Korean J Urol.  2009 Oct;50(10):942-946.

Effectiveness of Computed Tomography for Predicting the Nuclear Grade of Renal Cell Carcinoma

• Kwon YK
• Kim BH
• Park CH
• Kim CI
• Chang HS

Abstract

PURPOSE
Nuclear grade is one of the independent prognostic factors for renal cell carcinoma (RCC). We investigated the effectiveness of a preoperative CT scan for predicting the nuclear grade of clear cell RCC.
MATERIALS AND METHODS
We retrospectively reviewed the medical records of patients who underwent surgery for renal lesions between January 2002 and December 2007. We analyzed the pathologic and radiologic reports of 65 patients who underwent radical nephrectomy for RCC and were diagnosed with clear cell RCC. The Hounsfield unit (HU) of the area with maximum enhancement (M) and the total area of the RCC (T) were measured during CT. Ratio values by nuclear grade were calculated by using formulas (M HU/aorta HU, T HU/aorta HU) to eliminate differences between individuals.
RESULTS
A total of 65 cases of clear cell RCCs were classified according to Fuhrman nuclear grade. Five cases were grade I, 33 were grade II, 15 were grade III, and 12 were grade IV. There was a significant difference in CT enhancement between each nuclear grade, and lower nuclear grades tended to have an increased ratio of maximum enhancement (p=0.020). Fuhrman nuclear grade was divided into two groups: low (Fuhrman grades I, II) and high (Fuhrman grades III, IV). The ratio of enhancement for the M area was significantly higher in the low Fuhrman nuclear grade group than in the high group (p=0.033).
CONCLUSIONS
CT enhancement is inversely related to the nuclear grade of clear cell RCC. This study found that measuring the area of maximum enhancement in CT may be a useful method for presuming the pathologic nuclear grade of RCC, especially when the Fuhrman nuclear grade is divided into low and high groups.

Keyword

Renal cell carcinoma; Spiral computed tomography

MeSH Terms

Carcinoma, Renal Cell
Humans
Medical Records
Nephrectomy
Retrospective Studies
Tomography, Spiral Computed
Carcinoma, Renal Cell

Figure

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  Fig. 1 The maximum area of Hounsfield units (HU) was measured by tracing the highest HU of the localized circular portion, which was defined by 25% of the total area of the carcinoma at the largest diameter. (A) an example of measuring maximum area of HU in well enhanced small size carcinoma by localized circle. (B) an example of measuring maximum area of HU in heterogeneous large size carcinoma by localized circle.

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  Fig. 2 Hounsfield units (HU) of the total area of the carcinoma were measured by delineating around the lesion at the largest diameter. (A) an example of measuring the total area of HU in a well-enhanced, small-sized carcinoma. (B) an example of measuring the total area of HU in a heterogeneous enhanced large-sized carcinoma.

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