Differential radiologic characteristics of renal tumours on multiphasic computed tomography

Abstract

INTRODUCTIONThis study analysed the tumour attenuation characteristics of different subtypes of renal cell carcinomas (RCCs), including clear cell RCC (ccRCC), papillary RCC (pRCC), mixed RCC, chromophobe RCC (chRCC) and oncocytoma. METHODSWe randomly selected 100 RCC cases that underwent nephrectomy between 2004 and 2012 from a collaborative database. Of these cases, 36 were excluded due to the absence of available imaging. The remaining 64 cases comprised 35 ccRCCs, 11 pRCCs, eight chRCCs, seven mixed RCCs and three oncocytomas. The cases were classified as computed tomography (CT) kidney, CT urogram (with plain, nephrographic and pyelographic phases) or CT abdomen (with portovenous and delayed phases). A circular region of interest (ROI) ≥ 1 cm 2 was drawn and the same standard ROI size was used for each phase at the same site; three different circular ROIs were drawn per lesion per phase. Analysis of variance and t-test were used to examine differences in the radiological characteristics. RESULTSThere was no statistical difference in the attenuation and degree of enhancement between mixed RCCs and ccRCCs. The attenuation and degree of enhancement of the oncocytomas were significantly higher than those of the other RCC subtypes.CONCLUSION While mixed RCCs did not have attenuation characteristics that differed significantly from those of ccRCCs, oncocytomas can be distinguished from ccRCCs, pRCCs, chRCCs and mixed RCCs by their high radiological density and enhancement. The ability to differentiate oncocytomas from these tumours potentially allows the preoperative selection of patients with small renal masses for conservative management.

Multidetector CT Characteristics of Fumarate Hydratase-Deficient Renal Cell Carcinoma and Papillary Type II Renal Cell Carcinoma

“…With a cystic solid pattern, FH-deficient RCC should be differentiated from other renal tumors with similar characteristics. The mixed cystic solid (83.4%) pattern was more commonly found in FH-deficient RCC than in pRCC type II (29.6%) in our study, as well as other common subtypes of renal tumors reported, such as clear cell RCC (22.9%–54.1%), pRCC type I (23.0%–36.4%), and chromophobe RCC (12.5%–21.9%) [ 12 20 21 ]. Polycystic (80.0%) change with thin, smooth wall and/or septum could be considered a characteristic feature of FH-deficient RCC in our study, which could also be seen in previously reported papillary type II HLRCC-associated renal tumors but without systematic exposition [ 12 14 ].…”

“…This may be because the most common histopathological characteristic of FH-deficient RCC is papillary, although some are mixed with other forms. Moreover, FH-deficient RCC was susceptible to involvement in younger patients and showed larger size, and the rates of lymph node and distant metastasis were higher in FH-deficient RCC than in pRCC type II in our study, and among other reported subtypes of RCC [ 12 14 20 21 22 23 24 26 ].…”

The Role of Dynamic CT in The Differential Diagnosis of Renal Mass and Determination of the Renal Cell Carcinoma Subtype

“…Literatürde renal onkositomlarda santral skar, segmental kontrastlanma dönüşümü gibi görüntüleme bulguları tanımlanmakla birlikte RHK-onkositom ayrımı güvenli bir şekilde yapılamamakta, bununla ilgili hem BT hem MRG ile yapılan çalışmalar sürmektedir (14)(15)(16) . Onkositomlar, malign tümörler ile karşılaştırıldığında, nefrogram ve piyelogram fazlarında RHK'a göre yüksek atenuasyon değerleri göstermektedirler (17)(18)(19) . Güncel radyoloji literatürde onkositom ile kromofob hücreli tümörü ayırmayı hedefleyen çalışmalar mevcuttur (15)(16)(17)(18) .…”

Renal Oncocytoma: The Diagnostic Challenge to Unmask the Double of Renal Cancer

“…Another study evaluating the role of MDCT for SRM by Ching et al found that oncocytomas had greater attenuation and enhancement with respect to other RCCs, and even more, they a observed a different pattern of CT findings between oncocytomas and chRCC [ 134 ]. Bird et al found a similar result in their study on four-phase CT in <4 cm oncocytomas and RCCs, since the former displayed a greater mean enhancement change in arterial, venous and delayed phase, the enhancement pattern was significantly different, and the mean relative contrast extraction at the end of the delayed phase was higher for oncocytomas.…”