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Diagnostic Performance of Multidetector Computed Tomography in the Evaluation of Perinephric Fat Invasion in Renal Cell Carcinoma Patients

Kim, Cherry MD; Choi, Hyuck Jae MD; Cho, Kyoung-Sik MD

Journal of Computer Assisted Tomography: March/April 2014 - Volume 38 - Issue 2 - p 268–273
doi: 10.1097/RCT.0b013e3182aa672a
Abdominal Imaging

Purpose This study aimed to evaluate the diagnostic performance of multidetector computed tomography (MDCT) for preoperative evaluation of perinephric fat invasion in patients with renal cell carcinomas (RCCs).

Methods A total of 408 consecutive patients with surgically confirmed RCC who underwent MDCT were included in this study. Image analysis was first performed with axial-only CT images. A second analysis was then performed with both axial and coronal CT images. A qualitative analysis was then conducted by 2 reviewers who reached consensus. The reference standard was pathologic evaluation.

Results The areas under the curve of the receiver operating characteristic analysis were 0.786 and 0.877 for axial-only images and 0.805 and 0.836 for combined images in both readers. The area under the curve of tumor size was 0.833, a similar value to that of the reviewers. In multivariate analysis, tumor size, a linear-nodular or nodular type of fat infiltration, and an irregular tumor margin were independent predicting factors for perinephric fat invasion.

Conclusions The MDCT shows relatively high diagnostic performance in detecting perinephric fat invasion of RCC, but suffers from a relatively low positive predictive value. Tumor size, fat infiltration with a nodular appearance, and an irregular tumor margin were predictors for perinephric invasion.

From the Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.

Received for publication June 7, 2013; accepted August 29, 2013.

Reprints: Hyuck Jae Choi, MD, Department of Radiology, Asan Medical Center, 388-1 Poong-nap-dong, Songpa-gu, Seoul 138-736, Korea (e-mail:

The authors declare no conflict of interest.

Copyright © 2014 Wolters Kluwer Health, Inc. All rights reserved.