Renal masses: quantitative assessment of enhancement with dynamic MR imaging.

PURPOSE To establish a quantitative magnetic resonance (MR) imaging contrast enhancement criterion for distinguishing cysts from solid renal lesions. MATERIALS AND METHODS Regions of interest were measured in 74 patients with renal lesions evaluated by means of dynamic contrast material-enhanced MR imaging with serial breath-hold spoiled gradient-echo acquisitions. Sensitivity for renal tumors and specificity for renal cysts were established by using percentage of enhancement thresholds that varied between 5% and 35%. RESULTS The mean percentage of enhancement at MR imaging for the 50 renal cysts was less than 5%; for the 50 renal tumors, it was 97% or higher. With use of a threshold percentage of enhancement of 15% and results obtained between 2 and 4 minutes after administration of contrast material, all malignancies (sensitivity for tumor, 100%) were diagnosed, and there were 6% or fewer false-positive tumor diagnoses. Lower thresholds resulted in unacceptably high false-positive rates (ie, cysts that appeared to enhance-pseudoenhancement), whereas higher threshold values (>20%) resulted in an unacceptably lower sensitivity for tumors. CONCLUSION The optimal percentage of enhancement threshold for distinguishing cysts from malignancies with the imaging technique prescribed was 15%, and the optimal timing for measurement was 2-4 minutes after administration of contrast material.