Abstract
Purpose
To investigate the usefulness of MRI for detection of sarcomatoid renal cell carcinoma (SRCC) components within RCC and differentiation from other renal tumors.
Methods
Two observers independently interpreted T2-weighted images of 10 patients with pathologically confirmed RCCs with SRCC and 131 with non-SRCC renal tumors, with special reference to conspicuously low signal intensity (SI) areas (T2LIA) compared to the renal cortex. SRCC probability was classified as (1) definitely non-SRCC, no T2LIA; (2) probably non-SRCC, <1 cm T2LIA; (3) low probability of SRCC, homogeneous tumor with 1–3 cm T2LIA; (4) probably SRCC, heterogeneous tumor with 1–3 cm T2LIA; and (5) definitely SRCC, >3 cm T2LIA, multiple >1 cm T2LIAs, or showing disruption of the pseudocapsule. The observers used chemical shift imaging to exclude the area representing hemorrhage or hemosiderin deposition from T2LIA. Scores of 4/5 were regarded as positive for evaluating the accuracy and area under the receiver operating characteristic curve. The SI ratio of the lowest SI in the tumor to that of the renal cortex in the 1 and ≥2 score groups was compared using Mann-Whitney’s U test.
Results
Sensitivity, specificity, accuracy, and positive and negative predictive values were 90%, 95%, 94%, 56%, and 99%, respectively, and area under the receiver operating characteristic curve was 0.93. The mean SI ratio of the lowest SI in the tumor to that of the renal cortex was significantly lower in the ≥2 score group (0.58) than in the 1 score group (1.36).
Conclusions
MRI predicted RCC with SRCC with a moderate positive predictive value and a high negative predictive value.
Similar content being viewed by others
References
de Peralta-Venturina M, Moch H, Amin M, et al. (2001) Sarcomatoid differentiation in renal cell carcinoma: a study of 101 cases. Am J Surg Pathol 25:275–284
Crispen PL, Breau RH, Allmer C, et al. (2011) Lymph node dissection at the time of radical nephrectomy for high-risk clear cell renal cell carcinoma: indications and recommendations for surgical templates. Eur Urol 59:18–23
Mian BM, Bhadkamkar N, Slaton JW, et al. (2002) Prognostic factors and survival of patients with sarcomatoid renal cell carcinoma. J Urol 167:65–70
Shuch B, Said J, La Rochelle JC, et al. (2009) Cytoreductive nephrectomy for kidney cancer with sarcomatoid histology—is up-front resection indicated and, if not, is it avoidable? J Urol 182:2164–2171
Giannakis D, Tsili AC, Zioga A, Tsampoulas K, Sofikitis N (2009) Early-stage sarcomatoid renal cell carcinoma: multidetector CT findings. Urol Int 82:367–369
Mucci B, Lewi HJ, Fleming S (1987) The radiology of sarcomas and sarcomatoid carcinomas of the kidney. Clin Radiol 38:249–254
Shirkhoda A, Lewis E (1987) Renal sarcoma and sarcomatoid renal cell carcinoma: CT and angiographic features. Radiology 162:353–357
Rosenkrantz AB, Chandarana H, Melamed J (2011) MRI findings of sarcomatoid renal cell carcinoma in nine cases. Clin Imaging 35:459–464
Takeuchi M, Urano M, Hara M, et al. (2013) Characteristic MR imaging findings of sarcomatoid renal cell carcinoma dedifferentiated from clear cell renal carcinoma: radiological-pathological correlation. Clin Imaging 37:908–912
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 23:339–344
Oliva MR, Glickman JN, Zou KH, et al. (2009) Renal cell carcinoma: t1 and t2 signal intensity characteristics of papillary and clear cell types correlated with pathology. AJR 192:1524–1530
Prasad SR, Humphrey PA, Catena JR, et al. (2006) Common and uncommon histologic subtypes of renal cell carcinoma: imaging spectrum with pathologic correlation. Radiographics 26:1795–1806
Pickhardt PJ, Siegel CL, McLarney JK (2001) Collecting duct carcinoma of the kidney: are imaging findings suggestive of the diagnosis? AJR 176:627–633
Jinzaki M, Tanimoto A, Narimatsu Y, et al. (1997) Angiomyolipoma: imaging findings in lesions with minimal fat. Radiology 205:497–502
Bastide C, Rambeaud JJ, Bach AM, Russo P (2009) Metanephric adenoma of the kidney: clinical and radiological study of nine cases. BJU Int 103:1544–1548
Sasiwimonphan K, Takahashi N, Leibovich BC, et al. (2012) A small (<4 cm) renal mass: differentiation of angiomyolipoma without visible fat from Renal cell carcinoma utilizing MR imaging. Radiology 33:160–168
Landis JR, Koch CG (1977) The measurement of observer agreement for categorical data. Biometrics 33:159–174
Hanley JA, McNeil BJ (1982) The meaning and use of the area under a receiver operating characteristic (ROC) curve. Radiology 143:29–36
Brown PH (2003) Hypothesis testing of means. Radiology 229:930–931
Shinmoto H, Yuasa Y, Tanimoto A, et al. (1998) Small renal cell carcinoma: MRI with pathologic correlation. J Magn Reson Imaging 8:690–694
Johnson TR, Pedrosa I, Goldsmith J, Dewolf WC, Rofsky NM (2005) Magnetic resonance imaging findings in solitary fibrous tumor of the kidney. J Comput Assist Tomogr 29:481–483
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 250:793–802
Acknowledgment
This work was supported by JSPS KAKENHI Grant Number 25861116.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Takeuchi, M., Kawai, T., Suzuki, T. et al. MRI for differentiation of renal cell carcinoma with sarcomatoid component from other renal tumor types. Abdom Imaging 40, 112–119 (2015). https://doi.org/10.1007/s00261-014-0185-y
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00261-014-0185-y