6 - GU malignant radiology Flashcards
% with aml who have tuberous sclerosis
10%
% with TS who have AML
80%
what is missing in simple cyst - 5
fluid attenuation, calcifications, septations, mural nodules, enhancement
bosniak 2f cyst % malig
11%
bosniac 1 cyst
water density, thin wall, no enhancement, no septation
bosniac 2 cyst
thin hairline septa with percieved enhancement (cant measure), 2. fine calcification or slightly thickened calcification in cyst wall
bosniak 2f cyst
no enhancement, multile thin hairline septa (percieved enhancement), thick/ nodular calcification on wall/septa, cyst > 3 cm w uniform high attenuation (>20hu)
bosniak 3 % malig
25-59%
bosniak 3
thickened/irregular septa or cyst with measureable enhancement
bosniak 4 % malig
80-100%
bosniak 4
same as bosniak 3 but with enhancing soft tissue components adjacent to but independent of septum/wall
ADPKD and cysts
bosniak 2-3 cysts are observes as there are many complex cysts
ADPKD RCC risk
not inc over gen pop
aquired PKD RCC risk
high risk of rcc
ADPKD vs aquired PKD extrarenal cyst location
ADPKD - liver 50%, pancreas 10%, intracranial berry aneurysm (deadly) 3-20%. Extrarenal rare in aquired
when does ADPKD present
3rd-5th decade
VHL more likely to get what mass?
RCC - lower malignant potential
when to tx mass in VHL
> 3 cm
difference between UCC and RCC
central lesion, rare calcification, extends into colelcting system
renal lymphoma characteristics
perinephric rind, or infiltrative mass, or renal hylar mass. Rarely onlu site of involvement
most common adrenal lesion
adrenal adenoma
most adrenal adenoma < x cm are benign
3
adrenal adenoma ct diagnostic findings - 3
nonenhanced CT < 10 HU. OR delayed contrast CT < 25 HU @ 15 min, OR contrast washout > 40-60% at 15 mins (noncontrast vs delayed)
3 MRI characteristics in adrenal adenoma dx - 3
(chemical shift MRI) adrenal:spleen < 0.7, OR opposed phase drops 20% (darkening of parenchyma on opposed phase imaging), or qualitative signal drop
adrenal mets dx
appears hypodense compared to rest of adrenal
most common adrenal mets from - (top 4)
lung, breast, lymphoma, melanoma
adrenal lymphoma - more common type of lymphoma
NHL
where in the adrenal gland are pheo’s found
medulla
syndromes assd w pheochromocytoma
VHL, neurofibromatosis, tuberous sclerosis, MEN II and Iib
pheo imaging characteristics - 3
intense enhancement, calcifications in 12%. (No fat or washout like adenoma). Can be cystic
adrenal myelolipoma - 3
nonfunctional, benign, fatty on CT
risk with adrenal myelolipoma
hemorrhage like AML
adrenocortical carcinoma - sx
hyperfunctional in 50% (57% cushings)
adrenocortical carcinoma - size
80% > 6 cm
ACC - imaging- 3
heterogenious T1/Y2, hemorrhage/necrosis, nodular
% of traumas with adrenal hemorrhage
2%
adrenal hemangioma image characteristics -
**peripheral nodular enhancement**, central necrosis, 60% w calcifications
adrenal hemangioma size
upto 15 cm
what allows you to see prostate capsule well on MRI
high field strength
what % UTUC will seed downstream
40%
what kind of cyst is this
bosniac 1- water density, thin wall, no enhancement, no septation
what kind of cyst is this
Bosniac 2 - thin hairline septa with percieved enhancement (cant measure), 2. fine calcification or slightly thickened calcification in cyst wall
bosniac 2 - thin hairline septa with percieved enhancement (cant measure), 2. fine calcification or slightly thickened calcification in cyst wall
bosniac 2 - thin hairline septa with percieved enhancement (cant measure), 2. fine calcification or slightly thickened calcification in cyst wall
bosniac 2f - no enhancement, multile thin hairline cepts (percieved enhancement), thick/ nodular calcification on wall/septa, cyst > 3 cm w uniform high attenuatino (>20hu)
bosniac 3 - thickened/irregular septa or cyst with measureable enhancement
bosniac 3 - thickened/irregular septa or cyst with measureable enhancement
bosniac 4 - same as bosniak 3 but with enhancing soft tissue components adjacent to but independent of septum/wall
bosniac 4 - same as bosniak 3 but with enhancing soft tissue components adjacent to but independent of septum/wall
PCKD
embryoligic origin or adrenal cortex vs medulla
cortex - urogenital ridge, medulla - neural crest cells
cushings (not due to exogenous steroids) is usually due to a tumor located where? signifance of imaging
pituitary tumor therefore even unifocal enlargement reflects hyperplasia
imaging and conns syndrome
even a tiny nodule can be an aldosteronoma and may require adrenalectomy.
what is the lightbulb sign
high T2 signal intensity seen in pheo (practically not seen often)
2 imaging findings suggestive of adrenal cortical carcinoma
venous invasion (only adrenal mass that does this), mets (35% present with mets)
likelyhood af adrenal mass being initial manifestation of occult primary malignancy
epidermoid cyst on us
well circumscribed, target like laminated appearance. +/- calcification in wall
