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European Radiology
Published in: European Radiology 7/2015

01-07-2015 | Urogenital

Intracellular lipid in papillary renal cell carcinoma (pRCC): T2 weighted (T2W) MRI and pathologic correlation

Authors: Nicola Schieda, Christian B. van der Pol, Bardia Moosavi, Matthew D. F. McInnes, Kien T. Mai, Trevor A. Flood

Published in: European Radiology | Issue 7/2015

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Abstract

Objective

To evaluate if pRCCs demonstrate intracellular lipid (i-lipid) at chemical-shift (CS) MRI, and assess T2W-MRI and pathologic characteristics.

Methodology

Sixty-two patients with a pRCC diagnosis underwent MRI over 11 years (IRB-approved). Two radiologists independently assessed for presence of i-lipid on CS-MRI and homogeneity on T2W-MRI. Inter-observer agreement was assessed via an intraclass correlation and results were compared using the Chi-square test. Discordant cases were reviewed to establish consensus. T2W SI-ratios (SI.tumor/SI.kidney) and CS-SI index were compared using independent t-tests and Spearman correlation. Two pathologists re-evaluated the histopathology.

Results

Nine of the 62 pRCCs (14.5 %) demonstrated i-lipid; agreement was moderate (ICC = 0.63). Pathology review depicted clear cells in four tumours and foamy histiocytes in five tumours.
25.8-35.4 % (ICC = 0.65) of tumours were homogeneous on T2W-MRI. No pRCC with i-lipid was considered homogeneous (p = 0.01-0.04). Overall, T2W SI-ratio and CS-SI index were 0.89 (±0.29) and -3.63 % (-7.27 to 11.42). pRCC with i-lipid had significantly higher T2W SI-ratio (p = 0.003). There was a correlation between the CS-SI index and T2W SI-ratio, (r = 0.44, p < 0.001).

Conclusions

Intracellular lipid is uncommonly detected in pRCCs due to clear cell changes and foamy histiocytes. These tumours are associated with heterogeneously-increased SI in T2W-MRI.

Key Points

• A minority of pRCCs demonstrate intracellular lipid in CS-MRI.
• Quantitatively, intracellular lipid in pRCCs is minimal (<25 %).
• Intracellular lipid in pRCCs are from clear cell heterogeneity or foamy histiocytes.
• pRCCs with intracellular lipid are heterogeneously hyperintense at T2W-MRI.
• pRCCs that are homogeneously hypointense at T2W-MRI do not contain intracellular lipid.
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Metadata
Title
Intracellular lipid in papillary renal cell carcinoma (pRCC): T2 weighted (T2W) MRI and pathologic correlation
Authors
Nicola Schieda
Christian B. van der Pol
Bardia Moosavi
Matthew D. F. McInnes
Kien T. Mai
Trevor A. Flood
Publication date
01-07-2015
Publisher
Springer Berlin Heidelberg
Published in
European Radiology / Issue 7/2015
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI
https://doi.org/10.1007/s00330-015-3610-x

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