Prognostic implications of the magnetic resonance imaging appearance in papillary renal cell carcinoma

Andrew B. Rosenkrantz, Aarti Sekhar, Elizabeth M. Genega, Jonathan Melamed, James S. Babb, Amish D. Patel, Andy Lo, Robert M. Najarian, Muneeb Ahmed, Ivan Pedrosa

Research output: Contribution to journalArticlepeer-review

27 Scopus citations


Objective: To evaluate the prognostic implications of the MRI appearance and pathological features of papillary renal cell carcinoma (pRCC). Methods: A total of 128 pRCC in 115 patients who underwent preoperative MRI were characterised in terms of pathological type (type 1 vs. type 2), MRI appearance (focal vs. infiltrative) and additional MRI features. Patients were classified on the basis of the presence or absence of metastatic disease. Results: There were 65 focal type 1, 54 focal type 2 and 9 infiltrative pRCC. All infiltrative pRCC were of histopathological type 2. Renal vein thrombus was present in 89 % of infiltrative pRCC and no cases of focal pRCC. Metastatic disease was observed in 3.7 % of focal type 1, 7.5 % of focal type 2 and 75.0 % of infiltrative type 2 pRCC. Infiltrative MRI appearance was a significant predictor of metastatic disease, independent of pathological type, size and T stage (P ≤ 0.020). Among focal pRCC on MRI, pathological type 2 was not a significant predictor of metastatic disease (P = 0.648). No combination of features achieved significantly greater accuracy for predicting metastatic disease than renal vein thrombus alone (P > 0.5). Conclusion: Infiltrative MRI appearance and renal vein thrombus identify a subset of pathological type 2 pRCC at a significantly increased risk of metastatic disease. Key Points: • Magnetic resonance imaging (MRI) offers new preoperative insights into renal cell carcinoma (RCC). • Certain MRI features are associated with metastatic papillary RCC. • Metastases seem more common given an infiltrative appearance and renal vein thrombus.

Original languageEnglish (US)
Pages (from-to)579-587
Number of pages9
JournalEuropean Radiology
Issue number2
StatePublished - Feb 2013


  • MRI
  • Metastatic disease
  • Papillary
  • Renal cell carcinoma
  • Renal vein thrombus

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging


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