0:00

Dr.P here with a different patient in this set,

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3 00:00:05,040 --> 00:00:08,920 our 65-year-old gal that has a more rounded left-sided

0:08

renal mass, less exophytic, a mushroom-like than we

0:13

would expect for the classic type of angiomyolipoma.

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This lesion and prior vignettes demonstrated some

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ill-defined micro and minimal macroscopic fat,

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mostly microscopic fat, and I'm here to talk a

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little bit about the enhancement characteristics.

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I've got early enhancement, although

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it's not a complete arterial phase.

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We're probably in it around 50 seconds

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and then on subsequent images, obtained about every

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50 seconds thereafter, we see what happens to our mass.

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So early intense enhancement is

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characteristic of angiomyolipoma.

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There's the curve, but it's also characteristic

0:50

of hypervascular renal cell carcinoma.

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So the washout, you would expect

0:55

the benign lesion not to wash out.

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22 00:00:58,210 --> 00:01:02,520 But angiomyolipoma can and frequently does.

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Now the washout is usually a slower washout.

1:05

A hugely steep curve, which can be seen with either

1:08

one, and then a very brisk drop thereafter, would

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suggest something a bit more aggressive and malignant.

1:15

So DCEMRI, in my opinion, my pragmatic

1:18

opinion as a practitioner,

1:20

doesn't have a tremendous amount of value.

1:23

It can help drive you one way or the other,

1:25

to biopsy or not to biopsy, to remove or not to

1:27

remove, but it is not a major criterion for making

1:31

the decision as to whether you have the benign,

1:34

fat-poor angiomyolipoma or renal cell carcinoma.

1:38

And if you go deeper into the time activity

1:40

curve, the kidney itself, as you get into the

1:42

nephrogenic phase, 2, 3, 4 minutes and so on,

1:46

the kidney is getting brighter, the lesion

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is, and this one is staying somewhat constant.

1:51

So if I was to describe this curve, it looks like

1:53

a catch and hold or slight rise curve. But with the

1:56

kidney catching up to it, it's starting to blend in

1:59

with the rest of the kidney in contrast to the cyst,

2:03

which is totally, completely cold with no papillary

2:07

projections. And lesions like that, even ones that

2:10

are complex on non-contrast MRI, I leave alone.

2:14

Let's move on, shall we?

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Dr. P out.