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Renal lymphoma: demonstration by MR imaging
R C Semelka1, N L Kelekis, D A Burdeny
1Department of Radiology, University of North Carolina, Chapel Hill 27599-7510, USA.
Objective:
The objective of this study was to demonstrate the spectrum of appearances of renal lymphoma using current MR techniques including gadolinium enhancement.
Materials And Methods:
Twelve patients with renal lymphoma were examined by MR imaging on a 1.5-T scanner. MR examinations included T2-weighted, breath-hold T1-weighted spoiled gradient-echo, and T1-weighted fat-suppressed spin-echo imaging before and after gadolinium administration. Tumor morphology, signal intensity, and enhancement features were evaluated.
Results:
Three types of renal involvement were observed: large paraaortic retroperitoneal masses with extension into the renal hilum, the subcapsular space, or both (nine patients); unilateral diffuse infiltration of the renal parenchyma (one patient); and focal rounded intraparenchymal masses (two patients). Untreated lymphoma (10 patients) was slightly hypointense relative to the renal cortex on T1-weighted images and was heterogenous and slightly hypointense or isointense on T2-weighted images. Enhancement of lymphomatous tissue was mildly heterogenous and was minimal on early images after gadolinium enhancement and remained minimal on late contrast-enhanced images in most tumor masses. No central necrosis of tumor was identified, and no renal vein thrombus was present. Five patients with lymphoma that presented as a large paraaortic mass showed diminished renal cortical perfusion of the involved kidney. All of these patients also had tumor extension into the renal hilum.
Conclusion:
Three types of renal involvement with lymphoma were observed. The most common appearance was a large retroperitoneal mass that invaded the kidney. Tumors had low to intermediate signal intensity on T1- and T2-weighted images and had diffuse heterogenous enhancement that was less than that of renal parenchyma.
Insights
This study reveals three main appearances of renal lymphoma using MRI, with large retroperitoneal masses invading the kidney being most common. These tumors show characteristic signal intensities and heterogeneous enhancement patterns on MRI scans.
Area of Science:
- Radiology
- Oncology
- Medical Imaging
Background:
- Renal lymphoma is a rare but significant condition.
- Accurate imaging is crucial for diagnosis and management.
- Magnetic Resonance (MR) imaging offers detailed anatomical and functional information.
Purpose of the Study:
- To delineate the spectrum of renal lymphoma appearances on MR imaging.
- To evaluate the utility of current MR techniques, including gadolinium enhancement, in characterizing renal lymphoma.
- To correlate imaging findings with pathological subtypes and clinical presentation.
Main Methods:
- MR imaging was performed on 12 patients with renal lymphoma using a 1.5-T scanner.
- Standard MR sequences included T2-weighted, T1-weighted spoiled gradient-echo, and T1-weighted fat-suppressed spin-echo.
- Imaging was conducted before and after gadolinium administration to assess enhancement patterns.
Main Results:
- Three patterns of renal involvement were identified: large retroperitoneal masses with renal invasion (9 patients), diffuse renal infiltration (1 patient), and focal intraparenchymal masses (2 patients).
- Lymphoma typically appeared hypointense on T1-weighted and variable on T2-weighted images.
- Mildly heterogeneous, minimal enhancement was observed after gadolinium administration, with no central necrosis or renal vein thrombus.
Conclusions:
- Renal lymphoma presents with diverse appearances on MR imaging.
- The most frequent pattern involves large retroperitoneal masses extending into the kidney.
- MR imaging characteristics, including signal intensity and enhancement, aid in differentiating renal lymphoma from other renal masses.