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Characterization of clear cell renal cell carcinoma and other renal tumors: evaluation of dual-energy CT using material-specific iodine and fat imaging

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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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Authors and Affiliations

  1. Department of Medical Imaging, The Ottawa Hospital, University of Ottawa, 1053 Carling Avenue, Ottawa, ON, K1Y 4E9, Canada

    Amar Udare, Daniel Walker, Robert Chatelain, Matthew DF McInnes & Nicola Schieda

  2. Joint Department of Medical Imaging, Toronto General Hospital, The University of Toronto, Toronto, Canada

    Satheesh Krishna

  3. Department of Anatomical Pathology, The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada

    Trevor A Flood

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  1. Amar Udare
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  2. Daniel Walker
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  3. Satheesh Krishna
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  4. Robert Chatelain
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  5. Matthew DF McInnes
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  6. Trevor A Flood
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  7. Nicola Schieda
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Correspondence to Nicola Schieda.

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The scientific guarantor of this publication is Dr. Nicola Schieda.

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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

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