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Osseous Metastasis from Renal Cell Carcinoma: "Flow-Void" Sign at MR Imaging¹

¹ From the Department of Radiology, Seoul National University College of Medicine, 28 Yongon-dong, Chongno-gu, Seoul 110-744, Korea; and the Institute of Radiation Medicine, SNUMRC (Seoul National University Medical Research Center), and Clinical Research Institute, Seoul National University Hospital, Korea (J.A.C., K.H.L., W.S.J., H.S.K.); Department of Radiology, Kumi Cha Hospital, Pochon Cha University, Kyoungsangbook-do, Korea (M.G.Y.); and Department of Pathology, National Cancer Center, Gyeonggi-do, Korea (S.L.). Received September 9, 2002; revision requested November 18; revision received December 3; accepted January 15, 2003. Address correspondence to H.S.K. (e-mail: kanghs@radcom.snu.ac.kr).

View larger version (132K): [in a new window]   Figure 1a. Images of the femur in a 61-year-old man with osseous metastasis from RCC. (a) Anteroposterior radiograph shows ill-defined osteolytic lesion (arrows) in the medial condyle. (b) Coronal T1-weighted MR image acquired with a conventional SE pulse sequence (450/14) shows a mass with intermediate signal intensity. Note the multiple dotlike or tubular structures of low signal intensity (arrows) inside and adjacent to the mass.

View larger version (148K): [in a new window]   Figure 1b. Images of the femur in a 61-year-old man with osseous metastasis from RCC. (a) Anteroposterior radiograph shows ill-defined osteolytic lesion (arrows) in the medial condyle. (b) Coronal T1-weighted MR image acquired with a conventional SE pulse sequence (450/14) shows a mass with intermediate signal intensity. Note the multiple dotlike or tubular structures of low signal intensity (arrows) inside and adjacent to the mass.

View larger version (135K): [in a new window]   Figure 2a. Images of the spine in a 54-year-old man with osseous metastasis from RCC. (a) Lateral radiograph shows an osteolytic lesion (arrows) in the L1 vertebral body. (b) Sagittal T1-weighted MR image acquired with a conventional SE pulse sequence (650/12) shows masses with intermediate signal intensity in the T12 and L1 vertebral bodies. Note the multiple dotlike or tubular structures (arrows) of low signal intensity inside these metastatic lesions, also seen in c. (c) Sagittal T2-weighted MR image obtained with a fast SE pulse sequence (650/12; echo train length, 15) shows hyperintense masses containing multiple dotlike or tubular structures (arrows). (d) Lateral selective digital subtraction angiographic image shows engorged vessels (arrows) with arteriovenous shunting in the L1 vertebral body.

View larger version (140K): [in a new window]   Figure 2b. Images of the spine in a 54-year-old man with osseous metastasis from RCC. (a) Lateral radiograph shows an osteolytic lesion (arrows) in the L1 vertebral body. (b) Sagittal T1-weighted MR image acquired with a conventional SE pulse sequence (650/12) shows masses with intermediate signal intensity in the T12 and L1 vertebral bodies. Note the multiple dotlike or tubular structures (arrows) of low signal intensity inside these metastatic lesions, also seen in c. (c) Sagittal T2-weighted MR image obtained with a fast SE pulse sequence (650/12; echo train length, 15) shows hyperintense masses containing multiple dotlike or tubular structures (arrows). (d) Lateral selective digital subtraction angiographic image shows engorged vessels (arrows) with arteriovenous shunting in the L1 vertebral body.

View larger version (167K): [in a new window]   Figure 2c. Images of the spine in a 54-year-old man with osseous metastasis from RCC. (a) Lateral radiograph shows an osteolytic lesion (arrows) in the L1 vertebral body. (b) Sagittal T1-weighted MR image acquired with a conventional SE pulse sequence (650/12) shows masses with intermediate signal intensity in the T12 and L1 vertebral bodies. Note the multiple dotlike or tubular structures (arrows) of low signal intensity inside these metastatic lesions, also seen in c. (c) Sagittal T2-weighted MR image obtained with a fast SE pulse sequence (650/12; echo train length, 15) shows hyperintense masses containing multiple dotlike or tubular structures (arrows). (d) Lateral selective digital subtraction angiographic image shows engorged vessels (arrows) with arteriovenous shunting in the L1 vertebral body.

View larger version (140K): [in a new window]   Figure 2d. Images of the spine in a 54-year-old man with osseous metastasis from RCC. (a) Lateral radiograph shows an osteolytic lesion (arrows) in the L1 vertebral body. (b) Sagittal T1-weighted MR image acquired with a conventional SE pulse sequence (650/12) shows masses with intermediate signal intensity in the T12 and L1 vertebral bodies. Note the multiple dotlike or tubular structures (arrows) of low signal intensity inside these metastatic lesions, also seen in c. (c) Sagittal T2-weighted MR image obtained with a fast SE pulse sequence (650/12; echo train length, 15) shows hyperintense masses containing multiple dotlike or tubular structures (arrows). (d) Lateral selective digital subtraction angiographic image shows engorged vessels (arrows) with arteriovenous shunting in the L1 vertebral body.

View larger version (131K): [in a new window]   Figure 3a. Images of the chest in a 54-year-old man with osseous metastasis from RCC. (a) Anteroposterior radiograph shows the opacity of a large mass with destruction of the 5th rib on the patient’s right side. (b) Contrast-enhanced transverse CT image shows a mass near the chest wall. Note the tortuous vessels (arrows) inside the mass. (c) Transverse T1-weighted MR image acquired with a conventional SE sequence (550/12) shows a hyperintense mass. Note the multiple dotlike or tubular structures of low signal intensity (arrows) inside the lesions, also visible in d. (d) Contrast-enhanced coronal T1-weighted MR image acquired with a conventional SE sequence (594/15) shows enhancement in the mass and multiple dotlike or tubular structures of low signal intensity (arrows).

View larger version (122K): [in a new window]   Figure 3b. Images of the chest in a 54-year-old man with osseous metastasis from RCC. (a) Anteroposterior radiograph shows the opacity of a large mass with destruction of the 5th rib on the patient’s right side. (b) Contrast-enhanced transverse CT image shows a mass near the chest wall. Note the tortuous vessels (arrows) inside the mass. (c) Transverse T1-weighted MR image acquired with a conventional SE sequence (550/12) shows a hyperintense mass. Note the multiple dotlike or tubular structures of low signal intensity (arrows) inside the lesions, also visible in d. (d) Contrast-enhanced coronal T1-weighted MR image acquired with a conventional SE sequence (594/15) shows enhancement in the mass and multiple dotlike or tubular structures of low signal intensity (arrows).

View larger version (114K): [in a new window]   Figure 3c. Images of the chest in a 54-year-old man with osseous metastasis from RCC. (a) Anteroposterior radiograph shows the opacity of a large mass with destruction of the 5th rib on the patient’s right side. (b) Contrast-enhanced transverse CT image shows a mass near the chest wall. Note the tortuous vessels (arrows) inside the mass. (c) Transverse T1-weighted MR image acquired with a conventional SE sequence (550/12) shows a hyperintense mass. Note the multiple dotlike or tubular structures of low signal intensity (arrows) inside the lesions, also visible in d. (d) Contrast-enhanced coronal T1-weighted MR image acquired with a conventional SE sequence (594/15) shows enhancement in the mass and multiple dotlike or tubular structures of low signal intensity (arrows).

View larger version (147K): [in a new window]   Figure 3d. Images of the chest in a 54-year-old man with osseous metastasis from RCC. (a) Anteroposterior radiograph shows the opacity of a large mass with destruction of the 5th rib on the patient’s right side. (b) Contrast-enhanced transverse CT image shows a mass near the chest wall. Note the tortuous vessels (arrows) inside the mass. (c) Transverse T1-weighted MR image acquired with a conventional SE sequence (550/12) shows a hyperintense mass. Note the multiple dotlike or tubular structures of low signal intensity (arrows) inside the lesions, also visible in d. (d) Contrast-enhanced coronal T1-weighted MR image acquired with a conventional SE sequence (594/15) shows enhancement in the mass and multiple dotlike or tubular structures of low signal intensity (arrows).