PURPOSE: To evaluate pathologic outcomes and associations with MRI features in small renal masses measuring up to 20mm.
METHODS: 86 patients (61±13 years; 45M/41F) with 92 renal masses measuring up to 20mm that underwent MRI prior to tissue diagnosis were included. Two radiologists independently evaluated all masses for microscopic lipid, hemorrhage, T2-hyperintensity, T2-homogeneity, cystic/necrotic areas, hypervascularity, enhancement homogeneity, circumscribed margins, and predominantly exophytic location. These MRI features, as well as patient age, gender, and history of RCC, were compared with pathologic findings using Fisher's exact test, unpaired t-test, and multivariate logistic regression.
RESULTS: 26.1% (24/92) of masses under 2cm were benign, only 32.6% (30/92) were clear-cell RCC, and only 7.6% (7/92) were high-grade. Among 16 masses measuring up to 1cm, only 12.5% (2/16) were clear-cell RCC, and none was high-grade. Within the entire cohort, no MRI or clinical feature showed a significant difference between benign and malignant lesions (p≥0.053). However, for both readers, clear-cell RCC exhibited a significantly higher frequency of T2-hyperintensity, cystic/necrotic areas, and hypervascularity, and a significantly lower frequency of hemorrhage, T2-homogeneity, and enhancement homogeneity (p< 0.001-0.036). Hypervascularity was a significant independent predictor of clear-cell RCC for both readers (p=0.002-0.007), as was T2-hyperintensity for reader 2 (p=0.007).
CONCLUSION: A substantial fraction of small renal masses were benign, and when malignant, largely exhibited indolent pathologic characteristics, particularly when measuring under 1cm Although small benign and malignant masses could not be differentiated on MRI, hypervascularity showed a significant independent association with clear-cell RCC in comparison with other lesions.
Written by:
Rosenkrantz AB, Wehrli NE, Melamed J, Taneja SS, Shaikh MB. Are you the author?
Department of Radiology, NYU Langone Medical Center, 550 First Avenue, New York, NY 10016, United States; Department of Pathology, 550 First Avenue, New York, NY 10016, United States; Department of Urology, Division of Urologic Oncology, 550 First Avenue, New York, NY 10016, United States.
Reference: Eur J Radiol. 2014 Aug;83(8):1311-6.
doi: 10.1016/j.ejrad.2014.05.016
PubMed Abstract
PMID: 24882784
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