International Cancer Imaging Society Oct 17. Multiparametric imaging of renal tumours, H Chandarana скачать в хорошем качестве

International Cancer Imaging Society Oct 17. Multiparametric imaging of renal tumours, H Chandarana

https://www.icimagingsociety.org.uk/ Hersh Chandarana Department of Radiology, New York University School of Medicine, New York, NY 10016, USA Incidental detection of renal mass results in management dilemma. Historically all enhancing renal tumours without imaging evidence of bulk fat were considered surgical. However, it is clear that many of these small renal masses are either benign such as angiomyolipoma (AML) or oncocytoma, or are neoplasms with indolent behavior [1]. Surgical resection of these benign or indolent tumours, especially in patients with decreased renal function or other co-morbidities, results in increased cost without improvement in survival or mortality [2]. Use of advance imaging, such as diffusion weighted imaging (DWI) and perfusion weighted imaging (PWI), to non-invasively investigate renal tumour histopathology and aggressiveness can impact treatment decision and lower treatment cost. Number of key observations highlighting the role of MR including advance imaging techniques in evaluation of renal masses is as listed below: 1. Differentiating benign renal masses from malignant tumours. Certain MRI features such as homogenous T2 signal, uniform enhancement, restricted diffusion with low ADC, and without evidence for necrosis and calcification can differentiate lipid poor AML from clear cell and papillary subtype of kidney cancers [3, 4]. It is nearly impossible to discriminate benign oncocytoma from chromophobe and clear cell subtypes of kidney cancers on conventional imaging [5]. However, DWI and PWI have shown some promise in small studies. 2. Tumour aggressiveness of solid RCC Kidney cancers with different histologic subtypes differ in aggressiveness. Conventional MR imaging has shown some promise in differentiating papillary subtype of RCC from other subtypes based on hypovascularity, homogenous low T2 signal, T1 hyperintensity, and low ADC values. Advance DWI and PWI may further improve accuracy of MRI in discriminating papillary subtype from other types of kidney cancers. Clear cell subtype of kidney cancers is hypervascular with heterogeneous T2 and diffusion signal [6]. 3. Tumour aggressiveness/outcome of cystic RCC Cystic RCC with less than 25% solid enhancing component tend to be less aggressive than solid RCC [7]. References 1. Thompson RH, Kurta JM, Kaag M, et al. Tumour size is associated with malignant potential in renal cell carcinoma. J Urol 2009;181(5):2033–6. 2. Huang WC, Levey AS, Serio AM, et al. Chronic kidney disease after nephrectomy in patients with renal cortical tumours: A retrospective cohort study. The Lancet. Oncology. 2006;7:735-740 3. Hindman N, Ngo L, Genega EM, et al. Angiomyolipoma with minimal fat: can it be differentiated from clear cell renal cell carcinoma by using standard MR techniques? Radiology. 2012 Nov;265(2):468-77. 4. Sasiwimonphan K, Takahashi N, Leibovich BC, Carter RE, Atwell TD, Kawashima A. Small (smaller than 4 cm) renal mass: differentiation of angiomyolipoma without visible fat from renal cell carcinoma utilizing MR imaging. Radiology. 2012 Apr;263(1):160-8. 5. Rosenkrantz AB, Hindman N, Fitzgerald EF, Niver BE, Melamed J, Babb JS. MRI features of renal oncocytoma and chromophobe renal cell carcinoma. AJR Am J Roentgenol. 2010 Dec;195(6):W421-7. 6. Chandarana H, Rosenkrantz AB, Mussi TC, et al. Histogram analysis of whole-lesion enhancement in differentiating clear cell from papillary subtype of renal cell cancer. Radiology. 2012 Dec;265(3):790-8. 7. Doshi AM, Huang WC, Donin NM, Chandarana H. MRI features of renal cell carcinoma that predict favorable clinicopathologic outcomes. AJR Am J Roentgenol. 2015 Apr;204(4):798-803