title: Diagnostic accuracy of contrast-enhanced computed tomography and contrast-enhanced magnetic resonance imaging of small renal masses in real practice: sensitivity and specificity according to subjective radiologic interpretation.
abstract: BACKGROUND
  The aim of this study was to investigate the diagnostic accuracy of contrast-enhanced computed tomography (CT) and contrast-enhanced magnetic resonance imaging (MRI) of small renal masses in real practice.
  
  
  METHODS
  Contrast-enhanced CT and MRI were performed between February 2008 and February 2013 on 68 patients who had suspected small (≤4 cm) renal cell carcinoma (RCC) based on ultrasonographic measurements. CT and MRI radiographs were reviewed, and the findings of small renal masses were re-categorized into five dichotomized scales by the same two radiologists who had interpreted the original images. Receiver operating characteristics curve analysis was performed, and sensitivity and specificity were determined.
  
  
  RESULTS
  Among the 68 patients, 60 (88.2 %) had RCC and eight had benign disease. The diagnostic accuracy rates of contrast-enhanced CT and MRI were 79.41 and 88.23 %, respectively. Diagnostic accuracy was greater when using contrast-enhanced MRI because too many masses (67.6 %) were characterized as "4 (probably solid cancer) or 5 (definitely solid cancer)." The sensitivity of contrast-enhanced CT and MRI for predicting RCC were 79.7 and 88.1 %, respectively. The specificities of contrast-enhanced CT and MRI for predicting RCC were 44.4 and 33.3 %, respectively. Fourteen diagnoses (20.5 %) were missed or inconsistent compared with the final pathological diagnoses. One appropriate nephroureterectomy and five unnecessary percutaneous biopsies were performed for RCC. Seven unnecessary partial nephrectomies were performed for benign disease.
  
  
  CONCLUSIONS
  Although contrast-enhanced CT and MRI showed high sensitivity for detecting small renal masses, specificity remained low.
authors.affiliation: Department of Urology, Soonchunhyang University Hospital, Soonchunhyang University College of Medicine, 59, Daesagwan-ro, Yongsan-gu, Seoul, 140-743, Republic of Korea.
authors.forename: Jae Heon
authors.initials: JH
authors.lastname: Kim
authors.affiliation: Department of Urology, Soonchunhyang University Hospital, Soonchunhyang University College of Medicine, 59, Daesagwan-ro, Yongsan-gu, Seoul, 140-743, Republic of Korea.
authors.forename: Hwa Yeon
authors.initials: HY
authors.lastname: Sun
authors.affiliation: Department of Radiology, Soonchunhyang University Hospital, Soonchunhyang University College of Medicine, Seoul, Republic of Korea.
authors.forename: Jiyoung
authors.initials: J
authors.lastname: Hwang
authors.affiliation: Department of Radiology, Soonchunhyang University Hospital, Soonchunhyang University College of Medicine, Seoul, Republic of Korea.
authors.forename: Seong Sook
authors.initials: SS
authors.lastname: Hong
authors.affiliation: Department of Family Medicine, Soonchunhyang University Cheonan Hospital, Soonchunhyang University College of Medicine, Cheonan, Republic of Korea.
authors.forename: Yong Jin
authors.initials: YJ
authors.lastname: Cho
authors.affiliation: Department of Urology, Soonchunhyang University Hospital, Soonchunhyang University College of Medicine, 59, Daesagwan-ro, Yongsan-gu, Seoul, 140-743, Republic of Korea.
authors.forename: Seung Whan
authors.initials: SW
authors.lastname: Doo
authors.affiliation: Department of Urology, Soonchunhyang University Hospital, Soonchunhyang University College of Medicine, 59, Daesagwan-ro, Yongsan-gu, Seoul, 140-743, Republic of Korea.
authors.forename: Won Jae
authors.initials: WJ
authors.lastname: Yang
authors.affiliation: Department of Urology, Soonchunhyang University Hospital, Soonchunhyang University College of Medicine, 59, Daesagwan-ro, Yongsan-gu, Seoul, 140-743, Republic of Korea. yssong@schmc.ac.kr.
authors.forename: Yun Seob
authors.initials: YS
authors.lastname: Song
mesh_terms: D000368:Aged; D001707:Biopsy, Needle; D002292:Carcinoma, Renal Cell / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D003287:Contrast Media; D000068598:Data Accuracy; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D008279:Magnetic Resonance Imaging; D008297:Male; D009392:Nephrectomy; D000072177:Radiologists; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed; D014463:Ultrasonography; D014513:Ureter / Q000601:surgery
chemical_list: D003287:Contrast Media
keywords: Computed tomography; Magnetic resonance imaging; Renal cell carcinoma