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Are growth patterns on MRI in small (< 4 cm) solid renal masses useful for predicting benign histology?

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Abstract

Purpose

To evaluate previously described growth patterns in < 4 cm solid renal masses.

Materials and Methods

With IRB approval, 63 renal cell carcinomas (RCC; clear cell n = 22, papillary n = 28, chromophobe n = 13) and 36 benign masses [minimal-fat (mf) angiomyolipoma (AML) n = 13, oncocytoma n = 23) from a single institution were independently evaluated by two blinded radiologists (R1/R2) using T2-weighted MRI for (1) the angular interface sign (AIS), (2) bubble-over sign (BOS), (3) percentage (%) exophytic growth and (4) long-to-short axis ratio. Comparisons were performed using ANOVA, chi-square and multi-variate regression.

Results

AIS was present in 11.1% (7/63) -9.5% (6/63) R1/R2 RCC compared to 13.9% (5/36) -19.4% (7/36) R1/R2 benign masses (p = 0.68 and 0.16). BOS was present in 11.1% (7/63) -3.2% (2/63) R1/R2 RCC compared to 16.7% (6/36) -8.3% (3/36) R1/R2 benign masses (p = 0.432 and 0.261). Agreement was moderate (K = 0.50 and 0.55). mf-AML [66 ± 32% (range 0-100%)] and oncocytoma [53 ± 26% (0-90%)] had larger % exophytic growth compared to RCC [32 ± 23% (0-80%)] (p < 0.001). No RCC had 90-100% exophytic growth, present in 38.5% (5/13) mf-AMLs and 17.4% (4/23) oncocytomas. The long-to-short axis did not differ between groups (p = 0.053).

Conclusions

Benign masses show greater % exophytic growth whereas other growth patterns are not useful. Future studies evaluating % exophytic growth using multi-variate MR analysis in renal masses are required.

Key Points

• Greater exophytic growth is associated with benignity among solid renal masses.

• Only minimal fat AMLs and oncocytomas had 90-100% exophytic growth.

• The angular interface sign was not useful to differentiate benign masses from RCC.

• The bubble-over sign was not useful to differentiate benign masses from RCC.

• Subjective analysis of growth patterns had fair-to-moderate agreement.

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Abbreviations

MRI:

Magnetic resonance imaging

RCC:

Renal cell carcinoma

AML:

Angiomyolipoma

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Funding

The authors state that this work has not received any funding.

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Authors and Affiliations

  1. Department of Medical Imaging, The Ottawa Hospital, The University of Ottawa, 1053 Carling Avenue, Ottawa, Ontario, K1Y 4E9, Canada

    Robert S. Lim, Matthew D. F. McInnes, Mahadevaswamy Siddaiah, Trevor A. Flood, Luke T. Lavallee & Nicola Schieda

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  1. Robert S. Lim
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  2. Matthew D. F. McInnes
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  3. Mahadevaswamy Siddaiah
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  4. Trevor A. Flood
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  5. Luke T. Lavallee
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  6. Nicola Schieda
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Corresponding author

Correspondence to Nicola Schieda.

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Guarantor

The scientific guarantor of this publication is Nicola Schieda, MD.

Conflict of interest

The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.

Statistics and biometry

One of the authors has significant statistical expertise.

Informed consent

Written informed consent was waived by the Institutional Review Board.

Ethical approval

Institutional Review Board approval was obtained.

Study subjects or cohorts overlap

Some study subjects or cohorts have been previously reported in multiple studies our group has published evaluating fat-poor AMLs; however, these prior studies do not pertain to the current work and have been itemised in the manuscript.

Methodology

• retrospective

• case-control study

• performed at one institution

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Lim, R.S., McInnes, M.D.F., Siddaiah, M. et al. Are growth patterns on MRI in small (< 4 cm) solid renal masses useful for predicting benign histology?. Eur Radiol 28, 3115–3124 (2018). https://doi.org/10.1007/s00330-018-5324-3

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  • DOI: https://doi.org/10.1007/s00330-018-5324-3

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