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Quantitative Enhancement Washout Analysis of Solid Cortical Renal Masses Using Multidetector Computed Tomography

Shebel, Haytham M. MD*; Elsayes, Khaled M. MD; Sheir, Khaled Zaky MD; Abou El Atta, Heba M. MSc*; El-Sherbiny, Ahmad F. MD*; Ellis, James H. MD§; El-Diasty, Tarek A. MD*

Journal of Computer Assisted Tomography: May-June 2011 - Volume 35 - Issue 3 - p 337-342
doi: 10.1097/RCT.0b013e318219f92b
Original Article

Purpose: The aim of the study was to prospectively assess the utility of quantitative enhancement washout method in the differentiation of benign solid renal masses from various subtypes of malignant masses using multidetector computed tomography.

Methods: In a prospective investigation from January 2009 to May 2010, 97 patients with solid renal masses underwent CT scan examination with unenhanced, arterial, parenchymal, and delayed phases. The following features were analyzed: the maximum attenuation value in each phase, attenuation difference (enhancement) of the mass in each phase from the unenhanced phase (ΔH), and parenchymal and delayed phases' washout. Of these patients, 82 (85%) underwent unilateral radical nephrectomy, 15 (15%) underwent partial nephrectomy. Group comparison was performed with the Kruskal-Wallis test and Mann-Whitney U test.

Results: The masses included in our study were 45 clear cell renal cell carcinomas (CCRCCs); 18 chromophobe renal cell carcinomas, 16 papillary (PRCC), 14 oncocytomas, and 4 minimal fat containing angiomyolipomas. In the arterial phase, the CCRCC was the most enhancing type and could be differentiated from other renal masses (benign or malignant) with high sensitivity and specificity. In the parenchymal phase, the CCRCCs demonstrated the highest washout. Chromophobe renal cell carcinomas showed the second highest washout in this phase. Benign lesions and PRCCs did not exhibit significant washout in this phase.

In the delayed phase, the malignant lesions (with the exception of PRCCs) showed the highest washout. Benign lesions showed significant washout but less than malignant lesions.

Conclusions: Multiphasic multidetector CT utilizing arterial-phase attenuation and quantitative enhancement washout method could help in the preoperative differentiation of various types of solid renal masses.

From the *Department of Radiology, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt; †Department of Radiology, University of Texas MD Anderson Cancer Center, Houston, TX; ‡Department of Urology, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt; and §Department of Radiology, University of Michigan Health System, Ann Arbor, MI.

Received for publication December 14, 2010; accepted March 11, 2011.

Reprints: Khaled M. Elsayes, MD, Department of Radiology, University of Michigan Health System, Ann Arbor, MI 48109-0030 (e-mail:

The authors have nothing to disclose related to this study.

© 2011 Lippincott Williams & Wilkins, Inc.