Is it possible to detect a malignancy from the MRI?

Question

Hello doctor,

I have Li-Fraumeni syndrome; therefore I am in a study. It conducts annual full body MRI to detect anything early if it should arise. I had a 0.74 inch lesion laterally in the left kidney with signal suppression for three years. However, there is now a new 0.5 inch heterogeneously T2 hyperintense lesion at its lateral margin, which was not present previously. While this could conceivably represent a de novo cystic lesion, the contiguity with the fatty lesion raises the possibility of contained hemorrhage from an angiomyolipoma. The impression of the MRI was given as a 0.74 inch fatty lesion in left kidney associated with a 0.5 inch heterogeneously T2 hyperintense component at its lateral margin, suspicious for a small contained hemorrhage from an angiomyolipoma, though not specific for this. The left renal lesion could be further assessed at a targeted multi-phase contrast enhanced study. I have an allergy to iodine contrast; therefore the CT scan was canceled. A targeted MRI will be scheduled in the coming weeks. My urologist did not see this report when I went to see him and now, he is out of office on a holiday. I am anxious to know whether I am at risk of rupture or if this is a common occurrence with angiomyolipomas. Also, is it possible that it could be a malignancy? Would they write it in the report?

Answer 1

Hi,

Welcome to icliniq.com.

Relax and do not worry. I have gone through the MRI report (attachment removed to protect patient identity) that you posted. MRI shows a 0.74 inch lesion suggestive of angiomyolipoma with 0.5 inch heterogenous appearing lesion within it suggestive of hemorrhage. Now, according to the MRI report, this looks like a benign lesion angiomyolipoma only. As this lesion is present since three years, the chances of malignancy are very rare. If it was malignant, then it would not have been silent for three years. Hemorrhage is a known complication of angiomyolipoma. In your case, the tumor size is very small and the size of hemorrhage is 0.5 inch only and hence, not that significant at present. Hemorrhage should get absorbed by its own. Significant hemorrhages are caused by giant angiomyolipoma which will be more than 3.9 inches in size. So, at present, I think you should wait. There is nothing to get panic unless you get severe symptoms like severe back pain. At present, the treatment would be conservative only. If possible, you can get an MRI or ultrasound scan done in the next week to follow it up till your urologist is available. Give yourself bed rest and avoid strenuous activities and exercises.

Answer 2

Hi,

Welcome back to icliniq.com.

I have seen the reports sent by you (attachment removed to protect patient identity). Yes, an increase in the size to 1.2 inch is of concern, but do not get tensed. Consult your urologist. According to me, it is better to get it removed surgically or you can go for a percutaneous biopsy; whichever way your urologist recommends. It is not an acute emergency. You can wait for your urologist to come.

Is it possible to detect a malignancy from the MRI?

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