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The characterization of small hypoattenuating renal masses on contrast-enhanced CT

      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

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      References

        • Amendola MA
        • Bree RL
        • Pollack HM
        • et al.
        Small renal cell carcinomas: resolving a diagnostic dilemma.
        Radiology. 1988; 166: 637-641
        • Curry NS
        Small renal masses (lesions smaller than 3 cm): imaging evaluation and management.
        AJR Am J Roentgenol. 1995; 164: 355-362
        • Jayson M
        • Sanders H
        Increased incidence of serendipitously discovered renal cell carcinoma.
        Urology. 1998; 51: 203-205
        • Bosniak MA
        The small (less than or equal to 3.0 cm) renal parenchymal tumor: detection, diagnosis, and controversies.
        Radiology. 1991; 179: 307-317
        • Smith SJ
        • Bosniak MA
        • Megibow AJ
        • Hulnick DH
        • Horii SC
        • Raghavendra BN
        Renal cell carcinoma: earlier discovery and increased detection.
        Radiology. 1989; 170: 699-703
        • Jamis-Dow CA
        • Choyke PL
        • Jennings SB
        • Linehan WM
        • Thakore KN
        • Walther MM
        Small (< or = 3-cm) renal masses: detection with CT versus US and pathologic correlation.
        Radiology. 1996; 198: 785-788
        • Abdulla C
        • Kalra MK
        • Saini S
        • et al.
        Pseudoenhancement of simulated renal cysts in a phantom using different multidetector CT scanners.
        AJR Am J Roentgenol. 2002; 179: 1473-1476
        • Heneghan JP
        • Spielmann AL
        • Sheafor DH
        • Kliewer MA
        • DeLong DM
        • Nelson RC
        Pseudoenhancement of simple renal cysts: a comparison of single and multidetector helical CT.
        J Comput Assist Tomogr. 2002; 26: 90-94
        • Davidson AJ
        • Hartman DS
        • Choyke PL
        • Wagner BJ
        Radiologic assessment of renal masses: implications for patient care.
        Radiology. 1997; 202: 297-305
        • Silverman SG
        • Lee BY
        • Seltzer SE
        • Bloom DA
        • Corless CL
        • Adams DF
        Small (< or = 3 cm) renal masses: correlation of spiral CT features and pathologic findings.
        AJR Am J Roentgenol. 1994; 163: 597-605
        • Coulam CH
        • Sheafor DH
        • Leder RA
        • Paulson EK
        • DeLong DM
        • Nelson RC
        Evaluation of pseudoenhancement of renal cysts during contrast-enhanced CT.
        AJR Am J Roentgenol. 2000; 174: 493-498
        • Birnbaum BA
        • Maki DD
        • Chakraborty DP
        • Jacobs JE
        • Babb JS
        Renal cyst pseudoenhancement: evaluation with an anthropomorphic body CT phantom.
        Radiology. 2002; 225: 83-90
        • Hartman DS
        • Aronson S
        • Frazer H
        Current status of imaging indeterminate renal masses.
        Radiol Clin North Am. 1991; 29: 475-496
        • Levine E
        • Huntrakoon M
        • Wetzel LH
        Small renal neoplasms: clinical, pathologic, and imaging features.
        AJR Am J Roentgenol. 1989; 153: 69-73
        • Nikken JJ
        • Krestin GP
        Magnetic resonance in the diagnosis of renal masses.
        BJU Int. 2000; 86: 58-69
        • Szolar DH
        • Kammerhuber F
        • Altziebler S
        • et al.
        Multiphasic helical CT of the kidney: increased conspicuity for detection and characterization of small (<3-cm) renal masses.
        Radiology. 1997; 202: 211-217
        • Foster WL
        • Roberts L
        • Halvorsen RA
        • Dunnick NR
        Sonography of small renal masses with indeterminant density characteristics on computed tomography.
        Urol Radiol. 1988; 10: 59-67
        • Marotti M
        • Hricak H
        • Fritzsche P
        • Crooks LE
        • Hedgcock MW
        • Tanagho EA
        Complex and simple renal cysts: comparative evaluation with MR imaging.
        Radiology. 1987; 162: 679-684
        • Rofsky NM
        • Weinreb JC
        • Bosniak MA
        • Libes RB
        • Birnbaum BA
        Renal lesion characterization with gadolinium-enhanced MR imaging: efficacy and safety in patients with renal insufficiency.
        Radiology. 1991; 180: 85-89
        • Bland JM
        • Altman DG
        Statistical methods for assessing agreement between two methods of clinical measurement.
        Lancet. 1986; 1: 307-310
        • Landis JR
        • Koch GG
        The measurement of observer agreement for categorical data.
        Biometrics. 1977; 33: 159-174
        • DeLong ER
        • DeLong DM
        • Clarke-Pearson DL
        Comparing the areas under two or more correlated receiver operating characteristic curves: a nonparametric approach.
        Biometrics. 1988; 44: 837-845
        • Dorfman DD
        • Alf E
        Maximum likelihood estimation of parameters of signal detection theory—a direct solution.
        Psychometrika. 1968; 33: 117-124
        • Zagoria RJ
        • Dyer RB
        The small renal mass: detection, characterization, and management.
        Abdom Imaging. 1998; 23: 256-265
        • Curry NS
        • Schabel SI
        • Betsill WL
        Small renal neoplasms: diagnostic imaging, pathologic features, and clinical course.
        Radiology. 1986; 158: 113-117
        • Curry NS
        Imaging the small solid renal mass.
        Abdom Imaging. 2002; 27: 629-636
        • Motzer RJ
        • Bander NH
        • Nanus DM
        Renal-cell carcinoma.
        N Engl J Med. 1996; 335: 865-875
        • Levi C
        • Gray JE
        • McCullough EC
        • Hattery RR
        The unreliability of CT numbers as absolute values.
        AJR Am J Roentgenol. 1982; 139: 443-447