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MR Imaging of Renal Masses Interpreted on CT to Be Suspicious

Richard Tello1,2, Brian D. Davison1, Martin O'Malley1, Helen Fenlon1, Ken R. Thomson2, David J. Witte2 and Lawrence Harewood3

1 Department of Radiology, Boston Medical Center, Boston University, 88 E. Newton St., Boston. MA 02118
2 Department of Radiology, University of Melbourne, Melbourne, 3052 Australia.
3 Department of Urology, University of Melbourne, Melbourne, 3052 Australia.



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  		Fig. 1A. —52-year-old woman with painless hematuria. Coronal dynamic MR images obtained after administration of 0.1 mmol/kg of gadopentetate dimeglumine show enhancement of sarcomatous renal cell carcinoma of right kidney (arrow, A).

 


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  		Fig. 1B. —52-year-old woman with painless hematuria. Coronal dynamic MR images obtained after administration of 0.1 mmol/kg of gadopentetate dimeglumine show enhancement of sarcomatous renal cell carcinoma of right kidney (arrow, A).

 


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  		Fig. 1C. —52-year-old woman with painless hematuria. Coronal dynamic MR images obtained after administration of 0.1 mmol/kg of gadopentetate dimeglumine show enhancement of sarcomatous renal cell carcinoma of right kidney (arrow, A).

 


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  		Fig. 1D. —52-year-old woman with painless hematuria. Coronal dynamic MR images obtained after administration of 0.1 mmol/kg of gadopentetate dimeglumine show enhancement of sarcomatous renal cell carcinoma of right kidney (arrow, A).

 


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  		Fig. 2. —Graph shows different enhancement patterns. Classification types included the following: M, enhancing comparable to medulla; C, enhancing comparable to cortex; 1, enhancing comparable to medulla but less than cortex; 2, relative non-enhancement; and 3, enhancing more rapidly than cortex.

 


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  		Fig. 3. —Receiver operating characteristic curve for classification scheme based on presence of enhancement on gadopentetate dimeglumine administration and heterogeneous appearance of lesion on T2-weighted images. Area under curve = 0.9577.

 


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  		Fig. 4A. —72-year-old man with painless hematuria with two renal cell carcinomas of less than 1 cm. One carcinoma enhanced (straight arrow), and other (curved arrow) did not. Photograph of gross pathologic examination revealed hemorrhage in nonenhancing (curved arrow) lesion, with no hemorrhage in enhancing lesion (straight arrow).

 


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  		Fig. 4B. —72-year-old man with painless hematuria with two renal cell carcinomas of less than 1 cm. One carcinoma enhanced (straight arrow), and other (curved arrow) did not. Dynamic MR images in axial plane show type-1 enhancement of nonhemorrhagic lesion (region of interest 1) in plane just above hemorrhagic lesion (arrow, D). Region of interest 2 shows normal cortex.

 


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  		Fig. 4C. —72-year-old man with painless hematuria with two renal cell carcinomas of less than 1 cm. One carcinoma enhanced (straight arrow), and other (curved arrow) did not. Dynamic MR images in axial plane show type-1 enhancement of nonhemorrhagic lesion (region of interest 1) in plane just above hemorrhagic lesion (arrow, D). Region of interest 2 shows normal cortex.

 


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  		Fig. 4D. —72-year-old man with painless hematuria with two renal cell carcinomas of less than 1 cm. One carcinoma enhanced (straight arrow), and other (curved arrow) did not. Dynamic MR images in axial plane show type-1 enhancement of nonhemorrhagic lesion (region of interest 1) in plane just above hemorrhagic lesion (arrow, D). Region of interest 2 shows normal cortex.

 


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  		Fig. 4E. —72-year-old man with painless hematuria with two renal cell carcinomas of less than 1 cm. One carcinoma enhanced (straight arrow), and other (curved arrow) did not. Axial T2-weighted image at level that includes parts of both lesions shows homogeneous character of nonhemorrhagic lesion (straight arrow) and sharp dark crescent in hemorrhagic lesion (curved arrow) that contributed to its classification as heterogeneous.

 

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