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09.06.2020 | Urogenital

Hemosiderin deposition in papillary renal cell carcinoma and its potential to mask enhancement on MRI: analysis of 110 cases

verfasst von: Hiroaki Takahashi, Akira Kawashima, Akitoshi Inoue, Kazuto Kozaka, Theodora A. Potretzke, Adam T. Froemming, Stephen A. Boorjian, Mitchell R. Humphreys, Naoki Takahashi

Erschienen in: European Radiology | Ausgabe 11/2020

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Abstract

Objectives

To evaluate the relationship between imperceptible T1 enhancement of papillary renal cell carcinoma (pRCC) on MR and intratumoral hemosiderin deposition.

Methods

One hundred ten pRCCs (≤ 7 cm) were evaluated by MR with in- and opposed-phase spoiled gradient echo (GRE) and T1-weighted spoiled GRE with fat suppression before and after contrast. Hemosiderin deposition was assessed by SI_index and D_index on in- and opposed-phase images. SI_index and D_index are calculated as (SI_in − SI_opp)/(SI_in) × 100, where SI_in and SI_opp are tumor signal intensities on in- and opposed-phase images and (D_in)/(D_opp), where D_in and D_opp are tumor diameters on in- and opposed-phase images, respectively. The degree of tumor enhancement was classified as grade 1 (no), grade 2 (subtle), or grade 3 (definite). Tumor enhancement on CT was assessed when available.

Results

Five (5%), 10 (9%), and 95 (86%) tumors were categorized as grades 1, 2, and 3 enhancement, respectively. The mean SI_index was − 33.9, − 25.3, and 1.00, whereas the mean D_index was 1.26, 1.05, and 1.00 in tumors with grades 1, 2, and 3 enhancement, respectively. Tumors with grade 1 enhancement had significantly lower SI_index (p = 0.001) and higher D_index (p = 0.005) than those with grade 3 enhancement. Among six tumors with grade 1 or 2 enhancement and available CT, four tumors showed > 20 HU enhancement.

Conclusions

pRCC with no subjective enhancement on contrast-enhanced MR showed hemosiderin deposition evident by lower SI_index and higher D_index. Hemosiderin deposition might mask the tumor enhancement on MR.

Key Points

• 5% of papillary renal cell carcinoma showed imperceptible enhancement on contrast-enhanced MR.

• Hemosiderin deposition in papillary renal cell carcinoma might mask the tumor enhancement on contrast-enhanced MR due to T2/T2*-shortening effects.

• A renal lesion with extensive hemosiderin deposition but no perceptible enhancement on MR should be considered suspicious for papillary renal cell carcinoma.

Reuter VE (2006) The pathology of renal epithelial neoplasms. Semin Oncol 33:534–543CrossRef

Mydlo JH, Bard RH (1987) Analysis of papillary renal adenocarcinoma. Urology 30:529–534CrossRef

Vikram R, Ng CS, Tamboli P et al (2009) Papillary renal cell carcinoma: radiologic-pathologic correlation and spectrum of disease. Radiographics 29:741–754 discussion 755-747CrossRef

Roy C, Sauer B, Lindner V, Lang H, Saussine C, Jacqmin D (2007) MR imaging of papillary renal neoplasms: potential application for characterization of small renal masses. Eur Radiol 17:193–200CrossRef

Sun MR, Ngo L, Genega EM et al (2009) Renal cell carcinoma: dynamic contrast-enhanced MR imaging for differentiation of tumor subtypes--correlation with pathologic findings. Radiology 250:793–802CrossRef

Young JR, Margolis D, Sauk S, Pantuck AJ, Sayre J, Raman SS (2013) Clear cell renal cell carcinoma: discrimination from other renal cell carcinoma subtypes and oncocytoma at multiphasic multidetector CT. Radiology 267:444–453CrossRef

Jinzaki M, Tanimoto A, Mukai M et al (2000) Double-phase helical CT of small renal parenchymal neoplasms: correlation with pathologic findings and tumor angiogenesis. J Comput Assist Tomogr 24:835–842CrossRef

Wingen M, Alzen G, Gunther RW (1998) MR imaging fails to detect bone marrow oedema in osteomyelitis: report of two cases. Pediatr Radiol 28:189–192CrossRef

Roy C, El Ghali S, Buy X, Lindner V, Gangi A (2005) Papillary renal cell carcinoma in allograft kidney. Eur Radiol 15:661–665CrossRef

10.

Sussman SK, Glickstein MF, Krzymowski GA (1990) Hypointense renal cell carcinoma: MR imaging with pathologic correlation. Radiology 177:495–497CrossRef

11.

Yoshimitsu K, Kakihara D, Irie H et al (2006) Papillary renal carcinoma: diagnostic approach by chemical shift gradient-echo and echo-planar MR imaging. J Magn Reson Imaging 23:339–344CrossRef

12.

Egbert ND, Caoili EM, Cohan RH et al (2013) Differentiation of papillary renal cell carcinoma subtypes on CT and MRI. AJR Am J Roentgenol 201:347–355CrossRef

13.

Dilauro M, Quon M, McInnes MD et al (2016) Comparison of contrast-enhanced multiphase renal protocol CT versus MRI for diagnosis of papillary renal cell carcinoma. AJR Am J Roentgenol 206:319–325CrossRef

14.

Zand KR, Reinhold C, Haider MA, Nakai A, Rohoman L, Maheshwari S (2007) Artifacts and pitfalls in MR imaging of the pelvis. J Magn Reson Imaging 26:480–497CrossRef

15.

Wang S, Filipowicz EA, Schnadig VJ (2001) Abundant intracytoplasmic hemosiderin in both histiocytes and neoplastic cells: a diagnostic pitfall in fine-needle aspiration of cystic papillary renal-cell carcinoma. Diagn Cytopathol 24:82–85CrossRef

16.

Yan S, Chen Q, Zhang X et al (2016) Extensive blooming artifact predicts no recanalization after intravenous thrombolysis. Eur J Neurol 23:737–743CrossRef

17.

Bradley WG Jr (1993) MR appearance of hemorrhage in the brain. Radiology 189:15–26CrossRef

18.

Roubidoux MA (1994) MR imaging of hemorrhage and iron deposition in the kidney. Radiographics 14:1033–1044CrossRef

19.

McKee TC, Dave J, Kania L et al (2019) Are hemorrhagic cysts hyperintense enough on T1-weighted MRI to be distinguished from renal cell carcinomas? A retrospective analysis of 204 patients. AJR Am J Roentgenol. https://doi.org/10.2214/AJR.19.21257:1-7

20.

Davarpanah AH, Spektor M, Mathur M, Israel GM (2016) Homogeneous T1 hyperintense renal lesions with smooth borders: is contrast-enhanced MR imaging needed? Radiology 281:326CrossRef

21.

Yoshida K, Takahashi N, King BF et al (2019) Multiple unilateral subcapsular cortical hemorrhagic cystic disease of the kidney: CT and MRI findings and clinical characteristic. Eur Radiol 29:4843–4850CrossRef

22.

Herts BR, Silverman SG, Hindman NM et al (2018) Management of the incidental renal mass on CT: a white paper of the ACR Incidental Findings Committee. J Am Coll Radiol 15:264–273CrossRef

23.

Couvidat C, Eiss D, Verkarre V et al (2014) Renal papillary carcinoma: CT and MRI features. Diagn Interv Imaging 95:1055–1063CrossRef

24.

Ho VB, Allen SF, Hood MN, Choyke PL (2002) Renal masses: quantitative assessment of enhancement with dynamic MR imaging. Radiology 224:695–700CrossRef

25.

Hecht EM, Israel GM, Krinsky GA et al (2004) Renal masses: quantitative analysis of enhancement with signal intensity measurements versus qualitative analysis of enhancement with image subtraction for diagnosing malignancy at MR imaging. Radiology 232:373–378CrossRef

Titel: Hemosiderin deposition in papillary renal cell carcinoma and its potential to mask enhancement on MRI: analysis of 110 cases
verfasst von: Hiroaki Takahashi
Akira Kawashima
Akitoshi Inoue
Kazuto Kozaka
Theodora A. Potretzke
Adam T. Froemming
Stephen A. Boorjian
Mitchell R. Humphreys
Naoki Takahashi
Publikationsdatum: 09.06.2020
Verlag: Springer Berlin Heidelberg
Erschienen in: European Radiology / Ausgabe 11/2020
Print ISSN: 0938-7994
Elektronische ISSN: 1432-1084
DOI: https://doi.org/10.1007/s00330-020-06994-4

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Hemosiderin deposition in papillary renal cell carcinoma and its potential to mask enhancement on MRI: analysis of 110 cases