Renal cortical tumors: Use of multiphasic contrast-enhanced MR imaging to differentiate benign and malignant histologic subtypes Journal Article


Authors: Vargas, H. A.; Chaim, J.; Lefkowitz, R. A.; Lakhman, Y.; Zheng, J.; Moskowitz, C. S.; Sohn, M. J.; Schwartz, L. H.; Russo, P.; Akin, O.
Article Title: Renal cortical tumors: Use of multiphasic contrast-enhanced MR imaging to differentiate benign and malignant histologic subtypes
Abstract: Purpose: To investigate the use of quantitative multiphasic contrast material-enhanced magnetic resonance (MR) imaging in differentiating between common benign and malignant histologic subtypes of renal cortical tumors. Materials and Methods: The institutional review board waived informed consent and approved this retrospective HIPAA-compliant study of 138 patients who underwent preoperative contrast-enhanced MR imaging during the period of January 2004-December 2008. At surgery, 152 renal tumors were identified (77 clear cell, 22 papillary, 18 chromophobe, and 10 unclassified carcinomas; 16 oncocytomas; nine angiomyolipomas). Three readers independently identified and measured the most-enhanced area in each tumor and placed corresponding regions of interest in similar positions on images from the precontrast, corticomedullary, nephrographic, and excretory phases. The percentage change in signal intensity (%SI change) between precontrast imaging and each postcontrast phase was calculated. Interreader agreement was evaluated by using the overall concordance correlation coefficient (OCC). A linear mixed-effects model was used to estimate and compare the trajectories of the means of log %SI change across all phases between the six histologic subtypes. Results: Interreader agreement was substantial to almost perfect (OCC, 0.77-0.88). The %SI change differed significantly between clear cell carcinomas and papillary and chromophobe carcinomas in all phases of enhancement (P < .0001-.0120). In addition, %SI change was significantly higher in angiomyolipomas than in clear cell carcinomas, but only in the corticomedullary phase (P = .0231). Enhancement did not differ significantly between clear cell carcinoma and oncocytoma in any phase (P = .2081-.6000). Conclusion: Quantitative multiphase contrast-enhanced MR imaging offers a widely available, reproducible method to characterize several histologic subtypes of renal cortical tumors, although it does not aid differentiation between clear cell carcinomas and oncocytomas. © RSNA, 2012.
Keywords: adult; aged; aged, 80 and over; middle aged; retrospective studies; major clinical study; nuclear magnetic resonance imaging; magnetic resonance imaging; reproducibility; linear models; image interpretation, computer-assisted; diagnosis, differential; tumor volume; differential diagnosis; oncocytoma; kidney carcinoma; kidney neoplasms; kidney tumor; angiomyolipoma; quantitative analysis; contrast enhancement; contrast media; clear cell carcinoma; papillary carcinoma; gadolinium pentetate; gadolinium dtpa; kidney cortex; interrater reliability; neoplasm grading; kidney cortex tumor
Journal Title: Radiology
Volume: 264
Issue: 3
ISSN: 0033-8419
Publisher: Radiological Society of North America, Inc.  
Date Published: 2012-09-01
Start Page: 779
End Page: 788
Language: English
DOI: 10.1148/radiol.12110746
PROVIDER: scopus
PUBMED: 22829683
DOI/URL:
Notes: --- - "Export Date: 1 October 2012" - "CODEN: RADLA" - "Source: Scopus"
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MSK Authors
  1. Joshua Chaim
    17 Chaim
  2. Yuliya Lakhman
    34 Lakhman
  3. Junting Zheng
    133 Zheng
  4. Paul Russo
    457 Russo
  5. Chaya S. Moskowitz
    173 Moskowitz
  6. Oguz Akin
    179 Akin
  7. Michael J Sohn
    11 Sohn