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Association of tumor grade, enhancement on multiphasic CT and microvessel density in patients with clear cell renal cell carcinoma

  • Kidneys, Ureters, Bladder, Retroperitoneum
  • Published:
Abdominal Radiology Aims and scope Submit manuscript

Abstract

Purpose

Clear cell renal cell carcinoma (ccRCC) comprises nearly 90% of all diagnosed RCC subtypes and has the worst prognosis and highest metastatic potential. The strongest prognostic factors for patients with ccRCC include histological subtype and Fuhrman grade, which are incorporated into prognostic models. Since ccRCC is a highly vascularized tumor, there may be differences in enhancement patterns on multidetector CT (MDCT) due to the hemodynamics and microvessel density (MVD) of the lesions. This may provide a noninvasive method to characterize incidentally detected low- and high-grade ccRCCs on MDCT. The purpose of our study was to determine the correlation between MDCT enhancement parameters, ccRCC MVD, and Fuhrman grade to determine its utility and value in assessing tumor vascularity and grade in vivo.

Methods

In this retrospective, HIPAA-compliant, institutional review board-approved study with waiver of informed consent, 127 consecutive patients with 89 low-grade (LG), and 43 high-grade (HG) ccRCCs underwent preoperative four-phase MDCT. A 3D volume of interest (VOI) was obtained for every tumor and absolute enhancement and the wash-in/wash-out of enhancement for each phase was assessed. Immunohistochemistry on resected specimens was used to quantify MVD. Linear regression and Pearson correlation were used to investigate the strength of the association between 3D VOI enhancement and MVD. Stepwise logistic regression analysis determined independent predictors of HG ccRCC. Cut-off values and odds Ratio (OR) with 95% CIs were reported. The clinical, radiomic, and pathologic features with the highest performance in the stepwise logistic regression analysis were evaluated using receiver operator characteristics (ROC) and area under the curve (AUC).

Results

Absolute enhancement in the nephrographic phase < 52.1 Hounsfield Units (HU) (HR 0.979, 95% CI 0.964–0.994, p value = 0.006), lesion size > 4.3 cm (HR 1.450, 95% CI 1.211–1.738, p value < 0.001), and an intratumoral MVD < 15% (HR 0.932, 95% CI 0.867–1.002, p value = 0.058) were independent predictors of HG ccRCC with an AUC of 0.818 (95% CI 0.725–0.911). HG ccRCCs had a significant association between 3D VOI enhancement and MVD in each post-contrast phase (r2 = 0.238 to 0.455, p < 0.05).

Conclusions

Absolute enhancement of the entire lesion obtained from a 3D VOI in the nephrographic phase on preoperative MDCT can provide quantitative data that are a significant, independent predictor of a high-grade clear cell RCC and can be used to assess tumor vascularity and grade in vivo.

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Acknowledgements

Funding was provided by Society of Abdominal Radiology Howard S. Stern Research [Grant No. 20163335].

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Authors and Affiliations

  1. Department of Radiological Sciences, David Geffen School of Medicine at UCLA, Ronald Reagan-UCLA Medical Center, 924 Westwood Boulevard, Suite 615, Los Angeles, CA, 90024, USA

    Heidi Coy & Michael L. Douek

  2. Department of Radiology, City of Hope National Medical Center, 1500 East Duarte Road, Duarte, CA, 91010, USA

    Jonathan R. Young

  3. Department of Urology, David Geffen School of Medicine at UCLA, Ronald Reagan-UCLA Medical Center, 300 Stein Plaza, Room 346, BOX 957384, Los Angeles, CA, 90095, USA

    Allan J. Pantuck

  4. Department of Pathology and Laboratory Medicine, David Geffen School of Medicine at UCLA, 12-229 CHS, Box 957437, Los Angeles, CA, 90095-1732, USA

    Anthony Sisk & Clara Magyar

  5. Department of Radiological Sciences, Center for Computer Vision and Imaging Biomarkers, David Geffen School of Medicine at UCLA, 924 Westwood Boulevard, Suite 650, Los Angeles, CA, 90024, USA

    Matthew S. Brown

  6. Department of Biostatistics, UCLA School of Public Heath, Room 51-253A CHS/B3-116, Box 951772, Los Angeles, CA, 90095, USA

    James Sayre

  7. Department of Radiological Sciences, David Geffen School of Medicine at UCLA, Ronald Reagan-UCLA Medical Center, 757 Westwood Plaza, RRUMC 1621H, Box 957437, Los Angeles, CA, 90095, USA

    Steven S. Raman

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  1. Heidi Coy
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Correspondence to Heidi Coy.

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All data were acquired with IRB approval, followed HIPAA guidelines, and with a waiver of informed consent.

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Coy, H., Young, J.R., Pantuck, A.J. et al. Association of tumor grade, enhancement on multiphasic CT and microvessel density in patients with clear cell renal cell carcinoma. Abdom Radiol 45, 3184–3192 (2020). https://doi.org/10.1007/s00261-019-02271-1

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