Perirenal Fat Invasion on Renal Cell Carcinoma: Evaluation With Multidetector Computed Tomography–Multivariate Analysis

Objective The objective of this study was to assess the accuracy of multidetector computed tomography (CT) in diagnosing perinephric (PN) and/or renal sinus (RS) fat invasion in patients with renal cell carcinoma (RCC), with reference to the CT findings predictive for the diagnosis of invasion. Methods This was a retrospective study of 48 RCCs. Examinations were performed on a 16-row CT scanner, including unenhanced and 3-phase contrast-enhanced CT scanning. Unenhanced transverse images and multiplanar reformations of each contrast-enhanced CT phase were evaluated. The predictive value of CT findings in diagnosing PN and/or RS fat invasion was determined using multivariate logistic regression analysis. Results The CT findings that were most predictive for the diagnosis of PN fat invasion were the presence of contrast-enhancing nodules in the PN fat and tumoral margins. Invasion of the pelvicaliceal system was the most significant predictor in the diagnosis of RS fat invasion. Conclusions Multidetector CT provides satisfactory results in detecting PN and/or RS fat invasion in RCC.

[1]  P. Schirmacher,et al.  Perinephric and renal sinus fat infiltration in pT3a renal cell carcinoma: possible prognostic differences , 2009, BJU international.

[2]  Dual-phase helical CT of the kidney: value of the corticomedullary and nephrographic phase for evaluation of renal lesions and preoperative staging of renal cell carcinoma. , 1997 .

[3]  S. Bonsib,et al.  Renal sinus involvement in renal cell carcinomas. , 2000, The American journal of surgical pathology.

[4]  J. Cheville,et al.  Is renal sinus fat invasion the same as perinephric fat invasion for pT3a renal cell carcinoma? , 2005, The Journal of urology.

[5]  F. Montorsi,et al.  Renal sinus fat invasion in pT3a clear cell renal cell carcinoma affects outcomes of patients without nodal involvement or distant metastases. , 2009, The Journal of urology.

[6]  M. Kunin Bridging septa of the perinephric space: anatomic, pathologic, and diagnostic considerations. , 1986, Radiology.

[7]  L. Ohno-Machado,et al.  Positive predictive value of CT urography in the evaluation of upper tract urothelial cancer. , 2010, AJR. American journal of roentgenology.

[8]  Choung-Soo Kim,et al.  Prognostic significance of perinephric fat infiltration and tumor size in renal cell carcinoma. , 2008, The Journal of urology.

[9]  M. Stöckle,et al.  Current TNM classification of renal cell carcinoma evaluated: revising stage T3a. , 2005, The Journal of urology.

[10]  S. Jung,et al.  Reappraisal of T3N0/NxM0 renal cell carcinoma: significance of extent of fat invasion, renal vein invasion, and adrenal invasion. , 2008, Human pathology.

[11]  Y. Hata,et al.  Staging of Renal Cell Carcinoma by Computed Tomography , 1983, Journal of computer assisted tomography.

[12]  M. Bock,et al.  Diagnostic Accuracy of Staging Renal Cell Carcinomas Using Multidetector-Row Computed Tomography and Magnetic Resonance Imaging: A Prospective Study With Histopathologic Correlation , 2004, Journal of computer assisted tomography.

[13]  H. Hricak,et al.  Significance of Peritumoral Vascularity on CT in Evaluation of Renal Cortical Tumor , 2007, Journal of computer assisted tomography.

[14]  M. Bock,et al.  Preoperative Staging of Renal Cell Carcinoma With Inferior Vena Cava Thrombus Using Multidetector CT and MRI: Prospective Study With Histopathological Correlation , 2005, Journal of computer assisted tomography.

[15]  C. Johnson,et al.  Renal adenocarcinoma: CT staging of 100 tumors. , 1987, AJR. American journal of roentgenology.

[16]  T. Ueda,et al.  Selective Intra-Arterial 3-Dimensional Computed Tomography Angiography for Preoperative Evaluation of Nephron-Sparing Surgery , 2004, Journal of computer assisted tomography.

[17]  C. Catalano,et al.  High-resolution multidetector CT in the preoperative evaluation of patients with renal cell carcinoma. , 2003, AJR. American journal of roentgenology.

[18]  Y Narumi,et al.  Renal cell carcinoma: preoperative assessment for enucleative surgery with angiography, CT, and MRI. , 1996, Journal of computer assisted tomography.

[19]  E. Grabbe,et al.  Dual-phase helical CT of the kidney: value of the corticomedullary and nephrographic phase for evaluation of renal lesions and preoperative staging of renal cell carcinoma. , 1997, AJR. American journal of roentgenology.

[20]  S. Choi,et al.  Differentiating Radiological Features of Rapid- and Slow-Growing Renal Cell Carcinoma Using Multidetector Computed Tomography , 2012, Journal of computer assisted tomography.

[21]  E. Fishman,et al.  Current concepts in the diagnosis and management of renal cell carcinoma: role of multidetector ct and three-dimensional CT. , 2001, Radiographics : a review publication of the Radiological Society of North America, Inc.

[22]  C. Kwak,et al.  Reevaluation of renal cell carcinoma and perirenal fat invasion only. , 2009, The Journal of urology.

[23]  S. Eggener TNM staging for renal cell carcinoma: time for a new method. , 2010, European urology.

[24]  S. Jung,et al.  The renal sinus: pathologic spectrum and multimodality imaging approach. , 2004, Radiographics : a review publication of the Radiological Society of North America, Inc.

[25]  E. Fishman,et al.  Planning nephron-sparing renal surgery using 3D helical CT angiography. , 1999, Journal of computer assisted tomography.

[26]  V. Surabhi,et al.  Neoplastic and non-neoplastic proliferative disorders of the perirenal space: cross-sectional imaging findings. , 2008, Radiographics : a review publication of the Radiological Society of North America, Inc.

[27]  W J Davros,et al.  Preoperative use of 3D volume rendering to demonstrate renal tumors and renal anatomy. , 2000, Radiographics : a review publication of the Radiological Society of North America, Inc.

[28]  J. Dreyhaupt,et al.  Multislice Computed Tomography in Planning Nephron-Sparing Surgery in a Prospective Study With 76 Patients: Comparison of Radiological and Histopathological Findings in the Infiltration of Renal Structures , 2006, Journal of computer assisted tomography.

[29]  J. Cheville,et al.  Impact of tumor size on the predictive ability of the pT3a primary tumor classification for renal cell carcinoma. , 2005, The Journal of urology.

[30]  U. Capitanio,et al.  The extent of tumour fat invasion affects survival in patients with renal cell carcinoma and venous tumour thrombosis , 2011, BJU international.