Contrast-Enhanced MDCT in Clear Cell Renal Adenocarcinoma: Correlation with Fuhrman Grade
Abstract
Objective: to determine the effectiveness of multidetector commuted tomography (MDCT) for evaluating the grading (Fuhrman grade) of clear cell renal cell carcinoma (CCRCC) Materials and methods. Four-phase contrast-enhanced MDCT of 54 patients with histologically verified clear cell renal carcinoma operated on in A.V. Vishnevsky Institute of Surgery from April 2011 to March 2015 have been retrospectively analyzed. The patients were divided in two groups based on Furhman grade (1982). The first Group included Grade I and Grade II (n = 37). The second group included Grade III and Grade IV tumors (n = 17). Contrast enhancement was calculated for each group via manual ROI placement in arterial, portal, delayed phases and averaging tumor density. The non-parametric Mann-Whitney U test and Fisher criterion were used to determine whether there was a significant correlation between contrast enhancement and Fuhrman grade; p value of < 0.05 was considered statistically significant. The evaluated parameters were: the average contrast enhancement for each phase of research, tumor size and structure, contours of the tumor, the presence of tumor thrombus, the spread of tumor in the renal capsule and perirenal fat. Results. High grade clear cell adenocarcinoma showed significantly smaller lesion size (<60 mm) with distinct lesion contour, tumor structure was less heterogeneous due to less frequently observed areas of necrosis and hemorrhage, greater arterial (>90 HU) and venous (>80 HU) (p < 0.05) contrast medium washout in the excretory phase and intact renal capsule. Lower grade clear cell adenocarcinoma showed significantly larger lesion size (p < 0.05), irregular lesion contour tumor structure was heterogeneous due to the frequently observed areas of necrosis and hemorrhage, lower arterial and venous contrast enhancement (arterial and venous phase enhancement due to necrosis and hemorrhage), slow and heterogeneous contrast medium washout in the excretory phase, with renal capsule invasion (p < 0.05), inferior cava vein, renal vein tumoral thrombosis was frequent in lower grade lesion group. Conclusion. Parameters of contrast-enhanced multiphase computed tomography allow to evaluate clear cell renal cancer differentiation were determined.
About the Authors
Yulia Sergeevna Galchina
A.V. Vishnevsky Institute of Surgery
Russian Federation
Russian Federation
Andrey Vyacheslavovich Glotov
A.V. Vishnevsky Institute of Surgery
Russian Federation
Russian Federation
Sergey Sergeevich Pyanikin
A.V. Vishnevsky Institute of Surgery
Russian Federation
Russian Federation
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Review
For citations:
Galchina Yu.S., Glotov A.V., Pyanikin S.S. Contrast-Enhanced MDCT in Clear Cell Renal Adenocarcinoma: Correlation with Fuhrman Grade. Medical Visualization. 2016;(3):35-49. (In Russ.)
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