Magnetic Resonance Imaging Features of a Juxtaglomerular Cell Tumor

Abstract

Objective:To retrospectively determine whether magnetic resonance imaging (MRI) findings can help differentiate a juxtaglomerular cell tumor (JCT) from clear cell renal cell carcinoma (ccRCC).Materials and Methods:Eight patients with JCTs and 24 patients with pathologically proven ccRCC were included for image analysis. All patients underwent unenhanced MRI and dynamic contrast-enhanced MRI. Fat-suppressed T2-weighted imaging (T2WI), diffusion-weighted imaging (DWI), in- and opposed-phase imaging, and fat-suppressed preliver acquisitions with volume acceleration sequences were performed before enhancement. After the administration of contrast, dynamic imaging was performed in the corticomedullary, nephrographic, and excretory phases. Student's t-test, t′-test, Chi-square test, and nonparametric Kruskal–Wallis H-test were used to determine the significance of the difference between the two groups. The sensitivity and specificity of the MRI findings were calculated.Results:In patients with a JCT, a cystic part of the lesion of <10%, isointensity or mild hyperintensity on T2WI, heterogeneous hyperintensity on DWI, less signal drop (<10%) in in- and opposed-phase imaging, and a degree of enhancement <200% in the corticomedullary phase showed statistically significant differences compared with those of ccRCC (P < 0.05). After combining a lower apparent diffusion coefficient (ADC) value (heterogeneous hyperintensity) on DWI and a degree of enhancement <200% in the corticomedullary phase using a parallel test, the sensitivity and specificity were 90.9% and 91.7%, respectively.Conclusions:Isointensity or mild hyperintensity on T2WI, a lower ADC value (heterogeneous hyperintensity) on DWI, and a degree of enhancement <200% in the corticomedullary phase are the major MRI findings for JCTs, combined with relative clinical manifestations and excluding other renal masses. A main solid tumor, less signal drop (<10%) in in- and opposed-phase imaging, and a less-washout pattern of <10% in the delayed phase are secondary MRI findings for JCTs.

The Small Size and Superficial Location Suggest That Laparoscopic Partial Nephrectomy Is the First Choice for the Treatment of Juxtaglomerular Cell Tumors

“…The diffusion-WIs are related to the motion of water molecules and are highly sensitive for small lesions. All three JGCTs, including tumors as small as 0.7 cm × 0.7 cm, were significantly hyperintense on diffusion-WIs, as described previously (5,18). Unlike contrast CT, MRI provides more modalities, without enhancement, and does not affect the kidney function.…”

Juxtaglomerular cell tumor: Report of a case with unusual presentation

“…The reported features include iso-intensity or mild hyperintensity on T2-weighted imaging, heterogeneous hyperintensity on diffusionweighted imaging, and a degree of enhancement <200% in the corticomedullary phase. 9 The tumor size typically ranges from 2-5 cm as was seen in our case with the tumor measuring 2.4 cm in greatest dimension, but larger sizes have been reported. Imaging results demonstrating a renal mass in younger individuals usually prompts testing of aldosterone and renin levels if these are not tested in the early stages of the workup.…”

Characterization and Management of Juxtaglomerular Cell Tumor: Analysis of 9 Cases and Literature Review

“…Tanabe A et al also reported high-density renal mass in the plain CT scan for JGCT ( 17 ). For magnetic resonance imaging (MRI), Kang et al ( 18 ) report that iso-intensity or mild hyperintensity on T2WI, a lower ADC value (heterogeneous hyperintensity) on DWI, and a degree of enhancement <200% in the corticomedullary phase were the major MRI findings for JGCTs. Renal angiography can identify whether the hyperreninemia is caused by renal artery stenosis.…”