Renal cell carcinoma: Dynamic contrast-enhanced MR imaging for differentiation of tumor subtypes-correlation with pathologic findings

Maryellen R M Sun, Long Nao, Elizabeth M. Genega, Michael B. Atkins, Myra E. Finn, Neil M. Rofsky, Ivan Pedrosa

Research output: Contribution to journalArticle

198 Citations (Scopus)

Abstract

Purpose: To retrospectively evaluate whether the enhancement patterns of pathologically proved clear cell, papillary, and chromophobe renal cell carcinomas (RCCs) measured on clinical dynamic contrast agent-enhanced magnetic resonance (MR) images permit accurate diagnosis of RCC subtype. Materials and Methods: This study was Institutional Review Board approved and HIPAA compliant; informed consent was waived. One hundred twelve patients (76 men, 36 women; age range, 25-88 years; mean age, 58.1 years) underwent MR imaging of 113 renal masses (mean diameter, 5.4 cm) with pathologic diagnoses of clear cell (n = 75), papillary (n = 28), or chromophobe (n = 10) RCC. A 1.5-T clinical MR protocol was used before and after (corticomedullary and nephrographic phases) intravenous administration of contrast agent. Region-of-interest measurements within tumor and uninvolved renal cortex were used to calculate percentage signal intensity change and tumor-to-cortex enhancement index. Subtype groups were compared by using linear mixed-effects models. Receiver operating characteristic (ROC) curve analysis was performed for the comparison of clear cell and papillary RCCs. Results: On both the corticomedullary and nephrographic phase images, clear cell RCCs showed greater signal intensity change (205.6% and 247.1%, respectively) than did papillary RCCs (32.1% and 96.6%, respectively) (P < .001). Chromophobe RCCs showed intermediate change (109.9% and 192.5%, respectively). The tumor-to-cortex enhancement indexes at corticomedullary and nephrographic phases were largest for clear cell RCCs (1.4 and 1.2, respectively), smallest for papillary RCCs (0.2 and 0.4, respectively), and intermediate for chromophobe RCCs (0.6 and 0.8, respectively). Signal intensity changes on corticomedullary phase images were the most effective parameter for distinguishing clear cell and papillary RCC (area under ROC curve, 0.99); a threshold value of 84% permitted distinction with 93% sensitivity and 96% specificity.Conclusion: Clear cell, papillary, and chromophobe RCCs demonstrate different patterns of enhancement on two-time point clinical ynamic contrast-enhanced MR images, allowing their ifferentiation with high sensitivity and specificity.

Original languageEnglish (US)
Pages (from-to)793-802
Number of pages10
JournalRadiology
Volume250
Issue number3
DOIs
StatePublished - Mar 2009

Fingerprint

Renal Cell Carcinoma
Magnetic Resonance Imaging
Neoplasms
Magnetic Resonance Spectroscopy
ROC Curve
Contrast Media
Health Insurance Portability and Accountability Act
Kidney
Large Cell Carcinoma
Sensitivity and Specificity
Research Ethics Committees
Informed Consent
Intravenous Administration

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging

Cite this

Renal cell carcinoma : Dynamic contrast-enhanced MR imaging for differentiation of tumor subtypes-correlation with pathologic findings. / Sun, Maryellen R M; Nao, Long; Genega, Elizabeth M.; Atkins, Michael B.; Finn, Myra E.; Rofsky, Neil M.; Pedrosa, Ivan.

In: Radiology, Vol. 250, No. 3, 03.2009, p. 793-802.

Research output: Contribution to journalArticle

Sun, Maryellen R M ; Nao, Long ; Genega, Elizabeth M. ; Atkins, Michael B. ; Finn, Myra E. ; Rofsky, Neil M. ; Pedrosa, Ivan. / Renal cell carcinoma : Dynamic contrast-enhanced MR imaging for differentiation of tumor subtypes-correlation with pathologic findings. In: Radiology. 2009 ; Vol. 250, No. 3. pp. 793-802.
@article{08606b972c7945f8aa9b293263256b3e,
title = "Renal cell carcinoma: Dynamic contrast-enhanced MR imaging for differentiation of tumor subtypes-correlation with pathologic findings",
abstract = "Purpose: To retrospectively evaluate whether the enhancement patterns of pathologically proved clear cell, papillary, and chromophobe renal cell carcinomas (RCCs) measured on clinical dynamic contrast agent-enhanced magnetic resonance (MR) images permit accurate diagnosis of RCC subtype. Materials and Methods: This study was Institutional Review Board approved and HIPAA compliant; informed consent was waived. One hundred twelve patients (76 men, 36 women; age range, 25-88 years; mean age, 58.1 years) underwent MR imaging of 113 renal masses (mean diameter, 5.4 cm) with pathologic diagnoses of clear cell (n = 75), papillary (n = 28), or chromophobe (n = 10) RCC. A 1.5-T clinical MR protocol was used before and after (corticomedullary and nephrographic phases) intravenous administration of contrast agent. Region-of-interest measurements within tumor and uninvolved renal cortex were used to calculate percentage signal intensity change and tumor-to-cortex enhancement index. Subtype groups were compared by using linear mixed-effects models. Receiver operating characteristic (ROC) curve analysis was performed for the comparison of clear cell and papillary RCCs. Results: On both the corticomedullary and nephrographic phase images, clear cell RCCs showed greater signal intensity change (205.6{\%} and 247.1{\%}, respectively) than did papillary RCCs (32.1{\%} and 96.6{\%}, respectively) (P < .001). Chromophobe RCCs showed intermediate change (109.9{\%} and 192.5{\%}, respectively). The tumor-to-cortex enhancement indexes at corticomedullary and nephrographic phases were largest for clear cell RCCs (1.4 and 1.2, respectively), smallest for papillary RCCs (0.2 and 0.4, respectively), and intermediate for chromophobe RCCs (0.6 and 0.8, respectively). Signal intensity changes on corticomedullary phase images were the most effective parameter for distinguishing clear cell and papillary RCC (area under ROC curve, 0.99); a threshold value of 84{\%} permitted distinction with 93{\%} sensitivity and 96{\%} specificity.Conclusion: Clear cell, papillary, and chromophobe RCCs demonstrate different patterns of enhancement on two-time point clinical ynamic contrast-enhanced MR images, allowing their ifferentiation with high sensitivity and specificity.",
author = "Sun, {Maryellen R M} and Long Nao and Genega, {Elizabeth M.} and Atkins, {Michael B.} and Finn, {Myra E.} and Rofsky, {Neil M.} and Ivan Pedrosa",
year = "2009",
month = "3",
doi = "10.1148/radiol.2503080995",
language = "English (US)",
volume = "250",
pages = "793--802",
journal = "Radiology",
issn = "0033-8419",
publisher = "Radiological Society of North America Inc.",
number = "3",

}

TY - JOUR

T1 - Renal cell carcinoma

T2 - Dynamic contrast-enhanced MR imaging for differentiation of tumor subtypes-correlation with pathologic findings

AU - Sun, Maryellen R M

AU - Nao, Long

AU - Genega, Elizabeth M.

AU - Atkins, Michael B.

AU - Finn, Myra E.

AU - Rofsky, Neil M.

AU - Pedrosa, Ivan

PY - 2009/3

Y1 - 2009/3

N2 - Purpose: To retrospectively evaluate whether the enhancement patterns of pathologically proved clear cell, papillary, and chromophobe renal cell carcinomas (RCCs) measured on clinical dynamic contrast agent-enhanced magnetic resonance (MR) images permit accurate diagnosis of RCC subtype. Materials and Methods: This study was Institutional Review Board approved and HIPAA compliant; informed consent was waived. One hundred twelve patients (76 men, 36 women; age range, 25-88 years; mean age, 58.1 years) underwent MR imaging of 113 renal masses (mean diameter, 5.4 cm) with pathologic diagnoses of clear cell (n = 75), papillary (n = 28), or chromophobe (n = 10) RCC. A 1.5-T clinical MR protocol was used before and after (corticomedullary and nephrographic phases) intravenous administration of contrast agent. Region-of-interest measurements within tumor and uninvolved renal cortex were used to calculate percentage signal intensity change and tumor-to-cortex enhancement index. Subtype groups were compared by using linear mixed-effects models. Receiver operating characteristic (ROC) curve analysis was performed for the comparison of clear cell and papillary RCCs. Results: On both the corticomedullary and nephrographic phase images, clear cell RCCs showed greater signal intensity change (205.6% and 247.1%, respectively) than did papillary RCCs (32.1% and 96.6%, respectively) (P < .001). Chromophobe RCCs showed intermediate change (109.9% and 192.5%, respectively). The tumor-to-cortex enhancement indexes at corticomedullary and nephrographic phases were largest for clear cell RCCs (1.4 and 1.2, respectively), smallest for papillary RCCs (0.2 and 0.4, respectively), and intermediate for chromophobe RCCs (0.6 and 0.8, respectively). Signal intensity changes on corticomedullary phase images were the most effective parameter for distinguishing clear cell and papillary RCC (area under ROC curve, 0.99); a threshold value of 84% permitted distinction with 93% sensitivity and 96% specificity.Conclusion: Clear cell, papillary, and chromophobe RCCs demonstrate different patterns of enhancement on two-time point clinical ynamic contrast-enhanced MR images, allowing their ifferentiation with high sensitivity and specificity.

AB - Purpose: To retrospectively evaluate whether the enhancement patterns of pathologically proved clear cell, papillary, and chromophobe renal cell carcinomas (RCCs) measured on clinical dynamic contrast agent-enhanced magnetic resonance (MR) images permit accurate diagnosis of RCC subtype. Materials and Methods: This study was Institutional Review Board approved and HIPAA compliant; informed consent was waived. One hundred twelve patients (76 men, 36 women; age range, 25-88 years; mean age, 58.1 years) underwent MR imaging of 113 renal masses (mean diameter, 5.4 cm) with pathologic diagnoses of clear cell (n = 75), papillary (n = 28), or chromophobe (n = 10) RCC. A 1.5-T clinical MR protocol was used before and after (corticomedullary and nephrographic phases) intravenous administration of contrast agent. Region-of-interest measurements within tumor and uninvolved renal cortex were used to calculate percentage signal intensity change and tumor-to-cortex enhancement index. Subtype groups were compared by using linear mixed-effects models. Receiver operating characteristic (ROC) curve analysis was performed for the comparison of clear cell and papillary RCCs. Results: On both the corticomedullary and nephrographic phase images, clear cell RCCs showed greater signal intensity change (205.6% and 247.1%, respectively) than did papillary RCCs (32.1% and 96.6%, respectively) (P < .001). Chromophobe RCCs showed intermediate change (109.9% and 192.5%, respectively). The tumor-to-cortex enhancement indexes at corticomedullary and nephrographic phases were largest for clear cell RCCs (1.4 and 1.2, respectively), smallest for papillary RCCs (0.2 and 0.4, respectively), and intermediate for chromophobe RCCs (0.6 and 0.8, respectively). Signal intensity changes on corticomedullary phase images were the most effective parameter for distinguishing clear cell and papillary RCC (area under ROC curve, 0.99); a threshold value of 84% permitted distinction with 93% sensitivity and 96% specificity.Conclusion: Clear cell, papillary, and chromophobe RCCs demonstrate different patterns of enhancement on two-time point clinical ynamic contrast-enhanced MR images, allowing their ifferentiation with high sensitivity and specificity.

UR - http://www.scopus.com/inward/record.url?scp=62649115083&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=62649115083&partnerID=8YFLogxK

U2 - 10.1148/radiol.2503080995

DO - 10.1148/radiol.2503080995

M3 - Article

C2 - 19244046

AN - SCOPUS:62649115083

VL - 250

SP - 793

EP - 802

JO - Radiology

JF - Radiology

SN - 0033-8419

IS - 3

ER -