Evaluation of T1-Weighted MRI to Detect Intratumoral Hemorrhage Within Papillary Renal Cell Carcinoma as a Feature Differentiating From Angiomyolipoma Without Visible Fat

Murray, Catherine; Quon, Matthew; McInnes, Matthew D. F.; Pol, Christian B. van der; Hakim, Shaheed W.; Flood, Trevor A.; Schieda, Nicola

doi:10.2214/ajr.16.16062

Cited by 29 publications

(22 citation statements)

References 46 publications

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“…Their result was consistent with our observation. Because we do not routinely obtain T2*‐weighted images, we utilized dual‐echo T1‐weighted FFE images for detection of hemosiderin . Detection of hemosiderin by MRI may be helpful in cases of suspected UCP.…”

Section: Discussionmentioning

confidence: 99%

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Imaging features of undifferentiated carcinoma of the pancreas

et al. 2019

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Introduction:The purpose of this retrospective study was to evaluate imaging features of undifferentiated carcinoma of the pancreas. Methods: The study group included eight patients with surgically resected undifferentiated carcinoma of the pancreas. Multidetector-row computed tomography (MDCT, n = 8) and magnetic resonance imaging (MRI, n = 6) findings were retrospectively reviewed. Results: On MDCT, all eight cases were hypovascular with upstream main pancreatic duct (MPD) dilatation, and only 1 showed exophytic growth. Five cases (62.5%) showed necrosis/cystic change, and calcification was observed in two cases (25%). Calcification reflected tumour osteoid components. On MRI, haemorrhage and hemosiderin were observed in 4 of 6 (66.7%) cases. In addition, tumour thrombus in the splenic vein (n = 1) and intraductal tumour growth in the MPD (n = 2) were pathologically identified, although imaging studies only revealed 1 of these latter cases. Conclusion: Undifferentiated carcinoma of the pancreas may present as a tumour with haemorrhagic necrosis. Coexistence of calcification, intraductal tumour growth in the MPD and tumour thrombus may support the imaging diagnosis of this entity. MethodsInstitutional review board (IRB) approval was obtained, and the requirements for informed consent were waived due to the retrospective nature of the study. Between

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Section: Discussionmentioning

confidence: 99%

“…On the 3.0‐T MRI unit, TE of in‐ and out‐of‐phase images were 2.3 msec and 1.15 msec, respectively. The reviewers considered hemosiderin to be present if an area of signal loss was present on the in‐phase image compared with the out‐of‐phase image and the signal was voided on DWI (b‐factor = 0).…”

Section: Methodsmentioning

confidence: 99%

Imaging features of undifferentiated carcinoma of the pancreas

et al. 2019

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“…Fat‐poor AML are typically small (<4 cm) incidentally discovered masses that occur most commonly in female patients . These tumors do not tend to hemorrhage, are usually homogeneously hyperdense at unenhanced CT, and virtually always low signal intensity on T 2 ‐weighted (T 2 W) MRI and an apparent diffusion coefficient (ADC) map . Unlike papillary RCC, which also may be hyperdense at unenhanced CT and low signal intensity on T 2 W and ADC, fat‐poor AML are typically avidly enhancing (whereas papillary tumors show low‐level progressive enhancement) …”

Section: Description Of Adrenal and Renal Masses By The Presence And mentioning

confidence: 99%

Renal and adrenal masses containing fat at MRI: Proposed nomenclature by the society of abdominal radiology disease‐focused panel on renal cell carcinoma

Schieda

Davenport²,

Pedrosa

et al. 2019

Magnetic Resonance Imaging

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This article proposes a consensus nomenclature for fat‐containing renal and adrenal masses at MRI to reduce variability, improve understanding, and enhance communication when describing imaging findings. The MRI appearance of "macroscopic fat" occurs due to a sufficient number of aggregated adipocytes and results in one or more of: 1) intratumoral signal intensity (SI) loss using fat‐suppression techniques, or 2) chemical shift artifact of the second kind causing linear or curvilinear India‐ink (etching) artifact within or at the periphery of a mass at macroscopic fat–water interfaces. "Macroscopic fat" is most commonly observed in adrenal myelolipoma and renal angiomyolipoma (AML) and only rarely encountered in other adrenal cortical tumors and renal cell carcinomas (RCC). Nonlinear noncurvilinear signal intensity loss on opposed‐phase (OP) compared with in‐phase (IP) chemical shift MRI (CSI) may be referred to as "microscopic fat" and is due to: a) an insufficient amount of adipocytes, or b) the presence of fat within tumor cells. Determining whether the signal intensity loss observed on CSI is due to insufficient adipocytes or fat within tumor cells cannot be accomplished using CSI alone; however, it can be inferred when other imaging features strongly suggest a particular diagnosis. Fat‐poor AML are homogeneously hypointense on T2‐weighted (T2W) imaging and avidly enhancing; signal intensity loss at OP CSI is uncommon, but when present is usually focal and is caused by an insufficient number of adipocytes within adjacent voxels. Conversely, clear‐cell RCC are heterogeneously hyperintense on T2W imaging and avidly enhancing, with the signal intensity loss observed on OP CSI being typically diffuse and due to fat within tumor cells. Adrenal adenomas, adrenal cortical carcinoma, and adrenal metastases from fat‐containing primary malignancies also show signal intensity loss on OP CSI due to fat within tumor cells and not from intratumoral adipocytes. Level of Evidence: 5 Technical Efficacy Stage: 3 J. Magn. Reson. Imaging 2019;49:917–926.

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“…56 In addition, papillary RCCs usually have lower signal intensity compared to normal renal parenchyma on T 2 weighted images, thought to be secondary to the papillary architecture and presence of hemosiderin. 65 Hemosiderin, which can also be seen in other malignant renal tumors, is more commonly associated with papillary RCCs, [66][67][68] and manifests as areas of signal loss on in-phase images when compared to opposed-phased images. The presence of low-level enhancement, low signal on T 2 weighted images, and the presence of hemosiderin would suggest a papillary RCC 64,66 (Figures 16 and 17).…”

Section: Multiparametric Mri In Characterizing Renal Massesmentioning

confidence: 99%

CT and MRI of small renal masses

Wang

Westphalen

Zagoria

2018

BJR

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Small renal masses are increasingly detected incidentally at imaging. They vary widely in histology and aggressiveness, and include benign renal tumors and renal cell carcinomas that can be either indolent or aggressive. Imaging plays a key role in the characterization of these small renal masses. While a confident diagnosis can be made in many cases, some renal masses are indeterminate at imaging and can present as diagnostic dilemmas for both the radiologists and the referring clinicians. This article will summarize the current evidence of imaging features that correlate with the biology of small solid renal masses, and discuss key approaches in imaging characterization of these masses using CT and MRI.

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Evaluation of T1-Weighted MRI to Detect Intratumoral Hemorrhage Within Papillary Renal Cell Carcinoma as a Feature Differentiating From Angiomyolipoma Without Visible Fat

Cited by 29 publications

References 46 publications

Imaging features of undifferentiated carcinoma of the pancreas

Imaging features of undifferentiated carcinoma of the pancreas

Renal and adrenal masses containing fat at MRI: Proposed nomenclature by the society of abdominal radiology disease‐focused panel on renal cell carcinoma

CT and MRI of small renal masses

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