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Updated: Mar 15, 2026
In Vivo, Percutaneous, Needle Based, Optical Coherence Tomography of Renal Masses
Published on: March 30, 2015
Can the multiphasic computed tomography be useful in the clinical management of small renal masses?
Caterina Gaudiano1, Riccardo Schiavina2, Valerio Vagnoni2
11 Department of Radiology, Sant'Orsola-Malpighi Hospital, Bologna, Italy.
Abstract:
Background Small renal masses (SRMs; ≤4 cm) represent a challenging issue. Computed tomography (CT) is widely used for investigating renal tumors even if its ability to differentiate among the different subtypes has not yet been definitively established. Purpose To assess the potential role of the morphological features and angiodynamic behavior on multiphasic CT in the preoperative evaluation of SRMs. Material and Methods The CT images of 80 patients with SRMs who underwent surgical resection at our institution were retrospectively reviewed. The morphological features, the pattern, and the quantitative analysis of enhancement were assessed for each lesion and were correlated with the histological subtypes. Results Overall, 81 SRMs were evaluated. Final pathological examination showed 30 (37%) oncocytomas, 22 (27.2%) clear cell renal cell carcinomas (ccRCCs), 16 (19.8%) papillary RCCs (pRCCs), and 13 (16%) chromophobe RCCs (chRCCs). Of the morphological features, only necrosis was significantly associated with ccRCC ( P = 0.047). The analysis of enhancement allowed the identification of two groups of lesions, based on arterial behavior: hypervascular (oncocytomas/ccRCC) and hypovascular (chRCC/pRCC) lesions. A significant difference between the two groups in terms of degree of enhancement on CT phases was found ( P < 0.05); this was also confirmed by the receiver operating characteristic (ROC) analysis. Conclusion Except for necrosis, the morphological features are not useful in making a correct diagnosis in the case of SRMs. The angiodynamic behavior on multiphasic CT showed high accuracy in differentiating between hypovascular and hypervascular tumors; this differentiation could be useful for deciding on the most appropriate clinical management of SRMs.
Insights
Multiphasic CT angiodynamic behavior accurately differentiates small renal mass subtypes. Morphological features, except necrosis, are less useful for diagnosing small renal masses (SRMs).
Area of Science:
- Radiology
- Oncology
- Pathology
Background:
- Small renal masses (SRMs) ≤4 cm pose diagnostic challenges.
- Computed tomography (CT) is standard for investigating renal tumors, but subtype differentiation is limited.
- Accurate preoperative evaluation of SRMs is crucial for appropriate clinical management.
Purpose of the Study:
- To evaluate the role of multiphasic CT morphological features and angiodynamic behavior in preoperative SRM assessment.
- To correlate CT findings with histological subtypes of SRMs.
- To determine the diagnostic accuracy of CT in differentiating SRM subtypes.
Main Methods:
- Retrospective review of CT images from 80 patients with surgically resected SRMs.
- Assessment of morphological features, enhancement patterns, and quantitative enhancement on multiphasic CT.
- Correlation of CT findings with final histopathological diagnoses.
Main Results:
- 81 SRMs were analyzed: 37% oncocytomas, 27.2% clear cell RCC, 19.8% papillary RCC, 16% chromophobe RCC.
- Only necrosis showed a significant association with clear cell renal cell carcinoma (ccRCC).
- Angiodynamic analysis on multiphasic CT effectively distinguished hypervascular (oncocytomas/ccRCC) from hypovascular (chRCC/pRCC) lesions with high accuracy (P < 0.05).
Conclusions:
- Morphological features on CT are generally not useful for diagnosing SRMs, with the exception of necrosis.
- Multiphasic CT angiodynamic behavior demonstrates high accuracy in differentiating hypovascular from hypervascular renal tumors.
- This differentiation aids in selecting the most appropriate clinical management strategy for SRMs.
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