Renal Cell Carcinoma: Dynamic Contrast-enhanced MR Imaging for Differentiation of Tumor Subtypes—Correlation with Pathologic Findings

Abstract

Clear cell, papillary, and chromophobe RCCs demonstrate different patterns of enhancement on two-time point clinical dynamic contrast-enhanced MR images, allowing their differentiation with high sensitivity and specificity.

Renal Cortical Tumors: Use of Multiphasic Contrast-enhanced MR Imaging to Differentiate Benign and Malignant Histologic Subtypes

“…A potential alternative to increased use of biopsy might lie in the use of diagnostic imaging to characterize renal cortical tumors on the basis of their tissue composition, morphologic features, and/or contrast enhancement patterns (21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32). Doppler ultrasonography, contrast material-enhanced computed tomography, and magnetic resonance (MR) imaging have shown potential for enabling differentiation of clear cell renal carcinomas (which show increased vascular flow and enhance avidly) from papillary and chromophobe carcinomas (which show reduced vascular flow and less enhancement) (21)(22)(23)(24)(26)(27)(28)).…”

“…Doppler ultrasonography, contrast material-enhanced computed tomography, and magnetic resonance (MR) imaging have shown potential for enabling differentiation of clear cell renal carcinomas (which show increased vascular flow and enhance avidly) from papillary and chromophobe carcinomas (which show reduced vascular flow and less enhancement) (21)(22)(23)(24)(26)(27)(28)). Yet despite the encouraging early results, imaging diagnosis and particularly differentiation of benign and malignant histologic subtypes of renal cortical tumors remains problematic, and further studies with multiple independent readers are needed to assess the diagnostic performance of imaging in this clinical context.…”

“…In keeping with these changes in clinical management, the role of imaging has also been evolving from detection and staging to better characterization of renal cortical tumors. With the aim of supplementing established imaging criteria based on morphologic features, the vascularity and contrast enhancement features of renal cortical tumors have been investigated for their potential to help identify specific histologic subtypes of these tumors (21)(22)(23)(24)(26)(27)(28)). An analysis by Sun et al (28) of MR images from two postcontrast time points (corticomedullary and nephrographic phases) yielded findings similar to ours; specifically, the analysis found that contrast enhancement was greatest in clear cell carcinomas, intermediate in chromophobe carcinomas, and lowest in papillary carcinomas.…”

Radiologic Imaging of Renal Masses

“…[94] In addition, clear cell RCC has a strong association with necrosis and retroperitoneal collateral circulation that is best seen on MRI [95]. On the other hand, papillary RCCs show homogeneous low-level enhancement on both CT and MRI [94,96]. This will be discussed in detail for each type of imaging modality.…”

“…MR study of enhancement patterns of the clear cell, papillary, and chromophobe forms of renal cell carcinoma has been performed, showing some distinctive enhancement patterns for each of the three subtypes, however, no comparison was made to oncocytoma, the benign tumor that is of critical consideration in this differential diagnosis. [94] Studies also have shown that papillary RCCs are hypointense on T2-weighted imaging, likely due to old blood products, whereas clear cell RCCs tend to be T2 iso-to hyperintense. Though enhancing renal masses are reliably detected on MRI, renal cell tumor subtyping has not been as extensively investigated in a manner similar to that of CT.…”