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Hemosiderin deposition in papillary renal cell carcinoma and its potential to mask enhancement on MRI: analysis of 110 cases

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Abstract

Objectives

To evaluate the relationship between imperceptible T1 enhancement of papillary renal cell carcinoma (pRCC) on MR and intratumoral hemosiderin deposition.

Methods

One hundred ten pRCCs (≤ 7 cm) were evaluated by MR with in- and opposed-phase spoiled gradient echo (GRE) and T1-weighted spoiled GRE with fat suppression before and after contrast. Hemosiderin deposition was assessed by SIindex and Dindex on in- and opposed-phase images. SIindex and Dindex are calculated as (SIin − SIopp)/(SIin) × 100, where SIin and SIopp are tumor signal intensities on in- and opposed-phase images and (Din)/(Dopp), where Din and Dopp are tumor diameters on in- and opposed-phase images, respectively. The degree of tumor enhancement was classified as grade 1 (no), grade 2 (subtle), or grade 3 (definite). Tumor enhancement on CT was assessed when available.

Results

Five (5%), 10 (9%), and 95 (86%) tumors were categorized as grades 1, 2, and 3 enhancement, respectively. The mean SIindex was − 33.9, − 25.3, and 1.00, whereas the mean Dindex was 1.26, 1.05, and 1.00 in tumors with grades 1, 2, and 3 enhancement, respectively. Tumors with grade 1 enhancement had significantly lower SIindex (p = 0.001) and higher Dindex (p = 0.005) than those with grade 3 enhancement. Among six tumors with grade 1 or 2 enhancement and available CT, four tumors showed > 20 HU enhancement.

Conclusions

pRCC with no subjective enhancement on contrast-enhanced MR showed hemosiderin deposition evident by lower SIindex and higher Dindex. Hemosiderin deposition might mask the tumor enhancement on MR.

Key Points

• 5% of papillary renal cell carcinoma showed imperceptible enhancement on contrast-enhanced MR.

• Hemosiderin deposition in papillary renal cell carcinoma might mask the tumor enhancement on contrast-enhanced MR due to T2/T2*-shortening effects.

• A renal lesion with extensive hemosiderin deposition but no perceptible enhancement on MR should be considered suspicious for papillary renal cell carcinoma.

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Abbreviations

ER:

Enhancement ratio

FSE:

Fast spin echo

GRE:

Gradient echo

ICC:

Interclass correlation coefficient

pRCC:

Papillary renal cell carcinoma

RCC:

Renal cell carcinoma

ROI:

Region of interest

SE:

Spin echo

SI:

Signal intensity

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The authors state that this work has not received any funding.

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Authors and Affiliations

  1. Department of Diagnostic Radiology, Mayo Clinic, 200 First St. SW, Rochester, MN, 55905, USA

    Hiroaki Takahashi, Akitoshi Inoue, Kazuto Kozaka, Theodora A. Potretzke, Adam T. Froemming & Naoki Takahashi

  2. Department of Diagnostic Radiology, Mayo Clinic, Phoenix, AZ, USA

    Akira Kawashima

  3. Department of Urology, Mayo Clinic, Rochester, MN, USA

    Stephen A. Boorjian

  4. Department of Urology, Mayo Clinic, Phoenix, AZ, USA

    Mitchell R. Humphreys

Authors
  1. Hiroaki Takahashi
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  2. Akira Kawashima
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  3. Akitoshi Inoue
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  4. Kazuto Kozaka
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  5. Theodora A. Potretzke
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  6. Adam T. Froemming
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  8. Mitchell R. Humphreys
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  9. Naoki Takahashi
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Correspondence to Naoki Takahashi.

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Guarantor

The scientific guarantor of this publication is Naoki Takahashi.

Conflict of interest

The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.

Statistics and biometry

No complex statistical methods were necessary for this paper.

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Written informed consent was waived by the Institutional Review Board.

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Institutional Review Board approval was obtained.

Study subjects or cohorts overlap

Some study subjects or cohorts have been previously reported in “Small (<4 cm) renal mass: differentiation of angiomyolipoma without visible fat from renal cell carcinoma utilizing MR imaging” in Radiology.

Methodology

• retrospective

• diagnostic or prognostic study

• performed at one institution

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Takahashi, H., Kawashima, A., Inoue, A. et al. Hemosiderin deposition in papillary renal cell carcinoma and its potential to mask enhancement on MRI: analysis of 110 cases. Eur Radiol 30, 6033–6041 (2020). https://doi.org/10.1007/s00330-020-06994-4

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  • DOI: https://doi.org/10.1007/s00330-020-06994-4

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