Combined late gadolinium-enhanced and double-echo chemical-shift MRI help to differentiate renal oncocytomas with high central T2 signal intensity from renal cell carcinomas

AJR Am J Roentgenol. 2013 Apr;200(4):830-8. doi: 10.2214/AJR.12.9122.


Objective: The purpose of our study was to evaluate the combination of dynamic contrast-enhanced T1-weighted and double-echo gradient-echo MR imaging to distinguish renal oncocytoma with high T2 signal intensity centrally from renal cell carcinoma (RCC).

Materials and methods: Between 2006 and 2011, 63 renal tumors (59 patients) presenting with a high signal intensity (SI) central area on T2-weighted sequences were imaged with dynamic contrast-enhanced sequences, including phases later than 5 minutes after contrast injection, and double-echo chemical-shift sequences were selected from our institutional database. Two experienced radiologists visually assessed presence and distribution of signal enhancement of central areas after injection and measured SI changes on opposed-phase images for calculation of the SI index and tumor-to-spleen ratio. Cutoff values were derived from the receiver operating characteristic (ROC) curve.

Results: There were 19 oncocytomas (16 patients), 43 RCCs (42 patients), and one leiomyoma. Complete late enhancement of the central area was observed in 14 oncocytomas (74%) and in five RCCs (12%) (p = 0.05). The combination of complete enhancement and SI index lower than 2% (p = 0.02) or tumor-to-spleen ratio higher than -6% (p = 0.001) provided sensitivity of 36% and 55%, specificity of 95% and 97%, positive predictive value of 67% and 86%, and negative predictive value of 84% and 88%, respectively, for diagnosis of oncocytomas.

Conclusion: Absence of central area SI inversion or presence of a signal drop on chemical-shift imaging may rule out the diagnosis of oncocytoma.

MeSH terms

  • Adenoma, Oxyphilic / diagnosis*
  • Adult
  • Aged
  • Aged, 80 and over
  • Carcinoma, Renal Cell / diagnosis*
  • Contrast Media
  • Diagnosis, Differential
  • Female
  • Humans
  • Kidney Neoplasms / diagnosis*
  • Leiomyoma / diagnosis
  • Magnetic Resonance Imaging / methods*
  • Male
  • Middle Aged
  • Predictive Value of Tests
  • ROC Curve
  • Retrospective Studies
  • Sensitivity and Specificity


  • Contrast Media