How I do it: evaluating renal masses.

With modern computed tomography (CT) and magnetic resonance (MR) imaging equipment, the diagnosis of most renal masses is usually straightforward and accurate. The major question to be answered is whether the mass represents a surgical or nonsurgical lesion or, in some cases, if follow-up studies are necessary. This evaluation usually can be accomplished if a high-quality examination is performed, if the clinical history of the patient is kept in mind, if conditions that mimic a renal neoplasm are considered and excluded, and if there is an awareness of the potential pitfalls and limitations of CT and MR imaging. In this article, the authors present their technique in the performance of CT and MR imaging examinations, summarize their approach to the diagnosis of renal masses, review the imaging findings in these lesions, and stress the limitations in renal mass diagnosis.

[1]  E. Fishman,et al.  Renal lymphoma: CT patterns with emphasis on helical CT. , 2000, Radiographics : a review publication of the Radiological Society of North America, Inc.

[2]  O. Hélénon,et al.  CT of papillary renal cell carcinomas with cholesterol necrosis mimicking angiomyolipomas. , 2003, AJR. American journal of roentgenology.

[3]  I. Francis,et al.  Renal masses: assessment of corticomedullary-phase and nephrographic-phase CT scans. , 1995, Radiology.

[4]  Raju Thomas,et al.  CT-guided biopsy of indeterminate renal cystic masses (Bosniak 3 and 2F): accuracy and impact on clinical management , 2002, European Radiology.

[5]  D. D. Maki,et al.  Renal cyst pseudoenhancement: beam-hardening effects on CT numbers. , 1999, Radiology.

[6]  A. Megibow,et al.  Metastatic Neoplasm to the Kidney Studied by Computed Tomography and Sonography , 1985, Journal of computer assisted tomography.

[7]  J. Varghese,et al.  Incidence of malignancy in complex cystic renal masses (Bosniak category III): should imaging-guided biopsy precede surgery? , 2003, AJR. American journal of roentgenology.

[8]  K. Becker,et al.  Detection of fat in a renal cell carcinoma mimicking angiomyolipoma. , 1993, Radiology.

[9]  D. DeLong,et al.  Pseudoenhancement of Simple Renal Cysts: A Comparison of Single and Multidetector Helical CT , 2002, Journal of computer assisted tomography.

[10]  P. Ramchandani,et al.  Multiphasic renal CT: comparison of renal mass enhancement during the corticomedullary and nephrographic phases. , 1996, Radiology.

[11]  G. Israel,et al.  Calcification in cystic renal masses: is it important in diagnosis? , 2003, Radiology.

[12]  A. Megibow,et al.  CT diagnosis of renal angiomyolipoma: the importance of detecting small amounts of fat. , 1988, AJR. American journal of roentgenology.

[13]  M. Bosniak Diagnosis and management of patients with complicated cystic lesions of the kidney. , 1997, AJR. American journal of roentgenology.

[14]  H. Shinmoto,et al.  Angiomyolipoma: imaging findings in lesions with minimal fat. , 1997, Radiology.

[15]  M. Baker,et al.  The current role of percutaneous biopsy in the evaluation of renal masses. , 1995, Seminars in urologic oncology.

[16]  M. Nishikido,et al.  An evaluation of Bosniak's radiological classification of cystic renal masses , 2000, BJU international.

[17]  P. Pickhardt,et al.  From the Archives of the AFIP: Infiltrative Renal Lesions: Radiologic-Pathologic Correlation , 2000 .

[18]  T. Ohsawa,et al.  CT Pixel Mapping in the Diagnosis of Small Angiomyolipomas of the Kidneys , 1993, Journal of computer assisted tomography.

[19]  R C Nelson,et al.  Evaluation of pseudoenhancement of renal cysts during contrast-enhanced CT. , 2000, AJR. American journal of roentgenology.

[20]  F. Klein,et al.  Fat in renal cell carcinoma that lacks associated calcifications. , 2002, AJR. American journal of roentgenology.

[21]  N. Obuchowski,et al.  Enhancement characteristics of papillary renal neoplasms revealed on triphasic helical CT of the kidneys. , 2002, AJR. American journal of roentgenology.

[22]  M. Hammadeh Calcification within angiomyolipoma. , 1998, Radiographics : a review publication of the Radiological Society of North America, Inc.

[23]  N. Rofsky,et al.  Abdominal MR imaging with a volumetric interpolated breath-hold examination. , 1999, Radiology.

[24]  N. Obuchowski,et al.  Analysis of changes in attenuation of proven renal cysts on different scanning phases of triphasic MDCT. , 2004, AJR. American journal of roentgenology.

[25]  G. Israel,et al.  Follow-up CT of moderately complex cystic lesions of the kidney (Bosniak category IIF). , 2003, AJR. American journal of roentgenology.

[26]  S. Silverman,et al.  Evaluation of patients referred for percutaneous ablation of renal tumors: importance of a preprocedural diagnosis. , 2004, AJR. American journal of roentgenology.

[27]  R. Edelman,et al.  Diaphragmatic and cardiac motion during suspended breathing: preliminary experience and implications for breath-hold MR imaging. , 1998, Radiology.

[28]  O. Hélénon,et al.  [Cystic tumors of the kidney in adults: radio-histopathologic correlations]. , 1999, Journal de radiologie.

[29]  M. Bosniak The use of the Bosniak classification system for renal cysts and cystic tumors. , 1997, The Journal of urology.

[30]  R. Zagoria Imaging of small renal masses: a medical success story. , 2000, AJR. American journal of roentgenology.

[31]  N M Rofsky,et al.  Breath-hold single-dose gadolinium-enhanced three-dimensional MR aortography: usefulness of a timing examination and MR power injector. , 1996, Radiology.

[32]  P. Choyke,et al.  Renal masses: quantitative assessment of enhancement with dynamic MR imaging. , 2002, Radiology.

[33]  R. Cohan,et al.  Computed tomography of renal lymphoma. , 1990, Journal of computer assisted tomography.

[34]  Mannudeep K Kalra,et al.  Pseudoenhancement of simulated renal cysts in a phantom using different multidetector CT scanners. , 2002, AJR. American journal of roentgenology.

[35]  N. Rofsky,et al.  Problems in the detection and characterization of small renal masses. , 1996, Radiology.

[36]  O. Hélénon,et al.  Renal cell carcinoma containing fat: demonstration with CT. , 1993, Radiology.

[37]  E. Hecht,et al.  Renal masses: quantitative analysis of enhancement with signal intensity measurements versus qualitative analysis of enhancement with image subtraction for diagnosing malignancy at MR imaging. , 2004, Radiology.

[38]  M. Blute,et al.  Prospective analysis of computerized tomography and needle biopsy with permanent sectioning to determine the nature of solid renal masses in adults. , 2003, The Journal of urology.

[39]  T. Katsuda,et al.  Reducing misregistration of mask image in hepatic DSA. , 1997, Radiologic technology.

[40]  J. Wong-You-Cheong,et al.  Transitional cell carcinoma of the urinary tract: radiologic-pathologic correlation. , 1998, Radiographics : a review publication of the Radiological Society of North America, Inc.

[41]  J P Heiken,et al.  Renal cysts: is attenuation artifactually increased on contrast-enhanced CT images? , 2000, Radiology.

[42]  C. Slywotzky,et al.  Needle tract seeding of transitional cell carcinoma following fine-needle aspiration of a renal mass , 1994, Abdominal Imaging.

[43]  F. Rybicki,et al.  Percutaneous Biopsy of Renal Masses: Sensitivity and Negative Predictive Value Stratified by Clinical Setting and Size of Masses , 2003 .

[44]  M. Bosniak,et al.  Infiltrating neoplasms of the kidney. , 1977, AJR. American journal of roentgenology.

[45]  P. Humphrey,et al.  CT of cystic renal masses: analysis of diagnostic performance and interobserver variation. , 1997, AJR. American journal of roentgenology.

[46]  R. Zeman,et al.  Renal metastases: clinicopathologic and radiologic correlation. , 1987, Radiology.

[47]  M. Bosniak,et al.  The current radiological approach to renal cysts. , 1986, Radiology.

[48]  S T Cochran,et al.  Cystic renal masses: accurate Bosniak classification requires adequate renal CT. , 2000, AJR. American journal of roentgenology.

[49]  James S Babb,et al.  Renal cyst pseudoenhancement: evaluation with an anthropomorphic body CT phantom. , 2002, Radiology.

[50]  M. Bosniak Angiomyolipoma (hamartoma) of the kidney: A preoperative diagnosis is possible in virtually every case , 1981, Urologic radiology.

[51]  A. Renshaw,et al.  Fine‐needle aspiration of the adult kidney , 1997, Cancer.

[52]  Jeong Kon Kim,et al.  Angiomyolipoma with minimal fat: differentiation from renal cell carcinoma at biphasic helical CT. , 2004, Radiology.

[53]  A. Fisher,et al.  Interobserver variability in determining enhancement of renal masses on helical CT. , 1999, AJR. American journal of roentgenology.