Small (<4 cm) Renal Mass: Differentiation of Angiomyolipoma without Visible Fat from Renal Cell Carcinoma Utilizing MR Imaging
Radiology:Volume 263 Number 1-April 2012
Kewalee Sasiwimonphan, MD Naoki Takahashi, MD Bradley C. Leibovich, MD Rickey E. Carter, PhD Thomas D. Atwell, MD Akira Kawashima, MD, PhD
Purpose: To determine whether a combination of magnetic resonance (MR) parameters can help differentiate small angiomyoli-pomas (AMLs) without visible fat from renal cell carcinomas (RCCs).
Materials and Methods: This HIPAA-compliant retrospective study received institutional review board approval; 69 men and 42 women (mean age, 59.7 years) with 15 AMLs without visible fat and 104 RCCs underwent MR. The development set consisted of 10 AMLs and 71 RCCs; the validation set consisted of five AMLs and 33 RCCs. Tl-weighted fast spin-echo (SE), fat-suppressed T2-weighted fast SE, in- and opposed-phase gradient-echo (GRE), and fat-suppressed three-dimensional Tl-weighted spoiled GRE sequences were performed before and after contrast material administration. Tumor signal intensity (SI) was measured. Tl and T2 SI ratio (ratio of tumor to renal cortex SI on Tl- and T2-weighted images, respectively), SI index (SII) ([SIin- SIopp]/[SIin] X 100; SIin and SIopp are tumor SI on in- and opposed-phase images, respectively), and arterial-to-delayed enhancement ratio ([SIart - SIpre]/[SIdel - SIpre ]; SIpre, SIart , and SIdel are tumor SI on unenhanced, arterial phase, and delayed phase three-dimensional Tl-weighted spoiled GRE images, respectively) were compared. Combinations of MR parameter threshold levels were constructed from development set and validated with validation set. Sensitivity, specificity, and accuracy for differentiating between AML and RCC were calculated for combinations of MR parameter threshold levels.
Conclusion: A combination of T2 SI ratio less than 0.9 and ([SII greater than 20% and Tl SI ratio greater than 1.2] or arterial-to-delayed enhancement ratio greater than 1.5) was accurate in differentiating AML from RCC.