Frequency of Angiomyolipomas Among Echogenic Nonshadowing Renal Masses (&gt; 4 mm) Found at Ultrasound and the Utility of MRI for Diagnosis

Silva, Suresh de; Copping, Ross; Malouf, David; Hutton, Anthony; Maclean, Fiona; Aslan, Peter

doi:10.2214/ajr.16.17753

Cited by 9 publications

(22 citation statements)

References 24 publications

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“…This compares well to a 2017 study by De Silva et al who found a series of 158 hyperechoic masses in 132 patients with 62% confirmed AMLs. 17 The current lack of consensus regarding the surveillance of particularly subcentimetre echogenic renal lesions has led to various guidelines and recommendations. The present findings support previous studies that have demonstrated slow growth rates in small AMLs, and therefore, suggest that further follow-up is not required in the absence of symptoms or concerning imaging features.…”

Section: Discussionmentioning

confidence: 99%

Can subcentimetre ultrasound detected angiomyolipomas be safely disregarded?

et al. 2020

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Section: Discussionmentioning

confidence: 99%

Can subcentimetre ultrasound detected angiomyolipomas be safely disregarded?

et al. 2020

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“…One series found that 33 of 290 partial nephrectomies performed for a suspicious mass at CT yielded a diagnosis of an AML. 4,5 If an mpMRI had been performed in these cases and was strongly indicative of AML, those 10% could perhaps have avoided unnecessary major surgery.…”

Section: Resultsmentioning

confidence: 99%

“…This has significant clinical implications as lipid‐poor AMLs are difficult to diagnose radiologically on USS or CT, thus often leading to unnecessary surgical excision of an AML due to fears of it being an RCC. One series found that 33 of 290 partial nephrectomies performed for a suspicious mass at CT yielded a diagnosis of an AML 4,5 . If an mpMRI had been performed in these cases and was strongly indicative of AML, those 10% could perhaps have avoided unnecessary major surgery.…”

Section: Discussionmentioning

confidence: 99%

“…They can, however, be differentiated from lipid‐poor AMLs through other MRI parameters. Firstly, diffusion‐weighted imaging (DWI) and the calculated apparent diffusion coefficient (ADC) can be very useful because AMLs have the lowest ADC value of renal tumours, significantly lower than non‐papillary RCCs such as clear cell RCC 4,6 . Lipid‐poor AMLs also are frequently associated with decreased T2 SI, whereas clear cell RCCs often have increased SI 4,5 .…”

Section: Discussionmentioning

confidence: 99%

“…This in turn can be seen as a loss of signal intensity (SI) in the mass on opposed-phase chemical shift imaging compared with in-phase imaging. 4,5 This may be useful in the diagnosis of lipid-poor AMLs in which bulk fat is not appreciated. 5 RCCs may also contain fat due to lipid-producing tumour necrosis, bone metaplasia with fatty marrow elements or entrapment of perinephric or renal sinus fat.…”

Section: Introductionmentioning

confidence: 99%

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Chemical shift imaging in the identification of those renal tumours that contain microscopic fat and the utility of multiparametric MRI in their differentiation

et al. 2020

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Introduction: The aim of this study was to assess the qualitative and MRI findings of renal tumours, to determine which lesions contain microscopic fat, one of the potential differentiating factors between tumour types. Methods: 73 patients who underwent 3 Tesla MRI including chemical shift imaging, with subsequent biopsy or excision for histopathological diagnosis, were included in the study. The images were reviewed for a decrease in signal intensity (SI) on the opposed phase compared with the in-phase gradient echo T1 images, indicating the presence of microscopic fat. The chemical shift index was then calculated as a percentage of SI change and compared with the pathological diagnosis. Results: In total, 38 (52%) of lesions demonstrated a decrease in SI, consistent with microscopic fat. Microscopic fat was found in 28 (80%) clear cell renal cell carcinomas (RCCs), 6 (66.7%) angiomyolipomas, 2 (20%) papillary RCCs, 1 (20%) chromophobe RCC and 1 (9.1%) oncocytoma. Pairwise comparison of means indicated that the amount of microscopic fat was significantly larger only for angiomyolipomas compared with clear cell RCCs (P < 0.001) and other renal lesions (P < 0.001). Conclusions: A decrease in SI on opposed phase compared with in-phase chemical shift imaging favours the diagnosis of either clear cell RCC or an angiomyolipoma. When combined with other parameters in mpMRI, this may aid differentiation of benign from malignant tumours and differentiation of aggressive from indolent RCC subtypes. This may be of value where biopsy is non-diagnostic, not feasible due to location or in high-risk patients.

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The value of surveying the kidneys during pelvic ultrasound examinations

Brennan

Nečas

2019

Australas J Ultrason Med

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IntroductionPelvic ultrasounds are commonly performed for various clinical indications in female patients presenting to the hospital. A survey of the kidneys is routinely included as part of the examination, but there is limited justification for their inclusion in the assessment of every female presenting for a pelvic ultrasound.MethodWe examined the utility of surveying the kidney ultrasound during pelvic ultrasonography by reviewing the records of 1009 pelvic ultrasound examinations in 1000 women.ResultsIn total, 46 incidental findings were identified, but 91% of these were clinically inconsequential. Only four patients had incidental findings of high clinical priority requiring specialist treatment. Of these, two patients were symptomatic and had urinary tract obstruction due to stones. The other two patients harboured asymptomatic renal cell carcinomas. The overall incidence of renal incidental findings of high clinical priority in asymptomatic patients was two in 1009 examinations (1999 kidneys).ConclusionIndiscriminate uncritical screening of the kidneys in women presenting for pelvic ultrasound is not evidence‐based and represents a low‐yield examination with extremely low rate of incidental findings of clinical significance.

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Frequency of Angiomyolipomas Among Echogenic Nonshadowing Renal Masses (> 4 mm) Found at Ultrasound and the Utility of MRI for Diagnosis

Cited by 9 publications

References 24 publications

Can subcentimetre ultrasound detected angiomyolipomas be safely disregarded?

Can subcentimetre ultrasound detected angiomyolipomas be safely disregarded?

Chemical shift imaging in the identification of those renal tumours that contain microscopic fat and the utility of multiparametric MRI in their differentiation

The value of surveying the kidneys during pelvic ultrasound examinations

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