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Diagnostic accuracy of segmental enhancement inversion for diagnosis of renal oncocytoma at biphasic contrast enhanced CT: systematic review

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Abstract

Objectives

To use systematic review to evaluate the diagnostic accuracy of segmental enhancement inversion (SEI) at contrast-enhanced biphasic multi-detector computed tomography (MDCT) for the diagnosis of renal oncocytoma.

Methods

Several electronic databases were searched through October 2013. Two reviewers independently selected studies that met the inclusion criteria and extracted data. Study quality was assessed with the QUADAS-2 tool. The primary 2 × 2 data were investigated with forest plot and ROC plot of sensitivity and specificity.

Results

Four studies met the inclusion criteria (307 patients). Considerable heterogeneity between studies precluded meta-analysis. Two studies from the same group of investigators demonstrated reasonable diagnostic accuracy (sensitivity 59-80 % and specificity 87-99 %), while two others did not (sensitivity 0-6 %, specificity 93-100 %). Possible reasons for this include timing of biphasic MDCT and methods of interpretation but not size of lesion.

Conclusions

SEI is a specific imaging finding of renal oncocytoma with highly variable sensitivity. This substantial heterogeneity across studies and between institutions suggests that further validation of this imaging finding is necessary prior to application in clinical practice.

Key Points

• SEI on CT in small renal masses is specific for oncocytoma.

• Sensitivity of SEI varies substantially between studies and across institutions.

• Variability could relate to CT timing or methods of interpretation.

• High accuracy of SEI has only been reported by one group.

• Validation of SEI is needed prior to clinical implementation.

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Abbreviations

SEI:

segmental enhancement inversion

RCC:

renal cell cancer

PRISMA:

preferred reporting items for systematic reviews and meta-analyses

CCTR:

Cochrane central register of controlled trials

DARE:

database of abstracts of reviews of effects

CSDR:

Cochrane database of systematic reviews (CSDR)

TP:

true positive

TN:

true negative

FP:

false positive

FN:

false negative

ROC:

receiver operator curve

Ch-RCC:

chromophobe RCC

cc-RCC:

clear cell RCC

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Acknowledgements

We thank Sascha Davis MLIS, librarian at The Ottawa Hospital for her assistance with the search strategy.

The scientific guarantor of this publication is Matthew DF McInnes. The authors’ institution receives an unrestricted educational grant from GE Medical. The authors state that this work has not received any funding. One of the authors has significant statistical expertise. Institutional Review Board approval was not required because this is a systematic review of published literature. Our IRB waives approval for this type of study. Methodology: systematic review (retrospective).

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Authors and Affiliations

  1. Department of Medical Imaging, Ottawa Hospital Research Institute, Ottawa Hospital Civic Campus, Room c159, 1053 Carling Ave, Ottawa, ON, K1Y 4E9, Canada

    Nicola Schieda, Matthew D. F. McInnes & Lilly Cao

Authors
  1. Nicola Schieda
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  2. Matthew D. F. McInnes
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  3. Lilly Cao
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Corresponding author

Correspondence to Matthew D. F. McInnes.

Appendix

Appendix

Table 3 QUADAS-2 Tool
Full size table
Table 4 Sample search strategy
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Table 5 List of studies excluded and reason for exclusion (only excluded studies at the level of the secondary full text screen are provided)
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Schieda, N., McInnes, M.D.F. & Cao, L. Diagnostic accuracy of segmental enhancement inversion for diagnosis of renal oncocytoma at biphasic contrast enhanced CT: systematic review. Eur Radiol 24, 1421–1429 (2014). https://doi.org/10.1007/s00330-014-3147-4

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  • DOI: https://doi.org/10.1007/s00330-014-3147-4

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