0:00

Dr. Finazzo, how do you want to summarize,

0:01

3 00:00:03,310 --> 00:00:05,860 or could you summarize for us, the role of MRI

0:06

in the assessment of renal masses and why?

0:08

Yes, so as we brought home the point, and this one is,

0:11

the first one is, can we identify enhancement on CT?

0:15

And when we cannot identify enhancement,

0:18

uh, or whether or not something is truly

0:20

enhancing or if there's pseudo enhancement,

0:22

we tend to go to MRI as the next choice.

0:25

Another time that we have difficulty

0:27

in assessing whether or not there's

0:29

enhancement or not is in ultrasound.

0:31

And here's an example of a patient who's being

0:33

evaluated, and there's a hypoechoic or

0:38

isoechoic lesion along the lateral pole of the left

0:40

kidney and the question is, is there enhancement?

0:43

And we know that we can turn up the gain, we can turn

0:45

down the gain, we can do whatever we want with the

0:48

gain, uh, but as long as we have renal parenchyma

0:52

within this lesion that we're trying to evaluate,

0:55

we can pretty much say whether or not something

0:57

is, uh, solid or not solid, but whether there's

1:01

enhancement or not is sometimes very difficult.

1:04

And a third example of, um, wait times

1:08

that we can't truly evaluate enhancement

1:11

are in these densely calcified lesions.

1:15

Where we don't know if we're dealing with

1:17

just a hemorrhagic cyst that calcified or

1:20

are we dealing with a burnt-out renal cell,

1:23

almost similar to like a burnt-out seminoma.

1:26

So these are three classic examples

1:29

of indeterminate enhancement.

1:32

But now, once we define or clearly see

1:35

that we have an enhancing lesion, in this

1:38

particular case where we're dealing, we

1:40

know this is already a renal cell carcinoma.

1:43

But the second most important role for MRI

1:47

is to try to do some histologic subtyping

1:50

and to look at tumor aggressiveness.

1:52

And that's how we'll progress into MRI.

1:55

And we'll discuss some of the

1:56

biomarkers for those criteria.

1:58

Let's move on.

1:59

Dr. P and Dr. Finazzo, out.