J Korean Soc Radiol.  2016 Aug;75(2):77-91. 10.3348/jksr.2016.75.2.77.

Current MR Imaging of Renal Cell Carcinoma

• Oh S
• Sung DJ

• KMID: 2344797
• DOI: http://doi.org/10.3348/jksr.2016.75.2.77

Abstract

Renal cell carcinoma (RCC) consists of approximately 85-90% of renal masses, and its incidence is increasing due to widespread use of modern imaging modalities such as ultrasonography or computed tomography. Computed tomography has served an important role in the diagnosis and staging of RCC; however, recent advances in magnetic resonance imaging (MRI) techniques have considerably improved our ability to predict tumor biology beyond the morphologic assessment. Multiparametric MRI protocols include standard sequences tailored for the morphologic evaluation and acquisitions that provide information about the tumor microenvironment such as diffusion-weighted imaging and dynamic contrast-enhanced MRI. The role of multiparametric MRI in the evaluation of RCC now extends to preoperative characterization of RCC subtypes, histologic grade, and quantitative assessment of tumor response to targeted therapies in patients with metastatic disease. Herein, the clinical applications and recent advances in MRI applied to RCC are reviewed along with its merits and demerits. We aimed to review MRI techniques and image analysis that can improve the management of patients with RCC. Familiarity with the advanced MRI techniques and various imaging findings of RCC would also facilitate optimal clinical recommendations for patients.

MeSH Terms

Biology
Carcinoma, Renal Cell*
Diagnosis
Humans
Incidence
Magnetic Resonance Imaging*
Recognition (Psychology)
Tumor Microenvironment
Ultrasonography

Figure

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  Fig. 1 61-year-old woman with clear cell renal cell carcinoma in right kidney. A. On T2-weighted MR image, the tumor (arrow) in right kidney shows heterogeneous hyperintensity, as compared to the normal cortex. B. Fat-suppressed axial T1-weighted image shows the tumor (arrow) as slightly hypointense. C, D. Contrast-enhanced fat-suppressed axial T1-weighted images show heterogeneous enhancement in the tumor (arrow) at corticomedullary phase (C) and wash-out in the tumor at nephrographic phase (D).

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  Fig. 2 56-year-old man with papillary cell renal cell carcinoma in right kidney. A. Axial T2-weighted image shows a small hypointense tumor (arrow) in right kidney. B. Fat-suppressed axial T1-weighted image also shows the tumor (arrow) as isointense. C. Contrast-enhanced fat-suppressed axial T1-weighted image shows poor enhancement in the tumor (arrow) at corticomedullary phase.

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  Fig. 3 76-year-old woman with angiomyolipoma in left kidney. A. On T2-weighted MR image, the tumor (arrow) in left kidney shows hypointensity, as compared to the normal cortex. B. Fat-suppressed axial T1-weighted image also shows the tumor (arrow) as isointense. C. Contrast-enhanced fat-suppressed axial T1-weighted image shows heterogeneous enhancement in the tumor at corticomedullary phase. D. Diffusion-weighted image acquired at b = 800 sec/mm2 shows the tumor (arrow) as slightly hyperintense. E. Apparent diffusion coefficient map shows obvious diffusion restriction in the tumor (arrow).

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  Fig. 4 44-year-old woman with angiomyolipoma in right kidney. A, B. In-phase MR image (A) shows the tumor (arrow) as slightly hyperintense and out-of-phase MR image (B) shows obvious signal intensity drop in the tumor (arrow). C. Fat-suppressed axial T1-weighted image shows the tumor (arrow) as hypointense.

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  Fig. 5 82-year-old man with clear cell renal cell carcinoma in left kidney. A. Axial T2-weighted image shows a heterogeneously hyperintense tumor (arrow) in left kidney. B. Contrast-enhanced fat-suppressed axial T1-weighted image shows a heterogeneously enhancing tumor (arrow) in left kidney at corticomedullary phase. C, D. In-phase MR image (C) shows the tumor (arrow) as isointense and out-of-phase MR image (D) shows focal signal intensity drop (arrow) in the tumor.

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  Fig. 6 71-year-old woman with chromophobe renal cell carcinoma in left kidney. A. Axial T2-weighted image shows a small and heterogeneously hypointense tumor (arrow) in left kidney. B. Fat-suppressed axial T1-weighted image shows the tumor (arrow) as isointense. C. Contrast-enhanced fat-suppressed axial T1-weighted image shows poor enhancement in the tumor (arrow) at corticomedullary phase.

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  Fig. 7 47-year-old woman with clear cell renal cell carcinoma in left kidney. A. Axial T2-weighted image shows a heterogeneously hyperintense tumor in left kidney. B. Contrast-enhanced fat-suppressed axial T1-weighted image shows heterogeneous enhancement in the tumor at corticomedullary phase. C. Diffusion-weighted image acquired at b = 800 sec/mm2 shows the tumor (arrow) as heterogeneously hyperintense. D. Apparent diffusion coefficient map shows obvious diffusion restriction in the tumor (arrow).

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  Fig. 8 71-year-old man with papillary cell renal cell carcinoma in right kidney. A. On T2-weighted MR image, the tumor (arrow) in right kidney shows hypointensity, as compared to the normal cortex. B. Contrast-enhanced fat-suppressed axial T1-weighted image shows poor enhancement in the tumor (arrow) at corticomedullary phase. C. Diffusion-weighted image acquired at b = 800 sec/mm2 shows the tumor (arrow) as hyperintense. D. Apparent diffusion coefficient map shows diffusion restriction in the tumor (arrow).

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  Fig. 9 42-year-old woman with Fuhrman grade II clear cell renal cell carcinoma in left kidney and 66-year-old man with Fuhrman grade IV clear cell renal cell carcinoma in left kidney. A, B. The tumor (arrows) confirmed as Fuhrman grade II clear cell renal cell carcinoma shows subtle hyperintensity on diffusion-weighted image acquired at b = 800 sec/mm2 (A) and diffusion restriction on apparent diffusion coefficient map (B). The calculated apparent diffusion coefficient value of the Fuhrman grade II clear cell renal cell carcinoma is 1.15 × 10-3 mm2/sec. C, D. The tumor (arrows) confirmed as Fuhrman grade IV clear cell renal cell carcinoma shows heterogeneous hyperintensity on diffusion-weighted image acquired at b = 800 sec/mm2 (C) and prominent diffusion restriction on apparent diffusion coefficient map (D). The calculated apparent diffusion coefficient value of the Fuhrman grade IV clear cell renal cell carcinoma is 0.91 × 10-3 mm2/sec.

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  Fig. 10 48-year-old man with clear cell renal cell carcinoma in left kidney. A. Coronal T2-weighted image shows a heterogeneously hyperintense tumor in left kidney with thrombus (arrow) in left renal vein. B. Contrast-enhanced fat-suppressed coronal T1-weighted image shows heterogeneous enhancement in the thrombus (arrow) in left renal vein. The enhancing thrombus was confirmed as tumor thrombus at surgery.

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  Fig. 11 54-year-old man with clear cell renal cell carcinoma treated initially by renal cryoablation. A, B. Two years after cryoablation, the treated tumor (arrows) shows hypointensity on axial T2-weighted image (A) and no enhancement on contrast-enhanced axial T1-weighted image (B). C, D. Four years after cryoablation, a focal and subtle hyperintensity (arrow) is newly seen at the treated tumor on axial T2-weighted image (C), and a distinct nodular enhancement (arrow) is demonstrated at the newly developed, focal hyperintensity on contrast-enhanced fat-suppressed axial T1-weighted image (D). The nodular enhancement was confirmed as recurred clear cell renal cell carcinoma, which was treated again by radiofrequency ablation.

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  Fig. 12 54-year-old woman with tuberous sclerosis and clear cell renal cell carcinoma treated initially by radical nephrectomy. A. Contrast-enhanced axial CT image shows a heterogeneously enhancing mass suggesting tumor recurrence at previous left nephrectomy site. B, C. Three months after targeted therapy with antiangiogenetic agent, the recurred tumor shows heterogeneous hyperintensity on fat-suppressed axial T1-weighted image (B) and poor enhancement on contrast-enhanced fat-suppressed axial T1-weighted image (C). Angiomyolipoma showing heterogeneous enhancement is seen in upper pole of right kidney.

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