Renal Angiomyolipoma with Minimal Fat: Differentiation from Other Neoplasms at Double-Echo Chemical Shift FLASH MR Imaging

Kim, Jeong Kon; Kim, Soo Hyun; Jang, Yoon Jin; Ahn, Hanjong; Kim, Choung‐Soo; Park, Hyungkeun; Lee, Jun Woo; Kim, Suk; Cho, Kyoung‐Sik

doi:10.1148/radiol.2391050102

Cited by 164 publications

(111 citation statements)

References 20 publications

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“…All AMLs were diagnosed with computed tomography (CT) and/or magnetic resonance imaging (MRI) on the basis of the presence of intra-tumoral fat without calcification or necrosis (43)(44)(45). Macroscopic fat appeared as areas with a density less than −20 Hounsfield units (HU) on nonenhanced CT or with cancellation of high signal intensity on T1-weighted MR images with fat saturation.…”

Section: Diagnosis Tumor Size Measurement and Embolization Techniquementioning

confidence: 99%

Selective arterial embolization of symptomatic and asymptomatic renal angiomyolipomas: a retrospective study of safety, outcomes and tumor size reduction

Bardin¹,

Chevallier²,

Bertaut³

et al. 2017

Quant. Imaging Med. Surg.

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Background: Angiomyolipoma (AML) is the most common renal benign tumor. Treatment should be considered for symptomatic patients or for those at risk for complications, especially retroperitoneal bleeding which is correlated to tumor size, grade of the angiogenic component and to the presence of tuberous sclerosis complex (TSC). This study reports our single-center experience with the use of selective arterial embolization (SAE) in the management of symptomatic and asymptomatic renal AMLs. Methods:In this retrospective mono-centric study, all demographic and imaging data, medical records, angiographic features, outpatient charts and follow-up visits of patients who underwent prophylactic or emergency SAE for AMLs between January 2005 and July 2016 were reviewed. Tumor size and treatment outcomes were assessed at baseline and after the procedure during follow-up. Computed tomography (CT), magnetic resonance imaging (MRI) or ultrasonography was used to evaluate AML shrinkage. Renal function was measured pre-and post-procedure.Results: Twenty-three patients (18 females, 5 males; median age, 45 years; range, 19-85 years) who underwent SAE either to treat bleeding AML (n=6) or as a prophylactic treatment (n=17) were included.Overall, 34 AMLs were embolized. TSC status was confirmed for 6 patients. Immediate technical success rate was 96% and 4 patients benefitted from an additional procedure. Major complications occurred in 3 patients and minor post-embolization syndrome (PES) in 14 patients. The mean AML size reduction rate was 26.2% after a mean follow-up was 20.5 months (range, 0.5-56 months), and only non-TSC status was significantly associated with better shrinkage of tumor (P=0.022). Intralesional aneurysms were significantly more frequent in patients with hemorrhagic presentation (P=0.008). There was no change in mean creatinine level after SAE.Conclusions: SAE is a safe and effective technique to manage renal AMLs as a preventive treatment as well as in emergency setting, with significant reduction in tumor size during follow-up. A multidisciplinary approach remains fundamental, especially for TSC patients. In addition to size, the presence of intralesional aneurysms should be considered in any prophylactic treatment decision.

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Section: Diagnosis Tumor Size Measurement and Embolization Techniquementioning

confidence: 99%

Selective arterial embolization of symptomatic and asymptomatic renal angiomyolipomas: a retrospective study of safety, outcomes and tumor size reduction

Bardin¹,

Chevallier²,

Bertaut³

et al. 2017

Quant. Imaging Med. Surg.

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“…Ultrasound findings usually show hyperechoic lesions; in this manner, spectral fat suppression images using MR is suggestive of macroscopic fat in AML (20). Minimal fat AMLs contain only microscopic fat, thus, it is difficult to differentiate them from renal neoplasms (21). Despite the diagnostic potential of ultrasound, its overall reliability is not extensively confirmed as a confident tool to distinguish AMLs.…”

Section: Imagingmentioning

confidence: 99%

Recent Strategies for the Management of Renal Angiomyolipoma: A Review of Diagnostic and Therapeutic Approaches

et al. 2017

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Recent prophylactic treatment options and diagnostic tools show a suboptimal improvement in patients with renal angiomyolipoma (AML). This study was an attempt to review management strategies applied before invasive options. An extensive research on medical databases such as PubMed and Scopus was performed from 1999 to 2016 using the following keywords: 'kidney', 'renal', and 'angiomyolipoma'. All related studies on patients treating with conservative or minimally-invasive procedures were included. However, reports on surgical treatments were excluded. Treatment strategies have been selected based on outcomes resulting from computed tomography (CT) and magnetic resonance (MR) imaging. Fat content and tumor size are the most common used indications for AMLs. Unenhanced CT and chemical shift imaging provide good evidence in case of fat-poor AMLs. Chemical analysis and percutaneous biopsy are recommended in case of a diagnostic challenge. A tumor size of 6 cm or larger in diameter might necessitate invasive treatment, while AMLs patients with tumors around 4 cm may require prophylactic treatment. Of all treatment options, embolization indicated a high risk of reintervention. Moreover, everolimus and sirolimus as 2 inhibitors of mammalian target of rapamycin (mTOR) have been evaluated in clinical trials and demonstrated promising outcomes. In conclusion, advances in imaging techniques along with mTOR inhibitors and embolic materials potentiate functional outcomes in AMLs.

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“…[1][2][3][4][5][6][7][8][9][10][11][12][13][14] Despite these advancements, some cases still remain for which CT or MRI cannot be used for the histological characterization of a renal tumor. For example, the differentiation of RCC from AML and infiltrating UC of the kidney can be difficult in some cases.…”

Section: Introductionmentioning

confidence: 99%

Utility of Apparent Diffusion Coefficients in the Evaluation of Solid Renal Tumors at 3T

Sasamori

Saiki

Suyama

et al. 2014

MRMS

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Purpose: We assessed the usefulness of apparent diffusion coefficients (ADCs) for solid renal tumor imaging using diffusion-weighted magnetic resonance imaging (DWI) at 3T.Methods: This retrospective study assessed ADCs of 31 patients with renal tumors that were imaged using preoperative DWI. DWI was performed with the b values of 50, 500, and 1000 s/mm 2 , using a 3T magnetic resonance imaging (MRI) system (MAGNETOM Trio, 3T, Siemens Healthcare, Erlangen, Germany). The ADC map was calculated using the b values of 50 and 1000 s/mm 2 . ADCs of the different tumors were compared according to the Tukey-Kramer test.Results: The tumors were diagnosed as clear cell renal cell carcinoma (RCC; n = 20), papillary RCC (n = 1), infiltrating urothelial carcinoma (UC) of the kidney (n = 4), cystic RCC (n = 1), poorly differentiated carcinoma (n = 1), and angiomyolipoma (AML; n = 4). The mean ADC of clear cell RCC was significantly higher than that of infiltrating UC of the kidney (1.423 vs. 0.931 © 10 ¹3 mm 2 /s; P < 0.05), and the mean ADC of AML was significantly lower than that of clear cell RCC (0.674 vs. 1.423 © 10 ¹3 mm 2 /s; P < 0.01). Conclusion: ADCs used in DWI at 3T may be useful for differentiation of different types of solid renal tumors.

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Renal Angiomyolipoma with Minimal Fat: Differentiation from Other Neoplasms at Double-Echo Chemical Shift FLASH MR Imaging

Abstract: Double-echo GRE chemical shift MR imaging can be used to differentiate AML with minimal fat from other renal neoplasms.

Cited by 164 publications

References 20 publications

Selective arterial embolization of symptomatic and asymptomatic renal angiomyolipomas: a retrospective study of safety, outcomes and tumor size reduction

Selective arterial embolization of symptomatic and asymptomatic renal angiomyolipomas: a retrospective study of safety, outcomes and tumor size reduction

Recent Strategies for the Management of Renal Angiomyolipoma: A Review of Diagnostic and Therapeutic Approaches

Utility of Apparent Diffusion Coefficients in the Evaluation of Solid Renal Tumors at 3T

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