MP08-03 PREDICTION OF HISTOLOGICAL SUBTYPES OF SMALL RENAL MASSES: STRIVING FOR A STANDARDIZED MRI DIAGNOSTIC ALGORITHM

You have accessJournal of UrologyImaging/Radiology: Uroradiology I1 Apr 2017MP08-03 PREDICTION OF HISTOLOGICAL SUBTYPES OF SMALL RENAL MASSES: STRIVING FOR A STANDARDIZED MRI DIAGNOSTIC ALGORITHM Fernando U. Kay, Noah E. Canvasser, Yin Xi, Daniella F. Pinho, Daniel Costa, Alberto Diaz de Leon, Gaurav Khatri, John R. Leyendecker, Takeshi Yokoo, Aaron Lay, Nicholas Kavoussi, Ersin Koseoglu, Jeffrey A. Cadeddu, and Ivan Pedrosa Fernando U. KayFernando U. Kay More articles by this author , Noah E. CanvasserNoah E. Canvasser More articles by this author , Yin XiYin Xi More articles by this author , Daniella F. PinhoDaniella F. Pinho More articles by this author , Daniel CostaDaniel Costa More articles by this author , Alberto Diaz de LeonAlberto Diaz de Leon More articles by this author , Gaurav KhatriGaurav Khatri More articles by this author , John R. LeyendeckerJohn R. Leyendecker More articles by this author , Takeshi YokooTakeshi Yokoo More articles by this author , Aaron LayAaron Lay More articles by this author , Nicholas KavoussiNicholas Kavoussi More articles by this author , Ersin KoseogluErsin Koseoglu More articles by this author , Jeffrey A. CadedduJeffrey A. Cadeddu More articles by this author , and Ivan PedrosaIvan Pedrosa More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.290AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES MRI may aid in the management of small renal masses (≤4 cm, SRM) by differentiating among histologic subtypes. However, standardized approaches to MRI interpretation and interobserver agreement data are lacking. To assess the performance of a wide spectrum of MRI features for predicting the histologic diagnosis of SRM, and determine the interobserver agreement among multiple readers. METHODS Retrospective HIPAA-compliant IRB-approved study including 109 patients with cT1a SMR and a pre-surgical MRI. Images were reviewed by 7 radiologists with body MRI training and 1-15 years of experience. The following characteristics were analyzed on non-contrast images: T2-weighted (T2W) signal intensity/texture, presence/absence of intravoxel or bulk fat, magnetic susceptibility, central scar, and hemorrhage. Features assessed on post-contrast images included contrast avidity, enhancement homogeneity, dynamic characteristics, and segmental enhancement inversion. Multivariate generalized linear mixed model analysis with logit link was used to identify independent subtype predictors, as confirmed by histopathology, with p < 0.05 considered significant. Pairwise weighted analysis was used to measure interobserver agreement. RESULTS Clear cell renal cell carcinomas (ccRCC) represented 51% of the masses, papillary RCC (pRCC) 25%, chromophobe RCC (chrRCC) 6%, oncocytoma 6%, minimal-fat angiomyolipoma (mfAML) 6%, and others 9%. Table 1 includes values for the MRI features. ccRCC was predicted by signal intensity on T2W (high vs low, OR, odds ratio: 3.2 CI 95%: [1.4, 7.1], p < 0.001) and contrast avidity (avid vs. low, OR: 4.5 [1.8, 10.8], p < 0.0001), while pRCC was predicted by contrast avidity (low vs avid, OR: 0.05 [0.02, 0.2], p < 0.0001) on multivariate analysis. Segmental enhancement inversion was an independent predictor of oncocytoma (present vs absent, OR: 16.2 [1.0, 275.4], p < 0.05). None of the features were significant predictors of chrRCC or mfAML on the multivariate analysis. CONCLUSIONS Our data support the use of T2W signal intensity and contrast avidity as critical steps in the implementation of standardized MRI interpretation algorithms for predicting the histological subtype of SRM. Segmental enhancement inversion can be used as a feature for the diagnosis of oncocytomas. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e90-e91 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Fernando U. Kay More articles by this author Noah E. Canvasser More articles by this author Yin Xi More articles by this author Daniella F. Pinho More articles by this author Daniel Costa More articles by this author Alberto Diaz de Leon More articles by this author Gaurav Khatri More articles by this author John R. Leyendecker More articles by this author Takeshi Yokoo More articles by this author Aaron Lay More articles by this author Nicholas Kavoussi More articles by this author Ersin Koseoglu More articles by this author Jeffrey A. Cadeddu More articles by this author Ivan Pedrosa More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...