title: CT prediction of the Fuhrman grade of clear cell renal cell carcinoma (RCC): towards the development of computer-assisted diagnostic method.
abstract: OBJECTIVE
  There are distinct quantifiable features characterizing renal cell carcinomas on contrast-enhanced CT examinations, such as peak tumor enhancement, tumor heterogeneity, and percent contrast washout. While qualitative visual impressions often suffice for diagnosis, quantitative metrics if developed and validated can add to the information available from standard of care diagnostic imaging. The purpose of this study is to assess the use of quantitative enhancement metrics in predicting the Fuhrman grade of clear cell RCC.
  
  
  METHODS
  65 multiphase CT examinations with clear cell RCCs were utilized, 44 tumors with Fuhrman grades 1 or 2 and 21 tumors with grades 3 or 4. After tumor segmentation, the following data were extracted: histogram analysis of voxel-based whole lesion attenuation in each phase, enhancement and washout using mean, median, skewness, kurtosis, standard deviation, and interquartile range.
  
  
  RESULTS
  Statistically significant difference was observed in 4 measured parameters between grades 1-2 and grades 3-4: interquartile range of nephrographic attenuation values, standard deviation of absolute enhancement, as well as interquartile range and standard deviation of residual nephrographic enhancement. Interquartile range of nephrographic attenuation values was 292.86 HU for grades 1-2 and 241.19 HU for grades 3-4 (p value 0.02). Standard deviation of absolute enhancement was 41.26 HU for grades 1-2 and 34.66 HU for grades 3-4 (p value 0.03). Interquartile range was 297.12 HU for residual nephrographic enhancement for grades 1-2 and 235.57 HU for grades 3-4 (p value 0.02), and standard deviation of the same was 42.45 HU for grades 1-2 and 37.11 for grades 3-4 (p value 0.04).
  
  
  CONCLUSIONS
  Our results indicate that absolute enhancement is more heterogeneous for lower grade tumors and that attenuation and residual enhancement in nephrographic phase is more heterogeneous for lower grade tumors. This represents an important step in devising a predictive non-invasive model to predict the nucleolar grade.
authors: Department of Radiology, University of Southern California, 1500 San Pablo St, 2nd floor imaging, Los Angeles, CA, 90033, USA. huhdanpa@uw.edu.
authors: Hannu
authors: http://orcid.org/0000-0002-0574-9366
authors: H
authors: Huhdanpaa
authors: Department of Radiology, University of Southern California, 1500 San Pablo St, 2nd floor imaging, Los Angeles, CA, 90033, USA. darryl.hwang@med.usc.edu.
authors: Darryl
authors: D
authors: Hwang
authors: Department of Radiology, University of Southern California, 1500 San Pablo St, 2nd floor imaging, Los Angeles, CA, 90033, USA. cen@usc.edu.
authors: Steven
authors: S
authors: Cen
authors: Department of Radiology, University of Southern California, 1500 San Pablo St, 2nd floor imaging, Los Angeles, CA, 90033, USA. bqmemd@gmail.com.
authors: Brian
authors: B
authors: Quinn
authors: Department of Radiology, University of Southern California, 1500 San Pablo St, 2nd floor imaging, Los Angeles, CA, 90033, USA. mnayyar@usc.edu.
authors: Megha
authors: M
authors: Nayyar
authors: Viterbi School of Engineering, University of Southern California, Los Angeles, USA. guangxizxj@gmail.com.
authors: Xuejun
authors: X
authors: Zhang
authors: Department of Radiology, University of Southern California, 1500 San Pablo St, 2nd floor imaging, Los Angeles, CA, 90033, USA. frank.chen@med.usc.edu.
authors: Frank
authors: F
authors: Chen
authors: Department of Radiology, University of Southern California, 1500 San Pablo St, 2nd floor imaging, Los Angeles, CA, 90033, USA. Bhushan.Desai@med.usc.edu.
authors: Bhushan
authors: B
authors: Desai
authors: Department of Urology, University of Southern California, 1441 Eastlake Ave, NOR 7416, Los Angeles, CA, 9003, USA. gliang@usc.edu.
authors: Gangning
authors: G
authors: Liang
authors: Department of Urology, University of Southern California, 1441 Eastlake Ave, NOR 7416, Los Angeles, CA, 9003, USA. igill@usc.edu.
authors: Inderbir
authors: I
authors: Gill
authors: Department of Radiology, University of Southern California, 1500 San Pablo St, 2nd floor imaging, Los Angeles, CA, 90033, USA. vinay.duddalwar@med.usc.edu.
authors: Vinay
authors: V
authors: Duddalwar
mesh_terms: D002292:Carcinoma, Renal Cell / Q000000981:diagnostic imaging* / Q000473:pathology*; D003287:Contrast Media; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D007479:Iopamidol; D007668:Kidney / Q000000981:diagnostic imaging / Q000473:pathology; D007680:Kidney Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D011856:Radiographic Image Enhancement; D012189:Retrospective Studies; D036542:Tomography, Spiral Computed
chemical_list: D003287:Contrast Media; D007479:Iopamidol
keywords: Computed tomography (CT); Computer-assisted diagnosis; Quantitative imaging; Renal cell carcinoma