Histogram Analysis of Small Solid Renal Masses: Differentiating Minimal Fat Angiomyolipoma From Renal Cell Carcinoma

Chaudhry, Humaira; Davenport, Matthew S.; Nieman, Christopher M.; Ho, Lisa M.; Neville, Amy

doi:10.2214/ajr.11.6887

Cited by 65 publications

(41 citation statements)

References 24 publications

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“…5,6 The criteria used to define an angiomyolipoma on CT were based on attenuation measurements. As this issue still is a topic of debate, [7][8][9] we elected to use conservative criteria to have higher specificity for angiomyolipoma detection.…”

Section: Proof That a Lesion Was Benign Or Malignantmentioning

confidence: 99%

Sonographically Identified Echogenic Renal Masses Up to 1 cm in Size Are So Rarely Malignant They Can Be Safely Ignored

Itani

Pandya

Bude

2016

J of Ultrasound Medicine

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chogenic renal masses in general are more often angiomyolipomas than carcinomas. Without regard to size, the chance of carcinoma in general is high enough that echogenic masses should not be ignored, and further workup is advocated. To this end, a recent review by Farrelly et al 1 concluded that "all noncalcified echogenic renal lesions detected with ultrasound need a CT to rule out a renal cell carcinoma." Another study further recommended computed tomography (CT) ORIGINAL RESEARCHObjectives-The purpose of this study was to determine whether small echogenic renal masses up to 1 cm in size incidentally detected by sonography are rarely malignant and thus do not need further workup.Methods-We reviewed approximately 13,600 reports of all abdominal sonographic examinations performed between November 2001 and October 2007 that identified a small echogenic mass in a kidney. Patients with known malignancy of any kind, tuberous sclerosis, lesions larger than 1.0 cm, lesions with heterogeneous echogenicity, and lesions with posterior ring-down artifacts or posterior acoustic shadowing were excluded. All patients without magnetic resonance imaging or computed tomographic scans that completely characterized the lesions were excluded unless a follow-up study (sonography, magnetic resonance imaging, or contrast-enhanced computed tomography) at least 5 years later was available for comparison to prove that the lesion was benign.Results-A total of 120 lesions in 111 patients satisfied the inclusion criteria. Lesion sizes were 0 to 5 mm (n = 16) and 6 to 10 mm (n = 104). Of these, 54 lesions were characterized as definitely benign (47 angiomyolipomas and 7 other benign entities: calcifications in stones or within a cyst or calyx and cysts that were either simple on follow-up studies or complicated with hemorrhagic or proteinaceous content). For the remaining 66 lesions, follow-up results after at least 5 years were normal in 24 cases (which meant that the lesion was no longer visible), and the remaining 42 lesions were stable in size. The mean duration of follow-up for these 66 lesions was 7.4 years.Conclusions-Small echogenic renal masses up to 1 cm in size that fulfill our study criteria are so likely to be benign that they can be safely ignored.

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Section: Proof That a Lesion Was Benign Or Malignantmentioning

confidence: 99%

Sonographically Identified Echogenic Renal Masses Up to 1 cm in Size Are So Rarely Malignant They Can Be Safely Ignored

Itani

Pandya

Bude

2016

J of Ultrasound Medicine

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“…12,21,27 Furthermore, the use of CT histogram analysis to predict fp-AML has been met with conflicting results and is not readily utilized. 13,28,29 Finally, while ultrasound provides characteristic findings (i.e., hyperechogenicity) for lipid-rich AMLs, the ultrasonic findings for fp-AML are variable. In the present cohort, seven patients had ultrasounds available for interpretation.…”

Section: Discussionmentioning

confidence: 99%

Computed Tomography and Magnetic Resonance Findings of Fat-Poor Angiomyolipomas

Potretzke

Bauman

et al. 2017

Journal of Endourology

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"Computed tomography and magnetic resonance findings of fat-poor angiomyolipomas." Journal of Endourology.31,2. 119-128. (2017 Results: A total of 26 fp-AMLs were identified. Thirteen lesions had available unenhanced CT images, of which eight (62%) were hyperdense compared to the adjacent renal parenchyma, while five (38%) were isodense. Twenty lesions had enhanced CT images: 14 (70%) and 6 (30%) with homogeneous and heterogeneous enhancement, respectively. Of the nine lesions with enhanced MR sequences, five (56%) were homogeneously enhancing, and four (44%) were heterogeneously enhancing. Eight of nine (89%) lesions had hypointense signal intensity (SI) on T2-weighted MR sequences, while one (11%) had hyperintense SI. None of the eight lesions displayed a decrease in signal on fat-suppressed sequences. Conclusions: In this study, we confirmed common imaging features of fp-AML: high attenuation on unenhanced CT sequences, homogeneous enhancement on CT, and hypointensity on T2-weighted MR. When these features are present, a renal mass biopsy may be prudent.

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“…However, about 5% of triphasic AMLs have a marked paucity of fat (termed lipid poor or minimal fat AML), and can be difficult to differentiate from RCC on imaging [7,56].…”

Section: Angiomyolipomamentioning

confidence: 99%

Quantitative assessment of solid renal masses by contrast-enhanced ultrasound with time–intensity curves: how we do it

et al. 2015

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Histogram Analysis of Small Solid Renal Masses: Differentiating Minimal Fat Angiomyolipoma From Renal Cell Carcinoma

Abstract: Attenuation measurement histogram analysis cannot reliably differentiate minimal fat renal angiomyolipoma from RCC.

Cited by 65 publications

References 24 publications

Sonographically Identified Echogenic Renal Masses Up to 1 cm in Size Are So Rarely Malignant They Can Be Safely Ignored

Sonographically Identified Echogenic Renal Masses Up to 1 cm in Size Are So Rarely Malignant They Can Be Safely Ignored

Computed Tomography and Magnetic Resonance Findings of Fat-Poor Angiomyolipomas

Quantitative assessment of solid renal masses by contrast-enhanced ultrasound with time–intensity curves: how we do it

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