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Utility of multiphasic multidetector computed tomography in discriminating between clear cell renal cell carcinomas with high and low carbonic anhydrase-IX expression

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Abstract

Purpose

To investigate if multiphasic multidetector computed tomography (MDCT) enhancement profiles can distinguish clear cell renal cell carcinomas (ccRCCs) with high carbonic anhydrase-IX (CA-IX) expression from ccRCCs with low CA-IX expression.

Methods

With IRB approval for this retrospective study, we derived a cohort of 105 histologically proven ccRCCs with preoperative 4-phase renal mass MDCT from 2001 to 2013. Following manual segmentation, the computer-assisted detection algorithm selected a 0.5-cm-diameter region of maximal attenuation within each lesion in each phase. CA-IX expression level was determined by immunohistochemical staining of tumor specimens. In the high and low CA-IX expression subgroups, the magnitude of enhancement and washout were compared using t tests; the performance of contrast washout in differentiating between subgroups was assessed with logistic regression analysis.

Results

ccRCCs with high and low CA-IX expression both exhibited peak enhancement in the corticomedullary phase. ccRCCs with high CA-IX expression demonstrated significantly greater relative nephrographic washout than those with low CA-IX expression (18.4% vs. 7.8%, p = 0.03). ccRCCs with high CA-IX expression had greater relative excretory washout than ccRCCs with low CA-IX expression with a trend toward significance (33.4% vs. 25.2%, p = 0.05). After controlling for tumor size and stage, for distinguishing ccRCCs with high and low CA-IX expression, relative excretory washout had a sensitivity, negative predictive value, accuracy, and positive predictive value of 99% (65/66), 88% (7/8), 69% (72/105), and 67% (65/97), respectively.

Conclusion

Relative nephrographic and excretory washout may have the potential to help distinguish ccRCCs with high and low CA-IX expression, but this requires further validation.

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Acknowledgments

This study was funded by the Society of Abdominal Radiology Howard S. Stern Research Grant (Grant No. 20163335). We thank the UCLA Computer Vision and Imaging Biomarker (CVIB) group, including Dr. Jonathan Goldin, Dr. Matthew Brown, Moe Moe Ko, and War War Ko, for their assistance with this study.

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Authors and Affiliations

  1. Department of Radiology, UC Davis School of Medicine, 4860 Y Street #3100, Sacramento, CA, 95817, USA

    Jonathan R. Young

  2. Department of Radiology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA

    Heidi Coy, Hyun J. Kim, Michael Douek & Steven S. Raman

  3. Department of Pathology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA

    Anthony Sisk

  4. Department of Urology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA

    Arie Belldegrun & Allan J. Pantuck

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  1. Jonathan R. Young
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Correspondence to Jonathan R. Young.

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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.

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The Institutional Review Board waived the requirement of informed consent for this study.

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Young, J.R., Coy, H., Kim, H.J. et al. Utility of multiphasic multidetector computed tomography in discriminating between clear cell renal cell carcinomas with high and low carbonic anhydrase-IX expression. Abdom Radiol 43, 2734–2742 (2018). https://doi.org/10.1007/s00261-018-1546-8

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  • DOI: https://doi.org/10.1007/s00261-018-1546-8

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