RADIOLOGIC CHARACTERISTICS OF COMPUTERIZED TOMOGRAPHY ATTENUATION IN RENAL CELL CARCINOMA

Authors

  • Satit Siriboonrid Division of Urology, Department of Surgery, Phramongkutklao Hospital, Bangkok, Thailand
  • Waraporn Pongmorakot Division of Urology, Department of Surgery, Phramongkutklao Hospital, Bangkok, Thailand
  • Chatwadee Limpaiboon Department of Radiology, Phramongkutklao Hospital, Bangkok, Thailand
  • Nattapong Binsri Division of Urology, Department of Surgery, Phramongkutklao Hospital, Bangkok, Thailand
  • Sarayut Kanjanatarayon Division of Urology, Department of Surgery, Phramongkutklao Hospital, Bangkok, Thailand
  • Weerayut Wiriyabanditkul Division of Urology, Department of Surgery, Phramongkutklao Hospital, Bangkok, Thailand
  • Vittaya Jiraanankul Division of Urology, Department of Surgery, Phramongkutklao Hospital, Bangkok, Thailand

DOI:

https://doi.org/10.55374/jseamed.v6i0.117

Keywords:

renal cell carcinoma, attenuation, Hounsfield unit, kidney, cancer

Abstract

Background: Renal cell carcinoma (RCC) is the most common kidney cancer in adults. Computed Tomography (CT) with contrast study is used to diagnose RCC. The enhancement in the nephrogenic phase more than 15 Hounsfield units (HU) is suspected of RCCs. However, this threshold HU shows 15-20% false positive results for RCCs.

Objectives: This study aimed to determine RCC enhancement in CT that was below the standard threshold and to analyze the attenuation range of RCCs in noncontrast CT. Methods: Patients with pathological RCC and undergoing CT with contrast study were retrospectively reviewed. An average of attenuation values of three regions of interest (ROI) were measured in noncontrast and nephrogenic phases, by avoiding foci of calcification and peritumoral region. ROI values were calculated for enhancement and range of attenuation values in the noncontrast CT.

Results: A total of 152 pathologically RCCs were included in the study. Mean ± SD attenuation values were 32.54 ± 8.02 HU (range 13.3-57.23 HU) and 71.26 ± 33.1 HU (range 16.87-202.8 HU) for noncontrast and contrast CT, respectively. Thirty-one (20.4%) of RCCs did not reach 15 HU enhancement. Using multivariate analysis, significant differences among subtypes (p<0.001) and renal mass less than 7 cm (p<0.001) were observed. In noncontrast CT, using a range of 20-60 HU, 129 (84.9%) RCCs were entirely within this range. To improve the accuracy of RCC diagnosis, the combined use of both non-contrast attenuation group (<20 HU and >20 HU) and enhancement >15 HU could increase the accuracy to 96.7%.

Conclusion: One-fifth of RCCs did not reach the standard enhancement threshold that were mostly found in nonclear cell subtype. Especially, when the mass was larger than 7 cm or involved nonclear cell RCCs, the enhancement threshold >15 HU must be carefully used for diagnosis. Using a noncontrast phase regardless HU combined with enhancement >15 HU could improve the accuracy of RCC diagnosis.

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References

Ljungberg B, Albiges L, Abu-Ghanem Y, Bensalah K, Dabestani S, Fernández-Pello S, et al. European Association of Urology Guidelines on renal cell carcinoma: The 2019 Update. Eur Urol. 2019; 75: 799-810. DOI: https://doi.org/10.1016/j.eururo.2019.02.011

SEER Cancer Stat Facts: Kidney and renal pelvis cancer, Bethesda, MD: National cancer Institute; Available at: http://seer.cancer.gov/statfacts/html/kidrp.html. Accessed May 17, 2022.

Gudbjartsson T, Thoroddsen A, Petursdottir V, Hardarson S, Magnusson J, Einarsson GV. Effect of incidental detection for survival of patients with renal cell carcinoma: results of population-based study of 701 patients. Urology 2005; 66: 1186-91. DOI: https://doi.org/10.1016/j.urology.2005.07.009

Pickhardt PJ, Hanson ME, Vanness DJ, Lo JY, Kim DH, Taylor AJ, et al. Unsuspected extracolonic findings at screening CT colonography: clinical and economic impact. Radiology 2008; 249: 151-9. DOI: https://doi.org/10.1148/radiol.2491072148

Campbell SC, Lane BR. Malignant renal tumors. In: Wein AJ, Kavoussi LR, Partin AW, Peters CA editors. Campbell-Walsh Urology. 11th ed. Philadelphia: Elsevier; 2016. p.1315-64.

Harbi FA, Tabatabaeefar L, Jewett MA, Finelli A, O’Malley M, Atri M. Enhancement threshold small (<4 cm) solid renal masses on CT. Am J Roentgenol 2016; 206: 554-8. DOI: https://doi.org/10.2214/AJR.15.14806

Corcoran AT, Russo P, Lowrance WT, Asnis-Alibozek A, Libertino JA, Pryma DA, et al. Review of contemporary data on surgically resected renal masses--benign or malignant? Urology 2013; 81: 707-13. DOI: https://doi.org/10.1016/j.urology.2013.01.009

Israel GM, Bosniak MA. An update of the Bosniak renal cyst classification system. Urology 2005; 66: 484–8. DOI: https://doi.org/10.1016/j.urology.2005.04.003

Jonisch AI, Rubinowitz AN, Mutalik PG, Israel GM. Can high-attenuation renal cysts be differentiated from renal cell carcinomaat unenhanced CT? Radiology 2007; 243: 445–50. DOI: https://doi.org/10.1148/radiol.2432060559

Silverman SG, Israel GM, Herts BR, Richie JP. Management of the incidental renal mass. Radiology 2008; 249:16–31. DOI: https://doi.org/10.1148/radiol.2491070783

Willatt J, Francis IR. Imaging and management of the incidentally discovered renal mass. Cancer Imaging 2009; 9 (Spec No A): S30–7. DOI: https://doi.org/10.1102/1470-7330.2009.9008

Schieda N, Vakili M, Dilauro M, Hodgdon T, Flood TA, Shabana WM. Solid renal cell carcinoma measuring water attenuation (-10 to 20 HU) on unenhanced CT. Am J Roentgenol 2015: 1215-21. DOI: https://doi.org/10.2214/AJR.15.14554

Pooler BD, Pickhardt PJ, O’Connor SD, Bruce RJ, Patel SR, Nakada SY. Renal cell carcinoma: Attenuation values on unenhanced CT. Am J Roentgenol 2012; 198: 1115-20. DOI: https://doi.org/10.2214/AJR.11.7587

Sheir KZ, El-Azab M, Mosbah A, El-Baz M, Shaaban AA. Differentiation of renal cell carcinoma subtypes by multi slice computerized tomography. J Urol 2005; 174: 451-5. DOI: https://doi.org/10.1097/01.ju.0000165341.08396.a9

Reuter VE, Presti Jr JC. Contemporary approach to the classification of renal epithelial tumors. Semin Oncol 2000; 27: 124.

Fujimoto H, Wakao F, Moriyama N, Tobisu K, Sakamoto M, Kakizoe T. Alveolar architecture of clear cell renal carcinomas ( DOI: https://doi.org/10.1093/jjco/29.4.198

Abdulla C, Kalra MK, Saini S, Maher MM, Ahmad A, Halpern E, et al. Pseudoenhancement of simulated renal cysts in a phantom using different multidetector CT scanners. AJR Am J Roentgenol 2002; 179: 1473-6. DOI: https://doi.org/10.2214/ajr.179.6.1791473

Wang ZJ, Coakley FV, Fu Y, Joe BN, Prevrhal S, Landeras LA, et al. Renal cyst pseudoenhancement at multidetector CT: what are the effects of number of detectors and peak tube voltage? Radiology 2008; 248: 910-6. DOI: https://doi.org/10.1148/radiol.2482071583

Pickhardt PJ, Kim DH, Meiners RJ, Wyatt KS, Hanson ME, Barlow DS, et al. Colorectal and extracolonic cancers detected at screening CT colonography in 10,286 asymptomatic adults. Radiology 2010; 255: 83-8. DOI: https://doi.org/10.1148/radiol.09090939

Song C, Min GE, Song K, Kim JK, Hong B, Kim CS, et al. Differential diagnosis of complex cystic renal mass using multiphase computerized tomography. J Urol 2009; 181: 2446-50. DOI: https://doi.org/10.1016/j.juro.2009.01.111

Zhang J, Lefkowitz RA, Ishill NM, Wang L, Moskowitz CS, Russo P, et al. Solid renal cortical tumors: differentiation with CT. Radiology 2007; 244: 495-504. DOI: https://doi.org/10.1148/radiol.2442060927

O’Connor SD, Pickhardt PJ, Kim DH, Oliva MR, Silverman SG. Incidental renal masses at unenhanced CT: prevalence and analysis of features for guiding management. Am J Roentgenol 2011; 197: 139–45. DOI: https://doi.org/10.2214/AJR.10.5920

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Published

2022-06-28

How to Cite

1.
Siriboonrid S, Pongmorakot W, Limpaiboon C, Binsri N, Kanjanatarayon S, Wiriyabanditkul W, et al. RADIOLOGIC CHARACTERISTICS OF COMPUTERIZED TOMOGRAPHY ATTENUATION IN RENAL CELL CARCINOMA. J Southeast Asian Med Res [Internet]. 2022 Jun. 28 [cited 2024 Oct. 11];6:e0117. Available from: https://jseamed.org/index.php/jseamed/article/view/117

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