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Small renal masses (≤ 4 cm): differentiation of oncocytoma from renal clear cell carcinoma using ratio of lesion to cortex attenuation and aorta–lesion attenuation difference (ALAD) on contrast-enhanced CT

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Abstract

Purpose

We investigate the use of ratio of lesion to cortex (L/C) attenuation and aorta–lesion attenuation difference (ALAD) on multiphase contrast-enhanced CT to help distinguish oncocytoma from clear cell RCC in small renal masses (diameter < 4 cm).

Methods

We retrospectively identified 76 patients that undergo CT before surgery for a suspicious small renal mass between January 2014 and December 2018 with pathological diagnosis of 21 oncocytomas (ROs), 25 clear cell RCCs, 7 chromophobe RCCs, 7 papillary RCCs, 7 multilocular cystic RCCs, 7 angiomyolipomas and 2 leiomyomas. CT attenuation values were obtained for the tumor, the normal renal cortex and the aorta, placing a circular region of interest (ROI) in the same slice by two radiologists, independently.

Results

In the corticomedullary phase, ROs showed isodense enhancement to the renal cortex (ratio L/C 0.92 ± 0.12), while clear cell RCCs appeared hypodense to the renal cortex (ratio L/C 0.69 ± 0.20; p < 0.01) with an accuracy of 80% for diagnosing RO. In nephrographic phase, the ratio L/C attenuation was lower than the corticomedullary phase in ROs (0.78 ± 0.11) showing an early washout pattern, while the ratio L/C was similar to the corticomedullary phase in clear cell RCCs (0.69 ± 0.13; p = 0.025, with an accuracy of 65% for diagnosing RO). The ratio L/C attenuation showed considerable overlap between ROs and clear cell RCCs in the excretory phase (p = 0.27). Mean ALAD values in the nephrographic phase were 21.95 ± 16.24 for ROs and 36.96 ± 30.53 for clear cell RCCs (p = 0.049).

Conclusion

The ratio L/C attenuation in corticomedullary phase may be useful to differentiate RO from clear cell RCC.

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Funding

This study was not supported by any funding.

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Authors and Affiliations

  1. Section of Radiology, Unit of Surgical Sciences, Department of Medicine and Surgery, Azienda Ospedaliero-Universitaria di Parma, University of Parma, Parma, Italy

    Francesco Gentili, Ilaria Bronico, Sebastiano Buti & Massimo de Filippo

  2. Department of Urology, Azienda Ospedaliero-Universitaria di Parma, University of Parma, Parma, Italy

    Umberto Maestroni & Francesco Ziglioli

  3. Department of Biomedical, Biotechnological and Translational Sciences, Azienda Ospedaliero-Universitaria di Parma, University of Parma, Parma, Italy

    Enrico Maria Silini

  4. Department of Medical Oncology, Azienda Ospedaliero-Universitaria di Parma, University of Parma, Parma, Italy

    Sebastiano Buti

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  1. Francesco Gentili
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  2. Ilaria Bronico
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  3. Umberto Maestroni
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  7. Massimo de Filippo
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Correspondence to Francesco Gentili.

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Gentili, F., Bronico, I., Maestroni, U. et al. Small renal masses (≤ 4 cm): differentiation of oncocytoma from renal clear cell carcinoma using ratio of lesion to cortex attenuation and aorta–lesion attenuation difference (ALAD) on contrast-enhanced CT. Radiol med 125, 1280–1287 (2020). https://doi.org/10.1007/s11547-020-01199-7

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  • DOI: https://doi.org/10.1007/s11547-020-01199-7

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