T1 hyperintense renal lesions are a group of lesions that show high signal characteristics on T1-weighted MRI compared to the adjacent normal renal parenchyma.
The differential diagnoses for this group include:
hemorrhagic and/or highly proteinaceous renal cyst
renal leiomyosarcoma 1
collecting duct carcinoma 2
mucinous tubular carcinoma 2
spindle cell carcinoma 2
Practical points
the diagnostic challenge in this group is the distinction between papillary renal cell carcinoma and hemorrhagic and/or highly proteinaceous renal cysts, as both are often smooth-contoured and have a homogeneous internal structure
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the most important finding in distinguishing benign lesions from malignant lesions is the demonstration of contrast enhancement
since the T1 signal of the lesions is hyperintense, it is important to demonstrate contrast enhancement with subtraction
contrast enhancement of papillary renal cell carcinoma may be minimal; in this respect, it is important to evaluate subtracted images carefully
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in the literature, significant results were found in studies conducted with ADC values of lesions and lesion/renal cortex, lesion/psoas major muscle T1 signal intensity ratio values, to differentiate benign lesions from malignant, however, a consensus cut-off value could not be determined 1-3
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