title: Renal masses measuring under 2 cm: pathologic outcomes and associations with MRI features.
abstract: OBJECTIVE
  To evaluate pathologic outcomes and associations with MRI features in small renal masses measuring up to 20mm
  
  
  METHODS
  86 patients (61 ± 13 years; 45 M/41F) with 92 renal masses measuring up to 20mm that underwent MRI prior to tissue diagnosis were included. Two radiologists independently evaluated all masses for microscopic lipid, hemorrhage, T2-hyperintensity, T2-homogeneity, cystic/necrotic areas, hypervascularity, enhancement homogeneity, circumscribed margins, and predominantly exophytic location. These MRI features, as well as patient age, gender, and history of RCC, were compared with pathologic findings using Fisher's exact test, unpaired t-test, and multivariate logistic regression.
  
  
  RESULTS
  26.1% (24/92) of masses under 2 cm were benign, only 32.6% (30/92) were clear-cell RCC, and only 7.6% (7/92) were high-grade. Among 16 masses measuring up to 1cm, only 12.5% (2/16) were clear-cell RCC, and none was high-grade. Within the entire cohort, no MRI or clinical feature showed a significant difference between benign and malignant lesions (p ≥ 0.053). However, for both readers, clear-cell RCC exhibited a significantly higher frequency of T2-hyperintensity, cystic/necrotic areas, and hypervascularity, and a significantly lower frequency of hemorrhage, T2-homogeneity, and enhancement homogeneity (p<0.001-0.036). Hypervascularity was a significant independent predictor of clear-cell RCC for both readers (p=0.002-0.007), as was T2-hyperintensity for reader 2 (p=0.007).
  
  
  CONCLUSIONS
  A substantial fraction of small renal masses were benign, and when malignant, largely exhibited indolent pathologic characteristics, particularly when measuring under 1cm Although small benign and malignant masses could not be differentiated on MRI, hypervascularity showed a significant independent association with clear-cell RCC in comparison with other lesions.
authors.affiliation: Department of Radiology, NYU Langone Medical Center, 550 First Avenue, New York, NY 10016, United States. Electronic address: Andrew.Rosenkrantz@nyumc.org.
authors.forename: Andrew B
authors.initials: AB
authors.lastname: Rosenkrantz
authors.affiliation: Department of Radiology, NYU Langone Medical Center, 550 First Avenue, New York, NY 10016, United States.
authors.forename: Natasha E
authors.initials: NE
authors.lastname: Wehrli
authors.affiliation: Department of Pathology, 550 First Avenue, New York, NY 10016, United States.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Melamed
authors.affiliation: Department of Urology, Division of Urologic Oncology, 550 First Avenue, New York, NY 10016, United States.
authors.forename: Samir S
authors.initials: SS
authors.lastname: Taneja
authors.affiliation: Department of Radiology, NYU Langone Medical Center, 550 First Avenue, New York, NY 10016, United States.
authors.forename: Mohammed B
authors.initials: MB
authors.lastname: Shaikh
mesh_terms: D000328:Adult; D000368:Aged; D001706:Biopsy; D002292:Carcinoma, Renal Cell / Q000473:pathology*; D003287:Contrast Media; D003937:Diagnosis, Differential; D005260:Female; D019786:Gadolinium DTPA; D006801:Humans; D007089:Image Enhancement / Q000379:methods; D007090:Image Interpretation, Computer-Assisted / Q000379:methods; D007680:Kidney Neoplasms / Q000473:pathology*; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D012189:Retrospective Studies
chemical_list: D003287:Contrast Media; D019786:Gadolinium DTPA
keywords: Clear-cell renal cell carcinoma; MRI; Renal cell carcinoma; Renal mass