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Value of triphasic MDCT in the differentiation of small renal cell carcinoma and oncocytoma

Abstract

Introduction

Although differentiation between benign and malignant small renal tumors (≤4 cm) is still difficult, it is a demand for decision making and determining the treatment strategy. Our aim is to evaluate the role of multidetector row computed tomography (MDCT) in the differentiation of small renal clear cell carcinoma (RCC) and renal oncocytoma (RO).

Methods

We reviewed triphasic computed tomographic (CT) scans performed in 43 patients diagnosed with RCC (n = 23) and RO (n = 21). After an unenhanced CT phase of the upper abdomen, triple-phase acquisition included a cortico-medullary phase (CMP), a nephrographic phase (NP), and a pyelographic phase (PP), and lesions were evaluated both qualitatively and quantitatively.

Results

RCCs were hypervascular in 13 cases and hypovascular in 10 cases, while ROs were hypervascular in nine cases and hypovascular in 12 cases. Mean attenuation values (MAVs) for hypervascular RCCs and hypervascular ROs on unenhanced examination were 34.0 ± 7.1 and 31.3 ± 8.1 HU, respectively. Enhancement in CMP was 173.1 ± 45.2 HU for RCCs and 151.1 ± 36.0 HU for ROs and a gradual wash-out in NP (148.8 ± 34.3 and 137.1 ± 33.9 HU for RCCs and ROs, respectively) and in PP (98.2 ± 36.0 HU for RCCs and 79.4 ± 21.5 HU for ROs) was observed. MAV for hypovascular RCCs and hypovascular ROs on unenhanced examination were 32.4 ± 12.0 and 28.9 ± 8.0 HU, respectively. Both hypovascular RCCs and ROs showed a statistically significant difference in each post contrastographic phase.

Conclusions

Absolute attenuation and the quantitative amount of the enhancement were not strong predictors for RO and RCC differentiation.

Urologia 2017; 84(4): 244 - 250

Article Type: ORIGINAL RESEARCH ARTICLE

DOI:10.5301/uj.5000256

Authors

Michele Scialpi, Eugenio Martorana, Valeria Rondoni, Ahmed Eissa, Ahmed El Sherbiny, Luigi Bevilacqua, Luis H. Ros, Irene Escartín Martínez, Michele Milizia, Lucia Manganaro, Maria Antonietta Mazzei, Alfredo D’Andrea, Giampaolo Bianchi

Article History

Disclosures

Financial support: The authors have not received any funding for this study.
Conflict of interest: All authors declare that there is no conflict of interest regarding the publication of this paper.

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Authors

Affiliations

  • Department of Surgical and Biomedical Sciences, Division of Radiology 2, Perugia University, S. Maria della Misericordia Hospital, S. Andrea delle Fratte, Perugia - Italy
  • Department of Urology, University of Modena and Reggio Emilia, Modena - Italy
  • Department of Urology, Faculty of Medicine, Tanta University, Tanta - Egypt
  • Department of Radiology, University Hospital Miguel Servet, Zaragoza - Spain
  • Department of Radiologic, Oncologic and Pathologic Sciences, Sapienza University, Rome - Italy
  • Department of Radiology, University of Siena, Siena - Italy
  • Medical-Surgical Department of Internal, Clinical and Experimental Medicine “F. Magrassi and A. Lanzara”, University of Campania, Second University of Naples “Luigi Vanvitelli”, Caserta - Italy

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