Steven
K. Sussman,
#{149} Marc
MD
Hypointense MR Imaging
F. Glickstein,
terms:
81.1214 Kidney
Kidney neoplasms,
#{149}
Radiology
tomography
Kulkamni
et al (1)
finding.
In
addition,
three
renal
insufficiency
presented with a hisback pain that became progressive. Results of physi-
severe and cal and laboratory examinations were unremarkable, aside from a mildly elevated creatinine level. Abdominal CT performed with use of contiguous 5-mm sections (GE Medical Systems, Milwaukee) without intravenous administration of #{149}
contrast
material
demonstrated
ameter lesion of increased attenuation at the upper pole of the right kidney (Fig la). CT scans obtained after intravenous administration of contrast material showed some enhancement of a thin rim around the mass (Fig ib). This mass could not be appreciated at US (Acuson, Mountam View, Calif). Because of the indeterminate nature of this mass, MR imaging was performed with a i.5-T system (Signa; GE Medical Systems). The mass
appeared imaged weighted
markedly
hypointense
with use of both pulse sequences
A biopsy
of the mass
when
Ti- and T2(Fig ic, id).
was performed
CT guidance with a 22-gauge sidecut needle, and cytopathologic examina-
36
tion
revealed
renal
cell
carcinoma.
A pre-
increase
Partial
ed images.
Recently,
ported
a case in which
broma
was
T2-weighted rare appearance
on
Cormier
renal
hypointense
T2-weight-
et al (7) re-
medullamy
on both
images. They is typical
fi-
Ti-
and
state that of densely
this col-
lagenous hypocellular lesions and suggest that when such a lesion is seen in the kidney the diagnosis of benign medullary fibroma should be considered. We report two cases in which renal cell carcinoma appeared hypointense on both Ti- and T2-weighted images. Pathologic examina-
From
the
Departments
of Radiology
(S.K.S.,
M.F.G.) and Pathology (G.A.K.), Hartford Hospital, Hartford, Conn. Received April 19, 1990; revision requested May 14; revision received and accepted May 31. Address reprint requests to S.K.S., Jefferson X-ray Inc. 85 Seymour St. Suite 200, Hartford, CT 06106. RSNA, 1990
c
nephrectomy
of the
right
upper
pole demonstrated a 2-cm-diameter golden-tan mass with features of a well-differentiated papillary renal cell carcinoma and with some evidence of recent and old hemorrhage. Iron stains demonstrated abundant hemosiderin deposition within tumor cells (Fig if). Case 2.-A 53-year-old man presented at the emergency room with acute left flank pain. Results of physical and labomatory examinations were remarkable only for left upper quadrant tenderness and a creatinine level of 2.0 mg/dL (180 mol/
L). After I
strated
pole
an unremarkable
MR imaging
a Signa
a renal
that
i.5-T
lesion
of the
hypointense
was
of the abdo-
system
demonleft
and that remained images
The patient
diameter
hypointense
(Fig
2b, 2c).
subsequently
mass
with
upper
on Ti-weight-
underwent
repair of his abdominal aortic as well as a left nephrectomy.
aneurysm A 1.5-cm-
pathologic
features
consistent with renal cell carcinoma found in the left upper pole. Iron demonstrated hemosiderin within cells throughout the mass (Fig 2d). number of other tiny foci of renal cinoma were found in other parts
kidney, any
but these
of the
were
imaging
was stains tumor A cell carof the
not evident
with
studies.
plain
DISCUSSION Even
radio-
graph of the abdomen was obtained, abdominal CT was performed on a GE 9800 (GE Medical Systems) with contiguous 1cm sections, which demonstrated a left subcapsular hematoma with an associated small, lower-attenuation cortical lesion thought to represent a cyst (Fig 2a). A 5cm-diameter abdominal aortic aneurysm
though
in most centers
CT and
US are the primary modalities for the evaluation of renal masses, MR imaging has been selectively used as a supplemental imaging modality (1-6). Current clinical uses of MR imaging in the evaluation of renal masses are as follows: (a) in patients allergic to iodinated contrast mcdiurn, (b) in patients in whom bolus-en-
hanced CT staging has been performed sults,
under
operative angiogram obtained prior to partial nephrectomy demonstrated a predominantly hypovascular mass (Fig le).
intensity
with
a 2-cm-di-
renal cell carcinomas imaged by Fein et al (3) were hypointense on T2-weighted images. Most renal cell carcinomas are inhomogeneous on Ti-weighted images and in signal
noted.
also
on T2-weighted
tory of right-sided
a case
of the
REPORTS
2.-A 50-year-old man with a history of cardiovascular disease and mild
in which renal cell carcinoma was hypointense on both Ti- and T2-weighted images, they offered no explanation for this
men
Case
(CT)
described
was
tumor
ed images
and ultrasound (US) remain the mainstay for the evaluation of renal masses, magnetic resonance (MR) imaging has been used extensively (1-6). A renal mass that appears hypointense relative to normal renal parenchyma on both Ti- and T2-weighted images is mare. Although
MD
tion
CASE
1990; 177:495-497
computed
A. Krzymowski,
showed diffuse hemosiderin-laden cells, which probably accounted for this unusual appearance at MR imaging.
Iron #{149} Kidney, MR studies, neoplasms, diagnosis, 81.324 MR studies, 81.1214, 81.324
LTHOUGH
#{149} George
Renal Cell Carcinoma: with Pathologic Correlation’
In two pathologically documented cases of renal cell carcinoma, the appearance of the tumors at magnetic resonance (MR) imaging was markedly hypointense relative to normal renal parenchyma on both TI- and T2-weighted spin-echo images. Pathologic examination of both himoms revealed diffuse iron scattered throughout the tumors. The paramagnetic effect of the iron may account for this unusual hypointense appearance at spin-echo imaging, independent of pulse sequence. Index
MD
of renal cell carcinoma with suboptimal re-
(c) in patients
with
masses
the
na-
ture of which is indeterminate US, (d) in patients with masses
at CT and
whom
to be accu-
at either pole for identification of which coronal or sagittal imaging may be useful, and (e) in patients with renal cell carcinoma in
venous
extension
rately defined suggested that
needs
(5). Recent reports MR imaging may
have actually
be slightly superior to CT for staging of renal cell carcinoma (2,3). The appearance of the primary lesion in
renal
cell
carcinoma
Ti-weighted
images
may
be
varied.
the appearance
On
can
be inhomogeneous, varying from hypointense to hyperintense. On T2-weighted images the tumor usually increases in intensity,
becoming
normal
renal
hyperintense
parenchyma
A recent report renal lesion with both
Ti-
and
suggested low signal
T2-weighted
to the
(5).
that when a intensity on images
is en-
countered, the diagnosis of a benign renal medullary fibrorna should be considered (7). The low signal intensity in this entity is secondary to the densely collagenous, mor.
relatively acellular nature of the tuA similar cause of low signal intensity on T2-weighted images has also been recognized for other soft-tissue masses,
495
‘T4 .
I
-
.
._ ;
..
p
,%..
-.-‘q
p,;).
.r’
*,‘;
v,
,,.
.
3
4
..
. ..
.; .-.‘
., .
‘*Wd,
.
‘
“_%m,
‘
..‘
:
,. ‘)
::C4:
:1
i
:
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---
,
::
K. Sussman,
#{149} Marc
MD
Hypointense MR Imaging
F. Glickstein,
terms:
81.1214 Kidney
Kidney neoplasms,
#{149}
Radiology
tomography
Kulkamni
et al (1)
finding.
In
addition,
three
renal
insufficiency
presented with a hisback pain that became progressive. Results of physi-
severe and cal and laboratory examinations were unremarkable, aside from a mildly elevated creatinine level. Abdominal CT performed with use of contiguous 5-mm sections (GE Medical Systems, Milwaukee) without intravenous administration of #{149}
contrast
material
demonstrated
ameter lesion of increased attenuation at the upper pole of the right kidney (Fig la). CT scans obtained after intravenous administration of contrast material showed some enhancement of a thin rim around the mass (Fig ib). This mass could not be appreciated at US (Acuson, Mountam View, Calif). Because of the indeterminate nature of this mass, MR imaging was performed with a i.5-T system (Signa; GE Medical Systems). The mass
appeared imaged weighted
markedly
hypointense
with use of both pulse sequences
A biopsy
of the mass
when
Ti- and T2(Fig ic, id).
was performed
CT guidance with a 22-gauge sidecut needle, and cytopathologic examina-
36
tion
revealed
renal
cell
carcinoma.
A pre-
increase
Partial
ed images.
Recently,
ported
a case in which
broma
was
T2-weighted rare appearance
on
Cormier
renal
hypointense
T2-weight-
et al (7) re-
medullamy
on both
images. They is typical
fi-
Ti-
and
state that of densely
this col-
lagenous hypocellular lesions and suggest that when such a lesion is seen in the kidney the diagnosis of benign medullary fibroma should be considered. We report two cases in which renal cell carcinoma appeared hypointense on both Ti- and T2-weighted images. Pathologic examina-
From
the
Departments
of Radiology
(S.K.S.,
M.F.G.) and Pathology (G.A.K.), Hartford Hospital, Hartford, Conn. Received April 19, 1990; revision requested May 14; revision received and accepted May 31. Address reprint requests to S.K.S., Jefferson X-ray Inc. 85 Seymour St. Suite 200, Hartford, CT 06106. RSNA, 1990
c
nephrectomy
of the
right
upper
pole demonstrated a 2-cm-diameter golden-tan mass with features of a well-differentiated papillary renal cell carcinoma and with some evidence of recent and old hemorrhage. Iron stains demonstrated abundant hemosiderin deposition within tumor cells (Fig if). Case 2.-A 53-year-old man presented at the emergency room with acute left flank pain. Results of physical and labomatory examinations were remarkable only for left upper quadrant tenderness and a creatinine level of 2.0 mg/dL (180 mol/
L). After I
strated
pole
an unremarkable
MR imaging
a Signa
a renal
that
i.5-T
lesion
of the
hypointense
was
of the abdo-
system
demonleft
and that remained images
The patient
diameter
hypointense
(Fig
2b, 2c).
subsequently
mass
with
upper
on Ti-weight-
underwent
repair of his abdominal aortic as well as a left nephrectomy.
aneurysm A 1.5-cm-
pathologic
features
consistent with renal cell carcinoma found in the left upper pole. Iron demonstrated hemosiderin within cells throughout the mass (Fig 2d). number of other tiny foci of renal cinoma were found in other parts
kidney, any
but these
of the
were
imaging
was stains tumor A cell carof the
not evident
with
studies.
plain
DISCUSSION Even
radio-
graph of the abdomen was obtained, abdominal CT was performed on a GE 9800 (GE Medical Systems) with contiguous 1cm sections, which demonstrated a left subcapsular hematoma with an associated small, lower-attenuation cortical lesion thought to represent a cyst (Fig 2a). A 5cm-diameter abdominal aortic aneurysm
though
in most centers
CT and
US are the primary modalities for the evaluation of renal masses, MR imaging has been selectively used as a supplemental imaging modality (1-6). Current clinical uses of MR imaging in the evaluation of renal masses are as follows: (a) in patients allergic to iodinated contrast mcdiurn, (b) in patients in whom bolus-en-
hanced CT staging has been performed sults,
under
operative angiogram obtained prior to partial nephrectomy demonstrated a predominantly hypovascular mass (Fig le).
intensity
with
a 2-cm-di-
renal cell carcinomas imaged by Fein et al (3) were hypointense on T2-weighted images. Most renal cell carcinomas are inhomogeneous on Ti-weighted images and in signal
noted.
also
on T2-weighted
tory of right-sided
a case
of the
REPORTS
2.-A 50-year-old man with a history of cardiovascular disease and mild
in which renal cell carcinoma was hypointense on both Ti- and T2-weighted images, they offered no explanation for this
men
Case
(CT)
described
was
tumor
ed images
and ultrasound (US) remain the mainstay for the evaluation of renal masses, magnetic resonance (MR) imaging has been used extensively (1-6). A renal mass that appears hypointense relative to normal renal parenchyma on both Ti- and T2-weighted images is mare. Although
MD
tion
CASE
1990; 177:495-497
computed
A. Krzymowski,
showed diffuse hemosiderin-laden cells, which probably accounted for this unusual appearance at MR imaging.
Iron #{149} Kidney, MR studies, neoplasms, diagnosis, 81.324 MR studies, 81.1214, 81.324
LTHOUGH
#{149} George
Renal Cell Carcinoma: with Pathologic Correlation’
In two pathologically documented cases of renal cell carcinoma, the appearance of the tumors at magnetic resonance (MR) imaging was markedly hypointense relative to normal renal parenchyma on both TI- and T2-weighted spin-echo images. Pathologic examination of both himoms revealed diffuse iron scattered throughout the tumors. The paramagnetic effect of the iron may account for this unusual hypointense appearance at spin-echo imaging, independent of pulse sequence. Index
MD
of renal cell carcinoma with suboptimal re-
(c) in patients
with
masses
the
na-
ture of which is indeterminate US, (d) in patients with masses
at CT and
whom
to be accu-
at either pole for identification of which coronal or sagittal imaging may be useful, and (e) in patients with renal cell carcinoma in
venous
extension
rately defined suggested that
needs
(5). Recent reports MR imaging may
have actually
be slightly superior to CT for staging of renal cell carcinoma (2,3). The appearance of the primary lesion in
renal
cell
carcinoma
Ti-weighted
images
may
be
varied.
the appearance
On
can
be inhomogeneous, varying from hypointense to hyperintense. On T2-weighted images the tumor usually increases in intensity,
becoming
normal
renal
hyperintense
parenchyma
A recent report renal lesion with both
Ti-
and
suggested low signal
T2-weighted
to the
(5).
that when a intensity on images
is en-
countered, the diagnosis of a benign renal medullary fibrorna should be considered (7). The low signal intensity in this entity is secondary to the densely collagenous, mor.
relatively acellular nature of the tuA similar cause of low signal intensity on T2-weighted images has also been recognized for other soft-tissue masses,
495
‘T4 .
I
-
.
._ ;
..
p
,%..
-.-‘q
p,;).
.r’
*,‘;
v,
,,.
.
3
4
..
. ..
.; .-.‘
., .
‘*Wd,
.
‘
“_%m,
‘
..‘
:
,. ‘)
::C4:
:1
i
:
e.
---
,
::
