European Radiology

, Volume 23, Issue 2, pp 579–587

Prognostic implications of the magnetic resonance imaging appearance in papillary renal cell carcinoma

  • Andrew B. Rosenkrantz
  • Aarti Sekhar
  • Elizabeth M. Genega
  • Jonathan Melamed
  • James S. Babb
  • Amish D. Patel
  • Andy Lo
  • Robert M. Najarian
  • Muneeb Ahmed
  • Ivan Pedrosa
Urogenital

Abstract

Objective

To evaluate the prognostic implications of the MRI appearance and pathological features of papillary renal cell carcinoma (pRCC).

Methods

A total of 128 pRCC in 115 patients who underwent preoperative MRI were characterised in terms of pathological type (type 1 vs. type 2), MRI appearance (focal vs. infiltrative) and additional MRI features. Patients were classified on the basis of the presence or absence of metastatic disease.

Results

There were 65 focal type 1, 54 focal type 2 and 9 infiltrative pRCC. All infiltrative pRCC were of histopathological type 2. Renal vein thrombus was present in 89 % of infiltrative pRCC and no cases of focal pRCC. Metastatic disease was observed in 3.7 % of focal type 1, 7.5 % of focal type 2 and 75.0 % of infiltrative type 2 pRCC. Infiltrative MRI appearance was a significant predictor of metastatic disease, independent of pathological type, size and T stage (P ≤ 0.020). Among focal pRCC on MRI, pathological type 2 was not a significant predictor of metastatic disease (P = 0.648). No combination of features achieved significantly greater accuracy for predicting metastatic disease than renal vein thrombus alone (P > 0.5).

Conclusion

Infiltrative MRI appearance and renal vein thrombus identify a subset of pathological type 2 pRCC at a significantly increased risk of metastatic disease.

Key Points

Magnetic resonance imaging (MRI) offers new preoperative insights into renal cell carcinoma (RCC).

Certain MRI features are associated with metastatic papillary RCC.

Metastases seem more common given an infiltrative appearance and renal vein thrombus.

Keywords

Papillary Renal cell carcinoma MRI Metastatic disease Renal vein thrombus 

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Copyright information

© European Society of Radiology 2012

Authors and Affiliations

  • Andrew B. Rosenkrantz
    • 1
  • Aarti Sekhar
    • 2
    • 5
  • Elizabeth M. Genega
    • 3
  • Jonathan Melamed
    • 4
  • James S. Babb
    • 1
  • Amish D. Patel
    • 2
  • Andy Lo
    • 4
  • Robert M. Najarian
    • 3
  • Muneeb Ahmed
    • 2
  • Ivan Pedrosa
    • 2
    • 6
  1. 1.Department of RadiologyNYU Langone Medical CenterNew YorkUSA
  2. 2.Department of RadiologyBeth Israel Deaconess Medical CenterBostonUSA
  3. 3.Department of PathologyBeth Israel Deaconess Medical CenterBostonUSA
  4. 4.Department of PathologyNYU Langone Medical CenterNew YorkUSA
  5. 5.Department of RadiologyEmory University HospitalAtlantaUSA
  6. 6.Department of Radiology, UT Southwestern Medical CenterAdvanced Imaging Research CenterDallasUSA

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