Quantitative Differentiation of Renal Cell Carcinoma From Fat-Poor Angiomyolipoma and Between Renal Cell Carcinoma Subtypes by Using Three-Phase MDCT

Main Article Content

Sasiprapa Rongthong
Tanakorn Pisutkawin
Sith Phongkitkarun

Abstract

Background: Renal cell carcinoma (RCC) can be differentiated from angiomyolipoma by detection of macroscopic fat at multidetector computed tomography (MDCT). Measurement of enhancement at MDCT help classifying between RCC subtypes, which possibly predict tumor prognosis.


Objective: Retrospectively assess whether quantitative measurements (percentage enhancement ratio [PER] and absolute washout ratio [AWR]) of renal mass enhancement during three-phase MDCT help differentiating RCC from fat-poor angiomyolipoma and other RCC subtypes.


Methods: The retrospective review of the preoperative three-phase MDCT (unenhanced, corticomedullary, and early excretory phases) performed between January 2008 and July 2017, a total of 75 renal lesions (74 consecutive patients) were assessed for attenuation values in each phase. The enhancement values (PER and AWR) were compared by ANOVA tests. Cutoff analysis of enhancement values was performed to determine optimal threshold for each histologic subtype.


Results: The attenuation value of fat-poor angiomyolipoma was significantly higher than clear cell RCCs in unenhanced phase (P = .02). The PER of the clear cell RCCs was significantly lower than that of papillary RCCs, chromophobe RCCs, and fat-poor angiomyolipomas (P < .001). The AWR of the clear cell RCCs showed significantly greater than that of papillary RCCs and fat-poor angiomyolipoma (P < .001). The PER and AWR thresholds for differentiating RCCs from fat-poor angiomyolipoma were 93.0 and 31.6 with accuracy of 74.7% and 77.3%, respectively.


Conclusions: Quantitative measurement of enhancement (PER and AWR) might help differentiating RCCs from fat-poor angiomyolipoma, and differentiating clear cell RCCs from papillary RCCs.


 

Article Details

How to Cite
Rongthong, S., Pisutkawin, T., & Phongkitkarun, S. (2020). Quantitative Differentiation of Renal Cell Carcinoma From Fat-Poor Angiomyolipoma and Between Renal Cell Carcinoma Subtypes by Using Three-Phase MDCT. Ramathibodi Medical Journal, 43(4), 1–10. https://doi.org/10.33165/rmj.2020.43.4.243934
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Original Articles

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