Hannu Huhdanpaa1, Darryl Hwang2, Steven Cen3, Brian Quinn4, Megha Nayyar5, Xuejun Zhang6, Frank Chen7, Bhushan Desai8, Gangning Liang9, Inderbir Gill10, Vinay Duddalwar11. 1. Department of Radiology, University of Southern California, 1500 San Pablo St, 2nd floor imaging, Los Angeles, CA, 90033, USA. huhdanpa@uw.edu. 2. Department of Radiology, University of Southern California, 1500 San Pablo St, 2nd floor imaging, Los Angeles, CA, 90033, USA. darryl.hwang@med.usc.edu. 3. Department of Radiology, University of Southern California, 1500 San Pablo St, 2nd floor imaging, Los Angeles, CA, 90033, USA. cen@usc.edu. 4. Department of Radiology, University of Southern California, 1500 San Pablo St, 2nd floor imaging, Los Angeles, CA, 90033, USA. bqmemd@gmail.com. 5. Department of Radiology, University of Southern California, 1500 San Pablo St, 2nd floor imaging, Los Angeles, CA, 90033, USA. mnayyar@usc.edu. 6. Viterbi School of Engineering, University of Southern California, Los Angeles, USA. guangxizxj@gmail.com. 7. Department of Radiology, University of Southern California, 1500 San Pablo St, 2nd floor imaging, Los Angeles, CA, 90033, USA. frank.chen@med.usc.edu. 8. Department of Radiology, University of Southern California, 1500 San Pablo St, 2nd floor imaging, Los Angeles, CA, 90033, USA. Bhushan.Desai@med.usc.edu. 9. Department of Urology, University of Southern California, 1441 Eastlake Ave, NOR 7416, Los Angeles, CA, 9003, USA. gliang@usc.edu. 10. Department of Urology, University of Southern California, 1441 Eastlake Ave, NOR 7416, Los Angeles, CA, 9003, USA. igill@usc.edu. 11. Department of Radiology, University of Southern California, 1500 San Pablo St, 2nd floor imaging, Los Angeles, CA, 90033, USA. vinay.duddalwar@med.usc.edu.
Abstract
PURPOSE: 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. MATERIALS AND 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). CONCLUSION: 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.
PURPOSE: 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. MATERIALS AND 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). CONCLUSION: 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.
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