Abstract
To perform a feature analysis of malignant renal tumors evaluated with magnetic resonance (MR) imaging and to investigate the correlation between MR imaging features and histopathological findings. MR examinations in 79 malignant renal masses were retrospectively evaluated, and a feature analysis was performed. Each renal mass was assigned to one of eight categories from a proposed MRI classification system. The sensitivity and specificity of the MRI classification system to predict the histologic subtype and nuclear grade was calculated. Subvoxel fat on chemical shift imaging correlated to clear cell type (p < 0.05); sensitivity = 42%, specificity = 100%. Large size, intratumoral necrosis, retroperitoneal vascular collaterals, and renal vein thrombosis predicted high-grade clear cell type (p < 0.05). Small size, peripheral location, low intratumoral SI on T2-weighted images, and low-level enhancement were associated with low-grade papillary carcinomas (p < 0.05). The sensitivity and specificity of the MRI classification system for diagnosing low grade clear cell, high-grade clear cell, all clear cell, all papillary, and transitional carcinomas were 50% and 94%, 93% and 75%, 92% and 83%, 80% and 94%, and 100% and 99%, respectively. The MRI feature analysis and proposed classification system help predict the histological type and nuclear grade of renal masses.
Similar content being viewed by others
References
Jayson M, Sanders H (1998) Increased incidence of serendipitously discovered renal cell carcinoma. Urology 51:203–205
Volpe A, Panzarella T, Rendon RA, Haider MA, Kondylis FI, Jewett MA (2004) The natural history of incidentally detected small renal masses. Cancer 100:738–745
Lam JS, Shvarts O, Leppert JT, Figlin RA, Belldegrun AS (2005) Renal cell carcinoma 2005: new frontiers in staging, prognostication and targeted molecular therapy. J Urol 173:1853–1862
Stadler WM (2005) Targeted agents for the treatment of advanced renal cell carcinoma. Cancer 104:2323–2333
Kaelin WG Jr (2004) The von Hippel-Lindau tumor suppressor gene and kidney cancer. Clin Cancer Res 10:6290S–6295S
Hecht EM, Israel GM, Krinsky GA et al (2004) Renal masses: quantitative analysis of enhancement with signal intensity measurements versus qualitative analysis of enhancement with image subtraction for diagnosing malignancy at MR imaging. Radiology 232:373–378
Rofsky NM, Bosniak MA (1997) MR imaging in the evaluation of small (< or =3.0 cm) renal masses. Magn Reson Imaging Clin N Am 5:67–81
Rominger MB, Kenney PJ, Morgan DE, Bernreuter WK, Listinsky JJ (1992) Gadolinium-enhanced MR imaging of renal masses. Radiographics 12:1097–1116; discussion 1117–1098
Semelka RC, Hricak H, Stevens SK, Finegold R, Tomei E, Carroll PR (1991) Combined gadolinium-enhanced and fat-saturation MR imaging of renal masses. Radiology 178:803–809
Semelka RC, Shoenut JP, Magro CM, Kroeker MA, MacMahon R, Greenberg HM (1993) Renal cancer staging: comparison of contrast-enhanced CT and gadolinium-enhanced fat-suppressed spin-echo and gradient-echo MR imaging. J Magn Reson Imaging 3:597–602
Ho VB, Allen SF, Hood MN, Choyke PL (2002) Renal masses: quantitative assessment of enhancement with dynamic MR imaging. Radiology 224:695–700
Bosniak MA (1986) The current radiological approach to renal cysts. Radiology 158:1–10
Bosniak MA, Megibow AJ, Hulnick DH, Horii S, Raghavendra BN (1988) CT diagnosis of renal angiomyolipoma: the importance of detecting small amounts of fat. AJR Am J Roentgenol 151:497–501
Eilenberg SS, Lee JK, Brown J, Mirowitz SA, Tartar VM (1990) Renal masses: evaluation with gradient-echo Gd-DTPA-enhanced dynamic MR imaging. Radiology 176:333–338
Israel GM, Hindman N, Bosniak MA (2004) Evaluation of cystic renal masses: comparison of CT and MR imaging by using the Bosniak classification system. Radiology 231:365–371
Semelka RC, Shoenut JP, Kroeker MA, MacMahon RG, Greenberg HM (1992) Renal lesions: controlled comparison between CT and 1.5-T MR imaging with nonenhanced and gadolinium-enhanced fat-suppressed spin-echo and breath-hold FLASH techniques [see comments]. Radiology 182:425–430
Yoshimitsu K, Honda H, Kuroiwa T et al (1999) MR detection of cytoplasmic fat in clear cell renal cell carcinoma utilizing chemical shift gradient-echo imaging. J Magn Reson Imaging 9:579–585
Roy C, Sauer B, Lindner V, Lang H, Saussine C, Jacqmin D (2007) MR Imaging of papillary renal neoplasms: potential application for characterization of small renal masses. Eur Radiol 17:193–200
Yoshimitsu K, Irie H, Tajima T et al (2004) MR imaging of renal cell carcinoma: its role in determining cell type. Radiat Med 22:371–376
Earls J, Rofsky NM, DeCorato DR, Krinsky GA, Weinreb JC (1997) Hepatic arterial-phase dynamic gadolinium-enhanced MR imaging: optimization with a test examination and a power injector. Radiology 202:268–273
Israel GM, Hindman N, Hecht E, Krinsky G (2005) The use of opposed-phase chemical shift MRI in the diagnosis of renal angiomyolipomas. AJR Am J Roentgenol 184:1868–1872
Zhang J, Pedrosa I, Rofsky NM (2003) MR techniques for renal imaging. Radiol Clin North Am 41:877–907
Agresti A, Coull B (1998) Approximate is better than “exact” for interval estimation of binomial proportions. American Statistician 119–126
Chawla SN, Crispen PL, Hanlon AL, Greenberg RE, Chen DY, Uzzo RG (2006) The natural history of observed enhancing renal masses: meta-analysis and review of the world literature. J Urol 175:425–431
Kouba E, Smith A, McRackan D, Wallen EM, Pruthi RS (2007) Watchful waiting for solid renal masses: insight into the natural history and results of delayed intervention. J Urol 177:466–470
Guinan P, Frank W, Saffrin R, Rubenstein M (1994) Staging and survival of patients with renal cell carcinoma. Semin Surg Oncol 10:47–50
Kuczyk M, Wegener G, Merseburger AS et al (2005) Impact of tumor size on the long-term survival of patients with early stage renal cell cancer. World J Urol 23:50–54
Leibovich BC, Pantuck AJ, Bui MH et al (2003) Current staging of renal cell carcinoma. Urol Clin North Am 30:481–497, viii
Han KR, Janzen NK, McWhorter VC et al (2004) Cystic renal cell carcinoma: biology and clinical behavior. Urol Oncol 22:410–414
Mejean A, Hopirtean V, Bazin JP et al (2003) Prognostic factors for the survival of patients with papillary renal cell carcinoma: meaning of histological typing and multifocality. J Urol 170:764–767
Herts BR, Coll DM, Novick AC et al (2002) Enhancement characteristics of papillary renal neoplasms revealed on triphasic helical CT of the kidneys. AJR Am J Roentgenol 178:367–372
Turner KJ, Moore JW, Jones A et al (2002) Expression of hypoxia-inducible factors in human renal cancer: relationship to angiogenesis and to the von Hippel-Lindau gene mutation. Cancer Res 62:2957–2961
Djordjevic G, Mozetic V, Mozetic DV et al (2007) Prognostic significance of vascular endothelial growth factor expression in clear cell renal cell carcinoma. Pathol Res Pract 203:99–106
Cheville JC, Lohse CM, Zincke H, Weaver AL, Blute ML (2003) Comparisons of outcome and prognostic features among histologic subtypes of renal cell carcinoma. Am J Surg Pathol 27:612–624
Semenza GL (2000) HIF-1 and human disease: one highly involved factor. Genes Dev 14:1983–1991
Outwater EK, Bhatia M, Siegelman ES, Burke MA, Mitchell DG (1997) Lipid in renal clear cell carcinoma: detection on opposed-phase gradient-echo MR images. Radiology 205:103–107
Storkel S, Eble JN, Adlakha K et al (1997) Classification of renal cell carcinoma: Workgroup No. 1. Union Internationale Contre le Cancer (UICC) and the American Joint Committee on Cancer (AJCC). Cancer 80:987–989
Kim JK, Kim SH, Jang YJ et al (2006) Renal angiomyolipoma with minimal fat: differentiation from other neoplasms at double-echo chemical shift FLASH MR imaging. Radiology 239:174–180
Milner J, McNeil B, Alioto J et al (2006) Fat poor renal angiomyolipoma: patient, computerized tomography and histological findings. J Urol 176:905–909
Korobkin M, Lombardi TJ, Aisen AM et al (1995) Characterization of adrenal masses with chemical shift and gadolinium-enhanced MR imaging. Radiology 197:411–418
Mayo-Smith WW, Lee MJ, McNicholas MM, Hahn PF, Boland GW, Saini S (1995) Characterization of adrenal masses (<5 cm) by use of chemical shift MR imaging: observer performance versus quantitative measures. AJR Am J Roentgenol 165:91–95
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Pedrosa, I., Chou, M.T., Ngo, L. et al. MR classification of renal masses with pathologic correlation. Eur Radiol 18, 365–375 (2008). https://doi.org/10.1007/s00330-007-0757-0
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00330-007-0757-0