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Can we predict the existence of extrarenal feeders to renal angiomyolipomas?

  • Xixi Zhang
  • Ryohei KuwatsuruEmail author
  • Hiroshi Toei
  • Daiske Yashiro
  • Shingo Okada
  • Hitomi Kato
Urogenital
  • 77 Downloads

Abstract

Objectives

To identify factors predicting the presence of extrarenal feeders to renal angiomyolipomas (AMLs)

Methods

This is a retrospective study of 44 patients with 58 renal AMLs embolized in our department. Arteriography obtained during embolization and CT angiography obtained before and after embolization were reviewed to characterize AMLs with and without extrarenal feeders. Tumor characteristics were compared between the two groups. Simple logistic regression and ROC curve analysis were performed. P < 0.05 was considered to be statistically significant.

Results

Of the 58 AMLs reviewed, 29% had extrarenal arteries and 71% did not. AMLs with extrarenal feeders were significantly larger than those without, in terms of volume (median, 368 mL versus 109 mL, p < 0.0002) and the largest diameter (mean, 12.0 cm versus 7.7 cm, p < 0.0001). Patient age, presence of tuberous sclerosis complex or sporadic lymphangioleiomyomatosis, and tumor location did not differ between the groups. The largest diameter and volume had similar predictive values for the presence of extrarenal feeders (AUC, 0.83 versus 0.82, p = 0.673). Extrarenal feeders were present in 0%, 21%, and 79% of the AMLs ≤ 6.5 cm, AMLs 6.6–10.5 cm, and AMLs > 10.5 cm, respectively.

Conclusions

AML size correlates with the presence of extrarenal feeders, with the largest diameter and volume being significant predictors. AMLs > 10.5 cm had a high chance of extrarenal feeders, making it mandatory to search for feeders to them in order to avoid incomplete embolization; AMLs ≤ 6.5 cm did not have extrarenal feeders, making a search for them unnecessary in these cases.

Key Points

• The presence of extrarenal feeders to renal angiomyolipoma is associated with tumor size, but not with patient age, concomitant disease, or tumor location.

• The largest diameter and volume predict the presence of extrarenal feeders to AML, with similar predictive values.

• AMLs > 10.5 cm have a high chance (79%) of extrarenal feeders, making it mandatory to search for feeders to them in order to avoid incomplete embolization; AMLs ≤ 6.5 cm do not have extrarenal feeders, making a search for them unnecessary in these cases.

Keywords

Angiomyolipoma Arteries Angiography Endovascular procedures Kidney neoplasms 

Abbreviations

AB

Aortic branches

AML

Angiomyolipoma

MPR

Multiplanar reconstruction

NSS

Nephron-sparing surgery

RB

Renal arterial branches

sLAM

Sporadic lymphangioleiomyomatosis

TAE

Transcatheter arterial embolization

TSC

Tuberous sclerosis complex

Notes

Funding

The authors state that this work has not received any funding.

Compliance with ethical standards

Guarantor

The scientific guarantor of this publication is Ryohei Kuwatsuru.

Conflict of interest

The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.

Statistics and biometry

One of the authors has significant statistical expertise.

Informed consent

Written informed consent was waived by the Institutional Review Board.

Ethical approval

Institutional Review Board approval was obtained.

Study subjects or cohorts overlap

Some study subjects or cohorts have been previously reported in Kato H, Kuwatsuru R, Inoue T, Okada S, Aida M, Yamashiro Y (2018) Superselective Transcatheter Arterial Embolization for Large Unruptured Renal Angiomyolipoma in Lymphangioleiomyomatosis. J Vasc Interv Radiol 29:958–65.

Methodology

• Retrospective

• Observational

• Performed at one institution

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Copyright information

© European Society of Radiology 2018

Authors and Affiliations

  1. 1.Department of Radiology, Graduate School of MedicineJuntendo UniversityTokyoJapan
  2. 2.Department of Radiology, School of MedicineJuntendo UniversityTokyoJapan

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