Abstract
Objective
This study aimed to assess material-specific iodine and fat images for diagnosis of clear cell renal cell carcinoma (cc-RCC) compared to papillary RCC (p-RCC) and other renal masses.
Materials and methods
With IRB approval, we identified histologically confirmed solid renal masses that underwent rapid-kVp-switch DECT between 2016 and 2018: 25 cc-RCC (7 low grade versus 18 high grade), 11 p-RCC, and 6 other tumors (2 clear cell papillary RCC, 2 chromophobe RCC, 1 oncocytoma, 1 renal angiomyomatous tumor). A blinded radiologist measured iodine and fat concentration on material-specific iodine–water and fat–water basis pair images. Comparisons were performed between groups using univariate analysis and diagnostic accuracy calculated by ROC.
Results
Iodine concentration was higher in cc-RCC (6.14 ± 1.79 mg/mL) compared to p-RCC (1.40 ± 0.54 mg/mL, p < 0.001), but not compared to other tumors (5.0 ± 2.2 mg/mL, p = 0.370). Intratumoral fat was seen in 36.0% (9/25) cc-RCC (309.6 ± 234.3 mg/mL [71.1–762.3 ng/mL]), 9.1% (1/11) papillary RCC (97.11 mg/mL), and no other tumors (p = 0.036). Iodine concentration ≥ 3.99 mg/mL achieved AUC and sensitivity/specificity of 0.88 (CI 0.76–1.00) and 92.31%/82.40% to diagnose cc-RCC. To diagnose p-RCC, iodine concentration ≤ 2.5 mg/mL achieved AUC and sensitivity/specificity of 0.99 (0.98–1.00) and 100%/100%. The presence of intratumoral fat had AUC 0.64 (CI 0.53–0.75) and sensitivity/specificity of 34.6%/93.8% to diagnose cc-RCC. A logistic regression model combining iodine concentration and presence of fat increased AUC to 0.91 (CI 0.81–1.0) with sensitivity/specificity of 80.8%/93.8% to diagnose cc-RCC.
Conclusion
Iodine concentration values are highly accurate to differentiate clear cell RCC from papillary RCC; however, they overlap with other tumors. Fat-specific images may improve differentiation of clear cell RCC from other avidly enhancing tumors.
Key Points
• Clear cell renal cell carcinoma (RCC) has significantly higher iodine concentration than papillary RCC, but there is an overlap in values comparing clear cell RCC to other renal tumors.
• Iodine concentration ≤ 2.5 mg/mL is highly accurate to differentiate papillary RCC from clear cell RCC and other renal tumors.
• The presence of microscopic fat on material-specific fat images was specific for clear cell RCC, helping to differentiate clear cell RCC from other avidly enhancing renal tumors.
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Abbreviations
- AS:
-
Active surveillance
- ASiR:
-
Adaptive statistical iterative reconstruction
- AUC:
-
Area under curve
- cc-RCC:
-
Clear cell renal cell carcinoma
- CM phase:
-
Corticomedullary phase
- CS-MRI:
-
Chemical shift MRI
- CT:
-
Computed tomography
- DECT:
-
Dual-energy computed tomography
- GU:
-
Genitourinary
- HU:
-
Hounsfield unit
- ISUP:
-
International Society of Urogenital Pathology
- kVp:
-
Kilovoltage peak
- MRI:
-
Magnetic resonance imaging
- NECT:
-
Nonenhanced contrast tomography
- PACS:
-
Picture Archiving and Communication System
- PPV:
-
Positive predictive value
- RAT:
-
Renal angiomyomatous tumor
- RCC:
-
Renal cell carcinoma
- ROC:
-
Receiver operator characteristic
- ROI:
-
Region of interest
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Udare, A., Walker, D., Krishna, S. et al. Characterization of clear cell renal cell carcinoma and other renal tumors: evaluation of dual-energy CT using material-specific iodine and fat imaging. Eur Radiol 30, 2091–2102 (2020). https://doi.org/10.1007/s00330-019-06590-1
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DOI: https://doi.org/10.1007/s00330-019-06590-1