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Comparison of 16-MDCT and MRI for Characterization of Kidney Lesions

Department of Radiology, Technische Universitaet Munichen, Ismaninger Strasse 21, Munich, Germany, 81675.

View larger version (6K): [in a new window]   Fig. 1 —Graph shows comparison of mean image quality of MRI and MDCT on scale of 0-3. Difference is statistically significant (p <0.001).

View larger version (8K): [in a new window]   Fig. 2 —Graph shows results of receiver operating characteristic analysis of MDCT (solid line; Az = 0.979) and MRI (dotted line; Az = 0.957).

View larger version (123K): [in a new window]   Fig. 3A —54-year-old man with complicated cystic lesion on right side not correctly classified with MRI or CT in receiver operating characteristic (ROC) analysis. MR images show small hyperintense cortical lesion (arrows) not as intense as fluid compared with renal collecting system. No substantial contrast enhancement is present in T1-weighted contrast-enhanced images with fat suppression. T2-weighted sequence with fat saturation

View larger version (147K): [in a new window]   Fig. 3B —54-year-old man with complicated cystic lesion on right side not correctly classified with MRI or CT in receiver operating characteristic (ROC) analysis. MR images show small hyperintense cortical lesion (arrows) not as intense as fluid compared with renal collecting system. No substantial contrast enhancement is present in T1-weighted contrast-enhanced images with fat suppression. T1-weighted axial image, late venous phase.

View larger version (162K): [in a new window]   Fig. 3C —54-year-old man with complicated cystic lesion on right side not correctly classified with MRI or CT in receiver operating characteristic (ROC) analysis. MR images show small hyperintense cortical lesion (arrows) not as intense as fluid compared with renal collecting system. No substantial contrast enhancement is present in T1-weighted contrast-enhanced images with fat suppression. T1-weighted dynamic coronal image, venous phase.

View larger version (175K): [in a new window]   Fig. 3D —54-year-old man with complicated cystic lesion on right side not correctly classified with MRI or CT in receiver operating characteristic (ROC) analysis. CT scans corresponding to A-C show lesion (arrows) is mean 20 H in unenhanced scan (D) but no measurable enhancement in axial (E) or coronal (F) view of venous scan. Peripheral enhancement could not be excluded, which led to classification of level 3 (not sure) in ROC analysis and Bosniak classification of 2f. Histologic examination of surgical specimen revealed small clear cell carcinoma.

View larger version (169K): [in a new window]   Fig. 3E —54-year-old man with complicated cystic lesion on right side not correctly classified with MRI or CT in receiver operating characteristic (ROC) analysis. CT scans corresponding to A-C show lesion (arrows) is mean 20 H in unenhanced scan (D) but no measurable enhancement in axial (E) or coronal (F) view of venous scan. Peripheral enhancement could not be excluded, which led to classification of level 3 (not sure) in ROC analysis and Bosniak classification of 2f. Histologic examination of surgical specimen revealed small clear cell carcinoma.

View larger version (175K): [in a new window]   Fig. 3F —54-year-old man with complicated cystic lesion on right side not correctly classified with MRI or CT in receiver operating characteristic (ROC) analysis. CT scans corresponding to A-C show lesion (arrows) is mean 20 H in unenhanced scan (D) but no measurable enhancement in axial (E) or coronal (F) view of venous scan. Peripheral enhancement could not be excluded, which led to classification of level 3 (not sure) in ROC analysis and Bosniak classification of 2f. Histologic examination of surgical specimen revealed small clear cell carcinoma.

View larger version (119K): [in a new window]   Fig. 4A —55-year-old man with histologically confirmed multiple oncocytomas in both kidneys. All were considered surgical lesions. Sonogram shows one solid slightly hyperechoic mass (arrows) in left kidney.

View larger version (138K): [in a new window]   Fig. 4B —55-year-old man with histologically confirmed multiple oncocytomas in both kidneys. All were considered surgical lesions. MDCT scan shows solid mass (arrow) on left side and two small cortical solid enhancing lesions (arrows) on right side.

View larger version (134K): [in a new window]   Fig. 4C —55-year-old man with histologically confirmed multiple oncocytomas in both kidneys. All were considered surgical lesions. MR image of right kidney shows small cortical solid enhancing lesion (arrow).

View larger version (152K): [in a new window]   Fig. 4D —55-year-old man with histologically confirmed multiple oncocytomas in both kidneys. All were considered surgical lesions. MR image of left kidney shows solid mass (arrow).

View larger version (145K): [in a new window]   Fig. 5A —66-year-old man with angiomyolipoma in left kidney. T1-weighted MR image without fat saturation shows well-delineated lesion (arrow).

View larger version (131K): [in a new window]   Fig. 5B —66-year-old man with angiomyolipoma in left kidney. Fat-saturated T1-weighted sequence shows decrease in signal intensity (arrow) compared with A.

View larger version (122K): [in a new window]   Fig. 5C —66-year-old man with angiomyolipoma in left kidney. Unenhanced MDCT scan shows low fatlike attenuation (mean, -78 H; SD, 12 H) of lesion (arrow).

View larger version (133K): [in a new window]   Fig. 5D —66-year-old man with angiomyolipoma in left kidney. Contrast-enhanced MDCT scan shows slight contrast enhancement (arrow). Follow-up after 12 months showed no change.

View larger version (154K): [in a new window]   Fig. 6A —68-year-old woman with clear cell carcinoma of right kidney. MDCT scans (A-D) have excellent image quality (grade 3) with clear depiction of borders of tumor (arrow), especially in arterial phase (A, C). MR images (E, F) have good image quality (grade 2), showing tumor (arrow) with few motion artifacts. Axial arterial phase MDCT scan.

View larger version (154K): [in a new window]   Fig. 6B —68-year-old woman with clear cell carcinoma of right kidney. MDCT scans (A-D) have excellent image quality (grade 3) with clear depiction of borders of tumor (arrow), especially in arterial phase (A, C). MR images (E, F) have good image quality (grade 2), showing tumor (arrow) with few motion artifacts. Axial portal venous phase MDCT scan.

View larger version (162K): [in a new window]   Fig. 6C —68-year-old woman with clear cell carcinoma of right kidney. MDCT scans (A-D) have excellent image quality (grade 3) with clear depiction of borders of tumor (arrow), especially in arterial phase (A, C). MR images (E, F) have good image quality (grade 2), showing tumor (arrow) with few motion artifacts. Coronal arterial phase MDCT scan.

View larger version (161K): [in a new window]   Fig. 6D —68-year-old woman with clear cell carcinoma of right kidney. MDCT scans (A-D) have excellent image quality (grade 3) with clear depiction of borders of tumor (arrow), especially in arterial phase (A, C). MR images (E, F) have good image quality (grade 2), showing tumor (arrow) with few motion artifacts. Coronal portal venous phase MDCT scan.

View larger version (130K): [in a new window]   Fig. 6E —68-year-old woman with clear cell carcinoma of right kidney. MDCT scans (A-D) have excellent image quality (grade 3) with clear depiction of borders of tumor (arrow), especially in arterial phase (A, C). MR images (E, F) have good image quality (grade 2), showing tumor (arrow) with few motion artifacts. T2-weighted spectral presaturation by inversion recovery axial MR image.

View larger version (166K): [in a new window]   Fig. 6F —68-year-old woman with clear cell carcinoma of right kidney. MDCT scans (A-D) have excellent image quality (grade 3) with clear depiction of borders of tumor (arrow), especially in arterial phase (A, C). MR images (E, F) have good image quality (grade 2), showing tumor (arrow) with few motion artifacts. T1-weighted gradient-refocused echo coronal MR image.

View larger version (117K): [in a new window]   Fig. 7A —74-year-old woman with clear cell carcinoma of right kidney. Excellent image quality (grade 3) in both MR images and MDCT scans. Large hypervascular tumor and Bosniak type 1 cysts were correctly evaluated with both techniques, and results were histologically confirmed. Sonogram shows tumor (arrows) at upper pole.

View larger version (96K): [in a new window]   Fig. 7B —74-year-old woman with clear cell carcinoma of right kidney. Excellent image quality (grade 3) in both MR images and MDCT scans. Large hypervascular tumor and Bosniak type 1 cysts were correctly evaluated with both techniques, and results were histologically confirmed. Sonogram shows cystic lesion (arrow) at lower pole.

View larger version (113K): [in a new window]   Fig. 7C —74-year-old woman with clear cell carcinoma of right kidney. Excellent image quality (grade 3) in both MR images and MDCT scans. Large hypervascular tumor and Bosniak type 1 cysts were correctly evaluated with both techniques, and results were histologically confirmed. MR images show solid T2-weighted hyperintense (C) and contrast-enhancing lesion (D, unenhanced T1-weighted MRI; E, contrast-enhanced T1-weighted MRI) at upper pole and two cystic lesions without contrast enhancement at lower pole of kidney.

View larger version (97K): [in a new window]   Fig. 7D —74-year-old woman with clear cell carcinoma of right kidney. Excellent image quality (grade 3) in both MR images and MDCT scans. Large hypervascular tumor and Bosniak type 1 cysts were correctly evaluated with both techniques, and results were histologically confirmed. MR images show solid T2-weighted hyperintense (C) and contrast-enhancing lesion (D, unenhanced T1-weighted MRI; E, contrast-enhanced T1-weighted MRI) at upper pole and two cystic lesions without contrast enhancement at lower pole of kidney.

View larger version (147K): [in a new window]   Fig. 7E —74-year-old woman with clear cell carcinoma of right kidney. Excellent image quality (grade 3) in both MR images and MDCT scans. Large hypervascular tumor and Bosniak type 1 cysts were correctly evaluated with both techniques, and results were histologically confirmed. MR images show solid T2-weighted hyperintense (C) and contrast-enhancing lesion (D, unenhanced T1-weighted MRI; E, contrast-enhanced T1-weighted MRI) at upper pole and two cystic lesions without contrast enhancement at lower pole of kidney.

View larger version (60K): [in a new window]   Fig. 7F —74-year-old woman with clear cell carcinoma of right kidney. Excellent image quality (grade 3) in both MR images and MDCT scans. Large hypervascular tumor and Bosniak type 1 cysts were correctly evaluated with both techniques, and results were histologically confirmed. MDCT scans show solid lesion at upper pole and two cystic lesions at lower pole with equal image quality compared to MRI (F, contrast-enhanced axial plane; G, unenhanced and H, enhanced coronal reformations).

View larger version (116K): [in a new window]   Fig. 7G —74-year-old woman with clear cell carcinoma of right kidney. Excellent image quality (grade 3) in both MR images and MDCT scans. Large hypervascular tumor and Bosniak type 1 cysts were correctly evaluated with both techniques, and results were histologically confirmed. MDCT scans show solid lesion at upper pole and two cystic lesions at lower pole with equal image quality compared to MRI (F, contrast-enhanced axial plane; G, unenhanced and H, enhanced coronal reformations).

View larger version (142K): [in a new window]   Fig. 7H —74-year-old woman with clear cell carcinoma of right kidney. Excellent image quality (grade 3) in both MR images and MDCT scans. Large hypervascular tumor and Bosniak type 1 cysts were correctly evaluated with both techniques, and results were histologically confirmed. MDCT scans show solid lesion at upper pole and two cystic lesions at lower pole with equal image quality compared to MRI (F, contrast-enhanced axial plane; G, unenhanced and H, enhanced coronal reformations).

View larger version (121K): [in a new window]   Fig. 8A —78-year-old man with clear cell carcinoma of right kidney and invasion of renal vein and inferior vena cava. Sonogram shows large mass in right kidney (arrow).

View larger version (154K): [in a new window]   Fig. 8B —78-year-old man with clear cell carcinoma of right kidney and invasion of renal vein and inferior vena cava. Axial portal venous phase MDCT scan of excellent image quality (grade 3) clearly shows tumor (arrow).

View larger version (141K): [in a new window]   Fig. 8C —78-year-old man with clear cell carcinoma of right kidney and invasion of renal vein and inferior vena cava. Axial arterial phase MDCT scan in curved planar reformation shows tumor thrombus (arrow). Tumor thrombus was missed on MR images because of severe motion artifacts. MDCT scan has excellent image quality (grade 3).

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