Renal oncocytoma MRI: Difference between revisions

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{{Renal Oncocytoma}}
{{Renal Oncocytoma}}
{{CMG}}; {{AE}}{{Homa}} {{SC}}
{{CMG}}; {{AE}}{{Homa}} {{SC}}
==Overview==
[[MRI]] may be helpful in the diagnosis of renal oncocytoma.
==MRI==
Typical signal characterisitics include:<ref name=radio> Renal oncocytoma.Dr Donna D'Souza et al.  Radiopaedia.org 2015.http://radiopaedia.org/articles/renal-oncocytoma</ref>
* '''T1 weighted image:'''
:* Hypointense compared to [[renal cortex]]
* '''T2 weighted image:'''
:* Hyperintense compared to renal cortex
:* May demonstrate hypointense central stellate scar
* '''T1 with gadolinium contrast:'''
:* Usually demonstrates homogeneous enhancement


==Overview==
==Overview==


There are no MRI findings associated with [disease name].
[[Renal]] [[MRI]] may be helpful in the [[diagnosis]] of renal oncocytoma. Findings on [[MRI]] suggestive of renal oncocytoma include central scar, satellite pattern, pseudo-capsule, hypointensity in T1 and hyperintensity in T2 weighted images. Although, none of these characteristics can differentiate between renal oncocytoma and [[renal cell carcinoma]] ([[Renal cell carcinoma|RCC]]).
 
OR
 
[Location] MRI may be helpful in the diagnosis of [disease name]. Findings on MRI suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].
 
OR
 
There are no MRI findings associated with [disease name]. However, a MRI may be helpful in the diagnosis of complications of [disease name], which include [complication 1], [complication 2], and [complication 3].


==MRI==
==MRI==


There are no MRI findings associated with [disease name].
[[Magnetic resonance imaging|MRI]] may be helpful in the [[diagnosis]] of renal oncocytoma. Findings on [[Magnetic resonance imaging|MRI]] suggestive of renal oncocytoma include:<ref name="HarmonKing1996">{{cite journal|last1=Harmon|first1=William J.|last2=King|first2=Bernard F.|last3=Lieber|first3=Michael M.|title=Renal Oncocytoma: Magnetic Resonance Imaging Characteristics|journal=Journal of Urology|volume=155|issue=3|year=1996|pages=863–867|issn=0022-5347|doi=10.1016/S0022-5347(01)66329-8}}</ref><ref>{{Cite journal
 
| author = [[R. R. Remark]], [[T. H. Berquist]], [[M. M. Lieber]], [[J. W. Charboneau]] & [[G. W. Hartman]]
OR
| title = Magnetic resonance imaging of renal oncocytoma
 
| journal = [[Urology]]
[Location] MRI may be helpful in the diagnosis of [disease name]. Findings on MRI suggestive of/diagnostic of [disease name] include:
| volume = 31
*[Finding 1]
| issue = 2
*[Finding 2]
| pages = 176–179
*[Finding 3]
| year = 1988
 
| month = February
OR
| pmid = 3341111
 
}}</ref><ref>{{Cite journal
There are no MRI findings associated with [disease name]. However, an MRI may be helpful in the diagnosis of complications of [disease name], which include:
| author = [[B. J. Wagner]]
*[Complication 1]
| title = The kidney: radiologic-pathologic correlation
*[Complication 2]
| journal = [[Magnetic resonance imaging clinics of North America]]
*[Complication 3]
| volume = 5
 
| issue = 1
 
| pages = 13–28
Radiologic differentiation of oncocytoma from RCC
| year = 1997
would be invaluable prior to surgery since it may change the
| month = February
management. Nephron sparing surgery can be used for large
| pmid = 8995122
tumors. There are some radiologic features that might be noticed
}}</ref><ref name="PretoriusSiegelman1999">{{cite journal|last1=Pretorius|first1=E. Scott|last2=Siegelman|first2=Evan S.|last3=Ramchandani|first3=Parvati|last4=Cangiano|first4=Thomas|last5=Banner|first5=Marc P.|title=Renal Neoplasms Amenable to Partial Nephrectomy: MR Imaging|journal=Radiology|volume=212|issue=1|year=1999|pages=28–34|issn=0033-8419|doi=10.1148/radiology.212.1.r99jl3228}}</ref><ref>{{Cite journal
in oncocytomas but they are not specific to this type of
| author = [[D. S. Ball]], [[A. C. Friedman]], [[D. S. Hartman]], [[P. D. Radecki]] & [[D. F. Caroline]]
tumor. A central scar or stellate pattern can be observed in
| title = Scar sign of renal oncocytoma: magnetic resonance imaging appearance and lack of specificity
27% to 54% of the tumors [6,28,29]. However, the central
| journal = [[Urologic radiology]]
scar sometimes cannot be differentiated from a central necrosis
| volume = 8
that may be noticed with RCC even with MRI since
| issue = 1
both lesions may have low signal on T1 and high signal on
| pages = 46–48
T2 sequences [30]. Pedrosa et al. reported that delayed
| year = 1986
enhancement of the central scar may be seen with MRI after
| month =
gadolinium administration, a feature that is not noticed with
| pmid = 3523935
central necrosis [31]. Pseudo-capsule may be seen in 40% to
}}</ref><ref name="PedrosaSun2008">{{cite journal|last1=Pedrosa|first1=Ivan|last2=Sun|first2=Maryellen R.|last3=Spencer|first3=Matthew|last4=Genega|first4=Elizabeth M.|last5=Olumi|first5=Aria F.|last6=Dewolf|first6=William C.|last7=Rofsky|first7=Neil M.|title=MR Imaging of Renal Masses: Correlation with Findings at Surgery and Pathologic Analysis|journal=RadioGraphics|volume=28|issue=4|year=2008|pages=985–1003|issn=0271-5333|doi=10.1148/rg.284065018}}</ref><ref>{{Cite journal
45% of oncocytomas [29,32]. However it may be noticed in
| author = [[W. J. Harmon]], [[B. F. King]] & [[M. M. Lieber]]
up to 60% of RCC as well [29]. Davidson et al. [33]
| title = Renal oncocytoma: magnetic resonance imaging characteristics
concluded from their series (53 tumors in 48 patients) that
| journal = [[The Journal of urology]]
features such as homogenous enhancements and central
| volume = 155
stellate scar are poor predictors of oncocytomas on computerized
| issue = 3
tomography (CT) scans. Among oncocytomas larger
| pages = 863–867
than 3 cm, only two-thirds fulfilled the criteria for oncocytoma,
| year = 1996
whereas among RCC smaller than 3 cm, 42% had
| month = March
radiologic criteria consistent with oncocytomas. Choudhary
| pmid = 8583594
et al. [34] made a retrospective study of 28 oncocytomas
}}</ref>
and searched for CT features that could identify oncocytomas.
*Central scar
The authors could not find features that were pathognomonic
*Satellite pattern
for oncocytomas.
*Pseudo-capsule
Wildberger et al. [35] made a retrospective study in
*'''T1-weighted images:'''
which seven radiologists retrospectively reviewed the preoperative
**Low signal intensity [[homogenous]] [[lesion]] (compare to [[renal cortex]])
CT scans of 7 patients with renal masses diagnosed
*'''T2-weighted images:'''
as oncocytomas. The radiographic diagnosis was correct
**Increased [[intensity]] [[lesion]]
in 12% of 49 cases.
*[[Hemorrhage]] or [[necrosis]] are not detectable
Pretorius et al. searched for MR features that may distinguish
'''Note:''' None of these characteristics can differentiate between renal oncocytoma and [[Renal cell carcinoma|RCC]].
oncocytoma from RCC. However, similar to CT
[[File:InkedMRI renal oncocytoma LI.jpg|450px|none|thumb|https://openi.nlm.nih.gov/detailedresult?img=MPX1851_synpic27498&query=renal%20oncocytoma%20MRI&it=xg&req=4&npos=10]]
scans, the authors found a significant overlap between the MR
features of oncocytomas and RCCs, making the primary
radiologic diagnosis of oncocytoma not feasible with this
method [29]
 
Ultrasound sonography or computed tomography
(CT) scan of the tumor generally shows a solid mass, but
some oncocytomas are identified as partially cystic
lesions (Mei et al., 1980; Morra and Das, 1993).
Findings suggestive of oncocytoma in magnetic
resonance imaging (MRI) are a low-intensity
homogenous mass on T1-weighted images, which
appears as increased intensity on T2-weighted images,
the presence of a capsule, central scar or satellate pattern
and the absence of either hemorrhage or necrosis
(Ambos et al., 1978). Intravenous pyelography (IVP)
shows a mass defect (Mei et al., 1980; Choi et al., 1983).
Renal angiography of many oncocytomas shows
hypervascularity (Merino and Livolsi, 1982; Morra and
Das, 1993). Typically, the vascularity displays a spoked wheel pattern (Alanen et al., 1984; Morra and Das, 1993;
Harmon et al., 1996).  
 
Oncocytomas have the typical appearance of a solid renal
mass lesion, no matter what imaging technique is used.
Sizable masses compressing the collecting system or
disrupting the renal contour can be visualized with
excretory urography, but no features characteristic for
oncocytoma can be identified by this method. Renal ultrasonography is useful to distinguish solid from cystic
lesions and can visualize central scarring, calcifications,
and central necrosis, but again, none of these features are
diagnostic for a specific renal neoplasm [33].
Renal angiography was used historically to evaluate
renal tumor arterial anatomy and examine intratumoral
vascular patterns, but this modality has largely been
supplanted by less morbid and invasive techniques such as
CT angiography and magnetic resonance (MR) angiography. A number of typical angiographic signs have been
described, including a lucent rim sign, a homogeneous
capillary nephrogram phase, the absence of wild neoplastic
vessels, and the “spokewheeled” appearance of the feeding
arteries [34]. Nevertheless, these features significantly overlap with those observed with RCC, and as a consequence
renal angiography cannot be recommended to distinguish
between RCC and oncocytoma.
Because CT is commonly used for imaging intraabdominal and retroperitoneal pathology, and because
many renal masses are initially detected using this
modality, particular attention has been given to using this
modality to look for features unique to oncocytoma. Some
oncocytomas demonstrate a central stellate focus of low
attenuation that corresponds with the stellate scar visible
on gross pathology. Oncocytomas may tend to be more
homogeneous than the typical RCC, with overall lower
attenuation than surrounding normal renal parenchyma,
but they can contain areas of necrosis or hemorrhage that
produce variable attenuation (ie, heterogeneity) on
CT [35–37]. A recent study, in which seven radiologists
retrospectively reviewed the preoperative CT scans of
seven patients with renal masses, demonstrated that
oncocytoma was only correctly diagnosed in 12% of 49
observations [38].
Given the superior soft tissue imaging capabilities of
magnetic resonance imaging (MRI) for other medical
applications, there has been interest in using this modality
to differentiate between the characteristics of various renal
masses. MRI has proven valuable in the assessment of
tumoral renal vein and vena cava involvement, as well as in
gauging tumor extent by providing sagittal and coronal views (in addition to the traditional axial section) of the
primary lesion. In a 1996 report from our institution, we
looked at 11 patients with renal masses detected on MRI
who were subsequently found to have oncocytoma at time
of resection. Eight patients demonstrated decreased signal
intensity on T1-weighted images, whereas in the other
three the oncocytoma was isointense to the surrounding
renal parenchyma. Five of the tumors appeared homogeneous and four appeared encapsulated. A central scar
was only seen in one patient’s tumor. Results were even
more equivocal on T2-weighted images, which were
available for six of the 11 patients. One tumor demonstrated decreased signal intensity, three demonstrated
increased signal intensity, and two were isointense [39].
Unfortunately, as with CT there remains enough overlap
between the MR features of oncocytomas and RCCs that
primary radiologic diagnosis is not currently feasible with
this method [40].
 
 
==References==
==References==
{{reflist|2}}
{{reflist|2}}
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[[Category:Oncology]]
[[Category:Oncology]]
[[Category:Nephrology]]
[[Category:Nephrology]]
[[Category: Primary care]]
[[Category:Radiology]]
[[Category:Radiology]]

Latest revision as of 23:57, 29 July 2020

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Homa Najafi, M.D.[2] Shanshan Cen, M.D. [3]

Overview

Renal MRI may be helpful in the diagnosis of renal oncocytoma. Findings on MRI suggestive of renal oncocytoma include central scar, satellite pattern, pseudo-capsule, hypointensity in T1 and hyperintensity in T2 weighted images. Although, none of these characteristics can differentiate between renal oncocytoma and renal cell carcinoma (RCC).

MRI

MRI may be helpful in the diagnosis of renal oncocytoma. Findings on MRI suggestive of renal oncocytoma include:[1][2][3][4][5][6][7]

Note: None of these characteristics can differentiate between renal oncocytoma and RCC.

https://openi.nlm.nih.gov/detailedresult?img=MPX1851_synpic27498&query=renal%20oncocytoma%20MRI&it=xg&req=4&npos=10

References

  1. ↑ Harmon, William J.; King, Bernard F.; Lieber, Michael M. (1996). "Renal Oncocytoma: Magnetic Resonance Imaging Characteristics". Journal of Urology. 155 (3): 863–867. doi:10.1016/S0022-5347(01)66329-8. ISSN 0022-5347.
  2. ↑ R. R. Remark, T. H. Berquist, M. M. Lieber, J. W. Charboneau & G. W. Hartman (1988). "Magnetic resonance imaging of renal oncocytoma". Urology. 31 (2): 176–179. PMID 3341111. Unknown parameter |month= ignored (help)
  3. ↑ B. J. Wagner (1997). "The kidney: radiologic-pathologic correlation". Magnetic resonance imaging clinics of North America. 5 (1): 13–28. PMID 8995122. Unknown parameter |month= ignored (help)
  4. ↑ Pretorius, E. Scott; Siegelman, Evan S.; Ramchandani, Parvati; Cangiano, Thomas; Banner, Marc P. (1999). "Renal Neoplasms Amenable to Partial Nephrectomy: MR Imaging". Radiology. 212 (1): 28–34. doi:10.1148/radiology.212.1.r99jl3228. ISSN 0033-8419.
  5. ↑ D. S. Ball, A. C. Friedman, D. S. Hartman, P. D. Radecki & D. F. Caroline (1986). "Scar sign of renal oncocytoma: magnetic resonance imaging appearance and lack of specificity". Urologic radiology. 8 (1): 46–48. PMID 3523935.
  6. ↑ Pedrosa, Ivan; Sun, Maryellen R.; Spencer, Matthew; Genega, Elizabeth M.; Olumi, Aria F.; Dewolf, William C.; Rofsky, Neil M. (2008). "MR Imaging of Renal Masses: Correlation with Findings at Surgery and Pathologic Analysis". RadioGraphics. 28 (4): 985–1003. doi:10.1148/rg.284065018. ISSN 0271-5333.
  7. ↑ W. J. Harmon, B. F. King & M. M. Lieber (1996). "Renal oncocytoma: magnetic resonance imaging characteristics". The Journal of urology. 155 (3): 863–867. PMID 8583594. Unknown parameter |month= ignored (help)

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