What is the role of imaging in the diagnosis of renal lymphoma?

Updated: Mar 22, 2019
  • Author: Ali Shirkhoda, MD; Chief Editor: Eugene C Lin, MD  more...
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Answer

Numerous diagnostic studies are available for the evaluation of renal involvement from lymphoma, including intravenous urography, ultrasonography, nuclear medicine, MRI, and CT scanning. [16, 23, 24] Although each technique may provide useful information in the detection, characterization, and staging of the disease, CT scanning remains the most sensitive, efficient, and comprehensive modality. [21, 25]

Urography provides information regarding involvement of the collecting system, the functional status of the kidneys, and the severity of hydronephrosis. Ultrasonography is a good screening examination, particularly for the assessment and follow-up of patients with hydronephrosis. In comparison, nuclear medicine studies, particularly those that use gallium-67 citrate, have a higher degree of specificity in the detection of lymphomatous infiltration of the kidneys. MRI provides information for characterizing the lesion, and it is also helpful in assessing the renal vascular pedicle.

CT scanning is the diagnostic modality of choice in patients with suspected renal masses (see the images below). CT scans depict renal involvement in most patients with lymphoma, often help in defining the extent of disease within and outside of the kidneys, and provide information for staging of the patient's underlying malignancy. In addition, the result of treatment can be assessed on follow-up CT scans. The CT scan examination must be done with intravenous contrast media. Therefore, if contrast media cannot be used in patients for reasons such as renal failure or allergy to iodine, MRI then becomes the diagnostic modality of choice.

Contrast-enhanced computed tomography scan in a 15 Contrast-enhanced computed tomography scan in a 15-year-old male adolescent with non-Hodgkin lymphoma. This image shows a bilateral pattern of multiple small nodules that are almost of equal size and involve both kidneys.
Sagittal baseline sonogram in a 15-year-old male a Sagittal baseline sonogram in a 15-year-old male adolescent with non-Hodgkin lymphoma. This image shows near-normal architecture of the left kidney. Both kidneys were reported as normal (left kidney size, 11.4 X 5.7 cm), and no indication of hydronephrosis was noted.
Contrast-enhanced computed tomography scan obtaine Contrast-enhanced computed tomography scan obtained during the nephrographic phase in a 93-year-old woman with non-Hodgkin lymphoma, in whom renal lymphoma mimicked renal cell carcinoma. This image reveals a single mass with heterogeneous attenuation that involves the right kidney, as well as an associated lymphadenopathy in the right side of the retroperitoneum. The findings suggest renal cell carcinoma with ipsilateral adenopathy. A normal variant of an extrarenal pelvis is noted in the left side.
Contrast-enhanced, breath-hold, T1-weighted magnet Contrast-enhanced, breath-hold, T1-weighted magnetic resonance image (MRI) (repetition time, 190 ms; echo time, 4 ms) in a 93-year-old woman with non-Hodgkin lymphoma. This image shows a mass with heterogeneous signal intensity in the right kidney; areas of low signal intensity reveal necrosis in the mass. MRI was performed to assess the renal vascular pedicle and inferior vena cava, both of which were free of tumor. Because of the patient's history of non-Hodgkin lymphoma (for which she received treatment), biopsy was performed to exclude renal cell carcinoma. The diagnosis of renal lymphoma was proven, and the patient received appropriate treatment.

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