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Large renal angiomyolipomas: digital subtraction angiographic grading and presentation with bleeding
U Rimon1, M Duvdevani, A Garniek
1Department of Diagnostic Imaging, Chaim Sheba Medical Center, Tel-Hashomer, Sackler School of Medicine, Tel-Aviv University, Israel. rimonu@sheba.health.gov.il
Clinical Radiology
|May 23, 2006
Summary
A new grading system for renal angiomyolipomas (AMLs) using digital subtraction angiography (DSA) and computed tomography (CT) shows that large AMLs with minimal vascularity are less likely to bleed. These findings suggest that prophylactic treatment may not be necessary for such cases.
Area of Science:
- Radiology
- Interventional Radiology
- Oncology
Background:
- Renal angiomyolipomas (AMLs) are benign tumors that can cause significant complications, including bleeding.
- Selecting patients for embolization requires accurate risk assessment.
- Current grading systems may not fully capture the bleeding risk of renal AMLs.
Purpose of the Study:
- To evaluate a novel grading system for renal AMLs based on DSA and CT imaging.
- To determine if this grading system can aid in selecting patients for embolization.
- To correlate tumor vascularity with clinical presentation and bleeding risk.
Main Methods:
- Thirty patients with 35 renal AMLs underwent both DSA and CT.
- Tumors were graded into three categories (I, II, III) based on DSA-determined vascularity.
- Clinical data, including symptoms and bleeding events, were collected and analyzed.
Main Results:
- Seven grade I (minimal vascularity), 18 grade II (moderate vascularity), and 10 grade III (marked vascularity) tumors were identified.
- Grade I tumors were less likely to be symptomatic or cause bleeding (14.3% each) compared to grade II (39% bleeding) and grade III (50% bleeding) tumors.
- Larger tumors (mean 9.9 cm) were observed across all grades, with grade III tumors showing the highest mean size (12.1 cm).
Conclusions:
- The proposed grading system, based on DSA and CT, can help differentiate the bleeding risk of renal AMLs.
- Large AMLs with minimal vascularity (Grade I) appear to have a lower risk of bleeding and may not require prophylactic embolization.
- Further validation in larger patient cohorts is recommended to confirm these findings.
