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A review of clinical and MR imaging features of renal lipid-poor angiomyolipomas

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Abstract

Background

Lipid-poor angiomyolipomas (lpAMLs) constitute up to 5% of renal angiomyolipomas and are challenging to differentiate from malignant renal lesions on imaging alone. This review aims to identify clinical and MRI features which can be utilized to improve specificity and diagnostic accuracy for detecting lpAMLs in patients being considered for active surveillance rather than intervention.

Findings

Young age, female sex, and small lesion size are associated with lpAMLs in studies evaluating indeterminate renal lesions. The accuracy of criteria using T2-weighted imaging, diffusion-weighted imaging, chemical shift imaging, dynamic contrast enhancement, multiparametric imaging, and radiomics are reviewed. Low T2 signal intensity is a particularly important MRI feature for lpAML. In studies with low T2 signal intensity, homogeneous early enhancement is a typical feature with an arterial-to-delay enhancement ratio > 1.5. Intratumoral hemorrhage with decrease in signal intensity on in-phase chemical shift imaging may be particularly useful for differentiating papillary renal cell carcinomas from lpAMLs in low T2 signal intensity lesions. Combining clinical and multiparametric MRI features can result in near-perfect specificity for lpAML.

Summary

In select patients, clinical and MRI features can result in a high specificity and diagnostic accuracy for lpAMLs. These lesions can be considered for active surveillance rather than invasive diagnostic and therapeutic procedures such as biopsy or surgery.

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Funding

No funding was used for this review.

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Authors and Affiliations

  1. Department of Radiology and Diagnostic Imaging, University of Alberta, 2B2.41 WMC, 8440-112 Street NW, T6G 2B7, Edmonton, AB, Canada

    Mitchell P. Wilson, Deelan Patel, Prayash Katlariwala & Gavin Low

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  1. Mitchell P. Wilson
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  2. Deelan Patel
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  3. Prayash Katlariwala
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All authors have contributed to the design, review, write-up and editing of this article. All authors have approved the final manuscript.

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Correspondence to Mitchell P. Wilson.

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Wilson, M.P., Patel, D., Katlariwala, P. et al. A review of clinical and MR imaging features of renal lipid-poor angiomyolipomas. Abdom Radiol 46, 2072–2078 (2021). https://doi.org/10.1007/s00261-020-02835-6

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  • DOI: https://doi.org/10.1007/s00261-020-02835-6

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