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Aorta-Lesion-Attenuation-Difference (ALAD) on contrast-enhanced CT: a potential imaging biomarker for differentiating malignant from benign oncocytic neoplasms

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Abstract

Objective

To evaluate whether the Aorta-Lesion-Attenuation-Difference on contrast-enhanced CT can aid in the differentiation of malignant and benign oncocytic renal neoplasms.

Materials and methods

Two independent cohorts—an initial (biopsy) dataset and a validation (surgical) dataset—with oncocytomas and chromophobe renal cell carcinomas (chRCC) were included in this IRB-approved retrospective study. A region of interest was placed on the renal mass and abdominal aorta on the same CT image slice to calculate an Aorta-Lesion-Attenuation-Difference (ALAD). ROC curves were plotted for different enhancement phases, and diagnostic performance of ALAD for differentiating chRCC from oncocytomas was calculated.

Results

Seventy-nine renal masses (56 oncocytomas, 23 chRCC) were analyzed in the initial (biopsy) dataset. Thirty-six renal masses (16 oncocytomas, 20 chRCC) were reviewed in the validation (surgical) cohort. ALAD showed a statistically significant difference between oncocytomas and chromophobes during the nephrographic phase (p < 0.001), early excretory phase (p < 0.001), and excretory phase (p = 0.029). The area under the ROC curve for the nephrographic phase was 1.00 (95% CI: 1.00–1.00) for the biopsy dataset and showed the narrowest confidence interval. At a threshold value of 25.5 HU, sensitivity was 100 (82.2%–100%) and specificity was 81.5 (61.9%–93.7%). When tested on the validation dataset on measurements made by an independent reader, the AUROC was 0.93 (95% CI: 0.84–1.00) with a sensitivity of 100 (80.0%–100%) and a specificity of 87.5 (60.4%–97.8%).

Conclusions

Nephrographic phase ALAD has potential to differentiate benign and malignant oncocytic renal neoplasms on contrast-enhanced CT if histologic evaluation on biopsy is indeterminate.

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Authors and Affiliations

  1. Department of Radiology, Massachusetts General Hospital [MGH], Harvard Medical School, Boston, MA, 02114, USA

    Manish Dhyani, Zhikui Chen, Debra A. Gervais, Ronald S. Arellano, Peter F. Hahn & Anthony E. Samir

  2. Department of Radiology, University of Florida College of Medicine, Gainesville, FL, 32610, USA

    Joseph R. Grajo

  3. Department of Urology, Massachusetts General Hospital [MGH], Harvard Medical School, Boston, MA, 02114, USA

    Dayron Rodriguez & Adam Feldman

  4. Department of Pathology, Massachusetts General Hospital [MGH], Harvard Medical School, Boston, MA, 02114, USA

    Rosemary Tambouret

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  1. Manish Dhyani
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Correspondence to Manish Dhyani.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. For this type of study formal consent is not required.

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Statement of informed consent was not applicable since the manuscript was retrospective in nature and requirement for informed consent was waived by the IRB.

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Dhyani, M., Grajo, J.R., Rodriguez, D. et al. Aorta-Lesion-Attenuation-Difference (ALAD) on contrast-enhanced CT: a potential imaging biomarker for differentiating malignant from benign oncocytic neoplasms. Abdom Radiol 42, 1734–1743 (2017). https://doi.org/10.1007/s00261-017-1061-3

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