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The Use of Opposed-Phase Chemical Shift MRI in the Diagnosis of Renal Angiomyolipomas

Gary M. Israel1,2, Nicole Hindman1, Elizabeth Hecht1 and Glenn Krinsky1,3

1 Department of Radiology, New York University Medical Center, 560 First Ave., HW202, New York, NY 10016.



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  		Fig. 1A. —54-year-old woman with angiomyolipoma. Axial opposed-phase T1-weighted MR image (TR/TE, 160/2.7) shows 1.8-cm hyperintense mass in upper pole of right kidney. India ink artifact (arrow) is present at interface of renal mass with kidney, diagnostic of angiomyolipoma.

 


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  		Fig. 1B. —54-year-old woman with angiomyolipoma. Axial contrast-enhanced CT image shows fatty mass (-90 H) at upper pole of right kidney, confirming diagnosis of angiomyolipoma.

 


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  		Fig. 2A. —58-year-old man with hemorrhagic cyst. Axial opposed-phase T1-weighted MR image (TR/TE, 167/2.6) shows 1.3-cm hyperintense mass in upper pole of left kidney. India ink artifact (arrow) is present at interface of renal mass with perinephric fat and not at interface of mass with kidney. Therefore, this mass does not contain macroscopic fat, excluding diagnosis of macroscopic fat-containing angiomyolipoma.

 


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  		Fig. 2B. —58-year-old man with hemorrhagic cyst. Axial unenhanced CT image shows high-attenuation (62 H) mass in left kidney. Mass did not enhance on MRI examination and is consistent with hemorrhagic cyst.

 


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  		Fig. 3A. —49-year-old man with renal cell carcinoma (clear cell subtype). Axial in-phase T1-weighted MR image (TR/TE, 167/5) shows exophytic mass at posterior aspect of right kidney.

 


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  		Fig. 3B. —49-year-old man with renal cell carcinoma (clear cell subtype). Axial opposed-phase T1-weighted MR image (167/2) shows india ink artifact at interface of mass with perinephric fat (long arrow)—not at interface of mass with kidney or within mass. This implies that mass does not contain macroscopic fat. Notice that portion of mass loses signal (short arrow) on opposed-phase image, when compared with in-phase image, a finding described in clear cell subtype of renal cell carcinoma.

 


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  		Fig. 4. —56-year-old woman with renal cell carcinoma that was misdiagnosed as angiomyolipoma. Axial opposed-phase T1-weighted MR image (TR/TE, 167/2.6) shows 8-mm exophytic mass at posterior aspect of right kidney. India ink artifact (arrow) was identified by observers at interface of renal mass with kidney, suggesting that mass contains fat and is angiomyolipoma. Loss of signal at interface of mass and kidney (which has superficial resemblance to india ink artifact) is thought to be artifactual and secondary to combination of volume-averaging and "Gibbs" artifact.

 

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