Skip to main content

Advertisement

SpringerLink
Log in

Pretreatment differentiation of renal cell carcinoma subtypes by CT: the influence of different tumor enhancement measurement approaches

  • Urology - Original Paper
  • Published:
International Urology and Nephrology Aims and scope Submit manuscript

Abstract

Purpose

We conducted a retrospective study to evaluate the influence of different tumor enhancement measurement approaches on the ability of computed tomography (CT) to differentiate between solid forms of clear cell renal cell carcinoma (RCC), other RCC histologic subtypes and oncocytomas. Different RCC subtypes have a diverse range of malignant potential; consequently, the information about RCC subtype obtained using minimally invasive imaging method before the treatment could allow the more accurate therapy planning. Differentiation of ccRCCs from oncocytomas is important because oncocytomas are usually benign tumors which could be treated conservatively.

Methods

CT images of 113 patients with 118 solid renal tumors were evaluated. The imaging protocol consisted pre-contrast and post-contrast images during the arterial and nephrographic phases. Renal tumor attenuation values were measured using region of interest covering as much of the solid enhancing tumor tissue as possible. Tumor attenuation values and tumor enhancement ratios were correlated with histologic subtype. One hundred of tumors were diagnosed as clear cell RCC, nine as non-clear cell RCC and nine as oncocytoma.

Results

Tumor attenuation values of >74 HU on the arterial phase scans significantly correlated with clear cell RCC (Az 0.73). The tumor-to-aorta enhancement ratios calculated on tumor attenuation values measured on the arterial phase scans had a cutoff value of >0.29, which significantly correlated with clear cell RCC (Az 0.79). All ROC curves for differentiating the clear cell RCC from oncocytomas have area under the curve too small (0.5 or less) to have chose cutoff value with sensitivity and specificity that could be applied in clinical work.

Conclusion

Enhancement measurements of renal carcinomas on CT images in the arterial phase can be used as an auxiliary method in the pretreatment differentiation of solid forms of the most frequent RCC subtypes in patients not suitable for core biopsy but who are suitable for minimally invasive treatment methods and/or targeted therapy.

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
Fig. 5
Fig. 6
Fig. 7
Fig. 8
Fig. 9
Fig. 10

Similar content being viewed by others

References

  1. Motzer RJ, Bukowski RM (2006) Targeted therapy for metastatic renal cell carcinoma. J Clin Oncol 24:5601–5608

    Article  CAS  PubMed  Google Scholar 

  2. Ferlay J, Parkin DM (2008) Steliarova-Foucher E (2010) Estimates of cancer incidence and mortality in Europe in. Eur J Cancer 46:765–781. doi:10.1016/j.ejca.2009.12.014

    Article  Google Scholar 

  3. Eble JN, Togashi K, Pisani P, et al (2004) Chapter I:Tumours of the kidney In: Eble JN, Sauter G, Epstein JI, Sesterhenn IA (eds) Pathology and genetics of tumours of the urinary system and male genital organs, World health Organization Classification of Tumours, IARC Press, Lyon, pp 7–88. http://www.iarc.fr/en/publications/pdfs-online/pat-gen/bb7/BB7.pdf Accessed: 4 July 2012

  4. Lopez-Beltran A, Scarpelli M, Montironi R, Kirkali Z (2006) 2004 WHO classification of the renal tumors of the adults. Eur Urol 49:798–805

    Article  PubMed  Google Scholar 

  5. Prasad SR, Humphrey PA, Catena JR, Narra VR, Srigley JR, Cortez AD, Dalrymple NC, Chintapalli KN (2006) Common and uncommon histologic subtypes of renal cell carcinoma: imaging spectrum with pathologic correlation. RadioGraphics 26:1795–1806

    Article  PubMed  Google Scholar 

  6. Vikram R, Ng CS, Tamboli Ph, Tannir NM, Jonasch E, Matin SF, Wood CG (2009) Papillary renal cell carcinoma: radiologic-pathologic correlation and spectrum of disease. Radiographics. 29(3):741–54; discussion 755–7. doi: 10.1148/rg.293085190

  7. Pignot G, Elie C, Conquy S, Vieillefond A, Flam T, Zerbib M, Debré B, Amsellem-Ouazana D (2007) Survival analysis of 130 patients with papillary renal cell carcinoma: prognostic utility of type 1 and type 2 subclassification. Urology 69:230–235

    Article  PubMed  Google Scholar 

  8. Ljungberg B, Cowan CC, Hanbury DC, Hora M, Kuczyk MA, Merseburger AS, Patard JJ, Mulders PFA, Sinescu IC (2010) EAU guidelines on renal cell carcinoma: the 2010 update. Eur Urol 58(3):398–406. doi:10.1016/j.eururo.2010.06.032

    Article  PubMed  Google Scholar 

  9. Facchini G, Perri F, Caraglia M, Pisano C, Striano S, Marra L, Fiore F, Aprea P, Pignata S, Iaffaioli RV (2009) New treatment approaches in renal cell carcinoma. Anticancer Drugs 20(10):893–900. doi:10.1097/CAD.0b013e32833123d4

    Article  CAS  PubMed  Google Scholar 

  10. Schrader AJ, Steffens S, Schnoeller TJ, Schrader M, Kuczyk MA (2012) Neoadjuvant therapy of renal cell carcinoma: a novel treatment option in the era of targeted therapy? Int J Urol 19(10):903–907. doi:10.1111/j.1442-2042.2012.03065.x

    Article  CAS  PubMed  Google Scholar 

  11. Schatz SM, Lieber MM (2003) Update on oncocytoma. Curr Urol Rep. 4(1):30–35

    Article  PubMed  Google Scholar 

  12. World Medical Association (2008) World Medical Association Declaration of Helsinki–ethical principles for medical research involving human subjects; 59th WMA General Assembly, Oct 2008. http://.www.wma.net/en/30publications/10policies/b3/ Accessed: 4 July 2012

  13. Herts BR, Coll DM, Novick AC, Obuchowski N, Linnell G, Wirth SL, Baker ME (2002) Enhancement characteristics of papillary renal neoplasms revealed on triphasic helical CT of the kidneys. AJR Am J Roentgenol 178:367–372

    Article  PubMed  Google Scholar 

  14. Leveridge MJ, Finelli A, Kachura JR, Evans A, Chung H, Shiff DA, Fernandes K, Jewett MA (2011) Outcomes of small renal mass needle core biopsy, nondiagnostic percutaneous biopsy, and the role of repeat biopsy. Eur Urol 60(3):578–584. doi:10.1016/j.eururo.2011.06.021

    Article  PubMed  Google Scholar 

  15. Catalano C, Fraioli F, Laghi A, Napoli A, Pediconi F, Danti M, Nardis P, Passarielo R (2003) High resolution multidetector CT in the preoperative evaluation of patients with renal cell carcinoma. AJR Am J Roentgenol 180:1271–1277

    Article  CAS  PubMed  Google Scholar 

  16. Špero M, Brkljačić B, Kolarić B, Marotti M (2010) Preoperative staging of renal cell carcinoma using magnetic resonance imaging: comparison with pathological staging. Clin Imaging 34:441–447. doi:10.1016/j.clinimag.2009.09.005

    Article  PubMed  Google Scholar 

  17. Jinzaki M, Tanimoto A, Mukai M, Ikeda E, Kobayashi S, Yuasa Y, Narimatsu Y, Murai M (2000) Double-phase helical CT of small renal parenchymal neoplasms: correlation with pathologic findings and tumor angiogenesis. J Comput Assist Tomogr 24:835–842

    Article  CAS  PubMed  Google Scholar 

  18. Kim JK, Kim TK, Ahn HJ, Kim CS, Kim K-R, Cho K-S (2002) Differentiation of subtypes of renal cell carcinoma on helical CT scans. AJR Am J Roentgenol 178:1499–1506

    Article  PubMed  Google Scholar 

  19. Ruppert-Kohlmayr AJ, Uggowitzer M, Meissnitzer T, Ruppert G (2004) Differentiation of renal clear cell carcinoma and renal papillary carcinoma using quantitative CT enhancement parameters. AJR Am J Roentgenol 183:1387–1391

    Article  PubMed  Google Scholar 

  20. Sheir KZ, El-Azab M, Mosbah A, El-Baz M, Shaaban AA (2005) Differentiation of renal cell carcinoma subtypes by multislice computerized tomography. J Urol 174:451–455

    Article  PubMed  Google Scholar 

  21. Zhang J, Lefkowitz RA, Ishill NM, Wang L, Moskowitz ChS, Russo P, Eisenberg H, Hricak H (2007) Solid renal cortical tumors: differentiation with CT. Radiology 244(2):494–505

    Article  PubMed  Google Scholar 

  22. Jung SC, Cho JY, Kim SH (2012) Subtype differentiation of small renal cell carcinomas on three-phase MDCT: usefulness of the measurement of degree and heterogeneity of enhancement. Acta Radiol 53:112–118. doi:10.1258/ar.2011.110221

    Article  PubMed  Google Scholar 

  23. Young JR, Margolis D, Sauk S, Pantuck AJ, Sayre J, Raman SS (2013) Clear cell renal cell carcinoma: discrimination from other renal cell carcinoma subtypes and oncocytoma at multiphasic multidetector CT. Radiology 267(2):444–453. doi:10.1148/radiol.13112617

    Article  PubMed  Google Scholar 

  24. Yamada T, Endo M, Tsuboi M, Matsuhashi T, Takase K, Higano S, Takahashi S (2008) Differentiation of pathologic subtypes of papillary renal cell carcinoma on CT. AJR Am J Roentgenol 191(5):1559–1563. doi:10.2214/AJR.07.3181

    Article  PubMed  Google Scholar 

  25. Wildberger JE, Adam G, Boeckmann W, Munchau A, Brauers A, Gunther RW, Fuzesi L (1997) Computed tomography characterization of renal cell tumors in correlation with histopathology. Invest Radiol 32(10):596–601

    Article  CAS  PubMed  Google Scholar 

  26. Kim JK, Park SY, Shon JH, Cho KS (2004) Angiomyolipoma with minimal fat: differentiation from renal cell carcinoma at biphasic helical CT. Radiology 230:677–684. doi:10.1148/radiol.2303030003

    Article  PubMed  Google Scholar 

  27. Swets JA (1988) Measuring the accuracy of diagnostic systems. Science 240:1285–1293

    Article  CAS  PubMed  Google Scholar 

  28. Fujimoto H, Wakao F, Moriyama N, Tobisu K, Sakamoto M, Kakizoe T (1999) Alveolar architecture of clear cell renal carcinoma (< or = 5.0 cm) show high attenuation on dynamic CT scanning. Jpn J Clin Oncol 29:198–203

    Article  CAS  PubMed  Google Scholar 

  29. Johnson PT, Horton KM, Fishman EK (2010) How not to miss or mischaracterize a renal cell carcinoma: protocols, pearls, and pitfalls. AJR Am J Roentgenol 194(4):W307–W315. doi:10.2214/AJR.09.3033

    Article  PubMed  Google Scholar 

  30. Herts BR, Coll DM, Lieber ML et al (1999) Triphasic helical CT of the kidneys: contribution of vascular phase scanning in patients before urologic surgery. AJR Am J Roentgenol 173:1273–1277

    Article  CAS  PubMed  Google Scholar 

  31. Sheth S, Scatarige JC, Horton KM et al (2001) Current concepts in the diagnosis and management of renal cell carcinoma: role of multidetector CT and three-dimensional CT. Radiographics 21:S237–S254

    Article  PubMed  Google Scholar 

  32. Coll DM, Smith RC (2007) Update on radiological imaging of renal cell carcinoma. BJU International 99:1217–1222

    Article  PubMed  Google Scholar 

  33. Szolar DH, Kammerhuber F, Altziebler S (1997) Multiphasic helical CT of the kidney: increased conspicuity for detection and characterization of small (< 3-cm) renal masses. Radiology 202(1):211–217

    CAS  PubMed  Google Scholar 

  34. Kopka L, Fischer U, Zoeller G et al (1997) Dual-phase helical CT of the kidney: value of the corticomedullary and nephrographic phase for evaluation of renal lesions and preoperative staging of renal cell carcinoma. AJR Am J Roentgenol 169(6):1573–1578

    Article  CAS  PubMed  Google Scholar 

  35. Sacco E, Pinto F, Totaro A, D’Addessi A, Racioppi M, Gulino G, Volpe A, Marangi F, D’Agostino D, Bassi P (2011) Imaging of renal cell carcinoma: state of the art and recent advances. Urol Int 86:125–139. doi:10.1159/000322724

    Article  PubMed  Google Scholar 

  36. Schimdt N, Hess V, Zumbrunn T, Rothermundt C, Bongartz G, Potthast S (2013) Choi response for prediction of survival in patients with metastatic renal cell carcinoma treated with anti-angiogenic therapies. Eur Radiol 23:632–639. doi:10.1007/s00330-012-2640-x

    Google Scholar 

Download references

Acknowledgments

The authors wish to thank prof. László Horváth, M.D., Ph.D. and Nikola Gotovac, M.D. for their valuable suggestions and comments given during preparation of this paper.

Author information

Authors and Affiliations

  1. Department of Radiology and Ultrasound, County Hospital Čakovec, I.G. Kovačića 1e Čakovec, HR-40000, Čakovec, Croatia

    Ivan Žokalj

  2. Department of Diagnostic and Interventional Radiology, University Hospital Centre “Sisters of Mercy”, Zagreb, Croatia

    Miljenko Marotti

  3. Department of Social Medicine and Epidemiology, Medical School of the University of Rijeka, Rijeka, Croatia

    Branko Kolarić

  4. Institute of Public Health “Dr. Andrija Štampar”, Zagreb, Croatia

    Branko Kolarić

Authors
  1. Ivan Žokalj
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Miljenko Marotti
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Branko Kolarić
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Ivan Žokalj.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Žokalj, I., Marotti, M. & Kolarić, B. Pretreatment differentiation of renal cell carcinoma subtypes by CT: the influence of different tumor enhancement measurement approaches. Int Urol Nephrol 46, 1089–1100 (2014). https://doi.org/10.1007/s11255-013-0631-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11255-013-0631-8

Keywords

Search

Navigation