title: Large renal angiomyolipomas: digital subtraction angiographic grading and presentation with bleeding.
abstract: OBJECTIVE
  To investigate whether a grading system of renal AMLs based on digital subtraction angiography (DSA) and computerized tomography (CT), could help to select patients for embolization.
  
  
  METHODS
  Thirty patients with 35 renal angiomyolipomas (size range 4-20 cm, mean 9.9 cm) underwent both digital subtraction angiography (DSA) and computed tomography (CT). Based on the DSA appearance the tumours were graded into three grades: grade I, minimal vascularity; grade II, moderate vascularity; grade III, marked vascularity.
  
  
  RESULTS
  There were seven grade I (mean 9.3 cm, range 4.5-20 cm), 18 grade II (mean 8.9 cm, range 5-18 cm) and 10 grade III tumours (mean 12.1 cm, range 4-20 cm). Five grade I tumours did not cause symptoms (71%) and two caused flank pain and haematuria, respectively (14.3% each). Nine of the grade II tumours were asymptomatic (50%), seven caused bleeding (39%) and two caused flank pain (11%). Four grade III tumours were asymptomatic (40%), five caused bleeding (50%) and one pain (10%).
  
  
  CONCLUSIONS
  According to our criteria, large angiomyolipomas with minimal vascularity are less likely to bleed, and do not need prophylactic treatment. This needs to be confirmed in larger studies.
authors.affiliation: Department of Diagnostic Imaging, Chaim Sheba Medical Center, Tel-Hashomer, Sackler School of Medicine, Tel-Aviv University, Israel. rimonu@sheba.health.gov.il
authors.forename: U
authors.initials: U
authors.lastname: Rimon
authors.forename: M
authors.initials: M
authors.lastname: Duvdevani
authors.forename: A
authors.initials: A
authors.lastname: Garniek
authors.forename: G
authors.initials: G
authors.lastname: Golan
authors.forename: P
authors.initials: P
authors.lastname: Bensaid
authors.forename: J
authors.initials: J
authors.lastname: Ramon
authors.forename: B
authors.initials: B
authors.lastname: Morag
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015901:Angiography, Digital Subtraction / Q000379:methods; D018207:Angiomyolipoma / Q000000981:diagnostic imaging / Q000473:pathology*; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D012187:Retroperitoneal Space; D014057:Tomography, X-Ray Computed / Q000379:methods