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Significance of the Pseudocapsule on MRI of Renal Neoplasms and Its Potential Application for Local Staging: A Retrospective Study

¹ University Hospital of Strasbourg, Radiology B Chirugie A, Hopital Civil CHU, 1, place de l'hopital BP 426, Strasbourg, Cedex, France 67091.
² University Hospital of Strasbourg, Hopital Civil–Urology, Strasbourg, Cedex, France 67091.

OBJECTIVE. The purpose of our study was to evaluate the role of MRI in showing a pseudocapsule for local staging of renal tumors, and its potential application to select patients for partial surgery.

MATERIALS AND METHODS. Eighty tumors (73 renal cell carcinomas [RCCs] and seven oncocytomas) were preoperatively evaluated by MRI. MRI findings were assessed with a special focus on perinephric fat and pseudocapsule. Correlations were performed with pathologic staging after surgery.

RESULTS. At pathology, a pseudocapsule was recognized in 79 cases. Twenty-three RCC were staged pT3a (21 clear cell; two papillary). MR images exhibited a pseudocapsule in 90% of cases as a hypointense rim surrounding the tumor on T2-weighted images. MRI findings concerning isolated analysis of the pseudocapsule for differentiating stage T1/T2 from T3a were sensitivity: 86%, 50%; specificity: 95%, 92%; positive predictive value: 95%, 33%; negative predictive value: 88%, 92%; and accuracy: 93%, 89%, for clear cell and papillary types, respectively. For stage T3a, with both abnormalities of the pseudocapsule and perirenal fat, results were, for overall RCC sensitivity: 84%; specificity: 95%; positive predictive value: 91%; negative predictive value: 91%; and accuracy: 91%.

CONCLUSION. The identification of the pseudocapsule offers an additional value for local staging by MRI. The presence of an intact pseudocapsule is a sign of lack of perinephric fat invasion. It is more likely to predict that the tumor can be removed by partial surgery.

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