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Angiomyolipoma with Minimal Fat: Differentiation from Renal Cell Carcinoma at Biphasic Helical CT¹

¹ From the Department of Radiology, Asan Medical Center, 388–1 Poongnap-dong, Songpa-gu, Seoul 138–736, Korea. Received January 1, 2003; revision requested March 14; final revision received July 14; accepted August 22. Address correspondence to K.S.C. (e-mail: kscho@amc.seoul.kr).

View larger version (107K): [in a new window]   Figure 1a. Transverse CT scans in a 47-year-old woman with AML with minimal fat. (a) Unenhanced scan obtained at the level of the right renal hilum shows a well-defined mass (arrows) with high attenuation relative to adjacent renal parenchyma. On contrast-enhanced scans obtained at the same level as a in (b) the corticomedullary phase and (c) the early excretory phase, the tumor (arrows) shows homogeneous enhancement. The amount of tumor enhancement was 55 HU in the corticomedullary phase and 50 HU in the early excretory phase, and, hence, the tumor was considered to have a prolonged enhancement pattern.

View larger version (148K): [in a new window]   Figure 1b. Transverse CT scans in a 47-year-old woman with AML with minimal fat. (a) Unenhanced scan obtained at the level of the right renal hilum shows a well-defined mass (arrows) with high attenuation relative to adjacent renal parenchyma. On contrast-enhanced scans obtained at the same level as a in (b) the corticomedullary phase and (c) the early excretory phase, the tumor (arrows) shows homogeneous enhancement. The amount of tumor enhancement was 55 HU in the corticomedullary phase and 50 HU in the early excretory phase, and, hence, the tumor was considered to have a prolonged enhancement pattern.

View larger version (147K): [in a new window]   Figure 1c. Transverse CT scans in a 47-year-old woman with AML with minimal fat. (a) Unenhanced scan obtained at the level of the right renal hilum shows a well-defined mass (arrows) with high attenuation relative to adjacent renal parenchyma. On contrast-enhanced scans obtained at the same level as a in (b) the corticomedullary phase and (c) the early excretory phase, the tumor (arrows) shows homogeneous enhancement. The amount of tumor enhancement was 55 HU in the corticomedullary phase and 50 HU in the early excretory phase, and, hence, the tumor was considered to have a prolonged enhancement pattern.

View larger version (155K): [in a new window]   Figure 2a. Transverse CT scans in a 52-year-old man with RCC. (a) Unenhanced scan obtained at the level of the left renal hilum shows a well-defined mass (arrows) with isoattenuation relative to adjacent renal parenchyma. On contrast-enhanced scans obtained at the same level as a in (b) the corticomedullary phase and (c) the early excretory phase, the tumor (arrows) shows heterogeneous enhancement. The amount of tumor enhancement was 135 HU in the corticomedullary phase and 110 HU in the early excretory phase, and because the tumor decreased in attenuation by more than 20 HU, it was considered to have an early washout enhancement pattern.

View larger version (166K): [in a new window]   Figure 2b. Transverse CT scans in a 52-year-old man with RCC. (a) Unenhanced scan obtained at the level of the left renal hilum shows a well-defined mass (arrows) with isoattenuation relative to adjacent renal parenchyma. On contrast-enhanced scans obtained at the same level as a in (b) the corticomedullary phase and (c) the early excretory phase, the tumor (arrows) shows heterogeneous enhancement. The amount of tumor enhancement was 135 HU in the corticomedullary phase and 110 HU in the early excretory phase, and because the tumor decreased in attenuation by more than 20 HU, it was considered to have an early washout enhancement pattern.

View larger version (161K): [in a new window]   Figure 2c. Transverse CT scans in a 52-year-old man with RCC. (a) Unenhanced scan obtained at the level of the left renal hilum shows a well-defined mass (arrows) with isoattenuation relative to adjacent renal parenchyma. On contrast-enhanced scans obtained at the same level as a in (b) the corticomedullary phase and (c) the early excretory phase, the tumor (arrows) shows heterogeneous enhancement. The amount of tumor enhancement was 135 HU in the corticomedullary phase and 110 HU in the early excretory phase, and because the tumor decreased in attenuation by more than 20 HU, it was considered to have an early washout enhancement pattern.

View larger version (136K): [in a new window]   Figure 3a. Transverse CT scans in a 58-year-old man with RCC. (a) Unenhanced scan obtained at a level just above the left renal hilum shows a well-defined mass (arrowheads) with intratumoral calcifications. The tumor shows isoattenuation relative to adjacent renal parenchyma. On contrast-enhanced scans obtained at the same level as a in (b) the corticomedullary phase and (c) the early excretory phase, the tumor (arrowheads) shows homogeneous enhancement. The amount of tumor enhancement was 33 HU in the corticomedullary phase and 58 HU in the early excretory phase; thus, the tumor was considered to have a gradual enhancement pattern.

View larger version (159K): [in a new window]   Figure 3b. Transverse CT scans in a 58-year-old man with RCC. (a) Unenhanced scan obtained at a level just above the left renal hilum shows a well-defined mass (arrowheads) with intratumoral calcifications. The tumor shows isoattenuation relative to adjacent renal parenchyma. On contrast-enhanced scans obtained at the same level as a in (b) the corticomedullary phase and (c) the early excretory phase, the tumor (arrowheads) shows homogeneous enhancement. The amount of tumor enhancement was 33 HU in the corticomedullary phase and 58 HU in the early excretory phase; thus, the tumor was considered to have a gradual enhancement pattern.

View larger version (165K): [in a new window]   Figure 3c. Transverse CT scans in a 58-year-old man with RCC. (a) Unenhanced scan obtained at a level just above the left renal hilum shows a well-defined mass (arrowheads) with intratumoral calcifications. The tumor shows isoattenuation relative to adjacent renal parenchyma. On contrast-enhanced scans obtained at the same level as a in (b) the corticomedullary phase and (c) the early excretory phase, the tumor (arrowheads) shows homogeneous enhancement. The amount of tumor enhancement was 33 HU in the corticomedullary phase and 58 HU in the early excretory phase; thus, the tumor was considered to have a gradual enhancement pattern.

View larger version (115K): [in a new window]   Figure 4a. Transverse CT scans in a 49-year-old man with RCC. (a) Unenhanced scan obtained at the level of the lower portion of the left kidney shows a well-defined mass (arrows) with isoattenuation relative to adjacent renal parenchyma. On contrast-enhanced scans obtained at the same level as a in (b) the corticomedullary phase and (c) the early excretory phase, the tumor (arrows) shows homogeneous enhancement. The amount of tumor enhancement was 45 HU in the corticomedullary phase and 36 HU in the early excretory phase; thus, the tumor was considered to have a prolonged enhancement pattern.

View larger version (114K): [in a new window]   Figure 4b. Transverse CT scans in a 49-year-old man with RCC. (a) Unenhanced scan obtained at the level of the lower portion of the left kidney shows a well-defined mass (arrows) with isoattenuation relative to adjacent renal parenchyma. On contrast-enhanced scans obtained at the same level as a in (b) the corticomedullary phase and (c) the early excretory phase, the tumor (arrows) shows homogeneous enhancement. The amount of tumor enhancement was 45 HU in the corticomedullary phase and 36 HU in the early excretory phase; thus, the tumor was considered to have a prolonged enhancement pattern.

View larger version (124K): [in a new window]   Figure 4c. Transverse CT scans in a 49-year-old man with RCC. (a) Unenhanced scan obtained at the level of the lower portion of the left kidney shows a well-defined mass (arrows) with isoattenuation relative to adjacent renal parenchyma. On contrast-enhanced scans obtained at the same level as a in (b) the corticomedullary phase and (c) the early excretory phase, the tumor (arrows) shows homogeneous enhancement. The amount of tumor enhancement was 45 HU in the corticomedullary phase and 36 HU in the early excretory phase; thus, the tumor was considered to have a prolonged enhancement pattern.

View larger version (149K): [in a new window]   Figure 5a. Transverse CT scans in a 67-year-old man with AML with minimal fat. (a) Unenhanced scan obtained at the lower pole of the right kidney shows a well-defined mass (arrowheads). On contrast-enhanced scans obtained at the same level as a in (b) the corticomedullary phase and (c) the early excretory phase, the tumor (arrowheads) shows heterogeneous enhancement. The amount of tumor enhancement was 115 HU in the corticomedullary phase and 65 HU in the early excretory phase; thus, the tumor was considered to have an early washout enhancement pattern.

View larger version (158K): [in a new window]   Figure 5b. Transverse CT scans in a 67-year-old man with AML with minimal fat. (a) Unenhanced scan obtained at the lower pole of the right kidney shows a well-defined mass (arrowheads). On contrast-enhanced scans obtained at the same level as a in (b) the corticomedullary phase and (c) the early excretory phase, the tumor (arrowheads) shows heterogeneous enhancement. The amount of tumor enhancement was 115 HU in the corticomedullary phase and 65 HU in the early excretory phase; thus, the tumor was considered to have an early washout enhancement pattern.

View larger version (156K): [in a new window]   Figure 5c. Transverse CT scans in a 67-year-old man with AML with minimal fat. (a) Unenhanced scan obtained at the lower pole of the right kidney shows a well-defined mass (arrowheads). On contrast-enhanced scans obtained at the same level as a in (b) the corticomedullary phase and (c) the early excretory phase, the tumor (arrowheads) shows heterogeneous enhancement. The amount of tumor enhancement was 115 HU in the corticomedullary phase and 65 HU in the early excretory phase; thus, the tumor was considered to have an early washout enhancement pattern.