Small renal cell carcinoma: MRI with pathologic correlation

The MRI features of small renal cell carcinomas (RCCs) were retrospectively reviewed and correlated with histology in 24 patients. MRI features on both T1- and T2-weighted images were classified into hypointensity, isointensity, and hyperintensity. Each tumor was pathologically classified into four types: alveolar, papillary, tubular, and cystic. These findings were correlated with MR signal intensities. Alveolar tumors showed hypointensity to isointensity on T1-weighted image and isointensity to hyperintensity on T2-weighted image. In contrast, all papillary tumors showed hypointensity on T2-weighted image. Four of six tumors with hypointensity on T2-weighted image were caused by hemosiderin deposition, hemorrhage, and necrosis. However, there were two papillary RCCs that showed hypointensity on T2-weighted image despite no hemosiderin deposition and no hemorrhage. We conclude that papillary RCC is associated with T2-hypointense appearance as well as hemosiderin deposition, hemorrhage, and necrosis.