FDG PET/CT and CT Findings of Renal Cell Carcinoma With Sarcomatoid Differentiation.

OBJECTIVE. The purpose of this article is to investigate the value of ¹⁸ F-FDG PET/CT and enhanced CT in the diagnosis of renal cell carcinoma (RCC) with sarcomatoid differentiation and the differential diagnosis of clear cell renal cell carcinoma (ccRCC). MATERIALS AND METHODS. Among patients with renal tumors confirmed by pathologic examination from September 2010 to August 2019, 29 patients with RCC with sarcomatoid differentiation and 82 patients with ccRCC who underwent FDG PET/CT, renal contrast-enhanced CT examination, or both, before surgery were studied. Features of the two groups on CT and PET/CT were retrospectively reviewed. RESULTS. The tumor size of RCC with sarcomatoid differentiation was larger than that of ccRCC ( p = 0.0086). Cystic necrosis, peritumoral neovascularity, and metastasis were more common in RCC with sarcomatoid differentiation ( p = 0.0052, p = 0.0008, p < 0.0001, respectively). The ratio of necrotic area to tumor diameter of RCC with sarcomatoid differentiation was statistically significantly larger than that of ccRCC ( p = 0.0032). Three cases of RCC with sarcomatoid differentiation showed a large central necrotic area and dense intratu-moral neovascularity in the surrounding parenchyma, defined as the ring-of-fire sign, which was not found in ccRCC. The maximum standardized uptake value (SUV _max ), mean standardized uptake value (SUV _mean ), and peak standardized uptake value (SUV _peak ) of RCC with sarcomatoid differentiation were statistically significantly higher than those for ccRCC (all p < 0.0001), and the SUV _max , SUV _mean , and SUV _peak cutoff values of 5.4, 4.2, and 5.0, respectively, were helpful for discrimination. CONCLUSION. Imaging features including higher SUV _max , SUV _mean , and SUV _peak ; a larger ratio of necrotic area to tumor diameter; the presence of peritumoral neovascularity; and metastasis are more commonly associated with RCC with sarcomatoid differentiation than with ccRCC. The ring-of-fire sign and SUV _max , SUV _mean , SUV _peak cutoff values of 5.4, 4.2, 5.0, respectively, may be helpful to indicate RCC with sarcomatoid differentiation.