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  • Title: The characterization of small hypoattenuating renal masses on contrast-enhanced CT.
    Author: Patel NS, Poder L, Wang ZJ, Yeh BM, Qayyum A, Jin H, Coakley FV.
    Journal: Clin Imaging; 2009; 33(4):295-300. PubMed ID: 19559352.
    Abstract:
    PURPOSE: To determine if small hypoattenuating renal masses can be characterized as simple cysts or renal cell carcinomas on contrast-enhanced computed tomography (CT). MATERIALS AND METHODS: We retrospectively identified 20 small (<or=1.5 cm) hypoattenuating renal masses seen on contrast enhanced CT, consisting of 14 simple cysts and six renal cell carcinomas. Three independent readers recorded subjective visual impression (five-point scale from 1=definitely fluid to 5=definitely solid), CT attenuation, border (well circumscribed or ill defined), and shape (ovoid or irregular) for each lesion. RESULTS: The overall area under the receiver operator characteristic curves for subjective visual impression, CT attenuation, border, and shape were 0.97, 0.82, 0.59, and 0.55, respectively. Using dichotomized ratings (1-2=cyst and 3-5=carcinoma), subjective impression had a sensitivity and specificity of 100% and 79-100%, respectively, for the diagnosis of renal cell carcinoma. Using a threshold of 50 Hounsfield Units (HU) or more, CT attenuation had a sensitivity and specificity of 100% and 43-64%, respectively. CONCLUSION: Small hypoattenuating renal masses can be characterized with reasonable accuracy by subjective impression and CT attenuation; lesions that appear solid on visual inspection or have an attenuation value of 50 HU or more are likely to be renal cell carcinoma.
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