title: Segmental enhancement inversion of small renal oncocytoma: differences in prevalence according to tumor size.
abstract: OBJECTIVE
  The purpose of this study was to retrospectively assess the prevalence of segmental enhancement inversion of small renal oncocytomas according to tumor size.
  
  
  METHODS
  Thirty-three patients (19 men, 14 women; mean age, 61 years; range, 40-74 years) with 33 oncocytomas diagnosed at surgical resection who had undergone contrast-enhanced biphasic CT between January 2000 and December 2011 were included. CT scans were analyzed by two radiologists blinded to the specifics of the pathology report for size, presence of segmental enhancement inversion, enhancement pattern, and homogeneity. Segmental enhancement inversion was present when a renal mass was divided into two differently enhanced segments in the corticomedullary phase (30-40 seconds after contrast injection) with the degree of enhancement reversed in the nephrographic phase (120-180 seconds after contrast injection). The masses were further assessed for fibrous septa, cystic change, hemorrhage, and necrosis. For statistical analysis, the Pearson chi-square test and linear regression were used to evaluate the relation between the prevalence of segmental enhancement inversion and tumor size or pathologic changes.
  
  
  RESULTS
  The mean diameter of 33 renal oncocytomas was 2.65 cm (range, 0.8-4.8 cm). There was no significant linear trend according to size (p = 0.762), although segmental enhancement inversion was significantly (p = 0.006) more common (10/12) in tumors measuring 1.5-2.9 cm. Pathologic change was present in 14 oncocytomas. There was no significant linear trend according to size (p = 0.068), but 2.5-cm and larger tumors had a significantly higher prevalence (57.9%) (p = 0.036). Segmental enhancement inversion was more common (13/19) in tumors without pathologic change (p = 0.024).
  
  
  CONCLUSIONS
  Segmental enhancement inversion was a characteristic finding in our series of small renal oncocytomas and was more common in tumors measuring 1.5-2.9 cm. Pathologic changes such as central scar were more common in oncocytomas larger than 2.5 cm and may be related to the low occurrence of segmental enhancement inversion.
authors.affiliation: Department of Radiology, Seoul National University College of Medicine, Seoul, Korea.
authors.forename: Sungmin
authors.initials: S
authors.lastname: Woo
authors.forename: Jeong Yeon
authors.initials: JY
authors.lastname: Cho
authors.forename: Seung Hyup
authors.initials: SH
authors.lastname: Kim
authors.forename: Sang Youn
authors.initials: SY
authors.lastname: Kim
authors.forename: Hak Jong
authors.initials: HJ
authors.lastname: Lee
authors.forename: Sung Il
authors.initials: SI
authors.lastname: Hwang
authors.forename: Min Hoan
authors.initials: MH
authors.lastname: Moon
authors.forename: Chang Kyu
authors.initials: CK
authors.lastname: Sung
mesh_terms: D018249:Adenoma, Oxyphilic / Q000000981:diagnostic imaging* / Q000453:epidemiology*; D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D021621:Imaging, Three-Dimensional / Q000379:methods / Q000706:statistics & numerical data*; D007680:Kidney Neoplasms / Q000000981:diagnostic imaging* / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D015203:Reproducibility of Results; D056910:Republic of Korea / Q000453:epidemiology; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed / Q000706:statistics & numerical data*; D047368:Tumor Burden