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Intracellular lipid in papillary renal cell carcinoma (pRCC): T2 weighted (T2W) MRI and pathologic correlation

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Abstract

Objective

To evaluate if pRCCs demonstrate intracellular lipid (i-lipid) at chemical-shift (CS) MRI, and assess T2W-MRI and pathologic characteristics.

Methodology

Sixty-two patients with a pRCC diagnosis underwent MRI over 11 years (IRB-approved). Two radiologists independently assessed for presence of i-lipid on CS-MRI and homogeneity on T2W-MRI. Inter-observer agreement was assessed via an intraclass correlation and results were compared using the Chi-square test. Discordant cases were reviewed to establish consensus. T2W SI-ratios (SI.tumor/SI.kidney) and CS-SI index were compared using independent t-tests and Spearman correlation. Two pathologists re-evaluated the histopathology.

Results

Nine of the 62 pRCCs (14.5 %) demonstrated i-lipid; agreement was moderate (ICC = 0.63). Pathology review depicted clear cells in four tumours and foamy histiocytes in five tumours.

25.8-35.4 % (ICC = 0.65) of tumours were homogeneous on T2W-MRI. No pRCC with i-lipid was considered homogeneous (p = 0.01-0.04). Overall, T2W SI-ratio and CS-SI index were 0.89 (±0.29) and -3.63 % (-7.27 to 11.42). pRCC with i-lipid had significantly higher T2W SI-ratio (p = 0.003). There was a correlation between the CS-SI index and T2W SI-ratio, (r = 0.44, p < 0.001).

Conclusions

Intracellular lipid is uncommonly detected in pRCCs due to clear cell changes and foamy histiocytes. These tumours are associated with heterogeneously-increased SI in T2W-MRI.

Key Points

• A minority of pRCCs demonstrate intracellular lipid in CS-MRI.

• Quantitatively, intracellular lipid in pRCCs is minimal (<25 %).

• Intracellular lipid in pRCCs are from clear cell heterogeneity or foamy histiocytes.

• pRCCs with intracellular lipid are heterogeneously hyperintense at T2W-MRI.

• pRCCs that are homogeneously hypointense at T2W-MRI do not contain intracellular lipid.

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Acknowledgements

The scientific guarantor of this publication is Nicola Schieda, MD. 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. The authors state that this work has not received any funding. Nicola Schieda MD, has significant statistical expertise. Institutional Review Board approval was obtained. Written informed consent was waived by the Institutional Review Board. Methodology: retrospective, cross sectional study, performed at one institution.

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Authors and Affiliations

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

    Nicola Schieda, Christian B. van der Pol, Bardia Moosavi & Matthew D. F. McInnes

  2. Department of Anatomical Pathology, The Ottawa Hospital, The University of Ottawa, Ottawa, Ontario, Canada

    Kien T. Mai & Trevor A. Flood

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  1. Nicola Schieda
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  2. Christian B. van der Pol
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Correspondence to Nicola Schieda.

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Schieda, N., van der Pol, C.B., Moosavi, B. et al. Intracellular lipid in papillary renal cell carcinoma (pRCC): T2 weighted (T2W) MRI and pathologic correlation. Eur Radiol 25, 2134–2142 (2015). https://doi.org/10.1007/s00330-015-3610-x

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