Angiomyolipoma with minimal fat on MDCT: Can counts of negative-attenuation pixels aid diagnosis?

Claus Simpfendorfer, Brian R. Herts, Gaspar A. Motta-Ramirez, Daniel S. Lockwood, Ming Zhou, Michael Leiber, Erick M. Remer

Research output: Contribution to journalArticle

63 Scopus citations

Abstract

OBJECTIVE. The purpose of this study was to determine whether counts of pixels with sub-zero attenuation on CT scans can aid in the diagnosis of renal angiomyolipoma with minimal fat. MATERIALS AND METHODS. Of 33 angiomyolipomas identified among 719 renal masses resected from 702 patients over 4 years, 15 masses in 15 patients were prospectively diagnosed on the basis of the presence of fat at MDCT. The 18 patients with minimal-fat angiomyolipoma and a matched (age, sex, tumor size) cohort of patients with renal cell carcinoma were included in this study. Three radiologists independently counted the number of pixels with attenuation less than -10, -20, and -30 HU. Receiver operating characteristic analysis of the number of pixels at each cutoff was used to calculate sensitivity, specificity, and positive predictive value with the following criteria: 1, more than 10 pixels less than -20 HU; 2, more than 20 pixels less than -20 HU; 3, more than 5 pixels less than -30 HU. RESULTS. Using criterion 1, reader A identified six angiomyolipomas; reader B, five; and reader C, two. The combined sensitivity was 24%; specificity, 98%; and positive predictive value, 69%. Using criterion 2, reader A identified three angiomyolipomas; reader B, four; and reader C, two. The combined sensitivity was 17%; specificity, 100%; and positive predictive value, 100%. Using criterion 3, reader A identified four angiomyolipomas; reader B, four; and reader C, two. The combined sensitivity was 18%; specificity, 100%; and positive predictive value, 100%. CONCLUSION. CT findings of more than 20 pixels with attenuation less than -20 HU and more than 5 pixels with attenuation less than -30 HU have a positive predictive value of 100% in detection of angiomyolipoma, but most angiomyolipomas with minimal fat cannot be reliably identified on the basis of an absolute pixel count.

Original languageEnglish (US)
Pages (from-to)438-443
Number of pages6
JournalAmerican Journal of Roentgenology
Volume192
Issue number2
DOIs
StatePublished - Feb 2009

Keywords

  • Angiomyolipoma
  • CT
  • Renal neoplasms

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging

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    Simpfendorfer, C., Herts, B. R., Motta-Ramirez, G. A., Lockwood, D. S., Zhou, M., Leiber, M., & Remer, E. M. (2009). Angiomyolipoma with minimal fat on MDCT: Can counts of negative-attenuation pixels aid diagnosis? American Journal of Roentgenology, 192(2), 438-443. https://doi.org/10.2214/AJR.08.1180