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 contrast-enhanced 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 contrast-enhanced 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.