A comparison of effectiveness of the contrast enhanced computed tomography with magnetic resonance imaging in the differential diagnosis of clear cell renal carcinoma

Figure 1.

Figure 2.

Figure 3.

Figure 4.

Differences in risk factors detected in patients with ccRCC vs_ patients with other etiologies of indeterminate small renal masses (SRMs)

Risk factors	ccRCC group (n = 18)	non-ccRCC group (n = 33)	p-value
All risk factors	17 (94.4%)	22 (66.7%)	0.037
Smoking	11 (61.1%)	9 (27.3%)	0.018
Family history of neoplasm	0 (0%)	1 (3%)	1
Genetic syndrome	0 (0%)	0 (0%)	1
Dialysis related cystic disease	0 (0%)	0 (0%)	1
Obesity	0 (0%)	3 (9.1%)	0.544
Hypertension	14 (77.8%)	16 (48.5%)	0.042
Cyclophosphamide treatment	1 (5.6%)	1 (3.0%)	1
Male sex	6 (33.3%)	19 (57.6%)	0.098

Differences in CECT parameters in patients with ccRCC and patients with other etiologies of indeterminate small renal masses

CECT Features	ccRCC (n = 18)	Non-ccRCC (n = 33)	p-value
Anatomical
Right kidney	55.6% (10)	36.4% (13)	0.268
Left kidney	44.4% (8)	60.6% (20)	0.268
Morphological
Bean-like shape	38.9% (7)	27.3% (9)	0.393
Ball-like shape	61.1% (11)	72.2% (24)	0.393
Heterogeneous mass	88.9% (16)	60.6% (20)	0.034*
Enhancement
Significant (> 15 HU)	94.4% (17)	81.8% (27)	0.398
Heterogeneous enhancement	83.3% (15)	51.5% (17)	0.025*
Washout pattern	83.3% (15)	33.3% (11)	< 0.001*
Prolonged pattern	16.7% (3)	66.7% (22)	< 0.001*
Secondary Features
Tumor-feeding vessels	33.3% (6)	3.0% (1)	0.006*
Necrosis area	44.4% (8)	21.2% (7)	0.082
Calcification	5.6% (1)	9.1% (3)	1.000

Specificity, sensitivity, accuracy, positive likelihood ratio, and positive predictive value for selected imaging parameters

Imaging feature	Sensitivity	Specificity	Accuracy	PLR	PPV
MRI parameter
Intense CM phase enhancement	50.0(21.1–78.9)%	53.3(34.3–71.7)%	52.4 (36.4–68.0)%	1.1(0.5–2.1)	30.0(17.8–45.9)%
ADER > 0.99	75.0(42.8–94.5)%	53.3(34.3–71.7)%	59.5 (43.3–74.4)%	1.6(1.0–2.7)	39.1(28.0–51.5)%
T1 SI ratio < 0.73	41.7(15.2–72.3)%	96.7(82.8–99.9)%	81.0 (65.9–91.4)%	12.5(1.6–96.1)	83.3(39.4–97.5)%
ccLS = 5	25.0(5.5–57.2)%	100.0(88.4–100.0)%	78.6 (63.2–89.7)%	-	100.0(29.24–100.0)%
ccLS = 4/5	50.0(21.1–78.9)%	63.3(43.9–80.1)%	59.5 (43.3–74.4)%	1.4(0.7–2.9)	35.3(20.7–53.2)%
CECT parameter
Relative washout > 11.5	100.0(73.5–100.0)%	66.7(47.2–82.7)%	76.2 (60.6–88.0)%	3.0(1.8–5.0)	54.6(42.0–66.6)%

Difference in selected novel MRI and CECT parameters between ccRCC and non-ccRCC

Imaging features	ccRCC group (n = 12)	non-ccRCC group (n = 30)	p-value
MRI parameters
Intense corticomedullary enhancement	6 (50.0%)	14 (46.7%)	0.529
ADER > 0.99	9 (75.0%)	14 (46.7%)	0.291
T1 SI ratio <0.73	5 (41.7%)	1 (3.3%)	0.007
ccLS = 5	3 (25.0%)	0 (0.0%)	0.024
ccLS = 4/5	6 (50.0%)	11 (36.7%)	0.590
CECT parameter
Relative washout > 11.5	12 (100.0%)	10 (33.3%)	< 0.001

Area under the curve analyses according to selected CECT parameters in the prediction of ccRCC occurrence

CECT features	AUC	p-value
Enhancement in corticomedullary phase	0.752	0.003
Difference in enhancement between corticomedullary and native phase	0.751	0.003
Difference in enhancement between corticomedullary and nephrographic phase	0.828	< 0.001
Absolute washout - (difference in enhancement between corticomedullary and nephrographic phase/difference in enhancement between corticomedullary and native phase)*100	0.842	< 0.001
Relative washout - (difference in enhancement between corticomedullary and nephrographic phase/enhancement in corticomedullary phase)*100	0.850	< 0.001
Difference in enhancement between nephrographic and native phase	0.552	0.541
Enhancement in nephrographic phase	0.535	0.679

Clinical features and CECT parameters in the prediction of ccRCC occurrence in univariate and multivariate logistic regression analysis

Tested features	Univariate OR (CI: 95%), p-value	Multivariate OR (CI: 95%), p-value
Clinical parameter
Smoking	4.19 (1.24–14.17), p = 0.02	7.50 (1.13–49.88), p = 0.04
Hypertension	2.92 (0.79–10.76), p = 0.11	-
CECT parameter
Heterogeneous mass	5.2 (1.02–26.47), p = 0.05	-
Heterogeneous enhancement	4.71 (1.14–19.34), p = 0.03	4.51 (0.47–43.59), p = 0.19
Washout pattern (at least 20 HU between corticomedullary and nephrographic phases)	10.0 (2.38–42.01), p = 0.002	0.13 (0.01–3.28), p = 0.22
Relative washout - (difference in enhancement between corticomedullary and nephrographic phase/enhancement in corticomedullary phase)*100	1.08 (1.03–1.14), p = 0.001	1.19 (1.01–1.41), p = 0.04
Enhancement in corticomedullary phase	1.02 (1.00–1.03), p = 0.014	1.03 (0.95–1.12), p = 0.46
Difference in enhancement between corticomedullary and native phase	1.02 (1.00–1.03), p = 0.019	0.98 (0.91–1.06), p = 0.62
Difference in enhancement between nephrographic and corticomedullary phase	0.95 (0.92–0.98), p = 0.002	1.05 (0.95–1.16), p = 0.35