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

Updated: Dec 13, 2018
  • Author: Deborah A Baumgarten, MD, MPH; Chief Editor: Eugene C Lin, MD  more...
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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 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 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 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 ren 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 ren 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 ren 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 ren 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 ren 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 ren 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 wi 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 wi 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 wi Case 19. Left renal cell carcinoma in a patient with polycystic kidney disease. Axial T1-weighted contrast-enhanced MRI.

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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