Abstract
Purpose
To determine if small hypoattenuating renal masses can be characterized as simple
cysts or renal cell carcinomas on contrast-enhanced computed tomography (CT).
Materials and methods
We retrospectively identified 20 small (≤1.5 cm) hypoattenuating renal masses seen
on contrast enhanced CT, consisting of 14 simple cysts and six renal cell carcinomas.
Three independent readers recorded subjective visual impression (five-point scale
from 1=definitely fluid to 5=definitely solid), CT attenuation, border (well circumscribed
or ill defined), and shape (ovoid or irregular) for each lesion.
Results
The overall area under the receiver operator characteristic curves for subjective
visual impression, CT attenuation, border, and shape were 0.97, 0.82, 0.59, and 0.55,
respectively. Using dichotomized ratings (1–2=cyst and 3–5=carcinoma), subjective
impression had a sensitivity and specificity of 100% and 79–100%, respectively, for
the diagnosis of renal cell carcinoma. Using a threshold of 50 Hounsfield Units (HU)
or more, CT attenuation had a sensitivity and specificity of 100% and 43–64%, respectively.
Conclusion
Small hypoattenuating renal masses can be characterized with reasonable accuracy by
subjective impression and CT attenuation; lesions that appear solid on visual inspection
or have an attenuation value of 50 HU or more are likely to be renal cell carcinoma.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Clinical ImagingAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Small renal cell carcinomas: resolving a diagnostic dilemma.Radiology. 1988; 166: 637-641
- Small renal masses (lesions smaller than 3 cm): imaging evaluation and management.AJR Am J Roentgenol. 1995; 164: 355-362
- Increased incidence of serendipitously discovered renal cell carcinoma.Urology. 1998; 51: 203-205
- The small (less than or equal to 3.0 cm) renal parenchymal tumor: detection, diagnosis, and controversies.Radiology. 1991; 179: 307-317
- Renal cell carcinoma: earlier discovery and increased detection.Radiology. 1989; 170: 699-703
- Small (< or = 3-cm) renal masses: detection with CT versus US and pathologic correlation.Radiology. 1996; 198: 785-788
- Pseudoenhancement of simulated renal cysts in a phantom using different multidetector CT scanners.AJR Am J Roentgenol. 2002; 179: 1473-1476
- Pseudoenhancement of simple renal cysts: a comparison of single and multidetector helical CT.J Comput Assist Tomogr. 2002; 26: 90-94
- Radiologic assessment of renal masses: implications for patient care.Radiology. 1997; 202: 297-305
- Small (< or = 3 cm) renal masses: correlation of spiral CT features and pathologic findings.AJR Am J Roentgenol. 1994; 163: 597-605
- Evaluation of pseudoenhancement of renal cysts during contrast-enhanced CT.AJR Am J Roentgenol. 2000; 174: 493-498
- Renal cyst pseudoenhancement: evaluation with an anthropomorphic body CT phantom.Radiology. 2002; 225: 83-90
- Current status of imaging indeterminate renal masses.Radiol Clin North Am. 1991; 29: 475-496
- Small renal neoplasms: clinical, pathologic, and imaging features.AJR Am J Roentgenol. 1989; 153: 69-73
- Magnetic resonance in the diagnosis of renal masses.BJU Int. 2000; 86: 58-69
- Multiphasic helical CT of the kidney: increased conspicuity for detection and characterization of small (<3-cm) renal masses.Radiology. 1997; 202: 211-217
- Sonography of small renal masses with indeterminant density characteristics on computed tomography.Urol Radiol. 1988; 10: 59-67
- Complex and simple renal cysts: comparative evaluation with MR imaging.Radiology. 1987; 162: 679-684
- Renal lesion characterization with gadolinium-enhanced MR imaging: efficacy and safety in patients with renal insufficiency.Radiology. 1991; 180: 85-89
- Statistical methods for assessing agreement between two methods of clinical measurement.Lancet. 1986; 1: 307-310
- The measurement of observer agreement for categorical data.Biometrics. 1977; 33: 159-174
- Comparing the areas under two or more correlated receiver operating characteristic curves: a nonparametric approach.Biometrics. 1988; 44: 837-845
- Maximum likelihood estimation of parameters of signal detection theory—a direct solution.Psychometrika. 1968; 33: 117-124
- The small renal mass: detection, characterization, and management.Abdom Imaging. 1998; 23: 256-265
- Small renal neoplasms: diagnostic imaging, pathologic features, and clinical course.Radiology. 1986; 158: 113-117
- Imaging the small solid renal mass.Abdom Imaging. 2002; 27: 629-636
- Renal-cell carcinoma.N Engl J Med. 1996; 335: 865-875
- The unreliability of CT numbers as absolute values.AJR Am J Roentgenol. 1982; 139: 443-447
Article info
Publication history
Published online: January 27, 2009
Accepted:
October 20,
2008
Received:
July 2,
2008
Footnotes
☆ZJW supported by NIBIB T32 Training Grant 1 T32 EB001631.
Identification
Copyright
© 2009 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
