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Enhancement Characteristics of Papillary Renal Neoplasms Revealed on Triphasic Helical CT of the Kidneys

Brian R. Herts1, Deirdre M. Coll1,2, Andrew C. Novick3, Nancy Obuchowski1,4, Grant Linnell1, Susan L. Wirth1 and Mark E. Baker1

1 Department of Radiology-H66, The Cleveland Clinic Foundation, 9500 Euclid Ave., Cleveland, OH 44195.
2 Present address: Department of Radiology, Weill Hospital, Cornell University Medical Center, 525 E. 68th St., New York, NY 10021.
3 Urological Institute, The Cleveland Clinic Foundation, Cleveland, OH 44195.
4 Department of Biostatistics, The Cleveland Clinic Foundation, Cleveland, OH 44195.



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  		Fig. 1A. —53-year-old-man with papillary renal cell carcinoma (arrow). Unenhanced (A), vascular phase (B), and nephrographic phase (C) CT scans show minimal enhancement. Enhancement was 15 H on both B and C. Tumor-to-aorta enhancement ratio and tumor-to-kidney enhancement ratio are 0.08 and 0.09, respectively, giving positive predictive value for papillary renal cell carcinoma of approximately 50% and specificity of 95%.

 


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  		Fig. 1B. —53-year-old-man with papillary renal cell carcinoma (arrow). Unenhanced (A), vascular phase (B), and nephrographic phase (C) CT scans show minimal enhancement. Enhancement was 15 H on both B and C. Tumor-to-aorta enhancement ratio and tumor-to-kidney enhancement ratio are 0.08 and 0.09, respectively, giving positive predictive value for papillary renal cell carcinoma of approximately 50% and specificity of 95%.

 


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  		Fig. 1C. —53-year-old-man with papillary renal cell carcinoma (arrow). Unenhanced (A), vascular phase (B), and nephrographic phase (C) CT scans show minimal enhancement. Enhancement was 15 H on both B and C. Tumor-to-aorta enhancement ratio and tumor-to-kidney enhancement ratio are 0.08 and 0.09, respectively, giving positive predictive value for papillary renal cell carcinoma of approximately 50% and specificity of 95%.

 


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  		Fig. 2A. —46-year-old woman with papillary renal cell carcinoma (arrow). Unenhanced (A), vascular phase (B), and nephrographic phase (C) CT scans. Region of interest circles were drawn on observer-estimated areas of highest and lowest densities on contrast-enhanced scans (B and C) to determine tumor heterogeneity. During vascular phase, tumor enhancement is 22 H compared with aortic enhancement of 232 H, giving a 0.1 heterogeneity ratio.

 


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  		Fig. 2B. —46-year-old woman with papillary renal cell carcinoma (arrow). Unenhanced (A), vascular phase (B), and nephrographic phase (C) CT scans. Region of interest circles were drawn on observer-estimated areas of highest and lowest densities on contrast-enhanced scans (B and C) to determine tumor heterogeneity. During vascular phase, tumor enhancement is 22 H compared with aortic enhancement of 232 H, giving a 0.1 heterogeneity ratio.

 


View larger version (129K):

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  		Fig. 2C. —46-year-old woman with papillary renal cell carcinoma (arrow). Unenhanced (A), vascular phase (B), and nephrographic phase (C) CT scans. Region of interest circles were drawn on observer-estimated areas of highest and lowest densities on contrast-enhanced scans (B and C) to determine tumor heterogeneity. During vascular phase, tumor enhancement is 22 H compared with aortic enhancement of 232 H, giving a 0.1 heterogeneity ratio.

 


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  		Fig. 3A. —67-year-old man with clear cell carcinoma (arrow) of the kidney. Unenhanced (A), vascular phase (B), and nephrographic phase (C) CT scans. Measurements of Hounsfield density show avid enhancement on both vascular and nephrographic phase scans. Enhancement is 131 H on vascular phase and 123 H on nephrographic phase. Tumor-to-aorta enhancement ratio and tumor-to-kidney enhancement ratio are 0.66 and 0.54, respectively. These values have negative predictive value for papillary renal cell carcinoma of 98%, essentially excluding possibility of papillary cell type carcinoma.

 


View larger version (152K):

[in a new window]
  		Fig. 3B. —67-year-old man with clear cell carcinoma (arrow) of the kidney. Unenhanced (A), vascular phase (B), and nephrographic phase (C) CT scans. Measurements of Hounsfield density show avid enhancement on both vascular and nephrographic phase scans. Enhancement is 131 H on vascular phase and 123 H on nephrographic phase. Tumor-to-aorta enhancement ratio and tumor-to-kidney enhancement ratio are 0.66 and 0.54, respectively. These values have negative predictive value for papillary renal cell carcinoma of 98%, essentially excluding possibility of papillary cell type carcinoma.

 


View larger version (147K):

[in a new window]
  		Fig. 3C. —67-year-old man with clear cell carcinoma (arrow) of the kidney. Unenhanced (A), vascular phase (B), and nephrographic phase (C) CT scans. Measurements of Hounsfield density show avid enhancement on both vascular and nephrographic phase scans. Enhancement is 131 H on vascular phase and 123 H on nephrographic phase. Tumor-to-aorta enhancement ratio and tumor-to-kidney enhancement ratio are 0.66 and 0.54, respectively. These values have negative predictive value for papillary renal cell carcinoma of 98%, essentially excluding possibility of papillary cell type carcinoma.

 

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