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Insights into Imaging
Fig. 3 | Insights into Imaging

Fig. 3

From: Small (<1 cm) incidental echogenic renal cortical nodules: chemical shift MRI outperforms CT for confirmatory diagnosis of angiomyolipoma (AML)

Fig. 3

A 36-year-old man with incidental echogenic renal cortical nodule. Sagittal and transverse grey scale and colour (a) images of the right kidney depict a homogeneously hyperechoic nodule in the interpolar region (white arrows) which measures 8 × 6 × 6 mm in size. Axial unenhanced CT image (b) confirms the presence of a low-density nodule (open white arrow) with an ROI measurement of −3 HU. Pixel mapping was not performed and a follow-up CT was recommended. Six-month follow-up contrast-enhanced axial (c) CT image re-demonstrates the small renal cortical nodule (open white arrow), which is not changed in size but remains indeterminate; MRI was recommended. Axial T1-weighted IP, OP, and FS GRE images (left to right in d) reveal the renal nodule as a punctate focus of signal loss on OP image only (white arrow). The lesion was again considered indeterminate and follow-up was recommended. Axial T1-weighted IP, OP, and FS GRE images (left to right in e) performed 3 years later confirm the diagnosis of renal AML with persistent signal loss on the OP image (dotted arrow) and loss of signal intensity now noted on FS (thick black arrow) compared with IP (thin black arrow) T1-weighted images. In retrospect, the diagnosis was apparent on initial MRI examination (d); signal loss on OP imaging in uniformly echogenic nodules measuring <1 cm in size is confirmatory of AML

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