Which MRI findings are characteristic of renal cell carcinoma (RCC)?

Answer

MRI findings are similar to those of CT, with masses ranging from predominantly cystic with septa or nodularity to solid with enhancement. The numeric criteria for enhancement are not defined for MRI as they are for CT, but MRI signal intensity changes can be measured.^{[34, 35, 36, 37, 38, 39, 40, 41, 42]}

(For MRIs of RCC, see the images below.)

Case 16. Left renal cell carcinoma in patient who underwent prior right nephrectomy for renal cell carcinoma. T1-weighted axial magnetic resonance image (MRI).

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Case 16. Left renal cell carcinoma in patient with prior right nephrectomy for renal cell carcinoma. T2-weighted axial MRI with renal vein invasion and extension of tumor into the inferior vena cava.

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Case 16. Left renal cell carcinoma in patient with prior right nephrectomy for renal cell carcinoma. T2-weighted axial MRI obtained above the level in image 38. Tumor extends into the intrahepatic inferior vena cava.

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Case 17. Large right renal cell carcinoma with renal vein and inferior vena cava invasion. T2-weighted axial MRI.

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Case 17. Large right renal cell carcinoma with renal vein and inferior vena cava invasion. T2-weighted axial MRI.

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Case 17. Large right renal cell carcinoma with renal vein and inferior vena cava invasion. T2-weighted coronal MRI.

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Case 18. Large right renal cell carcinoma with renal vein and inferior vena cava invasion. T1-weighted axial MRI before contrast enhancement.

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Case 18. Large right renal cell carcinoma with renal vein and inferior vena cava invasion. T1-weighted contrast-enhanced axial MRI.

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Case 18. Large right renal cell carcinoma with renal vein and inferior vena cava invasion. T2-weighted axial MRI.

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Case 19. Left renal cell carcinoma in a patient with polycystic kidney disease. Axial T2-weighted MRI.

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Case 19. Left renal cell carcinoma in a patient with polycystic kidney disease. Axial T1-weighted MRI before contrast enhancement.

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Case 19. Left renal cell carcinoma in a patient with polycystic kidney disease. Axial T1-weighted contrast-enhanced MRI.

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On nonenhanced T1-weighted images, RCCs usually appear isointense or hypointense relative to the remainder of the kidney. With chemical shift imaging,^[43]some clear cell carcinomas show focal or diffuse loss of signal intensity. On T2-weighted images, RCCs are usually hyperintense. Most often, they are heterogeneous.

The presence of necrosis or hemorrhage may alter these signal intensity characteristics. MRI may be especially helpful in imaging the superior or inferior poles of the kidneys, in direct coronal or sagittal imaging, and in determining invasion of venous structures.

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Case 1. Large renal cell carcinoma. Three-minute tomogram.
Case 1. Large renal cell carcinoma. Delayed intravenous urographic image.
Case 1. Large renal cell carcinoma. Contrast-enhanced computed tomography (CT) scan.
Case 2. Large renal cell carcinoma. Delayed tomogram.
Case 2. Large renal cell carcinoma. Sonogram.
Case 2. Large renal cell carcinoma. Contrast-enhanced CT scan.
Case 3. Small left renal cell carcinoma is subtle on this intravenous urographic image.
Case 3. Small renal cell carcinoma. Tomogram.
Case 3. Small renal cell carcinoma. Contrast-enhanced CT scan.
Case 4. Renal cell carcinoma. Dedicated renal CT scan. Before contrast enhancement, right kidney.
Case 4. Renal cell carcinoma. Dedicated renal CT scan obtained before contrast enhancement. Right kidney has an attenuation measurement of 45.7 HU.
Case 4. Renal cell carcinoma. Contrast-enhanced dedicated renal CT scan. Right kidney.
Case 4. Renal cell carcinoma. Contrast-enhanced dedicated renal CT scan with an attenuation measurement of 101.7 HU.
Case 5. Typical renal cell carcinoma. CT scan obtained before contrast enhancement has an attenuation measurement of 33.9 HU.
Case 5. Typical renal cell carcinoma. Contrast-enhanced CT scan has an attenuation measurement of 75.8 HU.
Case 6. Multifocal renal cell carcinoma in a patient with Von Hippel-Lindau disease. Contrast-enhanced CT scan.
Case 6. Multifocal renal cell carcinoma in a patient with Von Hippel Lindau disease. Patient had already undergone a right nephrectomy. Contrast-enhanced CT scan.
Case 7. Multifocal renal cell carcinoma in patient presenting with palpable mass. Nonenhanced CT scan.
Case 7. Multifocal renal cell carcinoma. Nonenhanced CT scan.
Case 7. Multifocal renal cell carcinoma. Contrast-enhanced CT scan.
Case 7. Multifocal renal cell carcinoma. Contrast-enhanced CT scan.
Case 8. Cystic renal cell carcinoma. Nonenhanced CT scan with an attenuation measurement of 25.8 HU.
Case 8. Cystic renal cell carcinoma. Contrast-enhanced CT scan with an attenuation measurement of 47.1 HU.
Case 9. Cystic renal cell carcinoma. Contrast-enhanced CT scan with an enhancing rim of soft tissue.
Case 9. Renal cell carcinoma. Metastatic lesion to the thoracic spine. Loss of the anterior cortex of a midthoracic vertebral body, with the suggestion of an anterior soft-tissue mass is shown.
Case 10. Stage 4 renal cell carcinoma. Metastatic disease to the mediastinal nodes and left rib.
Case 10. Stage 4 renal cell carcinoma. Metastatic disease to the liver.
Case 10. Stage 4 renal cell carcinoma. Metastatic disease to the right iliac bone.
Case 11. Stage 3a renal cell carcinoma. Patient receiving long-term dialysis with a proven right-sided renal cell carcinoma. Image shows inferior vena cava invasion.
Case 11. Stage 3a renal cell carcinoma. Right atrial extension of a tumor thrombus.
Case 12. Recurrent renal cell carcinoma. Status post–right nephrectomy with local recurrence (arrow) in nephrectomy bed. Contrast-enhanced CT scan.
Case 13. Recurrent renal cell carcinoma. Status post–left nephrectomy with metastatic disease to mediastinal nodes. Contrast-enhanced CT scan.
Case 13. Recurrent renal cell carcinoma. Status post left nephrectomy with metastatic disease to the contralateral adrenal gland.
Case 14. Recurrent renal cell carcinoma. Status post right nephrectomy with metastatic disease to the ipsilateral psoas muscle and liver.
Case 14. Recurrent renal cell carcinoma. Status post right nephrectomy with metastatic disease to the liver.
Case 15. Renal cell carcinoma. Angiomyolipoma. Contrast-enhanced CT scan.
Case 16. Left renal cell carcinoma in patient who underwent prior right nephrectomy for renal cell carcinoma. T1-weighted axial magnetic resonance image (MRI).
Case 16. Left renal cell carcinoma in patient with prior right nephrectomy for renal cell carcinoma. T2-weighted axial MRI with renal vein invasion and extension of tumor into the inferior vena cava.
Case 16. Left renal cell carcinoma in patient with prior right nephrectomy for renal cell carcinoma. T2-weighted axial MRI obtained above the level in image 38. Tumor extends into the intrahepatic inferior vena cava.
Case 17. Large right renal cell carcinoma with renal vein and inferior vena cava invasion. T2-weighted axial MRI.
Case 17. Large right renal cell carcinoma with renal vein and inferior vena cava invasion. T2-weighted axial MRI.
Case 17. Large right renal cell carcinoma with renal vein and inferior vena cava invasion. T2-weighted coronal MRI.
Case 18. Large right renal cell carcinoma with renal vein and inferior vena cava invasion. T1-weighted axial MRI before contrast enhancement.
Case 18. Large right renal cell carcinoma with renal vein and inferior vena cava invasion. T1-weighted contrast-enhanced axial MRI.
Case 18. Large right renal cell carcinoma with renal vein and inferior vena cava invasion. T2-weighted axial MRI.
Case 19. Left renal cell carcinoma in a patient with polycystic kidney disease. Axial T2-weighted MRI.
Case 19. Left renal cell carcinoma in a patient with polycystic kidney disease. Axial T1-weighted MRI before contrast enhancement.
Case 19. Left renal cell carcinoma in a patient with polycystic kidney disease. Axial T1-weighted contrast-enhanced MRI.
Case 20. Renal cell carcinoma. Oncocytoma. T2-weighted axial MRI.
Case 20. Renal cell carcinoma. Oncocytoma. Dynamic enhanced coronal T1-weighted MRI.
Case 21. Right renal cell carcinoma. Ultrasonogram.
Case 21. Right renal cell carcinoma. Doppler ultrasonogram.
Case 21. Right renal cell carcinoma. Doppler ultrasonogram obtained prior to the intravenous administration of ultrasonographic contrast agent.
Case 21. Right renal cell carcinoma. Doppler ultrasonogram obtained after the intravenous administration of ultrasonographic contrast agent.
Case 22. Left renal cell carcinoma. Ultrasonogram.
Case 22. Left renal cell carcinoma. Nonenhanced CT scan.
Case 22. Left renal cell carcinoma. Contrast-enhanced CT scan.
Case 22. Left renal cell carcinoma. Anterior component of circumaortic renal vein is normal.
Case 22. Left renal cell carcinoma. Posterior component of circumaortic renal vein is normal.
Case 23. Renal cell carcinoma. Complex cyst. Nonenhanced CT scan.
Case 23. Renal cell carcinoma. Complex cyst. Contrast-enhanced CT scan.
Case 23. Renal cell carcinoma. Complex cyst. Ultrasonogram with low-level echoes.
Case 23. Renal cell carcinoma. Complex cyst. Doppler ultrasonogram shows no internal flow.
Case 24 CT axial image from a CT angiogram on a patient with renal cell carcinoma in a horseshoe kidney.
Case 24 CT axial image slightly lower from a CT angiogram on a patient with renal cell carcinoma in a horseshoe kidney.
Case 24 Volume rendered image from a CT angiogram on a patient with renal cell carcinoma in a horseshoe kidney. The tumor has been colored to show relationship to the multiple renal arteries (two on the left and two on the right, one of which comes from below from the iliac artery).

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Which MRI findings are characteristic of renal cell carcinoma (RCC)?

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