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Association of qualitative and quantitative imaging features on multiphasic multidetector CT with tumor grade in clear cell renal cell carcinoma

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Abstract

Purpose

The purpose of the study was to determine if enhancement features and qualitative imaging features on multiphasic multidetector computed tomography (MDCT) were associated with tumor grade in patients with clear cell renal cell carcinoma (ccRCC).

Methods

In this retrospective, IRB approved, HIPAA-compliant, institutional review board-approved study with waiver of informed consent, 127 consecutive patients with 89 low grade (LG) and 43 high grade (HG) ccRCCs underwent preoperative four-phase MDCT in unenhanced (UN), corticomedullary (CM), nephrographic (NP), and excretory (EX) phases. Previously published quantitative (absolute peak lesion enhancement, absolute peak lesion enhancement relative to normal enhancing renal cortex, 3D whole lesion enhancement and the wash-in/wash-out of enhancement within the 3D whole lesion ROI) and qualitative (enhancement pattern; presence of necrosis; pattern of; tumor margin; tumor–parenchymal interface, tumor–parenchymal interaction; intratumoral vascularity; collecting system infiltration; renal vein invasion; and calcification) assessments were obtained for each lesion independently by two fellowship-trained genitourinary radiologists. Comparisons between variables included χ2, ANOVA, and student t test. p values less than 0.05 were considered to be significant. Inter-reader agreement was obtained with the Gwet agreement coefficient (AC1) and standard error (SE) was reported.

Results

No significant differences were observed between the LG and HG ccRCC cohorts with respect to absolute peak lesion enhancement and relative lesion enhancement ratio. There was a significant inverse correlation between low and high grade ccRCC and tumor enhancement the NP (71 HU vs. 54 HU, p < 0.001) and EX (52 HU vs. 39 HU, p < 0.001) phases using the 3D whole lesion ROI method. The percent wash-in of 3D enhancement from the UN to the CM phase was also significantly different between LG and HG ccRCCs (352% vs. 255%, p = 0.003). HG lesions showed significantly more calcification, necrosis, collecting system infiltration and ill-defined tumor margins (p < 0.05). Overall agreement between the two readers had a mean AC1 of 0.8172 (SE 0.0235).

Conclusions

Quantitatively, high grade ccRCC had significantly lower whole lesion enhancement in the NP and EX phases on MDCT. Qualitatively, high grade ccRCC were significantly more likely to be associated with calcifications, necrosis, collecting system infiltration, and an ill-defined tumor margin.

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Authors and Affiliations

  1. Department of Radiological Sciences, David Geffen School of Medicine at UCLA, Ronald Reagan-UCLA Medical Center, 924 Westwood Boulevard, Suite 650, Los Angeles, CA, 90024, USA

    Heidi Coy, Michael L. Douek & Matthew S. Brown

  2. Department of Radiology, University of California, Davis, 4860 Y Street, Suite 3100, Sacramento, CA, 95817, USA

    Jonathan R. Young

  3. Department of Urology, David Geffen School of Medicine at UCLA, Ronald Reagan-UCLA Medical Center, Clark Urology Center-Westwood, 200 Medical Plaza, Suite 140, Los Angeles, CA, 90095, USA

    Alan Pantuck

  4. Department of Biostatistics, UCLA School of Public Heath, Room 51-253A, Los Angeles, CA, 90095, USA

    James Sayre

  5. UCLA Department of Radiological Sciences, Ronald Reagan UCLA Medical Center, 757 Westwood Plaza, RRUMC 1621H, Box 957437, Los Angeles, CA, 90095, USA

    Steven S. Raman

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  1. Heidi Coy
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  2. Jonathan R. Young
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Correspondence to Heidi Coy.

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All authors have no conflicts of interest.

Informed consent

This retrospective, single-center, Health Insurance Portability and Accountability Act-compliant study was approved by the Institutional Review board and a waiver of informed consent was obtained.

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Coy, H., Young, J.R., Douek, M.L. et al. 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 (2019). https://doi.org/10.1007/s00261-018-1688-8

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  • DOI: https://doi.org/10.1007/s00261-018-1688-8

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