Evaluating hemorrhage in renal cell carcinoma using susceptibility weighted imaging

• Published in: PloS one 2013-02, Vol.8 (2), p.e57691-e57691
• Main Authors: Xing, Wei, He, Xiaozhou, Kassir, Mohammad A, Chen, Jie, Ding, Jiule, Sun, Jun, Hu, Jiani, Zhang, Zishu, Haacke, E Mark, Dai, Yongming
• Format: Article
• Language: English
• Subjects: Adult; Aged; Bandwidths; Cancer; Carcinoma, Renal Cell - diagnosis; Carcinoma, Renal Cell - physiopathology; CAT scans; Clear cell-type renal cell carcinoma; Comparative analysis; Computed tomography; Diagnosis; Diagnostic imaging; Diagnostic systems; Female; Hemorrhage; Hemorrhage - diagnosis; Histochemistry; Histopathology; Humans; Imaging techniques; Kidney cancer; Kidney Neoplasms - diagnosis; Kidney Neoplasms - physiopathology; Kidney transplantation; Lesions; Magnetic permeability; Magnetic resonance; Magnetic resonance imaging; Magnetic Resonance Imaging - methods; Male; Materials selection; Medical imaging; Medical prognosis; Medicine; Middle Aged; Nephrectomy; NMR; Nuclear magnetic resonance; Patients; Renal cell carcinoma; Respiration; Retrospective Studies; Tomography, X-Ray Computed - methods; Trauma; Urology
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0057691

Intratumoral hemorrhage is a frequent occurrence in renal cell carcinoma and is an indicator of tumor subtype. We hypothesize that susceptibility weighted imaging (SWI) is sensitive to hemorrhage in renal cell carcinoma and can give a more diagnostic image when compared to conventional imaging techniques. A retrospective review of 32 patients with clear cell renal cell carcinoma was evaluated. All patients underwent magnetic resonance imaging (MRI) and 22 out of 32 patients also underwent a computed tomography (CT) scan. Hemorrhage was classified into 3 different categories according to shape and distribution. Histopathology was obtained from all masses by radical nephrectomy. The ability to detect the presence of hemorrhage using CT, non-contrast conventional MRI and SWI was evaluated, and the patterns of hemorrhage were compared. Using pathologic results as the gold standard, the sensitivities of non-contrast conventional MRI, SWI and CT in detecting hemorrhage in clear cell renal cell carcinoma were 65.6%, 100% and 22.7%, respectively. Accuracy of non-contrast conventional MRI and SWI in evaluating hemorrhagic patterns were 31.3% and 100%, respectively. These results demonstrate that SWI can better reveal hemorrhage and characterize the pattern more accurately than either non-contrast conventional MRI or CT. This suggests that SWI is the technique of choice for detecting hemorrhagic lesions in patients with renal cancer.