title: Diagnostic accuracy of segmental enhancement inversion for diagnosis of renal oncocytoma at biphasic contrast enhanced CT: systematic review.
abstract: OBJECTIVE
  To use systematic review to evaluate the diagnostic accuracy of segmental enhancement inversion (SEI) at contrast-enhanced biphasic multi-detector computed tomography (MDCT) for the diagnosis of renal oncocytoma.
  
  
  METHODS
  Several electronic databases were searched through October 2013. Two reviewers independently selected studies that met the inclusion criteria and extracted data. Study quality was assessed with the QUADAS-2 tool. The primary 2 × 2 data were investigated with forest plot and ROC plot of sensitivity and specificity.
  
  
  RESULTS
  Four studies met the inclusion criteria (307 patients). Considerable heterogeneity between studies precluded meta-analysis. Two studies from the same group of investigators demonstrated reasonable diagnostic accuracy (sensitivity 59-80 % and specificity 87-99 %), while two others did not (sensitivity 0-6 %, specificity 93-100 %). Possible reasons for this include timing of biphasic MDCT and methods of interpretation but not size of lesion.
  
  
  CONCLUSIONS
  SEI is a specific imaging finding of renal oncocytoma with highly variable sensitivity. This substantial heterogeneity across studies and between institutions suggests that further validation of this imaging finding is necessary prior to application in clinical practice.
  
  
  CONCLUSIONS
  SEI on CT in small renal masses is specific for oncocytoma. Sensitivity of SEI varies substantially between studies and across institutions. Variability could relate to CT timing or methods of interpretation. High accuracy of SEI has only been reported by one group. Validation of SEI is needed prior to clinical implementation.
authors.affiliation: Department of Medical Imaging, Ottawa Hospital Research Institute, Ottawa Hospital Civic Campus, Room c159, 1053 Carling Ave, Ottawa, ON, K1Y 4E9, Canada, nschieda@toh.on.ca.
authors.forename: Nicola
authors.initials: N
authors.lastname: Schieda
authors.forename: Matthew D F
authors.initials: MD
authors.lastname: McInnes
authors.forename: Lilly
authors.initials: L
authors.lastname: Cao
mesh_terms: D018249:Adenoma, Oxyphilic / Q000000981:diagnostic imaging*; D003287:Contrast Media; D006801:Humans; D007680:Kidney Neoplasms / Q000000981:diagnostic imaging*; D011856:Radiographic Image Enhancement / Q000379:methods / Q000592:standards; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed / Q000379:methods* / Q000592:standards*
chemical_list: D003287:Contrast Media