Skip to main content
SpringerLink
Log in

Tumor grade estımatıon of clear cell and papıllary renal cell carcınomas usıng contrast-enhanced MDCT and FSE T2 weıghted MR ımagıng: radıology-pathology correlatıon

  • Abdominal Radiology
  • Published:
La radiologia medica Aims and scope Submit manuscript

Abstract

Background

Discrimination of low grade (grade 1–2) renal tumors from high grade (grade 3–4) ones carries crucial importance in terms of the management of these patients and also in the decision-making of appropriate treatment strategies. Our aim was to investigate whether contrast-enhanced multidetector computed tomography (MDCT) and T2 weighted fast spin echo (FSE) magnetic resonance imaging (MRI) could play a specific role in the discrimination of low grade versus high grade tumors in clear cell renal cell carcinoma (ccRCC) and papillary renal cell carcinoma (pRCC) patients.

Methods

In this study, we retrospectively evaluated 66 RCC patients based on histopathologic findings who had underwent either partial or total nephrectomies. Our cohort consisted of 52 ccRCC and 14 pRCC patients, of whom 50 were male (%76) and 16 were female (%24). Among the 52 ccRCC patients, 18 had both cortico-medullary phase contrast-enhanced CT and MRI, 15 had only cortico-medullary phase CT and 19 had only MRI examination. In the pRCC group, 8 patients had both cortico-medullary phase contrast-enhanced CT and MRI, 3 had only cortico-medullary phase CT and 3 had only MRI. We both calculated mean tumor attenuation values on cortico-medullary phase MDCT images as HU (hounsfield unit) and also tumor mean signal intensity values on FSE T2 weighted MR images, using both region of interest and whole lesion measurements including normal renal cortex. The obtained values were compared with the grading results of the ccRCC and pRCC tumors according to the WHO/International Society of Urological Pathology grading system.

Results

A significant positive correlation was found between the mean attenuation values of both tumor subtypes on cortico-medullary phase contrast-enhanced CT and their grades (p < 0.001). High grade tumors exhibited higher mean attenuation values (74.3 ± 22.3 HU) than the low grade tumors (55.2 ± 23.7 HU) in both subtypes. However, a statistically significant correlation was not found between the mean signal intensity values of the two tumor subtypes on FSE T2 weighted MR images and their grades (p > 0.05). Low grade tumors had a mean signal intensity value of 408.9 ± 44.6, while high grade tumors showed a value of 382.1 ± 44.2. The analysis of the ccRCC group patients, yielded a statistically significant correlation between the mean signal intensity values on T2 weighted images and tumor grading (p < 0.001). Low grade (grade 1–2) ccRCC patients exhibited higher mean signal intensity values (475.7 ± 51.3), as compared to those of high grade (grade 3–4) (418.5 ± 45.7) tumors. On the other hand, analysis of the pRCC group patients revealed that there was a significant correlation between the mean attenuation values of tumors on cortico-medullary phase contrast-enhanced CT and their grades (p < 0.001). High grade papillary subtype tumors (54.2 ± 25.2) showed higher mean attenuation values than the low grade (35.5 ± 18.8) ones.

Conclusions

Contrast-enhanced MDCT and T2 weighted FSE MRI can play a considerable role in the discrimination of low grade versus high grade tumors of both subtype RCC patients. Thus, these non-invasive evaluation techniques may have positive impact on the determination of the management and treatment strategies of these patients.

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

Similar content being viewed by others

References

  1. Capitanio U, Montorsi F (2015) Renal cancer. Lancet 387:894–906

    Article  Google Scholar 

  2. Patard JJ, Leray E, Rioux-Leclercq N, Cindolo L, Ficarra V, Zisman A et al (2005) Prognostic value of histologic subtypes in renal cell carcinoma : a multicenter experience. J Clin Oncol 175:481–482

    Google Scholar 

  3. Tsili AC, Argyropoulou MI (2015) Advances of multidetector computed tomography in the characterization and staging of renal cell carcinoma. World J Radiol 7:110–127

    Article  Google Scholar 

  4. Rioux-Leclercq N, Karakiewicz PI, Trinh QD, Ficarra V, Cindolo L, de la Taille A et al (2007) Pognostic ability of simplified nuclear grading of renal cell carcinoma. Cancer 109:868–874

    Article  Google Scholar 

  5. Cui E, Li Z, Ma C, Li Q, Lei Y, Lan Y et al (2020) Predicting the ISUP grade of clear cell renal cell carcinoma with multiparametric MR and multiphase CT radiomics. Eur Radiol 30:2912–2921

    Article  Google Scholar 

  6. Lane BR, Samlaski MK, Herts BR, Zhou M, Novick AC, Campbell SC (2008) Renal mass biopsy: a renaissanse? J Urol 179:20–27

    Article  Google Scholar 

  7. Suzuki K, Mizuno R, Mikami S, Tanaka N, Kanao K, Kikuchi E et al (2012) Prognostic significance of high nuclear grade in patients with pathologic T1a renal cell carcinoma. J Clin Oncol 42:831–835

    Google Scholar 

  8. Palmowski M, Schifferdecker I, Zwick S, Macher-Goeppinger S, Laue H, HaferKamp A et al (2010) Tumor perfusion assessed by dynamic contrast-enhanced MRI correlates to the grading of renal cell carcinoma : initial results. Eur J Radiol 74:176–180

    Article  Google Scholar 

  9. Harris CR, Whitson JM, Meng MV (2012) Under-grading of < 4 cm renal masses on renal biopsy. BJU Int 110:794–797

    Article  Google Scholar 

  10. Feng Z, Shen O, Li Y, Hu Z (2019) CT texture analysis: a potential tool for predicting the Fuhrman grade of clear-cell renal carcinoma. Cancer Imaging 19:6

    Article  CAS  Google Scholar 

  11. Birnbaum BA, Bosniak MA, Krinsky GA, Cheng D, Waisman J, Ambrosino MM (1994) Renal cell carcinoma: correlation of CT findings with nuclear morphologic grading in 100 tumors. Abdom Imaging 19:262–266

    Article  CAS  Google Scholar 

  12. Pichler M, Hutterer GC, Chromecki TF, Jesche J, Kampelkettner K, Rehak P et al (2012) Histologic tumor necrosis is an independent prognostic indicator for clear cell and papillary renal cell carcinoma. Am J Clin Pathol 137:283

    Article  Google Scholar 

  13. Huber J, Winkler A, Jakobi H, Bruckner T, Roth W, Hallscheidt P et al (2014) Preoperative decision making for renal cell carcinoma: cystic morphology in cross-sectional imaging might predict lower malignant potential. Urol Oncol 32(37):e1-6

    Google Scholar 

  14. Beddy P, Genega EM, Ngo L, Hindman N, Wei J, Bullock A et al (2014) Tumor necrosis on magnetic resonance imaging correlates with aggressive histology and disease progression in clear cell renal cell carcinoma. Clin Genitourin Cancer 12:55–62

    Article  Google Scholar 

  15. Turun S, Banghua L, Zheng S, Wei Q (2012) Is tumor size a reliable predictor of histopathological characteristics of renal cell carcinoma? Urol Ann 4:24–28

    Article  Google Scholar 

  16. Oh S, Sung DJ, Yang KS, Sim KC, Han NY, Park BJ et al (2017) Correlation of CT imaging features and tumor size with Fuhrman grade of clear cell renal cell carcinoma. Acta Radiol 58:376–384

    Article  Google Scholar 

  17. Sun X, Liu L, Xu K, Li W, Huo Z, Liu H et al (2019) Prediction of ISUP grading of clear cell renal cell carcinoma using support vector machine model based on CT images. Med (Baltimore) 98:e15022

    Article  Google Scholar 

  18. Whittier WL (2012) Complications of the percutaneous kidney biopsy. Adv Chronic Kidney Dis 19:179–187

    Article  Google Scholar 

  19. Kwon YK, Kim BH, Park CH, Kim CI, Chang HS (2009) Effectiveness of computed tomography for predicting the nuclear grade of renal cell carcinoma. Korean J Urol 50:942–946

    Article  Google Scholar 

  20. Villalobos-Gollas M, Aguilar-Davidov B, Gomez-AlvaradoCulebro-Garcia MO, Rojas-Garcia P, Ibarra-Fombona R et al (2012) Pathological implications of areas of lower enhancement on contrast-enhanced computed tomography in renal-cell carcinoma: additional information for selecting candidates for survelliance protocols. Int Urol Nephrol 44:1369–1374

    Article  Google Scholar 

  21. Zhu HY, Wang X, Zhang J, Chen YH, Kong W, Huang YR (2014) Low enhancement on multiphase contrast-enhanced CT images : an independent predictor of the presence of high tumor grade of clear cell renal cell carcinoma. AJR Am J of Roentgenol 203:295–300

    Article  Google Scholar 

  22. Coy H, Young JR, Douek ML, Pantuck A, Brown MS, Sayre J et al (2019) Association of qualitative and quantitative imaging features on multiphasic multidetector CT with tumor grade in clear cell renal cell carcinoma. Abdom Radiol 44:180–189

    Article  Google Scholar 

  23. Sandrasegaran K, Sundaram CP, Ramaswamy R, Akisik FM, Rydberg MP, Lin C et al (2010) Usefulness of diffusion-weighted imaging in the evaluation of renal masses. AJR Am J of Roentgenol 194:438–445

    Article  Google Scholar 

  24. Doshi AM, Huang WC, Donin NM, Chandarana H (2015) MRI features of renal cell carcinoma that predict favorable clinico-pathologic outcomes. AJR Am J of Roentgenol 204:798–803

    Article  Google Scholar 

  25. Vargas HA, Delaney HG, Delappe EM, Wang Y, Zheng J, Moskowitz CS et al (2013) Multiphasic contrast-enhanced MRI : single-slice versus volumetric quantification of tumor enhancement for the assessment of renal clear-cell carcinoma fuhrman grade. J Magn Reson Imaging 37:1160–1167

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Sisli Hamidiye Etfal Training and Research Hospital, University of Health Sciences Turkey, Birlik sok. Parksaray ap. No:17/4, Levent, 34340, Istanbul, Turkey

    Ahmet Mesrur Halefoglu

  2. Department of Radiology and Pathology, 34371, Sisli, Istanbul, Turkey

    Ayse Aysim Ozagari

Authors
  1. Ahmet Mesrur Halefoglu
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ayse Aysim Ozagari
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Ahmet Mesrur Halefoglu.

Ethics declarations

Conflict of interest

There is no potential conflict of interest.

Ethical approval

Hospital Ethics comittee approval was not needed due to retrospective nature of the study.

Informed consent

Informed consents were obtained from the patients before examinations.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Halefoglu, A.M., Ozagari, A.A. Tumor grade estımatıon of clear cell and papıllary renal cell carcınomas usıng contrast-enhanced MDCT and FSE T2 weıghted MR ımagıng: radıology-pathology correlatıon. Radiol med 126, 1139–1148 (2021). https://doi.org/10.1007/s11547-021-01350-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11547-021-01350-y

Keywords

Search

Navigation