Purpose: We investigate the use of ratio of lesion to cortex (L/C) attenuation and aorta–lesion attenuation difference (ALAD) on multiphase contrast-enhanced CT to help distinguish oncocytoma from clear cell RCC in small renal masses (diameter < 4 cm). Methods: We retrospectively identified 76 patients that undergo CT before surgery for a suspicious small renal mass between January 2014 and December 2018 with pathological diagnosis of 21 oncocytomas (ROs), 25 clear cell RCCs, 7 chromophobe RCCs, 7 papillary RCCs, 7 multilocular cystic RCCs, 7 angiomyolipomas and 2 leiomyomas. CT attenuation values were obtained for the tumor, the normal renal cortex and the aorta, placing a circular region of interest (ROI) in the same slice by two radiologists, independently. Results: In the corticomedullary phase, ROs showed isodense enhancement to the renal cortex (ratio L/C 0.92 ± 0.12), while clear cell RCCs appeared hypodense to the renal cortex (ratio L/C 0.69 ± 0.20; p < 0.01) with an accuracy of 80% for diagnosing RO. In nephrographic phase, the ratio L/C attenuation was lower than the corticomedullary phase in ROs (0.78 ± 0.11) showing an early washout pattern, while the ratio L/C was similar to the corticomedullary phase in clear cell RCCs (0.69 ± 0.13; p = 0.025, with an accuracy of 65% for diagnosing RO). The ratio L/C attenuation showed considerable overlap between ROs and clear cell RCCs in the excretory phase (p = 0.27). Mean ALAD values in the nephrographic phase were 21.95 ± 16.24 for ROs and 36.96 ± 30.53 for clear cell RCCs (p = 0.049). Conclusion: The ratio L/C attenuation in corticomedullary phase may be useful to differentiate RO from clear cell RCC.

Small renal masses (≤ 4 cm): differentiation of oncocytoma from renal clear cell carcinoma using ratio of lesion to cortex attenuation and aorta–lesion attenuation difference (ALAD) on contrast-enhanced CT / Gentili, F.; Bronico, I.; Maestroni, U.; Ziglioli, F.; Silini, E. M.; Buti, S.; de Filippo, M.. - In: LA RADIOLOGIA MEDICA. - ISSN 0033-8362. - 125:12(2020), pp. 1280-1287. [10.1007/s11547-020-01199-7]

Small renal masses (≤ 4 cm): differentiation of oncocytoma from renal clear cell carcinoma using ratio of lesion to cortex attenuation and aorta–lesion attenuation difference (ALAD) on contrast-enhanced CT

Bronico I.;Maestroni U.;Ziglioli F.;Silini E. M.;Buti S.;de Filippo M.
2020-01-01

Abstract

Purpose: We investigate the use of ratio of lesion to cortex (L/C) attenuation and aorta–lesion attenuation difference (ALAD) on multiphase contrast-enhanced CT to help distinguish oncocytoma from clear cell RCC in small renal masses (diameter < 4 cm). Methods: We retrospectively identified 76 patients that undergo CT before surgery for a suspicious small renal mass between January 2014 and December 2018 with pathological diagnosis of 21 oncocytomas (ROs), 25 clear cell RCCs, 7 chromophobe RCCs, 7 papillary RCCs, 7 multilocular cystic RCCs, 7 angiomyolipomas and 2 leiomyomas. CT attenuation values were obtained for the tumor, the normal renal cortex and the aorta, placing a circular region of interest (ROI) in the same slice by two radiologists, independently. Results: In the corticomedullary phase, ROs showed isodense enhancement to the renal cortex (ratio L/C 0.92 ± 0.12), while clear cell RCCs appeared hypodense to the renal cortex (ratio L/C 0.69 ± 0.20; p < 0.01) with an accuracy of 80% for diagnosing RO. In nephrographic phase, the ratio L/C attenuation was lower than the corticomedullary phase in ROs (0.78 ± 0.11) showing an early washout pattern, while the ratio L/C was similar to the corticomedullary phase in clear cell RCCs (0.69 ± 0.13; p = 0.025, with an accuracy of 65% for diagnosing RO). The ratio L/C attenuation showed considerable overlap between ROs and clear cell RCCs in the excretory phase (p = 0.27). Mean ALAD values in the nephrographic phase were 21.95 ± 16.24 for ROs and 36.96 ± 30.53 for clear cell RCCs (p = 0.049). Conclusion: The ratio L/C attenuation in corticomedullary phase may be useful to differentiate RO from clear cell RCC.
2020
Small renal masses (≤ 4 cm): differentiation of oncocytoma from renal clear cell carcinoma using ratio of lesion to cortex attenuation and aorta–lesion attenuation difference (ALAD) on contrast-enhanced CT / Gentili, F.; Bronico, I.; Maestroni, U.; Ziglioli, F.; Silini, E. M.; Buti, S.; de Filippo, M.. - In: LA RADIOLOGIA MEDICA. - ISSN 0033-8362. - 125:12(2020), pp. 1280-1287. [10.1007/s11547-020-01199-7]
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11381/2885705
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