Differentiation of Renal Clear Cell Carcinoma and Renal Papillary Carcinoma Using Quantitative CT Enhancement Parameters

Ruppert-Kohlmayr, A.; Uggowitzer, M.; Meißnitzer, Thomas; Ruppert, Georg S.

doi:10.2214/ajr.183.5.1831387

Cited by 136 publications

(70 citation statements)

References 21 publications

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“…Ruppert-Kohlmayr et al (19) assessed 89 ccRCCs and 16 pRCCs by exclusion of intrinsic factors (e.g., cardiac function, intravenous access, amount of contrast material, weight and size of the patient, blood viscosity) and confirmed-similar to our findings-that there are significant enhancement differences in the corticomedullary and nephrographic phases between the two tumor types if standardized attenuation measurements are used. In the corticomedullary phase, attenuation values of ccRCC were significantly higher (152.6±35.4 HU) than those of pRCC (61.8±24.4 HU; P < 0.05).…”

Section: Discussionsupporting

confidence: 88%

Clear cell renal cell carcinoma and papillary renal cell carcinoma: differentiation of distinct histological types with multiphase CT

Bata

Gyebnar

Tárnoki

et al. 2013

Diagn Interv Radiol

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ABDOMINAL IMAGINGORIGINAL ARTICLE PURPOSE Conventional clear cell renal cell carcinoma (ccRCC) and papillary renal cell carcinoma (pRCC) have different behavioral characteristics and clinical management strategies (nephrectomy vs. nephron-sparing surgery). Our aim was to retrospectively evaluate the contrast enhancement pattern of ccRCC and pRCC and evaluate its possible diagnostic role for preoperative differentiation using a standardized protocol. MATERIALS AND METHODSQuadriphasic multidetector computed tomography (CT) images (unenhanced, corticomedullary, nephrographic, and excretory phases) of 19 patients with 20 ccRCC and 14 patients with 15 pRCC lesions (mean ages, 62.3±14.1 and 61.4±13.7 years, respectively) were reviewed retrospectively. The attenuation characteristics were compared with the attenuation of the normal renal cortex using either multiple 10 mm 2 regions of interest or whole tumor attenuation measurements. The degree of contrast enhancement was also compared. RESULTSUnivariate analysis revealed that ccRCC lesions showed higher mean attenuation values on the corticomedullary and nephrographic phases compared with pRCC masses (P < 0.05) using both measurement techniques. CONCLUSIONThe findings underscore the importance of multiphase CT in the differentiation of these two subtypes of RCC using standard assessment techniques. The measurement of the degree of enhancement on contrast-enhanced multidetector CT may be a simple and useful method to radiologically differentiate between the two histological types of RCC.

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Section: Discussionsupporting

confidence: 88%

Clear cell renal cell carcinoma and papillary renal cell carcinoma: differentiation of distinct histological types with multiphase CT

Bata

Gyebnar

Tárnoki

et al. 2013

Diagn Interv Radiol

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“…A potential alternative to increased use of biopsy might lie in the use of diagnostic imaging to characterize renal cortical tumors on the basis of their tissue composition, morphologic features, and/or contrast enhancement patterns (21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32). Doppler ultrasonography, contrast material-enhanced computed tomography, and magnetic resonance (MR) imaging have shown potential for enabling differentiation of clear cell renal carcinomas (which show increased vascular flow and enhance avidly) from papillary and chromophobe carcinomas (which show reduced vascular flow and less enhancement) (21)(22)(23)(24)(26)(27)(28)).…”

Section: Discussionmentioning

confidence: 99%

“…Doppler ultrasonography, contrast material-enhanced computed tomography, and magnetic resonance (MR) imaging have shown potential for enabling differentiation of clear cell renal carcinomas (which show increased vascular flow and enhance avidly) from papillary and chromophobe carcinomas (which show reduced vascular flow and less enhancement) (21)(22)(23)(24)(26)(27)(28)). Yet despite the encouraging early results, imaging diagnosis and particularly differentiation of benign and malignant histologic subtypes of renal cortical tumors remains problematic, and further studies with multiple independent readers are needed to assess the diagnostic performance of imaging in this clinical context.…”

Section: Discussionmentioning

confidence: 99%

“…In keeping with these changes in clinical management, the role of imaging has also been evolving from detection and staging to better characterization of renal cortical tumors. With the aim of supplementing established imaging criteria based on morphologic features, the vascularity and contrast enhancement features of renal cortical tumors have been investigated for their potential to help identify specific histologic subtypes of these tumors (21)(22)(23)(24)(26)(27)(28)). An analysis by Sun et al (28) of MR images from two postcontrast time points (corticomedullary and nephrographic phases) yielded findings similar to ours; specifically, the analysis found that contrast enhancement was greatest in clear cell carcinomas, intermediate in chromophobe carcinomas, and lowest in papillary carcinomas.…”

Section: Genitourinary Imaging: Renal Cortical Tumorsmentioning

confidence: 99%

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Renal Cortical Tumors: Use of Multiphasic Contrast-enhanced MR Imaging to Differentiate Benign and Malignant Histologic Subtypes

Vargas

Chaim²,

Lefkowitz³

et al. 2012

Radiology

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Purpose:To investigate the use of quantitative multiphasic contrast material-enhanced magnetic resonance (MR) imaging in differentiating between common benign and malignant histologic subtypes of renal cortical tumors. Materials and Methods:The institutional review board waived informed consent and approved this retrospective HIPAA-compliant study of 138 patients who underwent preoperative contrastenhanced MR imaging during the period of January 2004-December 2008. At surgery, 152 renal tumors were identified (77 clear cell, 22 papillary, 18 chromophobe, and 10 unclassified carcinomas; 16 oncocytomas; nine angiomyolipomas). Three readers independently identified and measured the most-enhanced area in each tumor and placed corresponding regions of interest in similar positions on images from the precontrast, corticomedullary, nephrographic, and excretory phases. The percentage change in signal intensity (%SI change) between precontrast imaging and each postcontrast phase was calculated.Interreader agreement was evaluated by using the overall concordance correlation coefficient (OCC). A linear mixed-effects model was used to estimate and compare the trajectories of the means of log %SI change across all phases between the six histologic subtypes. results:Interreader agreement was substantial to almost perfect (OCC, 0.77-0.88). The %SI change differed significantly between clear cell carcinomas and papillary and chromophobe carcinomas in all phases of enhancement (P , .0001-.0120). In addition, %SI change was significantly higher in angiomyolipomas than in clear cell carcinomas, but only in the corticomedullary phase (P = .0231). Enhancement did not differ significantly between clear cell carcinoma and oncocytoma in any phase (P = .2081-.6000). conclusion:Quantitative multiphase contrast-enhanced MR imaging offers a widely available, reproducible method to characterize several histologic subtypes of renal cortical tumors, although it does not aid differentiation between clear cell carcinomas and oncocytomas.q RSNA, 20121 From the Departments of Radiology (H

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“…[10] Ninety percent of clear cell RCCs are hypervascular with a heterogeneous enhancing pattern of mixed enhancing solid soft tissue components and low attenuation necrotic or cystic areas. [11,12] Clear cell carcinomas can be predominantly cystic. Renal vein tumour thrombus can be seen with aggressive higher stage tumours.…”

Section: Class IVmentioning

confidence: 99%

Ct Evaluation and C Haracterization of Renal Masses

Dongre¹,

Rangankar²,

Singh³

2015

jemds

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CONTEXT/BACKGROUND: The detection rate of renal masses has increased in the last decades owing to the widespread use of CT and MRI. [1] Therefore, an accurate characterization of renal masses is essential to ensure appropriate case management. This study was done to evaluate and characterize renal masses on CT for early and prompt management. AIMS: To detect the presence of solid renal masses on CT and to characterize them into benign and malignant masses with histopathological correlation. To assess the diagnostic accuracy of CT in distinguishing between benign and malignant lesions. SETTINGS AND DESIGN: A prospective study of 60 subjects was carried out from those referred to the Department of Radiodiagnosis for CT evaluation and characterization of renal masses after being clinically suspected or incidentally detected on other imaging studies. METHODS AND MATERIAL:The patients were subjected to contrast enhanced helical CT. The CT findings were correlated with the surgical or histological findings or the therapeutic response in the case of inflammatory lesions. STATISTICAL ANALYSIS: It was done using sensitivity, specificity positive predictive value and negative predictive value. CT diagnosis was compared with histopathological diagnosis, which was considered as the gold standard. RESULTS: Neoplastic lesions were observed in 42 cases (70%) cases and inflammatory lesions in 9 cases (15%). Renal cell carcinoma was observed in 27 cases, Wilm's tumour in 6, oncocytoma in 3 cases and angiomyolipoma in 6 patients. The inflammatory renal lesions observed were focal pyelonephritis in 4, renal abscesses in 4 and emphysematous pyelonephritis in 1. CONCLUSION: This study concludes that contrast enhanced spiral CT is sensitive as well as specific not only to diagnose neoplastic renal mass lesions but also to diagnose other non-neoplastic renal mass lesions. HOW TO CITE THIS ARTICLE:Aditi H. Dongre, Varsha P. Rangankar , Hariqbal Singh. "CT Evaluation and Characterization of Renal

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Differentiation of Renal Clear Cell Carcinoma and Renal Papillary Carcinoma Using Quantitative CT Enhancement Parameters

Cited by 136 publications

References 21 publications

Clear cell renal cell carcinoma and papillary renal cell carcinoma: differentiation of distinct histological types with multiphase CT

Clear cell renal cell carcinoma and papillary renal cell carcinoma: differentiation of distinct histological types with multiphase CT

Renal Cortical Tumors: Use of Multiphasic Contrast-enhanced MR Imaging to Differentiate Benign and Malignant Histologic Subtypes

Ct Evaluation and C Haracterization of Renal Masses

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