Magnetic Resonance Imaging Findings of Subtypes of Renal Cell Carcinoma
Özet
This article reviews the diagnostic value of Magnetic Resonance Imaging (MRI) in differentiating the main histological subtypes of renal cell carcinoma (RCC), which constitutes 90% of kidney tumors. The World Health Organization classifies RCC primarily into clear cell (ccRCC, 70-75%), papillary (pRCC, 10-21%), and chromophobe (chrRCC, 5%) subtypes. Accurate pre-operative differentiation remains challenging due to overlapping imaging features with benign lesions like angiomyolipomas and oncocytomas. ccRCC is characteristically hypervascular, showing strong enhancement during the corticomedullary phase, and typically appears hyperintense or isointense on T2-weighted images, often featuring central necrosis or vascular invasion in larger tumors. Conversely, pRCC is generally hypovascular, demonstrating low T2 signal intensity and progressive contrast enhancement. chrRCC typically presents as a large, well-circumscribed homogeneous lesion with moderate to low T2 intensity and a moderate enhancement pattern that sits between ccRCC and pRCC. While Diffusion-Weighted Imaging (DWI) and Apparent Diffusion Coefficient (ADC) values assist in identification—with ccRCC generally showing higher ADC values than non-ccRCCs—conflicting data exists regarding its efficacy in separating pRCC from chrRCC. Consequently, multiparametric MRI serves as a critical problem-solving tool, though biopsy remains necessary when imaging features are insufficient for a definitive prognostic evaluation.
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