Renal angiomyolipoma with minimal fat: differentiation from other neoplasms at double-echo chemical shift FLASH MR imaging

Abstract

Purpose: To prospectively evaluate the diagnostic performance of double-echo gradient-echo (GRE) chemical shift magnetic resonance (MR) imaging in the differentiation of angiomyolipoma (AML) with minimal fat from other renal neoplasms, with pathologic examination or follow-up data serving as the reference standard.

Materials and methods: Institutional review board approval and informed consent were obtained. Double-echo GRE chemical shift MR imaging was performed in 55 patients (29 men and 26 women; mean age, 49 years +/- 14 [standard deviation]) with 55 renal tumors, including 37 (67%) pathologically proved tumors (23 renal cell carcinomas, nine AMLs, two oncocytomas, two lymphomas, and one reninoma) and 18 (33%) clinically diagnosed tumors (17 AMLs and one indeterminate malignancy). All tumors showed no intratumoral fat and had homogeneous enhancement and a prolonged or gradual enhancement pattern on biphasic helical computed tomographic scans. Signal intensity was measured in the renal tumor and spleen on in-phase and opposed-phase images. The signal intensity index and tumor-to-spleen ratio in AMLs and non-AMLs were calculated and compared with the Student t test. Receiver operating characteristic (ROC) analysis was performed to evaluate the diagnostic accuracy of the signal intensity index and tumor-to-spleen ratio and to extract the optimal cut-off values in the differentiation of AMLs and non-AMLs.

Results: The signal intensity index and tumor-to-spleen ratio were different between AMLs (42% +/- 11 and -43% +/- 17, respectively) and non-AMLs (5% +/- 14 and -4% +/- 16, respectively) (P < .001). The area under the ROC curve was 0.975 for the signal intensity index and 0.952 for the tumor-to-spleen ratio. For differentiation of AMLs from non-AMLs, sensitivity and specificity were (a) 96% and 93%, respectively, with a signal intensity index of 25% and (b) 88% and 97%, respectively, with a tumor-to-spleen ratio of -32%.

Conclusion: Double-echo GRE chemical shift MR imaging can be used to differentiate AML with minimal fat from other renal neoplasms.