To see a visual flowchart of the algorithm go here
For non-commercial and non-clinical purposes only. Use at your own risk.
To apply the algorithm in a standardized MRI reporting template, go here
Kay FU, Pedrosa I. Imaging of Solid Renal Masses. Radiol Clin North Am. 2017;55(2):243-58. doi: 10.1016/j.rcl.2016.10.003
Canvasser NE, Kay FU, Xi Y, Pinho DF, Costa D, Diaz de Leon A, Khatri G, Leyendecker JR, Yokoo T, Lay A, Kavoussi N, Koseoglu E, Cadeddu JA, Pedrosa I. Diagnostic Accuracy of Multiparametric Magnetic Resonance Imaging to Identify Clear Cell Renal Cell Carcinoma in cT1a Renal Masses. J Urol. 2017;198(4):780-6. doi: 10.1016/j.juro.2017.04.089
Diaz de Leon A, Davenport MS, Silverman SG, Schieda N, Cadeddu JA, Pedrosa I. Role of Virtual Biopsy in the Management of Renal Masses. AJR Am J Roentgenol. 2019:1-10. doi: 10.2214/AJR.19.21172
Is there macroscopic fat?
Is it a solid mass? (>25% enhancing component)
You should not use ccLS for this mass
It is likely a classic angiomyolipoma (AML)
References:
Israel GM, Hindman N, Hecht E, Krinsky G. The Use of Opposed-Phase Chemical Shift MRI in the Diagnosis of Renal Angiomyolipomas. JR Am J Roentgenol. 2005;184: 1868-1872. doi: 10.2214/ajr.184.6.01841868
Jinzaki M, Silverman SG, Akita H, Mikami S, Mototsuga O. Diagnosis of Renal Angiomyolipomas: Classic, Fat-Poor, and Epithelioid Types. Semin Ultrasound CT MR. 2017;198(4):780-6. doi: 10.1053/j.sult.2016.11.001
Assess T2 signal ONLY in enhancing component of tumor
Enhancement on Corticomedullary (CM) Phase
Assess area with the HIGHEST enhancement on CM phase
Compare between phases using identicaly acquired images (i.e. same sequence and resolution)
Signal Intensity Tumor
Signal Intensity Cortex
Tumor enhancement: NA%
Cortex enhancement: NA%
Tumor-Cortex Ratio: NA%
Is Microscopic Fat Present?
In-Phase Imaging
Opposed-Phase Imaging
Is Segmental Enhancement Inversion (SEI) Present?
Arterial-Delayed Enhancement Ratio (ADER)
Assess for the relative "washout" of the tumor on delayed post-contrast phase
Compare between phases using identicaly acquired images (i.e. same sequence and resolution)
Signal Intensity
The calculated ADER is: 0
Is the tumor homogeneous or marked restriction on DWI?