyolipoma without visible fat from small clear cell renal cell carcinoma by using specific region of interest on contrast-enhanced CT: a new combination of quantitative tools

Xu Wang,Haitao Jiang,Ge Song

doi:10.1186/s40644-021-00417-3

Abstract

BackgroundTo investigate the value of using specific region of interest (ROI) on contrast-enhanced CT for differentiating renal angiomyolipoma without visible fat (AML.wovf) from small clear cell renal cell carcinoma (ccRCC).MethodsFour-phase (pre-contrast phase [PCP], corticomedullary phase [CMP], nephrographic phase [NP], and excretory phase [EP]) contrast-enhanced CT images of AML.wovf (n = 31) and ccRCC (n = 74) confirmed by histopathology were retrospectively analyzed. The CT attenuation value of tumor (AVT), net enhancement value (NEV), relative enhancement ratio (RER), heterogeneous degree of tumor (HDT) and standardized heterogeneous ratio (SHR) were obtained by using different ROIs [small: ROI (1), smaller: ROI (2), large: ROI (3)], and the differences of these quantitative data between AML.wovf and ccRCC were statistically analyzed. Multivariate regression was used to screen the main factors for differentiation in each scanning phase, and the prediction models were established and evaluated.ResultsAmong the quantitative parameters determined by different ROIs, the degree of enhancement measured by ROI (2) and the enhanced heterogeneity measured by ROI (3) performed better than ROI (1) in distinguishing AML.wovf from ccRCC. The receiver operating characteristic (ROC) curves showed that the area under the curve (AUC) of RER_CMP (2), RER_NP (2) measured by ROI (2) and HDT_CMP and SHR_CMP measured by ROI (3) were higher (AUC = 0.876, 0.849, 0.837 and 0.800). Prediction models that incorporated demographic data, morphological features and quantitative data derived from the enhanced phase were superior to quantitative data derived from the pre-contrast phase in differentiating between AML.wovf and ccRCC. Among them, the model in CMP was the best prediction model with the highest AUC (AUC = 0.986).ConclusionThe combination of quantitative data obtained by specific ROI in CMP can be used as a simple quantitative tool to distinguish AML.wovf from ccRCC, which has a high diagnostic value after combining demographic data and morphological features.

Highlights

Renal tumors with a diameter of 4 cm or less are usually called small renal tumors in clinical practice [1]
The combination of quantitative data obtained by specific region of interest (ROI) in contrast administration by applying bolus tracking (CMP) can be used as a simple quantitative tool to distinguish AML.wovf from clear cell renal cell carcinoma (ccRCC), which has a high diagnostic value after combining demographic data and morphological features
The results showed that gender, pseudocapsule sign, angular interface and AVT_PCP (1) were the main factors for differentiating AML.wovf and ccRCC in Pre-contrast phase (PCP) (P < 0.05); gender, cystic degeneration, RER_CMP (2) and SHR_CMP were the main factors for differentiating two tumors in CMP (P < 0.05); gender, pseudocapsule sign, RER_NP (2) and HDT_NP were the main factors for differentiating two tumors in Nephrographic phase (NP) (P < 0.05); gender, angular interface, RER_EP (2) and SHR_EP were the main factors for differentiating two tumors in Excretory phase (EP) (P < 0.01) (Table 4)

Summary

Introduction

Renal tumors with a diameter of 4 cm or less are usually called small renal tumors in clinical practice [1]. For most AMLs, visible fat can be detected on CT or MR [6], but for about 5% of AMLs that have less than 10% fat component, the fat is difficult to detect with imaging, and these are called angiomyolipoma without visible fat (AML.wovf) or angiomyolipoma with minimal fat [7,8,9]. This type of AML is radiologically prone to misdiagnosed as ccRCC which could lead to major treatment and outcome differences. To investigate the value of using specific region of interest (ROI) on contrast-enhanced CT for differentiating renal angiomyolipoma without visible fat (AML.wovf) from small clear cell renal cell carcinoma (ccRCC)

Methods

Results

Discussion

Conclusion