Multiphasic Enhancement Patterns of Small Renal Masses (≤4 cm) on Preoperative Computed Tomography: Utility for Distinguishing Subtypes of Renal Cell Carcinoma, Angiomyolipoma, and Oncocytoma

Objective To analyze the enhancement patterns of small renal masses (SRMs) during 4-phase computed tomography (CT) imaging to predict histology. Methods One-hundred consecutive patients with SRMs and 4-phase preoperative CT imaging, who underwent extirpative surgery with a pathologic diagnosis of re...

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Published in:Urology (Ridgewood, N.J.) N.J.), 2013-06, Vol.81 (6), p.1265-1272
Main Authors: Pierorazio, Phillip M, Hyams, Elias S, Tsai, Salina, Feng, Zhaoyong, Trock, Bruce J, Mullins, Jeffrey K, Johnson, Pamela T, Fishman, Elliot K, Allaf, Mohamad E
Format: Article
Language:English
Subjects:
Adenoma, Oxyphilic - diagnostic imaging
Adenoma, Oxyphilic - pathology
Adolescent
Adult
Aged
Angiomyolipoma - diagnostic imaging
Angiomyolipoma - pathology
Biological and medical sciences
Carcinoma, Renal Cell - diagnostic imaging
Carcinoma, Renal Cell - pathology
Contrast Media
Diagnosis, Differential
Female
Humans
Kidney Neoplasms - diagnostic imaging
Kidney Neoplasms - pathology
Kidneys
Logistic Models
Male
Medical sciences
Middle Aged
Multidetector Computed Tomography
Multiple tumors. Solid tumors. Tumors in childhood (general aspects)
Nephrology. Urinary tract diseases
Tumors
Tumors of the urinary system
Urology
Young Adult
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Summary:Objective To analyze the enhancement patterns of small renal masses (SRMs) during 4-phase computed tomography (CT) imaging to predict histology. Methods One-hundred consecutive patients with SRMs and 4-phase preoperative CT imaging, who underwent extirpative surgery with a pathologic diagnosis of renal cell carcinoma (RCC), angiomyolipoma (AML), or oncocytoma, were identified from a single institution. An expert radiologist, blinded to histologic results, retrospectively recorded tumor size, RENAL (radius, exophytic/endophytic properties of the tumor, nearness of tumor deepest portion to the collecting system or sinus, anterior/posterior descriptor, and the location relative to polar lines) nephrometry score, tumor attenuation, and the renal cortex on all 4 acquisitions (precontrast, corticomedullary, nephrogenic, and delayed density). Results Pathologic diagnoses included 48 clear-cell RCCs (ccRCCs), 22 papillary RCCs, 10 chromophobe RCCs, 13 oncocytomas, and 7 AMLs. There was no significant difference in median tumor size ( P  = .8), nephrometry score ( P  = .98), or anatomic location ( P >.2) among histologies. Significant differences were noted in peak enhancement ( P  
ISSN:0090-4295
1527-9995
DOI:10.1016/j.urology.2012.12.049