Differentiation of Subtypes of Renal Cell Carcinoma on Helical CT Scans
Jeong Kon Kim1,
Tae Kyoung Kim1,
Han Jong Ahn2,
Chung Soo Kim2,
Kyu-Rae Kim3 and
Kyoung-Sik Cho1
1 Department of Radiology, Asan Medical Center, University of Ulsan, 388-1
Poongnap-dong, Songpa-gu, Seoul, 138-736, South Korea.
2 Department of Urology, Asan Medical Center, University of Ulsan, Songpa-gu,
Seoul, 138-736, South Korea.
3 Department of Pathology, Asan Medical Center, University of Ulsan, Songpa-gu,
Seoul, 138-736, South Korea.
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Fig. 1A. —50-year-old man with conventional (clear cell) renal
carcinoma. Unenhanced CT scan obtained at level of renal hilum shows
well-demarcated round mass (arrows) in right kidney. Diameter of mass
is 2.5 cm, and attenuation value is 34 H.
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Fig. 2A. —62-year-old man with conventional (clear cell) renal
carcinoma. Unenhanced CT scan obtained at level of superior mesenteric artery
shows lobulated mass (arrowheads) with 8-cm diameter and 35-H
attenuation value.
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Fig. 3A. —55-year-old man with papillary renal carcinoma. Unenhanced CT
scan obtained at level of renal hilum shows well-demarcated round mass
(arrows) with 2.5-cm diameter and 38-H attenuation value in right
kidney.
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Fig. 4A. —58-year-old woman with papillary renal carcinoma. Unenhanced
CT scan obtained at level of superior mesenteric artery shows lobulated mass
(arrowheads) with 7-cm diameter and 37-H attenuation value.
Calcification (arrow) within tumor can be seen.
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Fig. 5A. —67-year-old man with chromophobe renal carcinoma. Unenhanced
CT scan obtained at level of upper pole of right kidney shows lobulated mass
(arrowheads) with 8-cm diameter and 37-H attenuation value.
Multifocal calcifications (arrows) can be seen within tumor.
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Fig. 1B. —50-year-old man with conventional (clear cell) renal
carcinoma. On contrast-enhanced CT scans obtained at same level as A,
attenuation value of lesion (arrows) was measured as 173 H in
corticomedullary phase (B) and 76 H in excretory phase (C).
Therefore, degree of enhancement was calculated as 139 H in corticomedullary
phase and 42 H in excretory phase. This lesion shows heterogeneous
enhancement.
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Fig. 2B. —62-year-old man with conventional (clear cell) renal
carcinoma. On contrast-enhanced CT scans, enhancement pattern of lesion
(arrowheads) is heterogeneous, and attenuation value was measured as
201 H in corticomedullary phase (degree of enhancement, 166 H) (B) and
128 H in excretory phase (degree of enhancement, 93 H) (C). Perinephric
change (arrows) is visible.
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Fig. 3B. —55-year-old man with papillary renal carcinoma.
Contrast-enhanced CT scans obtained at same level as A show homogeneous
enhancement of lesion (arrows); attenuation value was measured as 82
H in corticomedullary phase (B) and 75 H in excretory phase (C).
Therefore, degree of enhancement was calculated as 44 H in corticomedullary
phase and 37 H in excretory phase.
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Fig. 4B. —58-year-old woman with papillary renal carcinoma. On
contrast-enhanced CT scans, enhancement pattern of lesion
(arrowheads) is predominantly peripheral, and attenuation value was
measured as 94 H and degree of enhancement as 57 H in corticomedullary phase
(B) and 71 H and 34 H, respectively, in excretory phase (C).
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Fig. 5B. —67-year-old man with chromophobe renal carcinoma. On
contrast-enhanced CT scans obtained at same level as A, mass
(arrowheads) shows homogeneous enhancement that measured 51 H in
corticomedullary phase (B) and 33 H in excretory phase (C).
Attenuation value was 88 H in corticomedullary phase and 70 H in excretory
phase.
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Fig. 1C. —50-year-old man with conventional (clear cell) renal
carcinoma. On contrast-enhanced CT scans obtained at same level as A,
attenuation value of lesion (arrows) was measured as 173 H in
corticomedullary phase (B) and 76 H in excretory phase (C).
Therefore, degree of enhancement was calculated as 139 H in corticomedullary
phase and 42 H in excretory phase. This lesion shows heterogeneous
enhancement.
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Fig. 2C. —62-year-old man with conventional (clear cell) renal
carcinoma. On contrast-enhanced CT scans, enhancement pattern of lesion
(arrowheads) is heterogeneous, and attenuation value was measured as
201 H in corticomedullary phase (degree of enhancement, 166 H) (B) and
128 H in excretory phase (degree of enhancement, 93 H) (C). Perinephric
change (arrows) is visible.
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Fig. 3C. —55-year-old man with papillary renal carcinoma.
Contrast-enhanced CT scans obtained at same level as A show homogeneous
enhancement of lesion (arrows); attenuation value was measured as 82
H in corticomedullary phase (B) and 75 H in excretory phase (C).
Therefore, degree of enhancement was calculated as 44 H in corticomedullary
phase and 37 H in excretory phase.
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Fig. 4C. —58-year-old woman with papillary renal carcinoma. On
contrast-enhanced CT scans, enhancement pattern of lesion
(arrowheads) is predominantly peripheral, and attenuation value was
measured as 94 H and degree of enhancement as 57 H in corticomedullary phase
(B) and 71 H and 34 H, respectively, in excretory phase (C).
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Fig. 5C. —67-year-old man with chromophobe renal carcinoma. On
contrast-enhanced CT scans obtained at same level as A, mass
(arrowheads) shows homogeneous enhancement that measured 51 H in
corticomedullary phase (B) and 33 H in excretory phase (C).
Attenuation value was 88 H in corticomedullary phase and 70 H in excretory
phase.
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Fig. 6A. —Graphs show receiver operating characteristics curves for
degree of enhancement in differentiation of conventional (clear cell) renal
carcinoma from nonconventional renal carcinomas (i.e., papillary, chromophobe,
and collecting duct). In corticomedullary phase, area under curve
(Az value) is 0.833 (95% confidence interval [CI]:
0.702-0.923).
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Fig. 6B. —Graphs show receiver operating characteristics curves for
degree of enhancement in differentiation of conventional (clear cell) renal
carcinoma from nonconventional renal carcinomas (i.e., papillary, chromophobe,
and collecting duct). In excretory phase, Az value is
0.905 (95% CI: 0.825-0.956).
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Fig. 7A. —64-year-old man with collecting duct renal carcinoma.
Unenhanced CT scan obtained at level of upper pole of right kidney shows
lobulated mass (arrowheads) with 12-cm diameter and 37-H attenuation
value. Perinephric change (arrows) can be seen.
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Fig. 7B. —64-year-old man with collecting duct renal carcinoma. On
contrast-enhanced CT scans obtained at same level as A, mass
(arrowheads) shows heterogeneous enhancement with 43-H enhancement in
corticomedullary phase (B) and 35-H enhancement in excretory phase
(C). Attenuation value was 80 H in corticomedullary phase and 72 H in
excretory phase. Perinephric change (arrows) is shown.
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Fig. 7C. —64-year-old man with collecting duct renal carcinoma. On
contrast-enhanced CT scans obtained at same level as A, mass
(arrowheads) shows heterogeneous enhancement with 43-H enhancement in
corticomedullary phase (B) and 35-H enhancement in excretory phase
(C). Attenuation value was 80 H in corticomedullary phase and 72 H in
excretory phase. Perinephric change (arrows) is shown.
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Fig. 7D. —64-year-old man with collecting duct renal carcinoma. CT scan
obtained in excretory phase 8 cm above A shows tumor invasion
(arrows) of renal vein.
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