Which findings on MRI are characteristic of renal lymphoma?

Updated: Jul 26, 2016
  • Author: Ali Shirkhoda, MD; Chief Editor: Eugene C Lin, MD  more...
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Answer

MRI findings in lymphoma are similar to those seen on CT scans, and they are diagnostic to the same degree. Usually, lymphoma displays low signal intensity on T1-weighted MRIs, and it is either isointense or moderately hyperintense on T2-weighted images. Lymphomatous tissue may be minimally enhancing, but it does not enhance as much as normal renal parenchyma; therefore, the lymphomatous tissue remains hypointense relative to the kidney on contrast-enhanced T1-weighted MRIs (see the images below). [23, 24, 8, 21]

T1-weighted magnetic resonance image (repetition t T1-weighted magnetic resonance image (repetition time, 650 ms; echo time, 25 ms) in a 36-year-old woman with bilateral renal lymphoma. This image reveals right-sided nephromegaly. No discrete nodule can be seen in the kidneys.
T2-weighted magnetic resonance image (repetition t T2-weighted magnetic resonance image (repetition time, 2200 ms; echo time, 90 ms) in a 36-year-old woman with bilateral renal lymphoma. This image reveals heterogeneous intensity of the kidneys. Detection of discrete nodules is difficult.
Contrast-enhanced T1-weighted magnetic resonance i Contrast-enhanced T1-weighted magnetic resonance image (repetition time, 650 ms; echo time, 25 ms) in a 36-year-old woman with bilateral renal lymphoma. This image reveals enlargement of the right kidney with diffuse low signal intensity. The discrete low-intensity lesion in the left kidney is better depicted on the contrast-enhanced image. Note the splenomegaly with splenic involvement and ascites.

The degree of confidence of MRI for renal lymphoma depends on the technique that is used for scanning. On breath-hold high-resolution MRIs that are obtained with nonenhanced and contrast-enhanced sequences, MRI is probably equivalent to CT scanning.

When renal involvement is unilateral, it can mimic renal cell carcinoma (see image below). When diffuse renal infiltration is noted without a discrete lesion, the possibility of a false-negative finding increases.

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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