Angiomyolipoma (AML) without visible fat: Ultrasound, CT and MR imaging features with pathological correlation

Hakim, Shaheed W.; Schieda, Nicola; Hodgdon, Taryn; McInnes, Matthew D. F.; Dilauro, Marc; Flood, Trevor A.

doi:10.1007/s00330-015-3851-8

Cited by 49 publications

(36 citation statements)

References 38 publications

(80 reference statements)

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“…For example, a decrease in SI on opposed-phase T1-weighted chemical-shift MRI noted in combination with hypointensity on T2-weighted MRI is specific for AMLs without visible fat because, although papillary RCCs may also show a decrease in SI on opposed-phase images, these papillary tumors have a prolonged T2 signal [6,17,19,22,29].…”

Section: Methodsmentioning

confidence: 99%

“…Unfortunately, despite preliminary reports of the usefulness of chemical-shift MRI in the detection of microscopic fat in AMLs without visible fat [10], it is now known that few AMLs without visible fat have sufficient amounts of fat to be detected using chemical-shift MRI [6,18,22]. Moreover, although the combination of rapid wash-in enhancement with washout kinetics on gadoliniumenhanced MRI and low T2-weighted SI may differentiate AML without visible fat from papillary RCC (with the latter characteristically showing progressive enhancement) [17,22], approximately one-quarter of AMLs without visible fat may not show this typical enhancement pattern [6,30].…”

Section: Methodsmentioning

confidence: 99%

“…Moreover, although the combination of rapid wash-in enhancement with washout kinetics on gadoliniumenhanced MRI and low T2-weighted SI may differentiate AML without visible fat from papillary RCC (with the latter characteristically showing progressive enhancement) [17,22], approximately one-quarter of AMLs without visible fat may not show this typical enhancement pattern [6,30].…”

Section: Methodsmentioning

confidence: 99%

“…

AMLs without visible fat are commonly resected benign renal neoplasms [7,8]; therefore, preoperative differentiation of AML without visible fat from renal cell carcinoma (RCC) is desirable.Numerous CT and MRI findings associated with AML without visible fat have been reported [4,6,[9][10][11][12][13][14][15][16][17][18][19]. Of these findings, low T2-weighted signal intensity (SI) is a characteristic finding because of the abundant smooth muscle content of AML without visible fat [5,6,17,20,21].

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mentioning

confidence: 99%

“…Of these findings, low T2-weighted signal intensity (SI) is a characteristic finding because of the abundant smooth muscle content of AML without visible fat [5,6,17,20,21]. Although the T2-weighted SI of AML without visible fat differs significantly from that of clear G e nit ou r i n a r y I m ag i ng • O r ig i n a l Re s e a rc h…”

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confidence: 99%

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Evaluation of T1-Weighted MRI to Detect Intratumoral Hemorrhage Within Papillary Renal Cell Carcinoma as a Feature Differentiating From Angiomyolipoma Without Visible Fat

Murray

Quon

McInnes

et al. 2016

American Journal of Roentgenology

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

“…

…”

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confidence: 99%

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confidence: 99%

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Evaluation of T1-Weighted MRI to Detect Intratumoral Hemorrhage Within Papillary Renal Cell Carcinoma as a Feature Differentiating From Angiomyolipoma Without Visible Fat

Murray

Quon

McInnes

et al. 2016

American Journal of Roentgenology

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Renal and adrenal masses containing fat at MRI: Proposed nomenclature by the society of abdominal radiology disease‐focused panel on renal cell carcinoma

Schieda

Davenport²,

Pedrosa

et al. 2019

Magnetic Resonance Imaging

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This article proposes a consensus nomenclature for fat‐containing renal and adrenal masses at MRI to reduce variability, improve understanding, and enhance communication when describing imaging findings. The MRI appearance of "macroscopic fat" occurs due to a sufficient number of aggregated adipocytes and results in one or more of: 1) intratumoral signal intensity (SI) loss using fat‐suppression techniques, or 2) chemical shift artifact of the second kind causing linear or curvilinear India‐ink (etching) artifact within or at the periphery of a mass at macroscopic fat–water interfaces. "Macroscopic fat" is most commonly observed in adrenal myelolipoma and renal angiomyolipoma (AML) and only rarely encountered in other adrenal cortical tumors and renal cell carcinomas (RCC). Nonlinear noncurvilinear signal intensity loss on opposed‐phase (OP) compared with in‐phase (IP) chemical shift MRI (CSI) may be referred to as "microscopic fat" and is due to: a) an insufficient amount of adipocytes, or b) the presence of fat within tumor cells. Determining whether the signal intensity loss observed on CSI is due to insufficient adipocytes or fat within tumor cells cannot be accomplished using CSI alone; however, it can be inferred when other imaging features strongly suggest a particular diagnosis. Fat‐poor AML are homogeneously hypointense on T2‐weighted (T2W) imaging and avidly enhancing; signal intensity loss at OP CSI is uncommon, but when present is usually focal and is caused by an insufficient number of adipocytes within adjacent voxels. Conversely, clear‐cell RCC are heterogeneously hyperintense on T2W imaging and avidly enhancing, with the signal intensity loss observed on OP CSI being typically diffuse and due to fat within tumor cells. Adrenal adenomas, adrenal cortical carcinoma, and adrenal metastases from fat‐containing primary malignancies also show signal intensity loss on OP CSI due to fat within tumor cells and not from intratumoral adipocytes. Level of Evidence: 5 Technical Efficacy Stage: 3 J. Magn. Reson. Imaging 2019;49:917–926.

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The Value of Contrast‐Enhanced Ultrasound in Diagnosing Small Renal Cell Carcinoma Subtypes and Angiomyolipoma

Cao

Fang

Chen

et al. 2021

J of Ultrasound Medicine

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Objectives-To retrospectively explore the value of contrast-enhanced ultrasound (CEUS) in differentiating small renal cell carcinomas (RCCs) from angiomyolipomas (AMLs), and distinguishing between clear cell RCC (ccRCC), papillary RCC (pRCC), and chromophobe RCC (chRCC).Methods-A total of 151 patients with small renal masses (110 ccRCCs, 12 pRCCs, 9 chRCCs, and 20 AMLs) were enrolled between August 2016 and October 2019.Results-There were significant differences in terms of enhancement intensity (EI), enhancement homogeneity, perilesional rim-like enhancement (PRE), wash in, and wash out (WO) between RCC and AML (P = .000, .011, .000, .001, .000, respectively). Although there was no significant difference in EI between pRCC and chRCC (P = .272), EI of ccRCC was higher than that of pRCC (P = .000) and chRCC (P = .010). Multivariate regression analysis showed PRE and fast WO were related to RCC (OR = 18.189, 15.141, respectively). Although there were no significant differences in the sensitivity and area under the curve (AUC) between PRE and fast WO (95.0% vs. 95.0%, P = 1.000 and .880 vs. 0.799, P = .123, respectively), the specificity of PRE in predicting RCC was higher than that of fast WO (80.92% vs. 64.89%, P = .011). The sensitivity, specificity, and AUC of the two characteristics combination for differentiating RCC from AML were 95.0%, 90.8%, and 0.920, respectively, and that of EI for differentiating between ccRCC, pRCC, and chRCC were 81.0%, 78.2%, and 0.796, respectively.Conclusions-CEUS has value in differentiating small RCCs from AMLs and distinguishing ccRCC, a subtype associated with a greater likelihood of malignant behavior from pRCC and chRCC.

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Angiomyolipoma (AML) without visible fat: Ultrasound, CT and MR imaging features with pathological correlation

Cited by 49 publications

References 38 publications

Evaluation of T1-Weighted MRI to Detect Intratumoral Hemorrhage Within Papillary Renal Cell Carcinoma as a Feature Differentiating From Angiomyolipoma Without Visible Fat

Evaluation of T1-Weighted MRI to Detect Intratumoral Hemorrhage Within Papillary Renal Cell Carcinoma as a Feature Differentiating From Angiomyolipoma Without Visible Fat

Renal and adrenal masses containing fat at MRI: Proposed nomenclature by the society of abdominal radiology disease‐focused panel on renal cell carcinoma

The Value of Contrast‐Enhanced Ultrasound in Diagnosing Small Renal Cell Carcinoma Subtypes and Angiomyolipoma

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