0:01

Dr. Farnaz, we're back with our, our lady,

0:01

3 00:00:03,320 --> 00:00:05,649 our gal, with, uh, renal cell carcinoma.

0:05

As you know, they're more common in men.

0:07

And 95% of the time, they're sporadic.

0:10

But about 5% of the time,

0:12

they can be syndromic or familial.

0:14

The classic one is von Hippel-Lindau.

0:16

Another one would be tuberous sclerosis.

0:17

They can also get renal cell carcinoma.

0:20

But you and I were chatting on the side

0:22

about, uh, diffusion imaging, and in our prior

0:25

vignette, we got into some detail about it.

0:27

And said that viscosity, high viscosity

0:29

necrosis can produce diffusion restriction.

0:32

But these are not particularly cell-packed lesions.

0:35

But some people are using diffusion, uh,

0:38

to assess for hypernephroma recurrence.

0:41

Can you tell us a little bit about that?

0:42

Yeah, and that's true.

0:43

People are having a trend, especially in patients

0:46

who've already had nephrectomy, and they don't want

0:47

to be predisposed to any risks of giving contrast.

0:52

The pitfall that we really have to pay attention

0:56

to is renal cell, clear-celled renal cell, tends

1:00

to invade veins and will expand veins, but we

1:04

can't, uh, count, we can't use diffusion, uh,

1:09

to help us determine vascular invasion because

1:14

of the low cellularity that these lesions are.

1:17

We can miss vein invasion.

1:21

And which we've seen that, uh,

1:23

on different circumstances before.

1:24

Is there another potential problem?

1:24

35 00:01:26,130 --> 00:01:28,050 If the lesion doesn't, if the primary

1:28

doesn't diffusion restrict, what about

1:29

the metastases or the other lesions?

1:31

That's exactly right.

1:32

They might or might not diffusion restrict as well.

1:34

And then I'll leave you with one last point.

1:36

Um, the pathologic rating for renal cell

1:38

carcinoma includes the Furhman grading system.

1:41

I'm not going to give that to you right now.

1:43

But if there's necrosis, there's more

1:45

likely to be diffusion restriction

1:47

from hyperviscosity and necrosis

1:50

correlates with Furhman grades 3 and 4.

1:52

Shall we move on?

1:53

Yes.

1:54

Let's.