A comparison of effectiveness of the contrast enhanced computed tomography with magnetic resonance imaging in the differential diagnosis of clear cell renal carcinoma.

Background: The incidental detection of indeterminate small renal masses (SRMs) has been rising continuously over the last few decades. The aim of our study was to assess selected contrast enhanced computed tomography (CECT) parameters in the characterization of indeterminate SRMs and compare them with selected magnetic resonance imaging (MRI) data.

Patients and methods: Patients with indeterminate SRMs discovered on CECT were included in the study. Selected CECT features have been analyzed as differentiating between clear cell renal cell carcinoma (ccRCC) and other etiologies of SRMs. In 82% of patients, which had available MRI data, a comparison between selected MRI and CECT parameters were performed.

Results: Relative washout in CECT had the best accuracy (76.5%), sensitivity (88.9%), as well as satisfactory specificity (69.7%) in ccRCC prediction. The cut-off point determined in receiver operating analysis using the Youden index for this parameter was 11.54. Multivariable analysis showed that only T1 SI ratio < 0.73 from MRI parameters and relative washout > 11.5 from CECT parameters were independent predictors of ccRCC (OR: 30.86, 95% CI: 1.58-600.26, p = 0.024; OR: 15.36, 95% CI: 1.52-155.16, p = 0.021).

Conclusions: In clinical practice, the use of both CECT and MRI indicators, especially T1 SI ratio < 0.73 for MRI and relative washout > 11.5 for CECT, can support physicians in diagnosing and treating patients effectively.