Clear cell renal cell carcinoma and papillary renal cell carcinoma: differentiation of distinct histological types with multiphase CT

Diagn Interv Radiol. 2013 Sep-Oct;19(5):387-92. doi: 10.5152/dir.2013.13068.


Purpose: Conventional clear cell renal cell carcinoma (ccRCC) and papillary renal cell carcinoma (pRCC) have different behavioral characteristics and clinical management strategies (nephrectomy vs. nephron-sparing surgery). Our aim was to retrospectively evaluate the contrast enhancement pattern of ccRCC and pRCC and evaluate its possible diagnostic role for preoperative differentiation using a standardized protocol.

Materials and methods: Quadriphasic multidetector computed tomography (CT) images (unenhanced, corticomedullary, nephrographic, and excretory phases) of 19 patients with 20 ccRCC and 14 patients with 15 pRCC lesions (mean ages, 62.3±14.1 and 61.4±13.7 years, respectively) were reviewed retrospectively. The attenuation characteristics were compared with the attenuation of the normal renal cortex using either multiple 10 mm2 regions of interest or whole tumor attenuation measurements. The degree of contrast enhancement was also compared.

Results: Univariate analysis revealed that ccRCC lesions showed higher mean attenuation values on the corticomedullary and nephrographic phases compared with pRCC masses (P < 0.05) using both measurement techniques.

Conclusion: The findings underscore the importance of multiphase CT in the differentiation of these two subtypes of RCC using standard assessment techniques. The measurement of the degree of enhancement on contrast-enhanced multidetector CT may be a simple and useful method to radiologically differentiate between the two histological types of RCC.

MeSH terms

  • Carcinoma, Renal Cell / diagnostic imaging*
  • Carcinoma, Renal Cell / pathology
  • Contrast Media
  • Diagnosis, Differential
  • Female
  • Humans
  • Iohexol / analogs & derivatives
  • Kidney Neoplasms / diagnostic imaging*
  • Kidney Neoplasms / pathology
  • Male
  • Middle Aged
  • Multidetector Computed Tomography / methods*
  • Observer Variation
  • Radiographic Image Enhancement / methods
  • Reproducibility of Results
  • Retrospective Studies


  • Contrast Media
  • Iohexol
  • iopromide

Supplementary concepts

  • Papillary renal cell carcinoma, sporadic