Vascularisation patterns of solid renal tumours: differentiation of benign and malignant renal masses

Nina Malika Popova, Māra Liepa, Davis Simanis Putrins, Laura Saule, Madara Ratniece, Egils Vjaters, Jānis Jukonis, Inese Briede, Maija Radzina

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Abstract

Background. Renal masses present a wide histological spectrum ranging from benign oncocytoma and
angiomyolipoma to malignancies as high grade renal clear cell carcinoma.
Aim. The task was to study imaging patterns, including vascularization of renal masses on Computed
tomography (CT) to increase the accuracy of visual differentiation to further facilitate the decision of
choosing treatment tactics.
Methods. The retrospective study with 100 patients with total renal tumour resection. Qualitative and
quantitative parameters were evaluated to determine benign and malignant prognostic imaging parameters,
including contrast uptake and wash-out patterns in the lesion, and relative to the renal parenchyma in
preoperative CT examinations.
Results. 100 patients with solid renal lesions, male 49% vs. female 51% (31–84 years, mean 64 years).
From 100 lesions benign were 22 (14% oncocytoma, 6% AML, 2% adenoma), malignant were 78 (RCC
72%, urothelial 6%).
Statistically significant association between benign masses and homogeneity in non-enhanced CT was
found (p=0.019). Positive, mild correlation (r=0.236; p=0.020) of homogeneity and benign lesions in nonenhanced scans and AML and homogeneity in the arterial phase using chi2
test was found (p=0.031). AML
showed mild wash-out (p=0.018), and adenoma showed moderate wash-out (p=0.018) in venous phase.
Malignant lesions uptake contrast more than benign (U=465.5; p=0.013), also malignant masses uptake
more contrast relative to the cortex compared with benign lesions (U=545.5; p=0.38).
In the delayed phase malignant masses washed-out slower than benign (U=1123; p=0.002).
Conclusions. Qualitative and quantitative evaluation reveals differences between benign and malignant
renal masses, showing that benign masses are predominantly homogeneous on non-enhanced CT
examination, whereas malignant masses retain the contrast longer in the venous phase and wash-out slowly
in the delayed phase.
Acknowledgements. The authors declare that the research was conducted in the absence of any
commercial or financial relationships that could be construed as a potential conflict of interest.

Field of Science*

  • 3.2 Clinical medicine

Publication Type*

  • 3.4. Other publications in conference proceedings (including local)

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