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Combined late gadolinium-enhanced and double-echo chemical-shift MRI help to differentiate renal oncocytomas with high central T2 signal intensity from renal cell carcinomas.

AbstractOBJECTIVE:
The purpose of our study was to evaluate the combination of dynamic contrast-enhanced T1-weighted and double-echo gradient-echo MR imaging to distinguish renal oncocytoma with high T2 signal intensity centrally from renal cell carcinoma (RCC).
MATERIALS AND METHODS:
Between 2006 and 2011, 63 renal tumors (59 patients) presenting with a high signal intensity (SI) central area on T2-weighted sequences were imaged with dynamic contrast-enhanced sequences, including phases later than 5 minutes after contrast injection, and double-echo chemical-shift sequences were selected from our institutional database. Two experienced radiologists visually assessed presence and distribution of signal enhancement of central areas after injection and measured SI changes on opposed-phase images for calculation of the SI index and tumor-to-spleen ratio. Cutoff values were derived from the receiver operating characteristic (ROC) curve.
RESULTS:
There were 19 oncocytomas (16 patients), 43 RCCs (42 patients), and one leiomyoma. Complete late enhancement of the central area was observed in 14 oncocytomas (74%) and in five RCCs (12%) (p = 0.05). The combination of complete enhancement and SI index lower than 2% (p = 0.02) or tumor-to-spleen ratio higher than -6% (p = 0.001) provided sensitivity of 36% and 55%, specificity of 95% and 97%, positive predictive value of 67% and 86%, and negative predictive value of 84% and 88%, respectively, for diagnosis of oncocytomas.
CONCLUSION:
Absence of central area SI inversion or presence of a signal drop on chemical-shift imaging may rule out the diagnosis of oncocytoma.
AuthorsFrançois Cornelis, Anne-Sophie Lasserre, Thomas Tourdias, Colette Deminière, Jean-Marie Ferrière, Yann Le Bras, Nicolas Grenier
JournalAJR. American journal of roentgenology (AJR Am J Roentgenol) Vol. 200 Issue 4 Pg. 830-8 (Apr 2013) ISSN: 1546-3141 [Electronic] United States
PMID23521457 (Publication Type: Journal Article)
Chemical References
  • Contrast Media
Topics
  • Adenoma, Oxyphilic (diagnosis)
  • Adult
  • Aged
  • Aged, 80 and over
  • Carcinoma, Renal Cell (diagnosis)
  • Contrast Media
  • Diagnosis, Differential
  • Female
  • Humans
  • Kidney Neoplasms (diagnosis)
  • Leiomyoma (diagnosis)
  • Magnetic Resonance Imaging (methods)
  • Male
  • Middle Aged
  • Predictive Value of Tests
  • ROC Curve
  • Retrospective Studies
  • Sensitivity and Specificity

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