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Abdom Radiol (NY). 2017 Jun;42(6):1734-1743. doi: 10.1007/s00261-017-1061-3.

Aorta-Lesion-Attenuation-Difference (ALAD) on contrast-enhanced CT: a potential imaging biomarker for differentiating malignant from benign oncocytic neoplasms.

Author information

1
Department of Radiology, Massachusetts General Hospital [MGH], Harvard Medical School, Boston, MA, 02114, USA. Dhyani.manish@mgh.harvard.edu.
2
Department of Radiology, University of Florida College of Medicine, Gainesville, FL, 32610, USA.
3
Department of Urology, Massachusetts General Hospital [MGH], Harvard Medical School, Boston, MA, 02114, USA.
4
Department of Radiology, Massachusetts General Hospital [MGH], Harvard Medical School, Boston, MA, 02114, USA.
5
Department of Pathology, Massachusetts General Hospital [MGH], Harvard Medical School, Boston, MA, 02114, USA.

Abstract

OBJECTIVE:

To evaluate whether the Aorta-Lesion-Attenuation-Difference on contrast-enhanced CT can aid in the differentiation of malignant and benign oncocytic renal neoplasms.

MATERIALS AND METHODS:

Two independent cohorts-an initial (biopsy) dataset and a validation (surgical) dataset-with oncocytomas and chromophobe renal cell carcinomas (chRCC) were included in this IRB-approved retrospective study. A region of interest was placed on the renal mass and abdominal aorta on the same CT image slice to calculate an Aorta-Lesion-Attenuation-Difference (ALAD). ROC curves were plotted for different enhancement phases, and diagnostic performance of ALAD for differentiating chRCC from oncocytomas was calculated.

RESULTS:

Seventy-nine renal masses (56 oncocytomas, 23 chRCC) were analyzed in the initial (biopsy) dataset. Thirty-six renal masses (16 oncocytomas, 20 chRCC) were reviewed in the validation (surgical) cohort. ALAD showed a statistically significant difference between oncocytomas and chromophobes during the nephrographic phase (p < 0.001), early excretory phase (p < 0.001), and excretory phase (p = 0.029). The area under the ROC curve for the nephrographic phase was 1.00 (95% CI: 1.00-1.00) for the biopsy dataset and showed the narrowest confidence interval. At a threshold value of 25.5 HU, sensitivity was 100 (82.2%-100%) and specificity was 81.5 (61.9%-93.7%). When tested on the validation dataset on measurements made by an independent reader, the AUROC was 0.93 (95% CI: 0.84-1.00) with a sensitivity of 100 (80.0%-100%) and a specificity of 87.5 (60.4%-97.8%).

CONCLUSIONS:

Nephrographic phase ALAD has potential to differentiate benign and malignant oncocytic renal neoplasms on contrast-enhanced CT if histologic evaluation on biopsy is indeterminate.

KEYWORDS:

Biomarker; Chromophobe; Computed tomography (CT); Oncocytic neoplasm; Oncocytoma; Renal cell Caecinoma

PMID:
28197683
DOI:
10.1007/s00261-017-1061-3
[Indexed for MEDLINE]

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