Small (< 4 cm) renal masses: Differentiation of angiomyolipoma without visible fat from renal cell carcinoma using unenhanced and contrast-enhanced CT

OBJECTIVE. The purpose of this study was to evaluate if small (< 4 cm) angiomyolipoma without visible fat can be differentiated from renal cell carcinoma (RCC) using contrastenhanced CT alone and using unenhanced and contrast-enhanced CT in combination. MATERIALS AND METHODS. Twenty-three patients with 24 angiomyolipomas without visible fat and 130 patients with 148 RCCs underwent unenhanced and contrast-enhanced CT. Demographic data and size, shape, CT attenuation, and heterogeneity (entropy and subjective score) of the renal mass on unenhanced CT and contrast-enhanced CT were recorded. Multivariate logistic regression models were constructed for parameters obtained by contrastenhanced CT alone and by both unenhanced and contrast-enhanced CT. Demographic data and size and shape of renal mass were used in each model. Sensitivity and specificity were calculated. RESULTS. Logistic regression model from contrast-enhanced CT data included sex, percentage of exophytic growth, entropy, and CT attenuation on contrast-enhanced CT. Model from both unenhanced and contrast-enhanced CT data included age, sex, short-axis diameter, percentage of exophytic growth, lesion-to-kidney CT attenuation difference on unenhanced CT, and CT attenuation on contrast-enhanced CT. The contrast-enhanced CT-based model and combined unenhanced and contrast-enhanced CT-based model differentiated angiomyolipoma from RCC with sensitivity and specificity of 42% and 98% versus 50% and 98%, respectively. CONCLUSION. Combinations of various CT and demographic findings allowed differentiation of angiomyolipoma from RCC.