title: Low enhancement on multiphase contrast-enhanced CT images: an independent predictor of the presence of high tumor grade of clear cell renal cell carcinoma.
abstract: OBJECTIVE
  The purpose of this study was to assess the relation between tumor enhancement on multiphase contrast-enhanced CT images and Fuhrman grade of clear cell renal cell carcinoma.
  
  
  METHODS
  A single-institution retrospective review was conducted on the records of 255 patients who underwent radical or partial nephrectomy and received a histologic diagnosis of clear cell renal cell carcinoma. Two radiologists recorded the radiographic features of each patient, including the attenuation value of the lesion, lesion size, calcification within the lesion, cystic versus solid appearance, and margin regularity. Parameters representing the extent of tumor enhancement were defined and calculated. The association between tumor enhancement and Fuhrman grade was analyzed, and multivariate analysis was performed to find independent predictors of high tumor grade.
  
  
  RESULTS
  Significant differences existed in tumor enhancement among different Fuhrman grades (p < 0.001). High-grade tumors had significantly lower enhancement (p < 0.001). The enhancement parameter had a sensitivity of 0.84 and specificity of 0.93 in prediction of high tumor grade. In the multivariate analysis, more advanced age, irregular margin, and low tumor enhancement were the three independent predictors of high tumor grade.
  
  
  CONCLUSIONS
  Tumor enhancement of clear cell renal cell carcinoma on multiphase contrast-enhanced CT images is associated with Fuhrman grade. Low tumor enhancement in the corticomedullary phase is an independent predictor of high tumor grade. This system may be helpful in clinical decision making about the care of patients treated by nonsurgical approaches.
authors.affiliation: 1 All authors: Department of Urology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, 1630 Dongfang Rd, Shanghai, China 200127.
authors.forename: Ye-Hua
authors.initials: YH
authors.lastname: Zhu
authors.forename: Xun
authors.initials: X
authors.lastname: Wang
authors.forename: Jin
authors.initials: J
authors.lastname: Zhang
authors.forename: Yong-Hui
authors.initials: YH
authors.lastname: Chen
authors.forename: Wen
authors.initials: W
authors.lastname: Kong
authors.forename: Yi-Ran
authors.initials: YR
authors.lastname: Huang
mesh_terms: D000368:Aged; D000465:Algorithms; D002292:Carcinoma, Renal Cell / Q000000981:diagnostic imaging* / Q000473:pathology*; D003287:Contrast Media; D003974:Diatrizoate Meglumine; D005260:Female; D006801:Humans; D007089:Image Enhancement / Q000379:methods*; D007090:Image Interpretation, Computer-Assisted / Q000379:methods*; D007680:Kidney Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D015588:Observer Variation; D011379:Prognosis; D015203:Reproducibility of Results; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed / Q000379:methods
chemical_list: D003287:Contrast Media; D003974:Diatrizoate Meglumine
keywords: MDCT; carcinoma; kidney; neoplasm grading; renal cell carcinoma