Skip to main content
SpringerLink
Log in

Unenhanced CT for the detection of renal cell carcinoma: effect of tumor size and contour type

  • Published:
Abdominal Imaging Aims and scope Submit manuscript

Abstract

Purpose

To evaluate effect of tumor size and contour type for the detection of renal cell carcinoma (RCC) on unenhanced CT.

Methods

This retrospective institutional review board approved study that includes 111 patients with RCC and 100 patients without RCC who underwent unenhanced CT. Two readers performed a blinded and independent review of the presence of RCC on unenhanced CT. The area under the receiver operating characteristic curves (AUC) was compared by tumor size (<3 cm: small, or ≥3 cm: large) and contour type (endophytic, mesophytic, or exophytic).

Results

For tumor size, the AUC for small RCC (0.70 and 0.78, for reader 1 and reader 2) was significantly lower than that for large RCC (0.97 and 0.99, for reader 1 and reader 2) (p < 0.001). As for contour type of tumor, the AUC for endophytic RCC (0.60 and 0.71, for reader 1 and reader 2) was significantly lower than that for mesophytic RCC (0.95 and 0.98, for reader 1 and reader 2) and exophytic RCC (0.98 and 0.99, reader 1 and reader 2) (p < 0.001).

Conclusion

On unenhanced CT, tumor size and contour type can affect the detection of RCC. While most large or exophytic RCC can be easily detected, the detection of small and endophytic RCC is highly limited.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Barrett TW, Schierling M, Zhou C, et al. (2009) Prevalence of incidental findings in trauma patients detected by computed tomography imaging. Am J Emerg Med 27:428–435

    Article  PubMed  Google Scholar 

  2. Catalano O, Nunziata A, Sandomenico F, Siani A (2002) Acute flank pain: comparison of unenhanced helical CT and ultrasonography in detecting causes other than ureterolithiasis. Emerg Radiol 9:146–154

    Article  PubMed  Google Scholar 

  3. O’Connor SD, Pickhardt PJ, Kim DH, Oliva MR, Silverman SG (2011) Incidental finding of renal masses at unenhanced CT: prevalence and analysis of features for guiding management. Am J Roentgenol 197:139–145

    Article  Google Scholar 

  4. Pickhardt PJ, Hanson ME, Vanness DJ, et al. (2008) Unsuspected extracolonic findings at screening CT colonography: clinical and economic impact. Radiology 249:151–159

    Article  PubMed  Google Scholar 

  5. Katz DS, Lane MJ, Mindelzun RE (1999) Unenhanced CT of abdominal and pelvic hemorrhage. Semin Ultrasound CT MR 20:94–107

    Article  CAS  PubMed  Google Scholar 

  6. Hoppe H, Studer R, Kessler TM, et al. (2006) Alternate or additional findings to stone disease on unenhanced computerized tomography for acute flank pain can impact management. J Urol 175:1725–1730

    Article  PubMed  Google Scholar 

  7. Ng CS, Wood CG, Silverman PM, et al. (2008) Renal cell carcinoma: diagnosis, staging, and surveillance. Am J Roentgenol 191:1220–1232

    Article  Google Scholar 

  8. Zhang J, Lefkowitz RA, Bach A (2007) Imaging of kidney cancer. Radiol Clin North Am 45:119–147

    Article  PubMed  Google Scholar 

  9. Jayson M, Sanders H (1998) Increased incidence of serendipitously discovered renal cell carcinoma. Urology 51:203–205

    Article  CAS  PubMed  Google Scholar 

  10. Tsui KH, Shvarts O, Smith RB, et al. (2000) Renal cell carcinoma: prognostic significance of incidentally detected tumors. J Urol 163:426–430

    Article  CAS  PubMed  Google Scholar 

  11. Russo P (2000) Renal cell carcinoma: presentation, staging, and surgical treatment. Semin Oncol 27:160–176

    CAS  PubMed  Google Scholar 

  12. Nakano E, Iwasaki A, Seguchi T, et al. (1992) Incidentally diagnosed renal cell carcinoma. Eur Urol 21:294–298

    CAS  PubMed  Google Scholar 

  13. Sweeney JP, Thornhill JA, Graiger R, McDermott TE, Butler MR (1996) Incidentally detected renal cell carcinoma: pathological features, survival trends and implications for treatment. Br J Urol 78:351–353

    Article  CAS  PubMed  Google Scholar 

  14. Jonisch AI, Rubinowitz AN, Mutalik PG, Israel GM (2007) Can high-attenuation renal cysts be differentiated from renal cell carcinoma at unenhanced CT? Radiology 243:445–450

    Article  PubMed  Google Scholar 

  15. Pooler BD, Pickhardt PJ, O’Connor SD, et al. (2012) Renal cell carcinoma: attenuation values on unenhanced CT. Am J Roentgenol 198:1115–1120

    Article  Google Scholar 

  16. Zhang J, Lefkowitz RA, Ishill NM, et al. (2007) Solid renal cortical tumors: differentiation with CT. Radiology 244:494–504

    Article  PubMed  Google Scholar 

  17. Jamis-Dow CA, Choyke PL, Jennings SB, et al. (1996) Small (< or = 3-cm) renal masses: detection with CT versus US and pathologic correlation. Radiology 198:785–788

    CAS  PubMed  Google Scholar 

  18. Silverman SG, Lee BY, Seltzer SE, et al. (1994) Small (< or = 3 cm) renal masses: correlation of spiral CT features and pathologic findings. Am J Roentgenol 163:597–605

    Article  CAS  Google Scholar 

  19. Szolar DH, Kammerhuber F, Altziebler S, et al. (1997) Multiphasic helical CT of the kidney: increased conspicuity for detection and characterization of small (<3-cm) renal masses. Radiology 202:211–217

    CAS  PubMed  Google Scholar 

  20. Kutikov A, Uzzo RG (2009) The R.E.N.A.L. nephrometry score: a comprehensive standardized system for quantitating renal tumor size, location and depth. J Urol 182:844–853

    Article  PubMed  Google Scholar 

  21. Parsons RB, Canter D, Kutikov A, Uzzo RG (2012) RENAL nephrometry scoring system: the radiologist’s perspective. Am J Roentgenol 199:W355–W359

    Article  Google Scholar 

  22. Obuchowski NA (1997) Nonparametric analysis of clustered ROC curve data. Biometrics 53:567–578

    Article  CAS  PubMed  Google Scholar 

  23. Cohen J (1968) Weighted kappa: nominal scale agreement with provision for scaled disagreement or partial credit. Psychol Bull 70:213–220

    Article  CAS  PubMed  Google Scholar 

  24. Landis JR, Koch GG (1977) The measurement of observer agreement for categorical data. Biometrics 33:159–174

    Article  CAS  PubMed  Google Scholar 

  25. Smith RC, Rosenfield AT, Choe KA, et al. (1995) Acute flank pain: comparison of non-contrast-enhanced CT and intravenous urography. Radiology 194:789–794

    CAS  PubMed  Google Scholar 

  26. Kaiser S, Finnbogason T, Jorulf HK, Soderman E, Frenckner B (2004) Suspected appendicitis in children: diagnosis with contrast-enhanced versus nonenhanced Helical CT. Radiology 231:427–433

    Article  PubMed  Google Scholar 

  27. Lane MJ, Katz DS, Ross BA, et al. (1997) Unenhanced helical CT for suspected acute appendicitis. Am J Roentgenol 168:405–409

    Article  CAS  Google Scholar 

  28. Lane MJ, Liu DM, Huynh MD, et al. (1999) Suspected acute appendicitis: nonenhanced helical CT in 300 consecutive patients. Radiology 213:341–346

    Article  CAS  PubMed  Google Scholar 

  29. Johnson CD, Dachman AH (2000) CT colonography: the next colon screening examination? Radiology 216:331–341

    Article  CAS  PubMed  Google Scholar 

  30. Kim DH, Pickhardt PJ, Hanson ME, Hinshaw JL (2010) CT colonography: performance and program outcome measures in an older screening population. Radiology 254:493–500

    Article  PubMed  Google Scholar 

  31. Sahi K, Jackson S, Wiebe E, et al. (2013) The value of “liver windows” settings in the detection of small renal cell carcinomas on unenhanced computed tomography. Can Assoc Radiol J 12:00141–00146

    Google Scholar 

Download references

Acknowledgement

This work was supported by Konkuk University

Author information

Authors and Affiliations

  1. Department of Radiology, Research Institute of Medical Science, Konkuk University School of Medicine, 4-12 Hwayang-dong, Gwangjin-gu, Seoul, 143-729, Korea

    Sung Il Jung, Hee Sun Park, Young Jun Kim & Hae Jeong Jeon

Authors
  1. Sung Il Jung
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Hee Sun Park
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Young Jun Kim
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Hae Jeong Jeon
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Sung Il Jung.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Jung, S.I., Park, H.S., Kim, Y.J. et al. Unenhanced CT for the detection of renal cell carcinoma: effect of tumor size and contour type. Abdom Imaging 39, 348–357 (2014). https://doi.org/10.1007/s00261-013-0068-7

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00261-013-0068-7

Keywords

Search

Navigation