Early dark cortical band sign on CT for differentiating clear cell renal cell carcinoma from fat poor angiomyolipoma and detecting peritumoral pseudocapsule

To retrospectively evaluate whether the early dark cortical band (EDCB) on CT can be a predictor to differentiate clear cell renal cell carcinoma (ccRCC) from fat poor angiomyolipoma (Fp-AML) and to detect peritumoral pseudocapsules in ccRCC. The EDCBs, which are comprised of unenhanced thin lines at the tumor-renal cortex border in the corticomedullary phase, on the CT images of 342 patients who underwent partial nephrectomy were evaluated. Independent predictors among the clinical and CT findings for differentiating ccRCC from Fp-AML were identified using multivariate analyses. The diagnostic performance of the EDCB for diagnosing peritumoral pseudocapsule in ccRCC and differentiating ccRCC from Fp-AML was calculated. The EDCB was observed in 157 of 254 (61.8%) ccRCCs, 4 of 31 (12.9%) chromophobe RCCs, 1 of 21 (4.8%) papillary RCCs, 3 of 11 (27.3%) clear cell papillary RCCs, 3 of 8 (37.5%) oncocytomas, and 0 of 17 (0%) Fp-AMLs. There was substantial interobserver agreement for the EDCB (k = 0.719). The EDCB was a significant predictor for differentiating ccRCC from Fp-AML (p < 0.001). The sensitivity, specificity, positive predictive value (PPV), and negative predictive value of the EDCB for differentiating ccRCC from Fp-AML were 61.8%, 100%, 100%, and 14.9%, respectively, and those for detecting pseudocapsule in 236 ccRCCs were 62.3%, 68.8%, 96.5%, and 11.7%, respectively. Although diagnostic accuracy of the EDCB for detecting peritumoral pseudocapsule in RCC is inadequate, it can be a predictor for differentiating ccRCC from Fp-AML with high specificity and PPV. • The early dark cortical band (EDCB) sign is observed in nearly two-thirds of clear cell renal cell carcinoma (ccRCC) that are treated by partial nephrectomy and have substantial interobserver agreement. • The EDCB is a significant predictor for differentiating ccRCCs from fat poor angiomyolipomas, with a high specificity and positive predictive value. • Diagnostic accuracy of the EDCB for detecting peritumoral pseudocapsule in ccRCC is inadequate, though better than those in the nephrographic and excretory-phase images.