Are There Useful CT Features to Differentiate Renal Cell Carcinoma From Lipid-Poor Renal Angiomyolipoma?

作者：Yang Ching Wei; Shen Shu Huei^*; Chang Yen Hwa; Chung Hsiao Jen; Wang Jia Hwia; Lin Alex TL; Chen Kuang Kuo

来源：American Journal of Roentgenology, 2013, 201(5): 1017-1028.

DOI：10.2214/AJR.12.10204

• CT
• fat-minimal angiomyolipoma
• lipid-poor angiomyolipoma
• renal cell carcinoma subtypes
• renal cell tumor

OBJECTIVE. This study was an attempt to identify key CT features that can potentially be used to differentiate between lipid-poor renal angiomyolipoma and renal cell carcinoma (RCC). %26lt;br%26gt;MATERIALS AND METHODS. We conducted an analysis of patients who received nephrectomy or renal biopsy from 2002 to 2011 with suspected RCC. We included tumors smaller than 7 cm with a completed three-phase CT examination. A radiologist and a urology fellow, blinded to histopathologic diagnosis, recorded the imaging findings by consensus and compared the values for each parameter between lipid-poor angiomyolipoma, RCC sub-types, and RCC as a group. Multivariate logistic regression analysis was performed for each univariate significant feature. %26lt;br%26gt;RESULTS. The sample in our study consisted of 132 patients with 135 renal tumors, including 51 men (age range, 26-84 years; mean age, 57 years) and 81 women (age range, 2991 years; mean age, 57 years). These tumors included 33 lipid-poor angiomyolipomas, 54 clear-cell RCC, 31 chromophobe RCC, and 17 papillary RCC. Multivariate analysis revealed four significant parameters for differentiating RCC as a group from lipid-poor angiomyolipoma (angular interface, p = 0.023; hypodense rim, p = 0.045; homogeneity, p = 0.005; unenhanced attenuation %26gt; 38.5 HU, p %26lt; 0.001), five for clear-cell RCC, two for chromophobe RCC, and one for papillary RCC. Lipid-poor angiomyolipoma and clear-cell RCC showed early strong enhancement and a washout pattern, whereas chromophobe RCC and papillary RCC showed gradual enhancement over time. %26lt;br%26gt;CONCLUSION. Specific CT features can potentially be used to differentiate lipid-poor renal angiomyolipoma from renal cell carcinoma.

• 出版日期2013-11