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

Vargas, Hebert Alberto; Chaim, Joshua; Lefkowitz, Robert A.; Lakhman, Yulia; Zheng, Junting; Moskowitz, Chaya S.; Sohn, Michael; Schwartz, Lawrence H.; Russo, Paul; Akın, Oğuz

doi:10.1148/radiol.12110746

Cited by 89 publications

(38 citation statements)

References 39 publications

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“…Percentage signal intensity changes on corticomedullary phase images were found to be the most effective parameter for distinguishing clear cell and papillary RCC; a threshold value of 84% permitted distinction with 93% sensitivity and 96% specificity. Vargas et al (42) reported similar results with region of interest measurements in all three postcontrast phases. In corticomedullary, nephrographic, and excretory phases, the percentage change in signal intensity relative to the pre contrast phase was significantly lower in papillary carcinoma (49%, 92%, and 88% for corticomedullary, nephrographic, and excretory phases) compared with clear cell and chromophobe RCC.…”

Section: Papillary Cell Carcinomasupporting

confidence: 65%

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Subtypes of renal cell carcinoma: MRI and pathological features

Gürel¹,

Narra²,

Elsayes³

et al. 2013

Diagn Interv Radiol

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Renal cell carcinoma (RCC) is the most common malignant tumor involving the kidney. Determining the subtypes of renal cell carcinoma is among the major goals of preoperative radiological work-up. Among all modalities, magnetic resonance imaging (MRI) has several advantages, such as inherent soft tissue contrast, detection of lipid and blood products, and excellent sensitivity to detect small amounts of intravenous contrast, which facilitate the discrimination of subtypes of RCC. In this article, we review MRI and pathological features used for determining the main histologic subtypes of RCC, including clear cell, papillary, collecting duct, chromophobe, multilocular cystic, and unclassified RCC. Renal cell carcinoma (RCC) is the most common malignant epithelial tumor of the kidney, accounting for 85%-90% of all solid renal tumors in adults and comprising 1%-3% of all malignant visceral neoplasms (1). Approximately 40% of patients with RCC eventually die from progression of this disease, making it the most lethal urologic malignancy (2). Today, most RCC instances are incidental masses identified on imaging studies performed for nonurological reasons.Percutaneous biopsy is a minimally invasive method, and its accuracy for identifying renal tumors ranges from 70% to 90% (3, 4). However, widespread use of percutaneous biopsy remains controversial due to the potential complications of biopsy, the possibility of sampling errors, the dependence on an adequate biopsy sample for analysis, and concerns about how the biopsy information might alter the treatment plan (5). Therefore, histopathological characterization of renal masses with magnetic resonance imaging (MRI) compared with percutaneous biopsy becomes more advantageous.Determining subtypes of RCC has significant prognostic and theraupeutic implications for patients who are poor surgical candidates, for patients who have a metastatic disease, for surgical planning in patients who are surgical candidates, and for immunotherapy and use of the tyrosine kinase inhibitors "sunitinib" and "sorafenib" for clear cell RCC and "temsirolimus" for papillary RCC (6-9).The need for a different approach to the management of RCC among classical surgical procedures has arisen. Nephron-preserving surgical methods, cryoablation, radiofrequency ablation, targeted molecular therapy or follow-up, and MRI are believed to surpass other modalities both in the diagnosis of RCC and determination of its subtypes (10,11).In this article, we review MRI findings and pathological features used for determining the main histologic subtypes of RCC, including clear cell carcinoma, papillary, collecting duct, chromophobe, multilocular cystic, and unclassified RCC. The role of MRI in renal imagingThere are three indispensable components of renal MRI: breathhold imaging, three-dimensional (3D) gradient echo pulse sequence, and fat detection techniques.Breathhold imaging is one of the essential techniques in renal mass MRI protocols. Suspended expiration eliminates respiratory motion artifacts an...

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Section: Papillary Cell Carcinomasupporting

confidence: 65%

“…6a-d) (55). Unclassified RCCs display significantly smaller mean signal intensity changes than clear cell carcinoma at three postcontrast phases (42). Although it is classified as non-clear cell type and expected to have lower ADC than clear cell RCC, there is a lack of data specific for unclassified RCC in DWI.…”

Section: Unclassified Rccmentioning

confidence: 99%

Subtypes of renal cell carcinoma: MRI and pathological features

Gürel¹,

Narra²,

Elsayes³

et al. 2013

Diagn Interv Radiol

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“…[19][20][21][22] Oliva et al [19] compared contrast-enhanced MRI tumor signal intensity (SI) ratios (tumor SI/renal cortex SI) of 21 pRCC and 16 ccRCC lesions and found that tumor SI ratios on T1-weighted images were similar for the two RCC subtypes, although on T2-weighted images pRCC had a significantly lower SI ratio compared to ccRCC tumors (p<0.01). On qualitative assessment authors reported T2-weighted hypointense (SI≤0.66) tumors had a specificity of nearly 100% for pRCC, whereas SI of a hyperintense tumor was 100% specific for cRCC.…”

Section: Discussionmentioning

confidence: 99%

Can multiphase CT scan distinguish between papillary renal cell carcinoma type 1 and type 2?

Bindayı

McDonald

Beksaç

et al. 2018

Turkish Journal of Urology

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Objective: To investigate the utility of multiphase computed tomography (CT) and percutaneous renal mass biopsy (PRMB) in differentiating between papillary renal cell carcinoma (pRCC)-Type 1 and -Type 2, as emerging data have suggested differential enhancement patterns in different renal tumor histologies. Material and methods:Retrospective analysis of 51 patients (23 pRCC-Type 1/28 pRCC-Type 2) who underwent multiphase CT followed by surgery from July 2011 to April 2016 was performed. Data were analyzed between subgroups based on histology. Multiphase CT was analyzed for tumor size, and attenuation [Hounsfield Units (HU)]. Change in HU (ΔHU) was calculated between noncontrast (NC), corticomedullary (CM), nephrographic (N), and delayed (D) phases. Subset analysis was carried out on patients who underwent PRMB prior to surgery.Results: There was no difference in median tumor size (pRCC-Type 1 2.8 vs. pRCC-Type 2 2.6 cm, p= 0.832). In addition to tumor size being similar between groups, distribution of tumor stages between groups was also similar (p= 0.651). Greater proportion of high-grade tumors (III/IV) was noted in pRCC-Type 2 (42.9% vs. 8.7%) (p= 0.011). There was no difference in HU values for NC (p= 0.961), CM (p= 0.118), N (p= 0.277), and D (p=0.256) phases, and in ΔHU between CM-NC (p=0.278), N-NC (p=0.316), and D-NC (p=0.103). Thirteen patients underwent percutaneous biopsy, 11 of whom had diagnostic samples. Examination of 10/11 (90.9%) samples accurately predicted correct histology, and of 6/11 (54.5%) samples correctly identified high-vs. low-grade histology. Conclusion:Our findings suggest substantial overlap of CT findings, despite pRCC-Type 2 having greater proportion of high-grade tumors. Utility of CT is limited in the differentiation between pRCC subtypes. Patients with suggested pRCC on CT imaging being considered for a non-extirpative strategy should undergo PRMB for risk stratification.

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“…Acknowledging that clear cell RCCs are typically hypervascular, the degree of contrast enhancement during the arterial phase can help identify the difference between clear and nonclear cell subtypes [56]. The greater extent of signal intensity change on the corticomedullary phase sequence is the most specific and sensitive parameter for differentiating clear cell from papillary RCCs [57] (Fig. 6).…”

Section: Composite Papillary and Clear Cell Renal Cell Carcinomamentioning

confidence: 99%

Collision and composite tumors; radiologic and pathologic correlation

et al. 2017

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The terms composite and collision tumors have been used interchangeably throughout radiological literature. Both composite and collision tumors involve two morphologically and immunohistochemically distinct neoplasms coexisting within a single organ. However, collision tumors lack the histological cellular intermingling seen in composite tumors. Composite tumors often arise from a common driver mutation that induces a divergent histology from a common neoplastic source while collision tumors may arise from coincidental neoplastic change. The purpose of this review is to provide an overview of abdominal composite and collision tumors by discussing hallmark radiographic and pathological presentations of rare hepatic, renal, and adrenal case studies. A better understanding of the presentation of each lesion is imperative for proper recognition, diagnosis, and management of these unique tumor presentations.

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

Cited by 89 publications

References 39 publications

Subtypes of renal cell carcinoma: MRI and pathological features

Subtypes of renal cell carcinoma: MRI and pathological features

Can multiphase CT scan distinguish between papillary renal cell carcinoma type 1 and type 2?

Collision and composite tumors; radiologic and pathologic correlation

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