Correlation of CT imaging features and tumor size with Fuhrman grade of clear cell renal cell carcinoma

Saelin Oh, Deuk Jae Sung, Kyung Sook Yang, Ki Choon Sim, Na Yeon Han, Beom Jin Park, Min Ju Kim, Sung Bum Cho

Research output: Contribution to journalReview articlepeer-review

31 Citations (Scopus)


Background Identification of clinical features to determine the aggressive potential of tumors is highly warranted to stratify patients for adequate treatment. Computed tomography (CT) imaging features of clear cell renal cell carcinoma (ccRCC) may contribute to personalized risk assessment. Purpose To assess the correlation between CT imaging features and Fuhrman grade of ccRCC, and to identify the predictors of high Fuhrman grade in conjunction with tumor size. Material and Methods CT scans of 169 patients with 173 pathologically proven ccRCCs were retrospectively reviewed in consensus by two radiologists for the presence of intratumoral necrosis and intratumoral cyst and tumor size. Histologic grade was classified as either low (Fuhrman grade I or II) or high (Fuhrman grade III or IV). Statistical significance was evaluated by using univariate, multivariate regression, receiver operating characteristic (ROC) curve, and Spearman correlation analyses. Results On CT, 20 of the 173 tumors had intratumoral cysts, 60 had intratumoral necrosis, and 93 showed entirely solid tumors. The odds of high grade were higher with intratumoral necrosis and entirely solid tumor than with intratumoral cyst (P < 0.03). Intratumoral necrosis showed a significantly high odds ratio of 25.73 for high Fuhrman grade. The ROC curve showed a threshold tumor size of 36 mm to predict high Fuhrman grade for overall tumors (area under the ROC curve, 0.70). In ccRCCs with intratumoral necrosis or cyst, tumor size did not significantly correlate with Fuhrman grade. Conclusion Intratumoral necrosis on CT was a strong and independent predictor of biologically aggressive ccRCCs, irrespective of tumor size.

Original languageEnglish
Pages (from-to)376-384
Number of pages9
JournalActa Radiologica
Issue number3
Publication statusPublished - 2017 Mar
Externally publishedYes

Bibliographical note

Publisher Copyright:
© 2016 The Foundation Acta Radiologica.


  • Fuhrman grade
  • Multidetector computed tomography
  • clear cell renal cell carcinoma

ASJC Scopus subject areas

  • Radiological and Ultrasound Technology
  • Radiology Nuclear Medicine and imaging


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