Hyperechoic renal tumors: Anechoic rim and intratumoral cysts in US differentiation of renal cell carcinoma from angiomyolipoma

To determine whether angiomyolipomas (AMLs) and renal cell carcinomas (RCCs) can be differentiated at ultrasonography (US), the authors retrospectively evaluated the sonographic appearances of 31 AMLs and 38 RCCs. Sonograms were evaluated by three radiologists without knowledge of histologic findings, with respect to the echogenicity of the tumor, predominant echotexture, and whether an anechoic rim was present. All patients had also undergone computed tomography (CT) to check for tumoral fat. Intratumoral fat was evident at CT in 28 of the 31 AMLs. RCCs had no fat at CT or histologic evaluation. An anechoic rim was evident in 32 of 38 (84%) RCCs, and 10 RCCs had small anechoic areas with back echo enhancement, which corresponded to intratumoral cysts or cystic necrosis at histologic evaluation. The anechoic rim and areas indicative of cysts were not found in AMLs. Demonstration of an anechoic rim and/or intratumoral cysts in a hyperechoic mass at US suggests that the tumor is an RCC.