Renal cell cancer: incidence of hemorrhage on MR images in patients with chronic renal insufficiency.

This study describes the occurrence of hemorrhage in renal cancer in patients with chronic renal insufficiency as shown on MR images. Thirteen consecutive patients with chronic renal insufficiency who had histologically proven renal cancer and underwent MRI at 1.5 T were entered in the study. MR examinations included spoiled gradient echo (SGE) and T1-weighted fat-suppressed imaging pre- and postgadolinium administration. All renal cancers were well shown on MR images and were most clearly depicted on postgadolinium T1-weighted fat-suppressed images. Tumors in 12 of 13 patients had regions of high signal intensity on precontrast T1-weighted images. Histology demonstrated intratumoral hemorrhage in all 12 of these patients. Four hemorrhagic tumors were largely cystic on imaging studies. One of these cancers altered in appearance from largely cystic with extensive hemorrhage to largely solid with substantial enhancement after a 2.5-year interval. Renal cancers demonstrated minimal enhancement (11 patients) on early postgadolinium images and were minimally enhanced on delayed images in 10 of 13 tumors. Two renal cancers demonstrated intense enhancement. Renal cancers are well shown on MR images in patients with chronic renal insufficiency. Because of the common occurrence of hemorrhage into renal cancers in patients with renal insufficiency, caution should be exercised when evaluating hemorrhagic cystic lesions in these patients.