Is a single portal venous phase in contrast-enhanced CT sufficient to detect metastases or recurrence in clear cell renal cell carcinoma? - a single-center retrospective study

• Published in: Cancer imaging 2022-01, Vol.22 (1), p.9-9, Article 9
• Main Authors: Hagen, Florian, Peisen, Felix, Spogis, Jakob, Mair, Antonia, Nikolaou, Konstantin, Stenzl, Arnulf, Kruck, Stephan, Bedke, Jens, Kaufmann, Sascha, Thaiss, Wolfgang M
• Format: Article
• Language: English
• Subjects: Abdomen; Accuracy; Aged; Agreements; Arterial contrast phase; Carcinoma, Renal cell; Carcinoma, Renal Cell - diagnostic imaging; Computed tomography; Contrast Media; Criteria; CT imaging; Datasets; Diseases; Evaluation; Female; Health aspects; Histology; Humans; Image quality; Interreader-agreement; Kidney cancer; Kidney Neoplasms - diagnostic imaging; Lymphatic system; Magnetic resonance imaging; Medical imaging; Medical research; Medicine, Experimental; Metastasis; Middle Aged; Patients; Pelvis; Portal Vein; Portal venous contrast phase; Povidone; Reading; Relapse; Renal cell carcinoma; Retrospective Studies; Sensitivity; Thorax; Tomography; Tomography, X-Ray Computed
• ISSN: 1470-7330; 1740-5025; 1470-7330
• DOI: 10.1186/s40644-022-00444-8

This study aims at describing the imaging features of the metastatic presentation of clear cell renal cell carcinoma (ccRCC) in arterial (AP) and portal venous phase (PVP) of contrast-enhanced-computed-tomography (CECT) during clinical follow-up (FU) and to evaluate the necessity of a dual phase approach for metastasis detection. We identified a total of 584 patients that were diagnosed with ccRCC between January 2016 and April 2020. Inclusion criteria were histologically proven ccRCC with metastatic spread, proven by histology or interim follow-up of at least 2 years and follow-up CT examination with AP and PVP CECT including thorax/abdomen and pelvis. Exclusion criteria were defined by missing or incomplete CT-scans or lack of sufficient follow-up. CT studies of 43 patients with histologically proven ccRCCs were analyzed in retrospect. AP and PVP images were analyzed by two radiologists for metastases, two additional independent radiologists analyzed PVP images only. A 5-point Likert scale was used to evaluate the likelihood off the presence of metastasis. Imaging patterns of the metastases were analyzed visually. 43 patients (16 female; mean age: 67±10 years) with recurrent ccRCC and metastatic disease were included. Three imaging patterns were observed (solid, heterogeneous or cystic metastases), which rarely exhibited calcifications (2%). All metastases showed hyperenhancement in AP and PVP. Inter-reader agreement was substantial (Fleiss' κ 0.6-0.8, p