Solid Renal Cell Carcinoma Measuring Water Attenuation (−10 to 20 HU) on Unenhanced CT

Schieda, Nicola; Vakili, Maryam; Dilauro, Marc; Hodgdon, Taryn; Flood, Trevor A.; Shabana, Wael

doi:10.2214/ajr.15.14554

Cited by 40 publications

(22 citation statements)

References 24 publications

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“…The detection and characterization of incidentally imaged renal lesions on unenhanced CT remains difficult due to the method’s low soft-tissue contrast 4 . Additionally, unenhanced CT values of different RCC subtypes showed divergent measurements 4 24 . Contrast enhanced multiphasic CT and MRI images are used in clinical routine to diagnose RCC and to define the subtype 5 8 .…”

Section: Discussionmentioning

confidence: 99%

Qualitative and Quantitative Imaging Evaluation of Renal Cell Carcinoma Subtypes with Grating-based X-ray Phase-contrast CT

Braunagel¹,

Birnbacher

Willner

et al. 2017

Sci Rep

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Current clinical imaging methods face limitations in the detection and correct characterization of different subtypes of renal cell carcinoma (RCC), while these are important for therapy and prognosis. The present study evaluates the potential of grating-based X-ray phase-contrast computed tomography (gbPC-CT) for visualization and characterization of human RCC subtypes. The imaging results for 23 ex vivo formalin-fixed human kidney specimens obtained with phase-contrast CT were compared to the results of the absorption-based CT (gbCT), clinical CT and a 3T MRI and validated using histology. Regions of interest were placed on each specimen for quantitative evaluation. Qualitative and quantitative gbPC-CT imaging could significantly discriminate between normal kidney cortex (54 ± 4 HUp) and clear cell (42 ± 10), papillary (43 ± 6) and chromophobe RCCs (39 ± 7), p < 0.05 respectively. The sensitivity for detection of tumor areas was 100%, 50% and 40% for gbPC-CT, gbCT and clinical CT, respectively. RCC architecture like fibrous strands, pseudocapsules, necrosis or hyalinization was depicted clearly in gbPC-CT and was not equally well visualized in gbCT, clinical CT and MRI. The results show that gbPC-CT enables improved discrimination of normal kidney parenchyma and tumorous tissues as well as different soft-tissue components of RCCs without the use of contrast media.

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Section: Discussionmentioning

confidence: 99%

Qualitative and Quantitative Imaging Evaluation of Renal Cell Carcinoma Subtypes with Grating-based X-ray Phase-contrast CT

Braunagel¹,

Birnbacher

Willner

et al. 2017

Sci Rep

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“…In previous studies, the density of most RCCs has been in the range of 20–70 HU (15). However, a few solid RCCs can show similar attenuation to water (-10–20 HU) on unenhanced CT (18). In our study, none of the RCCs showed water attenuation.…”

Section: Discussionmentioning

confidence: 99%

“…RCCs were a rare (in the 1% range) finding at unenhanced CT and differentiating them from benign cyst on unenhanced CT is difficult in many cases (14). Previous studies have evaluated the characteristic image findings of RCC on unenhanced CT (15)(16)(17)(18); however, over one-third (37%) of potentially detectable cancers were missed or incorrectly interpreted on unenhanced CT (14). Moreover, these studies were not focused on only T1a RCC, which could be done minimally invasive treatment.…”

Section: Introductionmentioning

confidence: 99%

T1a renal cell carcinoma on unenhanced CT: analysis of detectability and imaging features

Gobara

Yoshizako

Yoshida

et al. 2019

Acta Radiologica Open

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Background Increasing use of unenhanced computed tomography (CT) has been associated with the increasing incidental detection of renal cell carcinoma (RCC) at an earlier stage. Purpose To evaluate the characteristics in detecting and differentiating T1a RCCs on unenhanced CT. Material and Methods We retrospectively reviewed 68 patients with 68 T1a RCCs and 39 benign regions. Two radiologists interpreted the images on unenhanced axial CT and performed a blinded and independent review of T1a RCCs. The readers evaluated the presence of RCC and differentiated the detected lesions. Results The consensus of two readers detected 53 (78%) RCCs. Of the 53 detected RCCs, 42 (62%) RCCs were correctly diagnosed and 11 (16%) masses were misdiagnosed as benign. Of the 39 benign regions, 29 (74%) cysts were diagnosed correctly, but 10 (26%) cysts were misdiagnosed as malignant. The following values of the radiologists were obtained by consensus: sensitivity = 61.8% (42/68); specificity = 74.4% (29/39); positive predictive value = 80.8% (42/52); negative predictive value = 55.0% (29/55); accuracy = 66.4% (71/107). The receiver operating characteristic curve of consensus was 0.754. Inter-observer correlation was κ = 0.849. There was a significant difference in tumor size ( P = 0.019) and the contour type of tumor ( P = 0.0207) between correctly diagnosed RCCs and not correctly diagnosed RCCs. Conclusion Our findings showed that tumor size and contour type could affect the detection and differentiation of T1a RCC on unenhanced CT. To detect and differentiate T1a RCC on unenhanced CT is difficult. However, the findings from this study may help detection of RCCs on unenhanced CT.

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“…Several papers have shown that the density of a homogeneous mass on non-contrast CT can safely categorize it as a cyst if region of interest measurements either fall between −10 to 20 HU or are equal to or greater than 70 HU (as a result of proteinaceous or hemorrhagic content) [14–17]. A recent study showed that in a population of patients 40–69 years of age, none of the 42 homogeneous masses on non-contrast CT with density values of 21–39 HU proved to be clinically significant after 5 years.…”

Section: Flowchart 1: Incidental Renal Mass On Non-contrast Ctmentioning

confidence: 99%

Recommendations for the Management of the Incidental Renal Mass in Adults: Endorsement and Adaptation of the 2017 ACR Incidental Findings Committee White Paper by the Canadian Association of Radiologists Incidental Findings Working Group

et al. 2019

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Solid Renal Cell Carcinoma Measuring Water Attenuation (−10 to 20 HU) on Unenhanced CT

Abstract: A minority of solid RCCs have attenuation similar to that of water on unenhanced CT. In this study, all such tumors were of the clear cell subtype and qualitatively heterogeneous, suggesting they can be distinguished from simple cysts on unenhanced CT.

Cited by 40 publications

References 24 publications

Qualitative and Quantitative Imaging Evaluation of Renal Cell Carcinoma Subtypes with Grating-based X-ray Phase-contrast CT

Qualitative and Quantitative Imaging Evaluation of Renal Cell Carcinoma Subtypes with Grating-based X-ray Phase-contrast CT

T1a renal cell carcinoma on unenhanced CT: analysis of detectability and imaging features

Recommendations for the Management of the Incidental Renal Mass in Adults: Endorsement and Adaptation of the 2017 ACR Incidental Findings Committee White Paper by the Canadian Association of Radiologists Incidental Findings Working Group

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