Related Experiment Video For Computed tomography
Updated: Jul 11, 2025
In Vivo, Percutaneous, Needle Based, Optical Coherence Tomography of Renal Masses
Published on: March 30, 2015
Evaluation of a multiparametric renal CT algorithm for diagnosis of clear-cell renal cell carcinoma among small
Fatma Eldihimi1, Cynthia Walsh1, Rebecca M Hibbert1
1Department of Medical Imaging, The Ottawa Hospital, 1053 Carling Avenue, Room C159, Ottawa, ON, K1Y 4E9, Canada.
Objective:
To evaluate a recently proposed CT-based algorithm for diagnosis of clear-cell renal cell carcinoma (ccRCC) among small (≤ 4 cm) solid renal masses diagnosed by renal mass biopsy.
Methods:
This retrospective study included 51 small renal masses in 51 patients with renal-mass CT and biopsy between 2014 and 2021. Three radiologists independently evaluated corticomedullary phase CT for the following: heterogeneity and attenuation ratio (mass:renal cortex), which were used to inform the CT score (1-5). CT score ≥ 4 was considered positive for ccRCC. Diagnostic accuracy was calculated for each reader and overall using fixed effects logistic regression modelling.
Results:
There were 51% (26/51) ccRCC and 49% (25/51) other masses. For diagnosis of ccRCC, area under curve (AUC), sensitivity, specificity, and positive predictive value (PPV) were 0.69 (95% confidence interval 0.61-0.76), 78% (68-86%), 59% (46-71%), and 67% (54-79%), respectively. CT score ≤ 2 had a negative predictive value 97% (92-99%) to exclude diagnosis of ccRCC. For diagnosis of papillary renal cell carcinoma (pRCC), CT score ≤ 2, AUC, sensitivity, specificity, and PPV were 0.89 (0.81-0.98), 81% (58-94%), 98% (93-99%), and 85% (62-97%), respectively. Pooled inter-observer agreement for CT scoring was moderate (Fleiss weighted kappa = 0.52).
Conclusion:
The CT scoring system for prediction of ccRCC was sensitive with a high negative predictive value and moderate agreement. The CT score is highly specific for diagnosis of pRCC.
Clinical Relevance Statement:
The CT score algorithm may help guide renal mass biopsy decisions in clinical practice, with high sensitivity to identify clear-cell tumors for biopsy to establish diagnosis and grade and high specificity to avoid biopsy in papillary tumors.
Key Points:
• A CT score ≥ 4 had high sensitivity and negative predictive value for diagnosis of clear-cell renal cell carcinoma (RCC) among solid ≤ 4-cm renal masses. • A CT score ≤ 2 was highly specific for diagnosis of papillary RCC among solid ≤ 4-cm renal masses. • Inter-observer agreement for CT score was moderate.
