Quantitative Measurement on Contrast-Enhanced CT Distinguishes Small Clear Cell Renal Cell Carcinoma From Benign Renal Tumors: A Multicenter Study

Shiwei Luo; Wanxian Lin; Jialiang Wu; Wanli Zhang; Xiaoyan Kui; Shengsheng Lai; Ruili Wei; Xinrui Pang; Ye Wang; Chutong He; Jun Liu; Ruimeng Yang

doi:10.1016/j.acra.2023.10.014

Quantitative Measurement on Contrast-Enhanced CT Distinguishes Small Clear Cell Renal Cell Carcinoma From Benign Renal Tumors: A Multicenter Study

Acad Radiol. 2024 Apr;31(4):1460-1471. doi: 10.1016/j.acra.2023.10.014. Epub 2023 Nov 8.

Authors

Shiwei Luo¹, Wanxian Lin², Jialiang Wu³, Wanli Zhang⁴, Xiaoyan Kui⁵, Shengsheng Lai⁶, Ruili Wei⁷, Xinrui Pang⁸, Ye Wang⁹, Chutong He¹⁰, Jun Liu¹¹, Ruimeng Yang¹²

Affiliations

¹ Department of Radiology, the Second Affiliated Hospital, School of Medicine, South China University of Technology, Guangzhou 510180, Guangdong, China (S.L., W.L., W.Z., R.W., X.P., Y.W., C.H., R.Y.); Department of Radiology, the Second Xiangya Hospital of Central South University, Changsha 410011, Hunan, China (S.L., J.L.). Electronic address: shiweiluo@csu.edu.cn.
² Department of Radiology, the Second Affiliated Hospital, School of Medicine, South China University of Technology, Guangzhou 510180, Guangdong, China (S.L., W.L., W.Z., R.W., X.P., Y.W., C.H., R.Y.). Electronic address: 202220157577@mail.scut.edu.cn.
³ Department of Radiology, University of Hong Kong-Shenzhen Hospital, Shenzhen, Guangdong 518000, China (J.W.). Electronic address: wujl@hku-szh.org.
⁴ Department of Radiology, the Second Affiliated Hospital, School of Medicine, South China University of Technology, Guangzhou 510180, Guangdong, China (S.L., W.L., W.Z., R.W., X.P., Y.W., C.H., R.Y.). Electronic address: zhangwanli2018@126.com.
⁵ School of Computer Science and Engineering, Central South University, Changsha 410083, Hunan, China (X.K.). Electronic address: xykui@csu.edu.cn.
⁶ School of Medical Equipment, Guangdong Food and Drug Vocational College, Guangzhou 510520, Guangdong, China (S.L.). Electronic address: laiss@gdyzy.edu.cn.
⁷ Department of Radiology, the Second Affiliated Hospital, School of Medicine, South China University of Technology, Guangzhou 510180, Guangdong, China (S.L., W.L., W.Z., R.W., X.P., Y.W., C.H., R.Y.). Electronic address: mcweiruili0825@mail.scut.edu.cn.
⁸ Department of Radiology, the Second Affiliated Hospital, School of Medicine, South China University of Technology, Guangzhou 510180, Guangdong, China (S.L., W.L., W.Z., R.W., X.P., Y.W., C.H., R.Y.). Electronic address: 202020157793@mail.scut.edu.cn.
⁹ Department of Radiology, the Second Affiliated Hospital, School of Medicine, South China University of Technology, Guangzhou 510180, Guangdong, China (S.L., W.L., W.Z., R.W., X.P., Y.W., C.H., R.Y.). Electronic address: 202120158673@mail.scut.edu.cn.
¹⁰ Department of Radiology, the Second Affiliated Hospital, School of Medicine, South China University of Technology, Guangzhou 510180, Guangdong, China (S.L., W.L., W.Z., R.W., X.P., Y.W., C.H., R.Y.). Electronic address: mcchutonghct@mail.scut.edu.cn.
¹¹ Department of Radiology, the Second Xiangya Hospital of Central South University, Changsha 410011, Hunan, China (S.L., J.L.). Electronic address: junliu123@csu.edu.cn.
¹² Department of Radiology, the Second Affiliated Hospital, School of Medicine, South China University of Technology, Guangzhou 510180, Guangdong, China (S.L., W.L., W.Z., R.W., X.P., Y.W., C.H., R.Y.). Electronic address: eyruimengyang@scut.edu.cn.

PMID: 37945492
DOI: 10.1016/j.acra.2023.10.014

Abstract

Rationale and objectives: To evaluate the potential of quantitative measurements on contrast-enhanced CT (CECT) in differentiating small (≤4 cm) clear cell renal cell carcinoma (ccRCC) from benign renal tumors, including fat-poor angiomyolipoma (fpAML) and renal oncocytoma (RO).

Materials and methods: 244 patients with pathologically confirmed ccRCC (n = 184) and benign renal tumors (fpAML, n = 50; RO, n = 10) were randomly assigned into training cohort (n = 193) and test cohort 1 (n = 51), while external test cohort 2 (n = 50) was from another hospital. Quantitative parameters were obtained from CECT (unenhanced phase, UP; corticomedullary phase, CMP; nephrographic phase, NP; excretory phase, EP) by measuring attenuation of renal mass and cortex and subsequently calculated. Univariable and multivariable logistic regression analyses were performed to evaluate the association between these parameters and ccRCC. Finally, the constructed models were compared with radiologists' diagnoses.

Results: In univariable analysis, UP-related parameters, particularly UP_C-T (cortex minus tumor attenuation on UP), demonstrated AUC of 0.766 in training cohort, 0.901 in test cohort 1, 0.805 in test cohort 2. The heterogeneity-related parameter SD (standard deviation) showed AUC of 0.781, 0.834, and 0.875 respectively. In multivariable analysis, model 1 incorporating UP_C-T, NP_C-T (cortex minus tumor attenuation on NP), CMP_T-UP_T (tumor attenuation on CMP minus UP), and SD yielded AUC of 0.866, 0.923, and 0.949 respectively. When compared with radiologists, multivariate models demonstrated higher accuracy (0.800-0.860) and sensitivity (0.794-0.971) than radiologists' assessments (accuracy: 0.700-0.720, sensitivity: 0.588-0.706).

Conclusion: Quantitative measurements on CECT, particularly UP- and heterogeneity-related parameters, have potential to discriminate ccRCC and benign renal tumors (fpAML, RO).

Keywords: Abdomen; Diagnosis, Differential; Kidney Neoplasms; Tomography, X-Ray Computed.

Publication types

Multicenter Study

MeSH terms

Adenoma, Oxyphilic*
Carcinoma, Renal Cell* / diagnostic imaging
Carcinoma, Renal Cell* / pathology
Contrast Media
Diagnosis, Differential
Humans
Kidney Neoplasms* / pathology
Retrospective Studies
Tomography, X-Ray Computed

Substances

Contrast Media

Supplementary concepts

Oncocytoma, renal