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Small Renal Masses

Assessment of Lesion Characterization and Vascularity on Dynamic Contrast-Enhanced MR Imaging with Fat Suppression

Michele Scialpi1, Arcangelo Di Maggio2, Massimi Midiri3, Angelo Loperfido2, Giuseppe Angelelli3 and Antonio Rotondo3

1 Department of Radiology, SS Annunziata Hospital, via Bruno, 74100 Taranto, Italy.
2 Department of Nephrology, SS. Annunziata Hospital, 74100 Taranto, Italy.
3 Department of Radiology, University Hospital, Piazza Giulio Cesare, 70124 Bari, Italy.



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  		Fig. 1A. —53-year-old man with hypervascular renal clear cell carcinoma of upper pole of right kidney. Note small simple renal cyst (black arrow). Coronal unenhanced gradient-echo fast low-angle shot (FLASH) T1-weighted MR image with fat suppression (TR/TE, 120/6.5; flip angle, 70°) shows lesion (white arrow).

 


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  		Fig. 1B. —53-year-old man with hypervascular renal clear cell carcinoma of upper pole of right kidney. Note small simple renal cyst (black arrow). Gradient-echo FLASH T1-weighted MR images at same level as A show early heterogeneous enhancement of lesion (white arrow) at 30 sec (B), lesion (white arrow) enhancement increasing at 90 sec (C), and lesion (white arrow) enhancement greater than that of renal cortex at 120 sec (D) after gadolinium injection.

 


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  		Fig. 1C. —53-year-old man with hypervascular renal clear cell carcinoma of upper pole of right kidney. Note small simple renal cyst (black arrow). Gradient-echo FLASH T1-weighted MR images at same level as A show early heterogeneous enhancement of lesion (white arrow) at 30 sec (B), lesion (white arrow) enhancement increasing at 90 sec (C), and lesion (white arrow) enhancement greater than that of renal cortex at 120 sec (D) after gadolinium injection.

 


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  		Fig. 1D. —53-year-old man with hypervascular renal clear cell carcinoma of upper pole of right kidney. Note small simple renal cyst (black arrow). Gradient-echo FLASH T1-weighted MR images at same level as A show early heterogeneous enhancement of lesion (white arrow) at 30 sec (B), lesion (white arrow) enhancement increasing at 90 sec (C), and lesion (white arrow) enhancement greater than that of renal cortex at 120 sec (D) after gadolinium injection.

 


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  		Fig. 2A. —65-year-old man with hypovascular renal cell papillary carcinoma of lower pole of left kidney. Coronal unenhanced gradient-echo fast low-angle shot (FLASH) T1-weighted MR image with fat suppression (TR/TE, 120/6.5; flip angle, 70°) shows lesion (arrow).

 


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  		Fig. 2B. —65-year-old man with hypovascular renal cell papillary carcinoma of lower pole of left kidney. Gradient-echo FLASH T1-weighted MR image at same level as A 30 sec after gadolinium injection shows heterogeneous low enhancement of lesion (arrow).

 


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  		Fig. 2C. —65-year-old man with hypovascular renal cell papillary carcinoma of lower pole of left kidney. Gradient-echo FLASH T1-weighted MR images at same level as A 90 (C) and 180 (D) sec after gadolinium injection show that lesion (arrow) remains hypointense with respect to renal cortex.

 


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  		Fig. 2D. —65-year-old man with hypovascular renal cell papillary carcinoma of lower pole of left kidney. Gradient-echo FLASH T1-weighted MR images at same level as A 90 (C) and 180 (D) sec after gadolinium injection show that lesion (arrow) remains hypointense with respect to renal cortex.

 


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  		Fig. 3A. —51-year-old woman with angiomyolipoma of upper pole of left kidney. Sagittal unenhanced gradient-echo fast low-angle shot (FLASH) T1-weighted MR image with fat suppression (TR/TE, 120/6.5; flip angle, 70°) shows that lesion (arrow) appears hypointense compared with renal parenchyma because of suppression of fat.

 


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  		Fig. 3B. —51-year-old woman with angiomyolipoma of upper pole of left kidney. Gradient-echo FLASH T1-weighted MR image at same level as A 30 sec after gadolinium injection shows early brisk enhancement of lesion (arrow).

 


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  		Fig. 3C. —51-year-old woman with angiomyolipoma of upper pole of left kidney. Gradient-echo FLASH T1-weighted MR images at same level as A 90 (C) and 150 (D) sec after gadolinium injection show that contrast material is washed out and lesion (arrows) appears inhomogeneously hypointense.

 


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  		Fig. 3D. —51-year-old woman with angiomyolipoma of upper pole of left kidney. Gradient-echo FLASH T1-weighted MR images at same level as A 90 (C) and 150 (D) sec after gadolinium injection show that contrast material is washed out and lesion (arrows) appears inhomogeneously hypointense.

 


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  		Fig. 4A. —70-year-old woman with complicated cyst of lower third of kidney. Note that another cyst (open arrows) with blood content is present on upper pole; this cyst was not included in quantitative study. Coronal unenhanced gradient-echo fast low-angle shot (FLASH) T1-weighted MR image with fat suppression (TR/TE, 120/6.5; flip angle, 70°) shows inhomogeneous signal intensity of lesion (solid arrow), which is indistinguishable from a solid lesion.

 


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  		Fig. 4B. —70-year-old woman with complicated cyst of lower third of kidney. Note that another cyst (open arrows) with blood content is present on upper pole; this cyst was not included in quantitative study. Gradient-echo FLASH T1-weighted MR images at same level as A 30 (B), 60 (C), and 180 (D) sec after gadolinium injection show no enhancement of lesion (solid arrows).

 


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  		Fig. 4C. —70-year-old woman with complicated cyst of lower third of kidney. Note that another cyst (open arrows) with blood content is present on upper pole; this cyst was not included in quantitative study. Gradient-echo FLASH T1-weighted MR images at same level as A 30 (B), 60 (C), and 180 (D) sec after gadolinium injection show no enhancement of lesion (solid arrows).

 


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  		Fig. 4D. —70-year-old woman with complicated cyst of lower third of kidney. Note that another cyst (open arrows) with blood content is present on upper pole; this cyst was not included in quantitative study. Gradient-echo FLASH T1-weighted MR images at same level as A 30 (B), 60 (C), and 180 (D) sec after gadolinium injection show no enhancement of lesion (solid arrows).

 


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  		Fig. 5. —Graph shows time curves of mean percentage of enhancement of signal intensity in renal cortex ({blacktriangleup}), medulla ({diamondsuit}), and different lesions. Note that after 60 sec from contrast injection, hypervascular renal cell carcinoma ({diamond}) enhances more than cortex. Hypovascular renal cell carcinoma ([UNK]) has much lower enhancement. Angiomyolipoma ({square}), after early peak, has enhancement curve similar to that of hypovascular carcinoma. Enhancement of complicated cyst ({circ}) is negligible.

 


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  		Fig. 6. —Graph shows time curves of mean contrast-to-noise ratio of renal medulla ({diamondsuit}) and different lesions. Note that contrast-to-noise ratio of hypervascular renal cell carcinoma ({diamond}) becomes positive from 150 sec after contrast injection; that is, lesion becomes hyperintense with respect to renal cortex. All other lesions remain hypointense, but hypovascular renal cell carcinoma ([UNK]) shows contrast-to-noise ratio curve intermediate between those of hypervascular carcinoma and benign lesions (angiomyolipoma [{square}] and complicated cyst [{circ}]).

 

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