Clinical Radiology
Volume 65, Issue 2 , Pages 99-108 , February 2010

The radiological diagnosis and treatment of renal angiomyolipoma—current status

  • D. Halpenny
  • ,
  • A. Snow
  • ,
  • G. McNeill
  • ,
  • W.C. Torreggiani

      Affiliations

    • Corresponding Author InformationGuarantor and correspondent: Department of Radiology, Adelaide and Meath Hospitals Incorporating the National Childrens Hospital, Tallaght, Dublin 7, Ireland. Tel.: +353 1 4142000; fax: +353 1 4143805.

Received 6 April 2009 ,Revised 1 September 2009 ,Accepted 7 September 2009.

References 

  1. Fujii Y, Ajima J, Oka K, et al. Benign renal tumors detected among healthy adults by abdominal ultrasonography. Eur Urol. 1995;27:124–127
  2. Nelson CP, Sanda MG. Contemporary diagnosis and management of renal angiomyolipoma. J Urol. 2002;168:1315–1325
  3. Rimon U, Duvdevani M, Garniek A, et al. Ethanol and polyvinyl alcohol mixture for transcatheter embolization of renal angiomyolipoma. AJR Am J Roentgenol. 2006;187:762–768
  4. Kim JK, Park SY, Shon JH, et al. Angiomyolipoma with minimal fat: differentiation from renal cell carcinoma at biphasic helical CT. Radiology. 2004;230:677–684
  5. Yamakado K, Tanaka N, Nakagawa T, et al. Renal angiomyolipoma: relationships between tumor size, aneurysm formation, and rupture. Radiology. 2002;225:78–82
  6. Oesterling JE, Fishman EK, Goldman SM, et al. The management of renal angiomyolipoma. J Urol. 1986;135:1121–1124
  7. Dickinson M, Ruckle H, Beaghler M, et al. Renal angiomyolipoma: optimal treatment based on size and symptoms. Clin Nephrol. 1998;49:281–286
  8. Fujii Y, Komai Y, Saito K, et al. Incidence of benign pathologic lesions at partial nephrectomy for presumed RCC renal masses: Japanese dual-center experience with 176 consecutive patients. Urology. 2008;72:598–602
  9. Reiff DB, Dow J. Invasive renal angiomyolipoma—sonographic and CT features. Clin Radiol. 1993;48:283–285
  10. Islam AH, Ehara T, Kato H, et al. Angiomyolipoma of kidney involving the inferior vena cava. Int J Urol. 2004;11:897–902
  11. Warakaulle DR, Phillips RR, Turner GD, et al. Malignant monotypic epithelioid angiomyolipoma of the kidney. Clin Radiol. 2004;59:849–852
  12. VanderBrink BA, Munver R, Tash JA, et al. Renal angiomyolipoma with contrast-enhancing elements mimicking renal malignancy: radiographic and pathologic evaluation. Urology. 2004;63:584–586
  13. Cibas ES, Goss GA, Kulke MH. Malignant epithelioid angiomyolipoma (“sarcoma ex angiomyolipoma”) of the kidney: a case report and review of the literature. Am J Surg Pathol. 2001;25:121–126
  14. Tsai CC, Wu WJ, Li CC, et al. Epithelioid angiomyolipoma of the kidney mimicking renal cell carcinoma: a clinicopathologic analysis of cases and literature review. Kaohsiung J Med Sci. 2009;25:133–140
  15. Siegel CL, Middleton WD, Teefey SA, et al. Angiomyolipoma and renal cell carcinoma: US differentiation. Radiology. 1996;198:789–793
  16. Turnbull DH, Wilson SR, Hine AL, et al. Ultrasonic characterization of selected renal tissues. Ultrasound Med Biol. 1989;15:241–253
  17. Charboneau JW, Hattery RR, Ernst EC, et al. Spectrum of sonographic findings in 125 renal masses other than benign simple cyst. AJR Am J Roentgenol. 1983;140:87–94
  18. Hartman DS, Goldman SM, Friedman AC, et al. Angiomyolipoma: ultrasonic–pathologic correlation. Radiology. 1981;139:451–458
  19. Forman HP, Middleton WD, Melson GL, et al. Hyperechoic renal cell carcinomas: increase in detection at US. Radiology. 1993;188:431–434
  20. Jinzaki M, Tanimoto A, Narimatsu Y, et al. Angiomyolipoma: imaging findings in lesions with minimal fat. Radiology. 1997;205:497–502
  21. Tamai H, Takiguchi Y, Oka M, et al. Contrast-enhanced ultrasonography in the diagnosis of solid renal tumors. J Ultrasound Med. 2005;24:1635–1640
  22. Setola SV, Catalano O, Sandomenico F, et al. Contrast-enhanced sonography of the kidney. Abdom Imaging. 2007;32:21–28
  23. Yip KH, Peh WC, Tam PC. Spontaneous rupture of renal tumours: the role of imaging in diagnosis and management. Br J Radiol. 1998;71:146–154
  24. Curry NS, Schabel SI, Garvin AJ, et al. Intratumoral fat in a renal oncocytoma mimicking angiomyolipoma. AJR Am J Roentgenol. 1990;154:307–308
  25. Williams MA, Schropp KP, Noe HN. Fat containing renal mass in childhood: a case report of teratoid Wilms tumor. J Urol. 1994;151:1662–1663
  26. Davidson AJ, Davis CJ. Fat in renal adenocarcinoma: never say never. Radiology. 1993;188:316
  27. Sherman JL, Hartman DS, Friedman AC, et al. Angiomyolipoma: computed tomographic–pathologic correlation of 17 cases. AJR Am J Roentgenol. 1981;137:1221–1226
  28. Lemaitre L, Claudon M, Dubrulle F, et al. Imaging of angiomyolipomas. Semin Ultrasound CT MR. 1997;18:100–114
  29. Bosniak MA, Megibow AJ, Hulnick DH, et al. CT diagnosis of renal angiomyolipoma: the importance of detecting small amounts of fat. AJR Am J Roentgenol. 1988;151:497–501
  30. Kurosaki Y, Tanaka Y, Kuramoto K, et al. Improved CT fat detection in small kidney angiomyolipomas using thin sections and single voxel measurements. J Comput Assist Tomogr. 1993;17:745–748
  31. Takahashi K, Honda M, Okubo RS, et al. CT pixel mapping in the diagnosis of small angiomyolipomas of the kidneys. J Comput Assist Tomogr. 1993;17:98–101
  32. Simpson E, Patel U. Diagnosis of angiomyolipoma using computed tomography-region of interest < or =−10 HU or 4 adjacent pixels < or =−10 HU are recommended as the diagnostic thresholds. Clin Radiol. 2006;61:410–416
  33. Prando A, Prando D, Prando P. Renal cell carcinoma: unusual imaging manifestations. RadioGraphics. 2006;26:233–244
  34. Merran S, Vieillefond A, Peyromaure M, et al. Renal angiomyolipoma with calcification: CT–pathology correlation. Br J Radiol. 2004;77:782–783
  35. Schuster TG, Ferguson MR, Baker DE, et al. Papillary renal cell carcinoma containing fat without calcification mimicking angiomyolipoma on CT. AJR Am J Roentgenol. 2004;183:1402–1404
  36. Hélénon O, Merran S, Paraf F, et al. Unusual fat-containing tumours of the kidney: a diagnostic dilemma. RadioGraphics. 1997;17:129–144
  37. Catalano OA, Samir AE, Sahani DV, et al. Pixel distribution analysis: can it be used to distinguish clear cell carcinomas from angiomyolipomas with minimal fat?. Radiology. 2008;247:738–746
  38. Kim JY, Kim JK, Kim N, et al. CT histogram analysis: differentiation of angiomyolipoma without visible fat from renal cell carcinoma at CT imaging. Radiology. 2008;246:472–479
  39. Kawashima A, Sandler CM, Ernst RD, et al. CT evaluation of renovascular disease. RadioGraphics. 2000;20:1321–1340
  40. Friedman AC, Hartman DS, Sherman J, et al. Computed tomography of abdominal fatty masses. Radiology. 1981;139:415–429
  41. Bosniak MA. Spontaneous subcapsular and perirenal hematomas. Radiology. 1989;172:601–602
  42. Frauenfelder T, Wildermuth S, Marincek B, et al. Nontraumatic emergent abdominal vascular conditions: advantages of multi-detector row CT and three-dimensional imaging. RadioGraphics. 2004;24:481–496
  43. Hiromura T, Nishioka T, Tomita K. Spontaneous rupture of renal angiomyolipoma: value of multidetector CT angiography for interventional therapy. Emerg Radiol. 2005;12:53–54
  44. Mitchell DG, Crovello M, Matteucci T, et al. Benign adrenocortical masses: diagnosis with chemical shift MR imaging. Radiology. 1992;185:345–51
  45. Hood MN, Ho VB, Smirniotopoulos JG, et al. Chemical shift: the artifact and clinical tool revisited. RadioGraphics. 1999;19:357–371
  46. Israel GM, Hindman N, Hecht E, et al. The use of opposed-phase chemical shift MRI in the diagnosis of renal angiomyolipomas. AJR Am J Roentgenol. 2005;184:1868–1872
  47. Levy LM, Di Chiro G, Brooks RA, et al. Spinal cord artifacts from truncation errors during MR imaging. Radiology. 1988;166:479–483
  48. Outwater EK, Bhatia M, Siegelman ES, et al. Lipid in renal clear cell carcinoma: detection on opposed-phase gradient-echo MR images. Radiology. 1997;205:103–107
  49. Zhang J, Israel GM, Krinsky GA, et al. Masses and pseudomasses of the kidney: imaging spectrum on MR. J Comput Assist Tomogr. 2004;28:588–595
  50. Burdeny DA, Semelka RC, Kelekis NL, et al. Small (<1.5 cm) angiomyolipomas of the kidney: characterization by the combined use of in-phase and fat-attenuated MR techniques. Magn Reson Imaging. 1997;15:141–145
  51. Choyke P, Kressel H, Pollack H, et al. Focal renal masses: magnetic resonance imaging. Radiology. 1984;152:471–477
  52. Hafron J, Fogarty JD, Hoenig DM, et al. Imaging characteristics of minimal fat renal angiomyolipoma with histologic correlations. Urology. 2005;66:1155–1159
  53. Kido T, Yamashita Y, Sumi S, et al. Chemical shift GRE MRI of renal angiomyolipoma. J Comput Assist Tomogr. 1997;21:268–270
  54. Kim JK, Kim SH, Jang YJ, et al. Renal angiomyolipoma with minimal fat: differentiation from other neoplasms at double-echo chemical shift FLASH MR imaging. Radiology. 2006;239:174–180
  55. Scialpi M, Di Maggio A, Midiri M, et al. Small renal masses: assessment of lesion characterization and vascularity on dynamic contrast-enhanced MR imaging with fat suppression. AJR Am J Roentgenol. 2000;175:751–757
  56. Somani BK, Nabi G, Thorpe P, et al. Therapeutic transarterial embolisation in the management of benign and malignant renal conditions. Surgeon. 2006;4:348–352
  57. Kessaris DN, Bellman GC, Pardalidis NP, et al. Management of hemorrhage after percutaneous renal surgery. J Urol. 1995;153:604–608
  58. Soulen MC, Faykus MH, Shlansky-Goldberg RD, et al. Elective embolization for prevention of hemorrhage from renal angiomyolipomas. J Vasc Interv Radiol. 1994;5:587–591
  59. Mourikis D, Chatziioannou A, Antoniou A, et al. Selective arterial embolization in the management of symptomatic renal angiomyolipomas. Eur J Radiol. 1999;32:153–159
  60. van Baal JG, Smits NJ, Keeman JN, et al. The evolution of renal angiomyolipomas in patients with tuberous sclerosis. J Urol. 1994;152:35–38
  61. Rimon U, Duvdevani M, Garniek A, et al. Large renal angiomyolipomas: digital subtraction angiographic grading and presentation with bleeding. Clin Radiol. 2006;61:520–526
  62. Lenton J, Kessel D, Watkinson AF. Embolization of renal angiomyolipoma: immediate complications and long-term outcomes. Clin Radiol. 2008;63:864–870
  63. Hajdu SI, Foote FW. Angiomyolipoma of the kidney: report of 27 cases and review of the literature. J Urol. 1969;102:396–401
  64. Kothary N, Soulen MC, Clark TW, et al. Renal angiomyolipoma: long-term results after arterial embolization. J Vasc Interv Radiol. 2005;16:45–50
  65. Hamlin JA, Smith DC, Taylor FC, et al. Renal angiomyolipomas: long-term follow-up of embolization for acute hemorrhage. Can Assoc Radiol J. 1997;48:191–198
  66. Kesler OJ, Gillon G, Neuman M, et al. Management of renal angiomyolipoma: analysis of 15 cases. Eur Urol. 1998;33:572–575
  67. Dabbeche C, Chaker M, Chemali R, et al. Role of embolization in the treatment of AMLs. J Radiol. 2006;87:1859–1867
  68. Han YM, Kim JK, Roh BS, et al. Renal angiomyolipoma: selective arterial embolization—effectiveness and changes in angiomyogenic components in long-term follow-up. Radiology. 1997;204:65–70
  69. Ramon J, Rimon U, Garniek A, et al. Renal angiomyolipoma: long-term results following selective arterial embolization. Eur Urol. 2008 Apr 23;[Epub ahead of print]
  70. Lee W, Kim TS, Chung JW, et al. Renal angiomyolipoma: embolotherapy with a mixture of alcohol and iodized oil. J Vasc Interv Radiol. 1998;9:255–261
  71. Bissler JJ, Racadio J, Donnelly LF, et al. Reduction of postembolization syndrome after ablation of renal angiomyolipoma. Am J Kidney Dis. 2002;39:966–971
  72. Zerhouni EA, Schellhammer P, Schaefer JC, et al. Management of bleeding renal angiomyolipomas by transcatheter embolization following CT diagnosis. Urol Radiol. 1984;6:205–209
  73. Adler J, Greweldinger J, Litzky G. “Macro” aneurysm in renal angiomyolipoma: two cases, with therapeutic embolization in one patient. Urol Radiol. 1984;6:201–203
  74. Levinson AW, Su LM, Agarwal D, et al. Long-term oncological and overall outcomes of percutaneous radio frequency ablation in high risk surgical patients with a solitary small renal mass. J Urol. 2008;180:499–504discussion 504
  75. Prevoo W, van den Bosch MA, Horenblas S. Radiofrequency ablation for treatment of sporadic angiomyolipoma. Urology. 2008;72:188–191
  76. Serrano Frago P, Del Agua Arias Camisón C, Gil Sanz MJ, et al. Controversies related to epithelioid variant of renal angiomyolipoma: a review of the literature. Urology. 2006;67:846.e3–846.e5

PII: S0009-9260(09)00367-5

doi: 10.1016/j.crad.2009.09.014

Clinical Radiology
Volume 65, Issue 2 , Pages 99-108 , February 2010