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Park SJ, Cho Y, Lee HN, Lee S, Chung HH, Park CH. Enhancing procedural decision making with cone beam CT in renal artery embolization. Sci Rep 2024; 14:18198. [PMID: 39107426 PMCID: PMC11303547 DOI: 10.1038/s41598-024-69363-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2024] [Accepted: 08/05/2024] [Indexed: 08/10/2024] Open
Abstract
Cone-beam computed tomography (CBCT) has proven to be a safe and effective adjunctive imaging tool for interventional radiology. Nevertheless, limited studies have examined the application of CBCT in renal artery embolization (RAE). The objective of this study is to evaluate the role of CBCT in intra-procedural decision-making for RAE. This multicenter retrospective study included 40 consecutive patients (age: 55.9 ± 16.5 years; male, 55%) who underwent CBCT during RAE from January 2019 to January 2023. The additional information provided by CBCT was classified into Category 1 (no additional information), Category 2 (more information without changing the treatment plan), and Category 3 (valuable information that led to a change in the treatment plan). CBCT did not add unique information for four patients (10%) classified as Category 1. CBCT clarified ambiguous angiographic findings and confirmed the existing treatment plan for 19 patients (47.5%) graded as Category 2; complex vascular anatomy was explained (n = 13), and a correlation between vascular territory and target lesion was established (n = 6). CBCT offered valuable information that was not visible on digital subtraction angiography and changed the treatment plan for 17 patients categorized as Category 3; a mismatch between the vascular territory and the target lesion led to the identification of alternative (n = 3) and additional feeders (n = 8); and the extent of embolization was reduced by using automatic feeder detection software (n = 6). CBCT is an efficient tool that aids in the decision-making process during the embolization procedure by providing supplementary imaging information. This additional information enables the confident identification of target vessels, facilitates superselective embolization, prevents non-target embolization, and helps locate missing feeders.
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Affiliation(s)
- Sung-Joon Park
- Department of Radiology, Korea University College of Medicine, Korea University Ansan Hospital, Ansan, Republic of Korea
| | - Youngjong Cho
- Department of Radiology, University of Ulsan College of Medicine, Gangneung Asan Hospital, Gangneung, Republic of Korea
| | - Hyoung Nam Lee
- Department of Radiology, Soonchunhyang University College of Medicine, Cheonan Hospital, Cheonan, Republic of Korea.
| | - Sangjoon Lee
- Vascular Center, The Eutteum Orthopedic Surgery Hospital, Paju, Republic of Korea
| | - Hwan Hoon Chung
- Department of Radiology, Korea University College of Medicine, Korea University Ansan Hospital, Ansan, Republic of Korea
| | - Chan Ho Park
- Department of Radiology, Soonchunhyang University College of Medicine, Cheonan Hospital, Cheonan, Republic of Korea
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Shah JN, Gandhi D, Prasad SR, Sandhu PK, Banker H, Molina R, Khan S, Garg T, Katabathina VS. Wunderlich Syndrome: Comprehensive Review of Diagnosis and Management. Radiographics 2023; 43:e220172. [PMID: 37227946 DOI: 10.1148/rg.220172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Wunderlich syndrome (WS), which was named after Carl Wunderlich, is a rare clinical syndrome characterized by an acute onset of spontaneous renal hemorrhage into the subcapsular, perirenal, and/or pararenal spaces, without a history of antecedent trauma. Patients may present with a multitude of symptoms ranging from nonspecific flank or abdominal pain to serious manifestations such as hypovolemic shock. The classic symptom complex of flank pain, a flank mass, and hypovolemic shock referred to as the Lenk triad is seen in a small subset of patients. Renal neoplasms such as angiomyolipomas and clear cell renal cell carcinomas that display an increased proclivity for hemorrhage and rupture contribute to approximately 60%-65% of all cases of WS. A plethora of renal vascular diseases (aneurysms or pseudoaneurysms, arteriovenous malformations or fistulae, renal vein thrombosis, and vasculitis syndromes) account for 20%-30% of cases of WS. Rare causes of WS include renal infections, cystic diseases, calculi, kidney failure, and coagulation disorders. Cross-sectional imaging modalities, particularly multiphasic CT or MRI, are integral to the detection, localization, and characterization of the underlying causes and facilitate optimal management. However, large-volume hemorrhage at patient presentation may obscure underlying causes, particularly neoplasms. If the initial CT or MRI examination shows no contributary causes, a dedicated CT or MRI follow-up study may be warranted to establish the cause of WS. Renal arterial embolization is a useful, minimally invasive, therapeutic option in patients who present with acute or life-threatening hemorrhage and can help avoid emergency radical surgery. Accurate diagnosis of the underlying cause of WS is critical for optimal patient treatment in emergency and nonemergency clinical settings. ©RSNA, 2023 Quiz questions for this article are available through the Online Learning Center.
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Affiliation(s)
- Jignesh N Shah
- From the Department of Radiology, University of Texas Health Science Center at Houston, McGovern Medical School (J.N.S., R.M., S.K.); Department of Radiology, University of Tennessee Health Science Center, Memphis, Tenn (D.G., P.K.S., H.B.); Department of Radiology, MD Anderson Cancer Center, Houston, Tex (S.R.P.); Department of Radiology, Sheth G S Medical College and KEM Hospital, Mumbai, India (T.G.); and Department of Radiology, University of Texas Health Science Center at San Antonio, San Antonio, Tex (V.S.K.)
| | - Darshan Gandhi
- From the Department of Radiology, University of Texas Health Science Center at Houston, McGovern Medical School (J.N.S., R.M., S.K.); Department of Radiology, University of Tennessee Health Science Center, Memphis, Tenn (D.G., P.K.S., H.B.); Department of Radiology, MD Anderson Cancer Center, Houston, Tex (S.R.P.); Department of Radiology, Sheth G S Medical College and KEM Hospital, Mumbai, India (T.G.); and Department of Radiology, University of Texas Health Science Center at San Antonio, San Antonio, Tex (V.S.K.)
| | - Srinivasa R Prasad
- From the Department of Radiology, University of Texas Health Science Center at Houston, McGovern Medical School (J.N.S., R.M., S.K.); Department of Radiology, University of Tennessee Health Science Center, Memphis, Tenn (D.G., P.K.S., H.B.); Department of Radiology, MD Anderson Cancer Center, Houston, Tex (S.R.P.); Department of Radiology, Sheth G S Medical College and KEM Hospital, Mumbai, India (T.G.); and Department of Radiology, University of Texas Health Science Center at San Antonio, San Antonio, Tex (V.S.K.)
| | - Preet K Sandhu
- From the Department of Radiology, University of Texas Health Science Center at Houston, McGovern Medical School (J.N.S., R.M., S.K.); Department of Radiology, University of Tennessee Health Science Center, Memphis, Tenn (D.G., P.K.S., H.B.); Department of Radiology, MD Anderson Cancer Center, Houston, Tex (S.R.P.); Department of Radiology, Sheth G S Medical College and KEM Hospital, Mumbai, India (T.G.); and Department of Radiology, University of Texas Health Science Center at San Antonio, San Antonio, Tex (V.S.K.)
| | - Hiral Banker
- From the Department of Radiology, University of Texas Health Science Center at Houston, McGovern Medical School (J.N.S., R.M., S.K.); Department of Radiology, University of Tennessee Health Science Center, Memphis, Tenn (D.G., P.K.S., H.B.); Department of Radiology, MD Anderson Cancer Center, Houston, Tex (S.R.P.); Department of Radiology, Sheth G S Medical College and KEM Hospital, Mumbai, India (T.G.); and Department of Radiology, University of Texas Health Science Center at San Antonio, San Antonio, Tex (V.S.K.)
| | - Ryan Molina
- From the Department of Radiology, University of Texas Health Science Center at Houston, McGovern Medical School (J.N.S., R.M., S.K.); Department of Radiology, University of Tennessee Health Science Center, Memphis, Tenn (D.G., P.K.S., H.B.); Department of Radiology, MD Anderson Cancer Center, Houston, Tex (S.R.P.); Department of Radiology, Sheth G S Medical College and KEM Hospital, Mumbai, India (T.G.); and Department of Radiology, University of Texas Health Science Center at San Antonio, San Antonio, Tex (V.S.K.)
| | - Salman Khan
- From the Department of Radiology, University of Texas Health Science Center at Houston, McGovern Medical School (J.N.S., R.M., S.K.); Department of Radiology, University of Tennessee Health Science Center, Memphis, Tenn (D.G., P.K.S., H.B.); Department of Radiology, MD Anderson Cancer Center, Houston, Tex (S.R.P.); Department of Radiology, Sheth G S Medical College and KEM Hospital, Mumbai, India (T.G.); and Department of Radiology, University of Texas Health Science Center at San Antonio, San Antonio, Tex (V.S.K.)
| | - Tushar Garg
- From the Department of Radiology, University of Texas Health Science Center at Houston, McGovern Medical School (J.N.S., R.M., S.K.); Department of Radiology, University of Tennessee Health Science Center, Memphis, Tenn (D.G., P.K.S., H.B.); Department of Radiology, MD Anderson Cancer Center, Houston, Tex (S.R.P.); Department of Radiology, Sheth G S Medical College and KEM Hospital, Mumbai, India (T.G.); and Department of Radiology, University of Texas Health Science Center at San Antonio, San Antonio, Tex (V.S.K.)
| | - Venkata S Katabathina
- From the Department of Radiology, University of Texas Health Science Center at Houston, McGovern Medical School (J.N.S., R.M., S.K.); Department of Radiology, University of Tennessee Health Science Center, Memphis, Tenn (D.G., P.K.S., H.B.); Department of Radiology, MD Anderson Cancer Center, Houston, Tex (S.R.P.); Department of Radiology, Sheth G S Medical College and KEM Hospital, Mumbai, India (T.G.); and Department of Radiology, University of Texas Health Science Center at San Antonio, San Antonio, Tex (V.S.K.)
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Kumar S, Virarkar M, Vulasala SSR, Daoud T, Ozdemir S, Wieseler C, Vincety-Latorre F, Gopireddy DR, Bhosale P, Lall C. Magnetic Resonance Imaging Virtual Biopsy of Common Solid Renal Masses-A Pictorial Review. J Comput Assist Tomogr 2023; 47:186-198. [PMID: 36790908 DOI: 10.1097/rct.0000000000001424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
ABSTRACT The expanded application of radiologic imaging resulted in an increased incidence of renal masses in the recent decade. Clinically, it is difficult to determine the malignant potential of the renal masses, thus resulting in complex management. Image-guided biopsies are the ongoing standard of care to identify molecular variance but are limited by tumor accessibility and heterogeneity. With the evolving importance of individualized cancer therapies, radiomics has displayed promising results in the identification of tumoral mutation status on routine imaging. This article discusses how magnetic resonance imaging features can guide a radiologist toward identifying renal mass characteristics.
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Affiliation(s)
- Sindhu Kumar
- From the Department of Radiology, University of Florida College of Medicine, Jacksonville, FL
| | - Mayur Virarkar
- From the Department of Radiology, University of Florida College of Medicine, Jacksonville, FL
| | - Sai Swarupa R Vulasala
- From the Department of Radiology, University of Florida College of Medicine, Jacksonville, FL
| | - Taher Daoud
- Division of Diagnostic Imaging, Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Savas Ozdemir
- From the Department of Radiology, University of Florida College of Medicine, Jacksonville, FL
| | - Carissa Wieseler
- From the Department of Radiology, University of Florida College of Medicine, Jacksonville, FL
| | | | - Dheeraj R Gopireddy
- From the Department of Radiology, University of Florida College of Medicine, Jacksonville, FL
| | - Priya Bhosale
- Division of Diagnostic Imaging, Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Chandana Lall
- From the Department of Radiology, University of Florida College of Medicine, Jacksonville, FL
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Fejes Z, Sánta F, Jenei A, Király IE, Varga L, Kuthi L. Angiomyolipoma of the kidney-Clinicopathological analysis of 52 cases. Pathol Oncol Res 2023; 28:1610831. [PMID: 36699622 PMCID: PMC9868137 DOI: 10.3389/pore.2022.1610831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 12/20/2022] [Indexed: 01/10/2023]
Abstract
The renal angiomyolipoma (AML) is a benign tumor characteristically composed of fat, smooth muscle tissue, and vessels. We collected AMLs from our nephrectomy database, reclassified them according to their histological appearance, recorded the demographic, clinical, and pathological parameters, and compared them with oncocytoma (RO) and renal cell carcinoma (RCC). Immunohistochemistry was ordered in 41 cases. In 2224 nephrectomies, we found 52 AMLs with a 53 mm median size. The mean age was 52.76. Forty-eight tumors were sporadic, while four were hereditary. The revision resulted in 31 classic, 13 leiomyoma-like, five lipoma-like, two epithelioid, and one AML with epithelial cysts. SMA was diffusely positive, except for the epithelioid type, while MelanA harbored stronger expression than HMB45. AML was more frequent in females and appeared ten and 7 years earlier than RO and RCC, respectively. The follow-up time was 7.42 years, and neither tumor-related death nor relapse occurred. AML is rare in nephrectomies and develops primarily in females in their 50s with an average size of 50-60 mm at the surgery. The histological appearance in order of frequency is classic, leiomyoma-like, lipoma-like, epithelioid, and cystic. The MelanA, HMB45, and SMA immunohistochemistry can support the light-microscopic findings.
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Affiliation(s)
- Zsuzsanna Fejes
- Department of Radiology, Albert Szent-Györgyi Medical School, University of Szeged, Szeged, Hungary
| | - Fanni Sánta
- Department of Pathology, Albert Szent-Györgyi Medical School, University of Szeged, Szeged, Hungary
| | - Alex Jenei
- Department of Pathology and Experimental Cancer Research, Semmelweis University, Budapest, Hungary
| | - István Előd Király
- Department of Urology, Albert Szent-Györgyi Medical School, University of Szeged, Szeged, Hungary
| | - Linda Varga
- Department of Oncotherapy, Albert Szent-Györgyi Medical School, University of Szeged, Szeged, Hungary
| | - Levente Kuthi
- Department of Pathology, Albert Szent-Györgyi Medical School, University of Szeged, Szeged, Hungary,*Correspondence: Levente Kuthi,
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5
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Ahmed M, Teo H, Sami T, Otite U. Sporadic Renal Angiomyolipoma: Can We Adopt a Uniform Management Protocol? Rev Urol 2022. [DOI: 10.1055/s-0042-1759625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
AbstractRenal angiomyolipomas (AMLs), formerly known as PEComas (tumors showing perivascular epithelioid cell differentiation) are common benign renal masses composed of a varying ratio of fat, blood vessels, and smooth muscles. They are largely asymptomatic and diagnosed incidentally on imaging.The adipose tissue content is the factor that gives AMLs their characteristic appearance on imaging and makes them easily identifiable. However, the fat-poor or fat-invisible varieties, which are difficult to differentiate radiologically from renal cell carcinomas (RCCs), present a diagnostic challenge. It is thus essential to establish the diagnosis and identify the atypical and hereditary cases as they require more intense surveillance and management due to their potential for malignant transformation.Multiple management options are available, ranging from conservative approach to embolization and to the more radical option of nephrectomy. While the indications for intervention are relatively clear and aimed at a rather small cohort, the protocol for follow-up of the remainder of the cohort forming the majority of cases is not well established. The surveillance and discharge policies therefore vary between institutions and even between individual practitioners. We have reviewed the literature to establish an optimum management pathway focusing on the typical AMLs.
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Affiliation(s)
- Mussammet Ahmed
- Department of Urology, Sandwell and West Birmingham NHS Trust, West Midlands, United Kingdom
| | - Hong Teo
- Department of Radiology, Sandwell and West Birmingham NHS Trust, West Midlands, United Kingdom
| | - Tariq Sami
- Department of Urology, Sandwell and West Birmingham NHS Trust, West Midlands, United Kingdom
| | - Ugo Otite
- Department of Urology, Sandwell and West Birmingham NHS Trust, West Midlands, United Kingdom
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Sanchez NG, Ávila Romay AA, Martínez Luna E, Padilla Rodríguez AL. Cutaneous Angiomyolipoma-A Distinct Entity That Should Be Separated From Classic Angiomyolipoma: Complete Review of Existing Cases and Defining Fundamental Features. JMIR DERMATOLOGY 2022; 5:e40168. [PMID: 37632898 PMCID: PMC10334929 DOI: 10.2196/40168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 09/07/2022] [Accepted: 09/17/2022] [Indexed: 11/13/2022] Open
Abstract
Cutaneous angiomyolipoma is a rare mesenchymal tumor that is demographically, clinically, and immunohistochemically distinct from its renal and extrarenal counterparts. We present a case of cutaneous angiomyolipoma in the right retroauricular area of a 35-year-old male patient and provide a broad systematic review of the literature and the largest compilation of cutaneous angiomyolipomas reported to date. According to the findings presented in this review, we conclude that cutaneous angiomyolipoma should be completely separated from renal and extrarenal angiomyolipomas and therefore be considered a distinct entity in the classification of skin tumors.
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Affiliation(s)
- Natalia Gabriela Sanchez
- DIGIPATH: Digital Pathology Laboratory, Mexico City, Mexico
- Instituto Tecnológico y de Estudios Superiores De Monterrey Campus Ciudad de México, Mexico City, Mexico
| | | | | | - Alvaro Lezid Padilla Rodríguez
- DIGIPATH: Digital Pathology Laboratory, Mexico City, Mexico
- Instituto Tecnológico y de Estudios Superiores De Monterrey Campus Ciudad de México, Mexico City, Mexico
- Escuela de Medicina Universidad Panamericana Campus Ciudad de México, Mexico City, Mexico
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Pfirmann P, Jambon E, Aupy J, Bernhard JC, Bakis H, Combe C, Grenier N, Rigothier C. Radiological Characteristics of Renal Lesions During Tuberous Sclerosis Complex: Impact of Mechanistic Target of Rapamycin Inhibitor Treatment. Kidney Int Rep 2022; 7:2299-2302. [PMID: 36217523 PMCID: PMC9546737 DOI: 10.1016/j.ekir.2022.07.168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 07/19/2022] [Accepted: 07/21/2022] [Indexed: 11/27/2022] Open
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Mapuranga H, Douglas-Jones B, du Plessis D, le Roux CE, du Buisson C, Moosa S. A rare case of tuberous sclerosis complex-associated renal cell carcinoma. SA J Radiol 2022; 26:2406. [PMID: 35747782 PMCID: PMC9210185 DOI: 10.4102/sajr.v26i1.2406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Accepted: 03/23/2022] [Indexed: 12/05/2022] Open
Abstract
Renal cell carcinoma is rarely described in paediatric patients with tuberous sclerosis complex. This report describes a case of an 11-year-old male with tuberous sclerosis-associated renal cell carcinoma.
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Affiliation(s)
- Humphrey Mapuranga
- Department of Radio-Diagnosis, Faculty of Medical Imaging and Clinical Oncology, Tygerberg Hospital, Stellenbosch University, Cape Town, South Africa
| | - Bianca Douglas-Jones
- Department of Medical Genetics, Division of Molecular Biology and Human Genetics, Tygerberg Hospital, Stellenbosch University, Cape Town, South Africa
| | - Danelo du Plessis
- Department of Surgery, Division of Urology, Faculty of Medicine and Health Sciences, Tygerberg Hospital, Stellenbosch University, Cape Town, South Africa
| | - Camilla E le Roux
- Department of Radio-Diagnosis, Faculty of Medical Imaging and Clinical Oncology, Tygerberg Hospital, Stellenbosch University, Cape Town, South Africa
| | - Christel du Buisson
- Department of Paediatrics and Child Health, Paediatric Nephrology, Faculty of Medicine and Health Sciences, Tygerberg Hospital, Stellenbosch University, Cape Town, South Africa
| | - Shahida Moosa
- Department of Medical Genetics, Division of Molecular Biology and Human Genetics, Tygerberg Hospital, Stellenbosch University, Cape Town, South Africa
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Pavan H, Garcia TS, Torres FS, Gazzoni FF, Folador L, Ghezzi CLA. Focal incidental upper abdominal findings on unenhanced chest computed tomography that do not require further imaging: a roadmap for the thoracic radiologist. Radiol Bras 2022; 55:173-180. [PMID: 35795597 PMCID: PMC9254702 DOI: 10.1590/0100-3984.2021.0106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Accepted: 09/18/2021] [Indexed: 11/21/2022] Open
Abstract
Abstract Chest scans usually include the upper abdomen, leading radiologists to evaluate the upper abdominal structures. The aim of this article is to summarize the most common incidental upper abdominal findings that do not require further imaging or management in patients undergoing unenhanced computed tomography of the chest for the investigation of thoracic symptoms or diseases. We review common incidental findings of the liver, gallbladder, spleen, adrenal glands, kidney, and retroperitoneum, as well as findings that mimic other lesions. Thoracic radiologists should be aware of such typical findings and report when no further investigation is needed, thus avoiding unnecessary imaging examinations, protecting patients from additional medical interventions, and allaying patient concerns.
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[Modern tomography imaging techniques in urological diseases]. Urologe A 2022; 61:374-383. [PMID: 35262753 DOI: 10.1007/s00120-022-01792-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/08/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND Radiologic imaging is important for the detection, staging and follow-up of urological tumors. Basic therapy decisions for both oncological (surgical vs. systemic therapy, e.g. in testicular cancer) and non-oncological pathologies (interventional vs. conservative therapy, e.g. for ureteral stones) depend largely on the tomographic imaging performed. Due to its almost ubiquitous availability, speed and cost-effectiveness, computed tomography (CT) plays an important role not only in the clarification of abdominal trauma and non-traumatic emergencies, but also in staging and follow-up of oncological patients. However, the level of radiation exposure, impaired renal function and allergies to iodinated contrast media limit the use of CT. Magnetic resonance imaging (MRI) can be a good alternative for many areas of application in oncological and non-oncological imaging due to its high soft tissue differentiation and functional-specific protocols but without the use of ionizing radiation. AIM In the following, the main indications of abdominal and pelvic CT and MRI in urology and their limitations are summarized. RESULTS The areas of application between CT and MRI are increasingly overlapping, since the latest developments in CT continue to further reduce radiation exposure and increase contrast information, while the speed and robustness of MRI are significantly improving at the same time.
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The Benign Renal Masses that Were Exposed after Nephron-Sparing Surgery: "Postsurgical Fatty Tumor." Is It Related to the Surgical Technique? J Kidney Cancer VHL 2021; 9:1-8. [PMID: 34888127 PMCID: PMC8571989 DOI: 10.15586/jkcvhl.v9i1.195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Accepted: 10/18/2021] [Indexed: 11/24/2022] Open
Abstract
After nephron-sparing surgery (NSS), postsurgical fatty tumor could be mistakenly reported as angiomyolipoma during radiologic imaging of some patients. In the present paper, we studied the postsurgical fatty tumor detected after NSS but not covered before in the literature. In addition, we also evaluated whether the postsurgical fatty tumor was related to the surgical technique employed. Patients admitted to the urology department of our university hospital from 2014 to 2019 and operated with open NSS were evaluated retrospectively. We detected those 156 patients were operated with NSS. Nine patients with angiomyolipoma as primary pathology and four patients with surgical border positivity were excluded from the study. The patients were divided into two groups based on the repair of tumor extraction region. In Group 1, fatty tissue was used for repair, and Group 2 is the primary repair group. In all, 143 patients (Group 1 = 79, and Group 2 = 64) were included in the study. No demographic and radiologic differences, such as number of patients, age, gender, positioning of tumor, mass localization, tumor diameter, and RENAL nephrometry scoring system, were detected between the two groups. Postsurgical fatty tumors were detected in 28 patients in Group 1 and in two patients in Group 2 (P < 0.001). In patients with negative surgical margins after partial nephrectomy, lesions that were radiologically detected mimicking as angiomyolipoma were defined as “postsurgical fatty tumor.” This mass containing adipose tissue only neither depicted vascularization and enhancement nor increase in size for at least 1 year. We assumed that these lesions must be followed as benign lesions not requiring additional treatment.
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Liu J, Bao J, Zhang W, Li Q, Hou J, Wei X, Huang Y. The Potential of Visceral Adipose Tissue in Distinguishing Clear Cell Renal Cell Carcinoma from Renal Angiomyolipoma with Minimal Fat. Cancer Manag Res 2021; 13:8907-8914. [PMID: 34876853 PMCID: PMC8643137 DOI: 10.2147/cmar.s336920] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 11/13/2021] [Indexed: 01/05/2023] Open
Abstract
Purpose To overcome the challenge of preoperative differentiation between clear cell renal cell carcinoma (ccRCC) and renal angiomyolipoma with minimal fat (RMFAML), we evaluated the potential of visceral adipose tissue (VAT) in distinguishing RMFAML from ccRCC. Patients and Methods Patients (191) were divided into ccRCC and RMFAML groups according to postoperative pathology. Umbilical horizontal computed tomography (CT) images were used for visceral fat area (VFA), subcutaneous fat area (SFA) and total fat area (TFA) measurements. Logistic regression was used to identify risk factors for ccRCC. Areas under the receiver operating characteristic (ROC) curve (AUCs) were compared to identify the most valuable indicator for identifying ccRCC and RMFAML. Results In total, 166 patients had ccRCC, and 25 had RMFAML. ccRCC and RMFAML patients showed significant differences in age (P<0.001), sex (P<0.001), hypertension (P=0.027), BMI (P<0.001), SFA (P=0.046), VFA (P<0.001) and TFA (P<0.001). According to multiple logistic regression analysis, male sex [4.311 (1.469~12.653), p=0.008]; older age [1.047 (1.008~1.088), p=0.017]; and higher BMI [1.305 (1.088~1.566), p=0.004], SFA [1.013 (1.003~1.023), p=0.008], VFA [1.026 (1.012~1.041), p<0.001] and TFA [1.011 (1.005~1.017), p=0.001] were associated with ccRCC. The AUCs of sex (male), age, BMI, TFA, VFA, and SFA were 0.726, 0.687, 0.783, 0.769, 0.840, and 0.645, respectively. The VFA cut-off value was 69.99 cm2. The sensitivity and specificity of higher VFA (≥69.99 cm2) for ccRCC diagnosis were 79.52% and 80.00%, respectively. Conclusion In differentiating ccRCC from RMFAML, male sex, older age, and higher BMI, TFA, SFA, and VFA are risk factors for ccRCC. VFA is the most effective indicator for identifying ccRCC.
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Affiliation(s)
- Jianhu Liu
- Department of Urology, The First Affiliated Hospital of Soochow University, Suzhou, 215006, People's Republic of China.,Department of Urology, Affiliated Kunshan Hospital of Jiangsu University, Suzhou, 215300, People's Republic of China
| | - Jie Bao
- Department of Radiology, The First Affiliated Hospital of Soochow University, Suzhou, 215006, People's Republic of China
| | - Weijie Zhang
- Department of Urology, The First Affiliated Hospital of Soochow University, Suzhou, 215006, People's Republic of China
| | - Qiaoxing Li
- Department of Urology, Affiliated Kunshan Hospital of Jiangsu University, Suzhou, 215300, People's Republic of China
| | - Jianquan Hou
- Department of Urology, The First Affiliated Hospital of Soochow University, Suzhou, 215006, People's Republic of China
| | - Xuedong Wei
- Department of Urology, The First Affiliated Hospital of Soochow University, Suzhou, 215006, People's Republic of China
| | - Yuhua Huang
- Department of Urology, The First Affiliated Hospital of Soochow University, Suzhou, 215006, People's Republic of China
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Salvador R, Sebastià M, Cárdenas G, Páez-Carpio A, Paño B, Solé M, Nicolau C. CT differentiation of fat-poor angiomyolipomas from papillary renal cell carcinomas: development of a predictive model. Abdom Radiol (NY) 2021; 46:3280-3287. [PMID: 33674961 DOI: 10.1007/s00261-021-02988-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 01/19/2021] [Accepted: 02/09/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE To identify specific contrast-enhanced CT (CECT) findings and develop a predictive model with logistic regression to differentiate fat-poor angiomyolipomas (fpAML) from papillary renal cell carcinomas (pRCC). METHODS This is a single-institution retrospective study that assess CT features of histologically proven 67 pRCC and 13 fpAML. CECT variables were studied by means of univariate logistic regression. Variables included patients' demographics, tumor attenuation (unenhanced and at arterial, venous and excretory post-contrast phases), type of enhancement, morphological features (axial long and short diameters, long-short axis ratio (LSR) and tumor to kidney angle interface) and presence of visible calcifications or vessels. Those variables with a p ≤ 0.05 underwent standard stepwise logistic regression to find predictive combinations of clinical variables. Best models were evaluated by AUROC curves and were subjected to Leave-one-out cross validation to assess their robustness. RESULTS Odds ratio (OR) between pRCC and fpAML was statistically significant for patient's gender, tumor attenuation in arterial, venous and excretory phases, tumor's long diameter, short diameter, LSR, type of enhancement, presence of intratumoral vessels and tumor-kidney angle interface. The best predictive model resulted in an area under the curve (AUC) of 0.971 and included gender, tumor-kidney angle interface and venous attenuation with the following equation: Log(p/1 - p) = - 2.834 + 4.052 * gender + - 0.066 * AngleInterface + 0.074 * VenousphaseHU. CONCLUSIONS The combination of patients' gender, tumor to kidney angle interface and venous enhancement helps to distinguish fpAML from pRCC.
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Affiliation(s)
- R Salvador
- Department of Radiology, Hospital Clínic, Villarroel 170, 08036, Barcelona, Spain.
- Faculty of Medicine and Health Sciences, Universitat de Barcelona, Casanova 143, 08036, Barcelona, Spain.
| | - M Sebastià
- Department of Radiology, Hospital Clínic, Villarroel 170, 08036, Barcelona, Spain
| | - G Cárdenas
- Department of Radiology, Hospital Clínico de la Universidad de Chile, Dr. Carlos Lorca Tobar 999, Independencia, Región Metropolitana, Chile
| | - A Páez-Carpio
- Department of Radiology, Hospital Clínic, Villarroel 170, 08036, Barcelona, Spain
| | - B Paño
- Department of Radiology, Hospital Clínic, Villarroel 170, 08036, Barcelona, Spain
| | - M Solé
- Department of Pathology, Hospital Clínic, Villarroel 170, 08036, Barcelona, Spain
| | - C Nicolau
- Department of Radiology, Hospital Clínic, Villarroel 170, 08036, Barcelona, Spain
- Faculty of Medicine and Health Sciences, Universitat de Barcelona, Casanova 143, 08036, Barcelona, Spain
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14
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Anton DG, Kovvuru K, Kanduri SR, Aeddula NR, Bathini T, Thongprayoon C, Kaewput W, Wijarnpreecha K, Watthanasuntorn K, Salim SA, Matemavi P, Vaitla P, Rivera FC, Cheungpasitporn W. Use and outcomes of kidneys from donors with renal angiomyolipoma: A systematic review. Urol Ann 2021; 13:67-72. [PMID: 33897168 PMCID: PMC8052899 DOI: 10.4103/ua.ua_14_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2020] [Accepted: 08/25/2020] [Indexed: 11/20/2022] Open
Abstract
Background: Renal angiomyolipoma (AML) is the most frequent mesenchymal tumor of the kidney. Although there is a rare possibility of malignant transformation of AML, this risk has not been studied in immunosuppressed patients. The safety of donors with AML and their kidney transplant recipients has not been well established. Methods: A literature search was conducted utilizing MEDLINE, EMBASE, and Cochrane databases from inception through May 15, 2018 (updated on October 2019). We included studies that reported the outcomes of kidney donors with AML or recipients of donor with AML. The protocol for this meta-analysis is registered with PROSPERO (International Prospective Register of Systematic Reviews; no. CRD42018095157). Results: Fourteen studies with a total of 16 donors with AML were identified. None of the donors had a diagnosis of tuberous sclerosis complex (TSC), pulmonary lymphangioleiomyomatosis (LAM), or epithelioid variant of AML. Donor age ranged from 35 to 77 years, and recipient age ranged from 27 to 62 years. Ninety-two percent of the donors were female. Only 8% were deceased donor renal transplant. The majority underwent ex vivo resection (65%) before transplantation, followed by no resection (18%), and the remaining had in vivo resection. Tumor size varied from 0.4 cm to 7 cm, and the majority (87%) were localized in the right kidney. Follow-up time ranged from 1 to 107 months. Donor creatinine prenephrectomy ranged 0.89–1.1 mg/dL and postnephrectomy creatinine 1.0–1.17 mg/dL. In those who did not have resection of the AML, tumor size remained stable. None of the donors with AML had end-stage renal disease or died at last follow-up. None of the recipients had malignant transformation of AML. Conclusion: These findings are reassuring for the safety of donors with AML (without TSC or LAM) as well as their recipients without evidence of malignant transformation of AML. As such, this can also positively impact the donor pool by increasing the number of available kidneys.
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Affiliation(s)
- Desiree Garcia Anton
- Department of Internal Medicine, Division of Nephrology, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Karthik Kovvuru
- Department of Internal Medicine, Division of Nephrology, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Swetha R Kanduri
- Department of Internal Medicine, Division of Nephrology, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Narothama Reddy Aeddula
- Department of Medicine, Division of Nephrology, Deaconess Health System, Evansville, IN, USA
| | - Tarun Bathini
- Department of Internal Medicine, University of Arizona, Tucson, AZ, USA
| | | | - Wisit Kaewput
- Department of Military and Community Medicine, Phramongkutklao College of Medicine, Bangkok, Thailand
| | - Karn Wijarnpreecha
- Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine, Mayo Clinic, Jacksonville, Florida, USA
| | | | - Sohail Abdul Salim
- Department of Internal Medicine, Division of Nephrology, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Praise Matemavi
- Department of Department of Transplant and Hepatobiliary Surgery, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Pradeep Vaitla
- Department of Internal Medicine, Division of Nephrology, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Franco Cabeza Rivera
- Department of Internal Medicine, Division of Nephrology, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Wisit Cheungpasitporn
- Department of Internal Medicine, Division of Nephrology, University of Mississippi Medical Center, Jackson, Mississippi, USA
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15
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Guo Y, Kapoor A, Cheon P, So AI, Lattouf JB, Jamal M. Canadian Urological Association best practice report: Diagnosis and management of sporadic angiomyolipomas. Can Urol Assoc J 2020; 14:E527-E536. [PMID: 33213697 DOI: 10.5489/cuaj.6942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Yanbo Guo
- Division of Urology, Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - Anil Kapoor
- Division of Urology, Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - Paul Cheon
- Division of Urology, Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - Alan I So
- Department of Urologic Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Jean-Baptiste Lattouf
- Departments of Surgery and Urology, Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada
| | - Munir Jamal
- Division of Urology, Department of Surgery, Trillium Health Partners, Mississauga, ON, Canada
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Wang S, Li J, Zhu D, Hua T, Zhao B. Contrast-enhanced magnetic resonance (MR) T1 mapping with low-dose gadolinium-diethylenetriamine pentaacetic acid (Gd-DTPA) is promising in identifying clear cell renal cell carcinoma histopathological grade and differentiating fat-poor angiomyolipoma. Quant Imaging Med Surg 2020; 10:988-998. [PMID: 32489923 DOI: 10.21037/qims-19-723] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Background This study aimed to identify clear cell renal cell carcinoma (ccRCC) histopathological grade and differentiate it from fat-poor angiomyolipoma (AML). This was achieved through contrast-enhanced magnetic resonance (MR) T1 mapping with intravenous low-dose gadolinium-diethylenetriamine pentaacetic acid (Gd-DTPA). Methods In total, 56 consecutive patients received MR scanning between January 2016 and December 2018 using the pre- and post- contrast-enhanced T1 mapping sequences with low-dose Gd-DTPA (0.036 mmol/kg). RCCs were pathologically proven in 40 patients after surgery and graded according to the International Society of Urological Pathology (ISUP) classification system. Ten AMLs were pathologically proven by surgery histopathology and six AMLs were diagnosed by magnetic resonance imaging (MRI). Patients were followed up for more than half a year. The mean T1 values of the renal lesion and ipsilateral normal renal parenchyma were measured before and after Gd-DTPA administration (T1p and T1e). The reduction of T1 value (T1d) and the ratio of its reduction (T1d %) were calculated and compared. Results In 40 ccRCCs, higher-grade [International Society of Urologic Pathology (ISUP) grade 3 and 4] and lower-grade (ISUP grade 1 and 2) ccRCCs were noted in 13 and 27 patients, respectively. The mean T1p was 1,514.8±139.4 ms and the mean T1d was 907.7±193.7 ms in the higher-grade ccRCCs, which were significantly higher than in the lower-grade ccRCCs (T1p =1,251.7±151.5 ms and T1d =648.5±218.2 ms, respectively; P<0.001). Fat-poor AMLs had higher T1p (1,677.3±104.8 ms) and T1e (865.6±251.5 ms) as compared to ccRCCs (P<0.001). Combined T1p + T1d showed the highest area under the curve (AUC) (0.912) in the differentiation of higher-grade ccRCCs from lower-grade ccRCCs (P=0.010). Combined T1p + T1e had the highest AUC (0.956) in the differentiation between ccRCCs and fat-poor AMLs (P=0.010). All T1 mapping metrics could discriminate between normal renal parenchyma and renal lesions (P<0.001). No significant difference was found in the T1p and T1e at different parts of the ipsilateral normal renal parenchyma. Interobserver agreement for quantitative longitudinal relaxation time in the T1 maps was excellent. Conclusions Contrast-enhanced T1 mapping with low-dose Gd-DTPA may provide a more reliable and accurate approach in identifying ccRCCs histopathological grade and differentiating ccRCCs from fat-poor AMLs.
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Affiliation(s)
- Shuai Wang
- Department of Radiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai 200072, China
| | - Junheng Li
- Department of Radiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai 200072, China
| | - Diru Zhu
- Department of Radiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai 200072, China
| | - Ting Hua
- Department of Radiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai 200072, China
| | - Binghui Zhao
- Department of Radiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai 200072, China
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17
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Park SG, Park BK. New radiologic classification of renal angiomyolipoma: frequently asked questions. Clin Imaging 2019; 55:156-160. [DOI: 10.1016/j.clinimag.2019.01.025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Revised: 01/15/2019] [Accepted: 01/31/2019] [Indexed: 01/20/2023]
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18
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Renal Angiomyolipoma Based on New Classification: How to Differentiate It From Renal Cell Carcinoma. AJR Am J Roentgenol 2019; 212:582-588. [PMID: 30620673 DOI: 10.2214/ajr.18.20408] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
OBJECTIVE The purpose of this article is to describe useful imaging features for differentiating angiomyolipoma (AML) subtypes from renal cell carcinoma subtypes. CONCLUSION A newer radiologic classification of renal AML consists of fat-rich AML (≤ -10 HU), fat-poor AML (> -10 HU; tumor-to-spleen ratio < 0.71; signal intensity index, > 16.5%), and fat-invisible AML (> -10 HU; tumor-to-spleen ratio, > 0.71; signal intensity index, < 16.5%). Each subtype must be differentiated from the renal cell carcinoma subtype because of overlapping imaging features.
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Abstract
Angiomyolipomas (AMLs) are the most common benign renal tumours. Most of these neoplasms are found incidentally on imaging. However, symptomatic presentation does exist. Renal AMLs are typically composed of smooth muscle, blood vessels, and adipose tissue. Because of the abundant fat tissue, they give a characteristic appearance on imaging and are therefore easily diagnosed. However, sometimes they contain too little fat to be detected. This increases the difficulty in differentiating them from renal cell carcinoma (RCC). Management of AML is based on clinical presentation and should be individualized for every patient. Treatment modalities range from active surveillance to more invasive approaches.
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20
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Reply to “Radiologic Classification and Imaging Features of Renal Angiomyolipomas According to the Amount of Fat”. AJR Am J Roentgenol 2018; 210:W137-W138. [PMID: 29469629 DOI: 10.2214/ajr.17.19120] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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21
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Radiologic Classification and Imaging Features of Renal Angiomyolipomas According to the Amount of Fat. AJR Am J Roentgenol 2018; 210:W136. [DOI: 10.2214/ajr.17.19079] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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Thiravit S, Teerasamit W, Thiravit P. The different faces of renal angiomyolipomas on radiologic imaging: a pictorial review. Br J Radiol 2018; 91:20170533. [PMID: 29327940 DOI: 10.1259/bjr.20170533] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Renal angiomyolipoma (AML) is an uncommon renal tumour, generally composed of mature adipose tissue, dysmorphic blood vessels and smooth muscle. Identification of intratumoral fat on unenhanced CT images is the most reliable finding for establishing the diagnosis of renal AML. However, AMLs sometimes exhibit atypical findings, including cystic as well as solid forms; some of these variants overlap with the appearance of other renal tumours. A rare type of AML, the epithelioid type, possesses malignant potential. The aim of this pictorial review is to gather the different imaging features of AMLs including the classic and fat-poor types, AMLs with epithelial cysts, epithelioid AML, AML associated with tuberous sclerosis, haemorrhagic AML and large AMLs mimicking retroperitoneal liposarcomas. The diagnostic clues that help to distinguish AMLs from other renal tumours are also described in the review.
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Affiliation(s)
- Shanigarn Thiravit
- 1 Department of Radiology, Faculty of Medicine Siriraj Hospital, Mahidol University , Bangkok , Thailand
| | - Wanwarang Teerasamit
- 1 Department of Radiology, Faculty of Medicine Siriraj Hospital, Mahidol University , Bangkok , Thailand
| | - Phakphoom Thiravit
- 1 Department of Radiology, Faculty of Medicine Siriraj Hospital, Mahidol University , Bangkok , Thailand
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Park BK. Reply: Can Angiomyolipomas be classified fully into three types? Eur J Radiol 2017; 96:117-118. [PMID: 28969873 DOI: 10.1016/j.ejrad.2017.09.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2017] [Accepted: 09/22/2017] [Indexed: 12/26/2022]
Affiliation(s)
- Byung Kwan Park
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
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Recent Strategies for the Management of Renal Angiomyolipoma: A Review of Diagnostic and Therapeutic Approaches. Nephrourol Mon 2017. [DOI: 10.5812/numonthly.14251] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Renal Angiomyolipoma: Radiologic Classification and Imaging Features According to the Amount of Fat. AJR Am J Roentgenol 2017; 209:826-835. [PMID: 28726505 DOI: 10.2214/ajr.17.17973] [Citation(s) in RCA: 61] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE The purposes of this article are to introduce the radiologic classifications of renal angiomyolipoma (AML) and the clinical implications, to show the imaging features of each type of AML, and to describe which types of AML should be biopsied. CONCLUSION Renal AML can be classified according to amount of fat as fat rich, fat poor, or fat invisible. To detect fat, one needs to thoroughly evaluate the entire AML by controlling the size and shape of the ROI. Fat-invisible AML should be biopsied, and fat-poor AML requires further investigation to determine whether biopsy is necessary to differentiate it from renal cell carcinoma. If differentiation between AML and renal cell carcinoma is not clear with CT and MRI, percutaneous biopsy may be performed.
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Jinzaki M, Silverman SG. Can Angiomyolipomas be classified fully into three types? Eur J Radiol 2017; 96:115-116. [PMID: 28595802 DOI: 10.1016/j.ejrad.2017.05.037] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Accepted: 05/26/2017] [Indexed: 11/29/2022]
Affiliation(s)
- Masahiro Jinzaki
- Department of Radiology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan; Department of Radiology, Brigham and Women's Hospital, 75 Francis St., Boston, MA, 02115, United States.
| | - Stuart G Silverman
- Department of Radiology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan; Department of Radiology, Brigham and Women's Hospital, 75 Francis St., Boston, MA, 02115, United States
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The Role of Interventional Radiology Techniques in the Management of Renal Angiomyolipomas. Curr Urol Rep 2017; 18:36. [DOI: 10.1007/s11934-017-0687-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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