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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==
Line 31: Line 17:
==MRI==
==MRI==


MRI may be helpful in the diagnosis of renal oncocytoma. Findings on MRI suggestive of renal oncocytoma include:
MRI may be helpful in the diagnosis of renal oncocytoma. Findings on 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
*central scar or stellate pattern
| author = [[R. R. Remark]], [[T. H. Berquist]], [[M. M. Lieber]], [[J. W. Charboneau]] & [[G. W. Hartman]]
| title = Magnetic resonance imaging of renal oncocytoma
| journal = [[Urology]]
| volume = 31
| issue = 2
| pages = 176–179
| year = 1988
| month = February
| pmid = 3341111
}}</ref><ref>{{Cite journal
| author = [[B. J. Wagner]]
| title = The kidney: radiologic-pathologic correlation
| journal = [[Magnetic resonance imaging clinics of North America]]
| volume = 5
| issue = 1
| pages = 13–28
| year = 1997
| month = February
| pmid = 8995122
}}</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
| author = [[D. S. Ball]], [[A. C. Friedman]], [[D. S. Hartman]], [[P. D. Radecki]] & [[D. F. Caroline]]
| title = Scar sign of renal oncocytoma: magnetic resonance imaging appearance and lack of specificity
| journal = [[Urologic radiology]]
| volume = 8
| issue = 1
| pages = 46–48
| year = 1986
| month =
| pmid = 3523935
}}</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
| author = [[W. J. Harmon]], [[B. F. King]] & [[M. M. Lieber]]
| title = Renal oncocytoma: magnetic resonance imaging characteristics
| journal = [[The Journal of urology]]
| volume = 155
| issue = 3
| pages = 863–867
| year = 1996
| month = March
| pmid = 8583594
}}</ref>
*Central scar
*Satellite pattern
*Pseudo-capsule
*Pseudo-capsule
*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
*'''T1-weighted images:'''
 
**low signal intensity homogenous mass (compare to renal cortex)
*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
*'''T2-weighted images:'''
*The most consistent finding for oncocytomas is low signal intensity relative to the renal cortex on T1-weighted spin echo sequences. However, 27% of the cases did not demonstrate this finding and were actually isointense relative to the renal cortex.49 The tumors are usually hyperintense on T2-weighted spin echo images,49,50 but isointensity and low intensity have also been demonstrated.49 A low intensity rim and central stellate areas of hypointensity can sometimes be detected on T1 and T2-weighted images. This can be differentiated from the necrosis common to RCC, which appears as areas of decreased signal intensity on T1 weighted imaging and as areas of increased signal intensity on T2-weighted imaging.49 Unfortunately, a direct comparison of various renal tumors using magnetic resonance imaging indicated that a distinction between tumor types was not possible.
**Increased intensity mass
 
*Hemorrhage or necrosis are not detectable
 
Radiologic differentiation of oncocytoma from RCC
would be invaluable prior to surgery since it may change the
management. Nephron sparing surgery can be used for large tumors. There are some radiologic features that might be noticed
in oncocytomas but they are not specific to this type of
tumor. A central scar or stellate pattern can be observed in 27% to 54% of the tumors [6,28,29]. However, the central scar sometimes cannot be differentiated from a central necrosis
that may be noticed with RCC even with MRI since both lesions may have low signal on T1 and high signal on
T2 sequences [30]. Pedrosa et al. reported that delayed enhancement of the central scar may be seen with MRI after
gadolinium administration, a feature that is not noticed with
central necrosis [31]. Pseudo-capsule may be seen in 40% to 45% of oncocytomas [29,32]. However it may be noticed in
up to 60% of RCC as well [29]. Davidson et al. [33]
concluded from their series (53 tumors in 48 patients) that
features such as homogenous enhancements and central stellate scar are poor predictors of oncocytomas on computerized tomography (CT) scans. Among oncocytomas larger
than 3 cm, only two-thirds fulfilled the criteria for oncocytoma,
whereas among RCC smaller than 3 cm, 42% had
radiologic criteria consistent with oncocytomas. Choudhary
et al. [34] made a retrospective study of 28 oncocytomas
and searched for CT features that could identify oncocytomas. The authors could not find features that were pathognomonic for oncocytomas. Wildberger et al. [35] made a retrospective study in
which seven radiologists retrospectively reviewed the preoperative CT scans of 7 patients with renal masses diagnosed
as oncocytomas. The radiographic diagnosis was correct in 12% of 49 cases. Pretorius et al. searched for MR features that may distinguish
oncocytoma from RCC. However, similar to CT
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).
 
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. Oncocytoma 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.
 


==References==
==References==

Revision as of 15:19, 17 May 2019

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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

There are no MRI findings associated with [disease name].

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

  • Central scar
  • Satellite pattern
  • Pseudo-capsule
  • T1-weighted images:
    • low signal intensity homogenous mass (compare to renal cortex)
  • T2-weighted images:
    • Increased intensity mass
  • Hemorrhage or necrosis are not detectable

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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