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European Radiology

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01-05-2019 | Urogenital

Can we predict the existence of extrarenal feeders to renal angiomyolipomas?

Authors: Xixi Zhang, Ryohei Kuwatsuru, Hiroshi Toei, Daiske Yashiro, Shingo Okada, Hitomi Kato

Published in: European Radiology | Issue 5/2019

Abstract

Objectives

To identify factors predicting the presence of extrarenal feeders to renal angiomyolipomas (AMLs)

Methods

This is a retrospective study of 44 patients with 58 renal AMLs embolized in our department. Arteriography obtained during embolization and CT angiography obtained before and after embolization were reviewed to characterize AMLs with and without extrarenal feeders. Tumor characteristics were compared between the two groups. Simple logistic regression and ROC curve analysis were performed. P < 0.05 was considered to be statistically significant.

Results

Of the 58 AMLs reviewed, 29% had extrarenal arteries and 71% did not. AMLs with extrarenal feeders were significantly larger than those without, in terms of volume (median, 368 mL versus 109 mL, p < 0.0002) and the largest diameter (mean, 12.0 cm versus 7.7 cm, p < 0.0001). Patient age, presence of tuberous sclerosis complex or sporadic lymphangioleiomyomatosis, and tumor location did not differ between the groups. The largest diameter and volume had similar predictive values for the presence of extrarenal feeders (AUC, 0.83 versus 0.82, p = 0.673). Extrarenal feeders were present in 0%, 21%, and 79% of the AMLs ≤ 6.5 cm, AMLs 6.6–10.5 cm, and AMLs > 10.5 cm, respectively.

Conclusions

AML size correlates with the presence of extrarenal feeders, with the largest diameter and volume being significant predictors. AMLs > 10.5 cm had a high chance of extrarenal feeders, making it mandatory to search for feeders to them in order to avoid incomplete embolization; AMLs ≤ 6.5 cm did not have extrarenal feeders, making a search for them unnecessary in these cases.

Key Points

• The presence of extrarenal feeders to renal angiomyolipoma is associated with tumor size, but not with patient age, concomitant disease, or tumor location.

• The largest diameter and volume predict the presence of extrarenal feeders to AML, with similar predictive values.

• AMLs > 10.5 cm have a high chance (79%) of extrarenal feeders, making it mandatory to search for feeders to them in order to avoid incomplete embolization; AMLs ≤ 6.5 cm do not have extrarenal feeders, making a search for them unnecessary in these cases.

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Title: Can we predict the existence of extrarenal feeders to renal angiomyolipomas?
Authors: Xixi Zhang
Ryohei Kuwatsuru
Hiroshi Toei
Daiske Yashiro
Shingo Okada
Hitomi Kato
Publication date: 01-05-2019
Publisher: Springer Berlin Heidelberg
Published in: European Radiology / Issue 5/2019
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI: https://doi.org/10.1007/s00330-018-5877-1

At a glance: The STEP trials

Springer Medicine

Can we predict the existence of extrarenal feeders to renal angiomyolipomas?

Abstract

Objectives

Methods

Results

Conclusions

Key Points

At a glance: The STEP trials

Springer Medicine

Abstract

Objectives

Methods

Results

Conclusions

Key Points

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