Renal oncocytoma MRI

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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

MRI may be helpful in the diagnosis of renal oncocytoma.

MRI

Typical signal characterisitics include:

• 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

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

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]
• [Finding 3]

OR

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:

• [Complication 1]
• [Complication 2]
• [Complication 3]

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]