Five-Tiered CT Algorithm for Diagnosing Clear-Cell Renal Cell Carcinoma

A new study in the American Journal of Roentgenology reports a five-tiered CT scoring algorithm may represent a clinically useful tool for diagnosis of clear-cell renal cell carcinoma (RCC) in small (≤4 cm) solid renal masses.

“A 5-tiered renal CT algorithm, including mass-to-cortex corticomedullary attenuation ratio and heterogeneity score, had substantial inter-observer agreement, moderate AUC and PPV, and high NPV for diagnosing clear-cell RCC,” concluded Nicola Schieda, MD, FRCPC, from the department of medical imaging at Canada’s Ottawa Hospital.

Dr Schieda and colleagues’ study included 148 patients (mean age, 58 years; 73 men, 75 women) with 148 small (≤4 cm) solid (>25% enhancing tissue) renal masses that underwent renal-mass CT (unenhanced, corticomedullary, and nephrographic phases) before resection between January 2016 and December 2019. Two radiologists independently evaluated CT examinations and recorded calcification, mass attenuation in all phases, mass-to-cortex corticomedullary attenuation ratio, and heterogeneity score (5-point Likert scale, assessed in corticomedullary phase).

Ultimately, this five-tiered CT scoring algorithm—including mass-to-cortex corticomedullary attenuation ratio and heterogeneity score—had substantial interobserver agreement (weighted kappa=0.71) and achieved AUC for diagnosing clear-cell RCC of 0.75 (95% CI, 0.68-0.82) for reader 1 and 0.72 (95% CI, 0.66-0.82) for reader 2.

“If validated,” the authors of this AJR article acknowledged, “the CT algorithm may represent a useful clinical tool for diagnosing clear-cell renal cell carcinoma.”