CT-Based Texture Analysis in Indeterminate Pediatric Renal and Pararenal Masses

Differentiation between pediatric Wilms tumor and neuroblastoma may be difficult when solely based on conventional computed tomography (CT) features, especially in large tumors.

This article analyzes the role of CT-based texture analysis (CTTA) in differentiating (1) pediatric Wilms tumor and neuroblastoma and (2) between histological and MYCN amplified subtypes of neuroblastoma.

Treatment-naive cases of pediatric (< 18 years) renal/pararenal tumors who underwent a single-phase contrast-enhanced CT of chest, abdomen, and pelvis for staging and preoperative evaluation purposes were enrolled. CT images were processed with texture analysis software for first-order texture features. Calculated parameters included mean, variance, skewness, and kurtosis. Grayscale features were also analyzed among the tumor groups and subgroups. Mann-Whitney U and Fisher's exact tests were used for statistical analysis. A p -value of < 0.05 was considered significant.

A total of 37 lesions (22 neuroblastoma, 15 Wilms) were evaluated. With respect to grayscale features, neuroblastoma tumors exhibited calcifications in greater frequency with a higher propensity for nodal and visceral metastasis. Significant differences were observed when comparing variance of the two tumor groups with neuroblastoma showing higher intralesional variance values than Wilms tumor. Undifferentiated subtype of neuroblastoma demonstrated higher intralesional variance than other two subtypes combined; MYCN amplified tumors showed higher intralesional mean value than unamplified tumors ( p  < 0.05 for both). The various neuroblastoma subgroups did not significantly differ when considering the grayscale parameters.

CTTA has a potential role in allowing differentiation between neuroblastoma and Wilms tumor. It may additionally allow differentiation among various histological subtypes of neuroblastoma and detection of MYCN amplified neuroblastoma.