Advertisement
Review Article| Volume 59, ISSUE 4, P631-646, July 2021

The Incidental Renal Mass- Update on Characterization and Management

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribers receive full online access to your subscription and archive of back issues up to and including 2002.

      Content published before 2002 is available via pay-per-view purchase only.

      Subscribe:

      Subscribe to Radiologic Clinics
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Eknoyan G.
        A clinical view of simple and complex renal cysts.
        J Am Soc Nephrol. 2009; 20: 1874-1876
        • Mensel B.
        • Kuhn J.P.
        • Kracht F.
        • et al.
        Prevalence of renal cysts and association with risk factors in a general population: an MRI-based study.
        Abdom Radiol. 2018; 43: 3068-3074
        • O’Connor S.D.
        • Silverman S.G.
        • Ip I.K.
        • et al.
        Simple cyst–appearing renal masses at unenhanced CT: Can they be presumed to be benign?.
        Radiology. 2013; 269: 793-800
        • Silverman S.G.
        • Pedrosa I.
        • Ellis J.H.
        • et al.
        Bosniak classification of cystic renal masses, version 2019: an update proposal and needs assessment.
        Radiology. 2019; 292: 475-488
        • Maki D.D.
        • Birnbaum B.A.
        • Chakraborty D.P.
        • et al.
        Renal cyst pseudoenhancement: beam-hardening effects on CT numbers.
        Radiology. 1999; 213: 468-472
        • Bae K.T.
        • Heiken J.P.
        • Siegel C.L.
        • et al.
        Renal cysts: is attenuation artifactually increased on contrast-enhanced CT images?.
        Radiology. 2000; 216: 792-796
        • Hirai T.
        • Ohishi H.
        • Yamada R.
        • et al.
        Usefulness of color doppler flow imaging in differential diagnosis of multilocular cystic lesions of the kidney.
        J Ultrasound Med. 1995; 14: 771-776
        • Jonisch A.I.
        • Rubinowitz A.N.
        • Mutalik P.G.
        • et al.
        Can high-attenuation renal cysts be differentiated from renal cell carcinoma at unenhanced CT?.
        Radiology. 2007; 243: 445-450
        • Hindman N.M.
        Approach to very small (< 1.5 cm) cystic renal lesions: ignore, observe, or treat?.
        Am J Roentgenol. 2015; 204: 1182-1189
        • Davarpanah A.
        • Spektor M.
        • Mathur M.
        • et al.
        Homogeneous T1 hyperintense renal lesions with smooth borders: is contrast-enhanced MR imaging needed?.
        Radiology. 2016; 280: 128-136
        • Mickisch G.
        • Carballido J.
        • Hellsten S.
        • et al.
        Guidelines on renal cell cancer.
        Eur. 2001; 40: 252-255
        • Amin M.B.
        • Tamboli P.
        • Javidan J.
        • et al.
        Prognostic impact of histologic subtyping of adult renal epithelial neoplasms: an experience of 405 cases.
        Am J Surg Pathol. 2002; 26: 281-291
        • Young J.R.
        • Coy H.
        • Kim H.J.
        • et al.
        Performance of relative enhancement on multiphasic MRI for the differentiation of clear cell renal cell carcinoma (RCC) from papillary and chromophobe RCC subtypes and oncocytoma.
        Am J Roentgenol. 2017; 208: 812-819
        • Sun M.R.
        • Ngo L.
        • Genega E.M.
        • et al.
        Renal cell carcinoma: dynamic contrast-enhanced MR imaging for differentiation of tumor subtypes—correlation with pathologic findings.
        Radiology. 2009; 250: 793-802
        • Vendrami C.L.
        • Parada Villavicencio C.
        • DeJulio T.J.
        • et al.
        Differentiation of solid renal tumors with multiparametric MR imaging.
        Radiographics. 2017; 37: 2026-2042
        • Jhaveri K.S.
        • Elmi A.
        • Hosseini-Nik H.
        • et al.
        Predictive value of chemical-shift MRI in distinguishing clear cell renal cell carcinoma from non–clear cell renal cell carcinoma and minimal-fat angiomyolipoma.
        Am J Roentgenol. 2015; 205: W79-W86
        • Lopez-Beltran A.
        • Carrasco J.C.
        • Cheng L.
        • et al.
        2009 update on the classification of renal epithelial tumors in adults.
        Int J Urol. 2009; 16: 432-443
        • Herts B.R.
        • Coll D.M.
        • Novick A.C.
        • et al.
        Enhancement characteristics of papillary renal neoplasms revealed on triphasic helical CT of the kidneys.
        Am J Roentgenol. 2002; 178: 367-372
        • Agochukwu N.
        • Huber S.
        • Spektor M.
        • et al.
        Differentiating renal neoplasms from simple cysts on contrast-enhanced CT on the basis of attenuation and homogeneity.
        Am J Roentgenol. 2017; 208: 801-804
        • Dilauro M.
        • Quon M.
        • McInnes M.D.F.
        • et al.
        Comparison of contrast-enhanced multiphase renal protocol CT versus MRI for diagnosis of papillary renal cell carcinoma.
        Am J Roentgenol. 2016; 206: 319-325
        • Egbert N.D.
        • Caoili E.M.
        • Cohan R.H.
        • et al.
        Differentiation of papillary renal cell carcinoma subtypes on CT and MRI.
        Am J Roentgenol. 2013; 201: 347-355
        • Oliva M.R.
        • Glickman J.N.
        • Zou K.H.
        • et al.
        Renal cell carcinoma: T1 and T2 signal intensity characteristics of papillary and clear cell types correlated with pathology.
        Am J Roentgenol. 2009; 192: 1524-1530
        • Prando A.
        • Prando P.
        • Prando D.
        Urothelial cancer of the renal pelvicaliceal system: unusual imaging manifestations.
        Radiographics. 2010; 30: 1553-1566
        • Patel U.
        • Ramachandran N.
        • Halls J.
        • et al.
        Synchronous renal masses in patients with a non renal malignancy: incidence of metastasis to the kidney versus primary renal neoplasia and differentiating features on CT.
        Am J Roentgenol. 2011; 197: W680-W686
        • Zhou C.
        • Urbauer D.L.
        • Fellman B.M.
        • et al.
        Metastases to the kidney: a comprehensive analysis of 151 patients from a tertiary referral centre.
        BJU Int. 2016; 117: 775-782
        • Ganeshan D.
        • Iyer R.
        • Devine C.
        • et al.
        Imaging of primary and secondary renal lymphoma.
        Am J Roentgenol. 2013; 201: W712-W719
        • Johnson D.C.
        • Vukina J.
        • Smith A.B.
        • et al.
        Preoperatively misclassified, surgically removed benign renal masses: a systematic review of surgical series and United States population level burden estimate.
        J Urol. 2015; 193: 30-35
        • Kutikov A.
        • Fossett L.K.
        • Ramchandani P.
        • et al.
        Incidence of benign pathologic findings at partial nephrectomy for solitary renal mass presumed to be renal cell carcinoma on preoperative imaging.
        Urology. 2006; 68: 737-740
        • Jinzaki M.
        • Tanimoto A.
        • Narimatsu Y.
        • et al.
        Angiomyolipoma: imaging findings in lesions with minimal fat.
        Radiology. 1997; 205: 497-502
        • Karlo C.A.
        • Donati O.F.
        • Burger I.A.
        • et al.
        MR imaging of renal cortical tumours: qualitative and quantitative chemical shift imaging parameters.
        Eur Radiol. 2013; 23: 1738-1744
        • Outwater E.K.
        • Bhatia M.
        • Siegelman E.S.
        • et al.
        Lipid in renal clear cell carcinoma: detection on opposed-phase gradient-echo MR images.
        Radiology. 1997; 205: 103-107
        • Chaudhry H.S.
        • Davenport M.S.
        • Nieman C.M.
        • et al.
        Histogram analysis of small solid renal masses: differentiating minimal fat angiomyolipoma from renal cell carcinoma.
        Am J Roentgenol. 2012; 198: 377-383
        • Jeong C.J.
        • Park B.K.
        • Park J.J.
        • et al.
        Unenhanced CT and MRI parameters that can be used to reliably predict fat-invisible angiomyolipoma.
        Am J Roentgenol. 2016; 206: 340-347
        • Perez-Ordonez B.
        • Hamed G.
        • Campbell S.
        • et al.
        Renal oncocytoma: a clinicopathologic study of 70 cases.
        Am J Surg Pathol. 1997; 21: 871-883
        • Sasaguri K.
        • Takahashi N.
        • Gomez-Cardona D.
        • et al.
        Small (< 4 cm) renal mass: differentiation of oncocytoma from renal cell carcinoma on biphasic contrast-enhanced CT.
        Am J Roentgenol. 2015; 205: 999-1007
        • Rosenkrantz A.B.
        • Hindman N.
        • Fitzgerald E.F.
        • et al.
        MRI features of renal oncocytoma and chromophobe renal cell carcinoma.
        Am J Roentgenol. 2010; 195: W421-W427
        • Davidson A.J.
        • Hayes W.S.
        • Hartman D.S.
        • et al.
        Renal oncocytoma and carcinoma: failure of differentiation with CT.
        Radiology. 1993; 186: 693-696
        • Kim J.I.
        • Cho J.Y.
        • Moon K.C.
        • et al.
        Segmental enhancement inversion at biphasic multidetector CT: characteristic finding of small renal oncocytoma.
        Radiology. 2009; 252: 441-448
        • O’Malley M.E.
        • Tran P.
        • Hanbidge A.
        • et al.
        Small renal oncocytomas: is segmental enhancement inversion a characteristic finding at biphasic MDCT?.
        Am J Roentgenol. 2012; 199: 1312-1315
        • McGahan J.P.
        • Lamba R.
        • Fisher J.
        • et al.
        Is segmental enhancement inversion on enhanced biphasic MDCT a reliable sign for the noninvasive diagnosis of renal oncocytomas?.
        Am J Roentgenol. 2011; 197: W674-W679
        • Jhaveri K.
        • Gupta P.
        • Elmi A.
        • et al.
        Cystic renal cell carcinomas: do they grow, metastasize, or recur?.
        Am J Roentgenol. 2013; 201: 292-296
        • Hindman N.M.
        • Bosniak M.A.
        • Rosenkrantz A.B.
        • et al.
        Multilocular cystic renal cell carcinoma: comparison of imaging and pathologic findings.
        Am J Roentgenol. 2012; 198: 20-26
        • Corwin M.T.
        • Loehfelm T.W.
        • McGahan J.P.
        • et al.
        Prevalence of low-attenuation homogeneous papillary renal cell carcinoma mimicking renal cysts on CT.
        Am J Roentgenol. 2018; 211: 1259-1263
        • Koga S.
        • Nishikido M.
        • Hayashi T.
        • et al.
        Outcome of surgery in cystic renal cell carcinoma.
        Urology. 2000; 56: 67-70
        • Onishi T.
        • Oishi Y.
        • Goto H.
        • et al.
        Cyst-associated renal cell carcinoma: clinicopathologic characteristics and evaluation of prognosis in 27 cases.
        Int J Urol. 2001; 8: 268-274
        • Webster W.S.
        • Thompson R.H.
        • Cheville J.C.
        • et al.
        Surgical resection provides excellent outcomes for patients with cystic clear cell renal cell carcinoma.
        Urology. 2007; 70: 900-904
        • Bosniak M.A.
        The current radiological approach to renal cysts.
        Radiology. 1986; 158: 1-10
        • Mousessian P.N.
        • Yamauchi F.I.
        • Mussi T.C.
        • et al.
        Malignancy rate, histologic grade, and progression of Bosniak category III and IV complex renal cystic lesions.
        Am J Roentgenol. 2017; 209: 1285-1290
        • Bhatt S.
        • MacLennan G.
        • Dogra V.
        Renal pseudotumors.
        Am J Roentgenol. 2007; 188: 1380-1387
        • Craig W.D.
        • Wagner B.J.
        • Travis M.D.
        Pyelonephritis: radiologic-pathologic review.
        RadioGraphics. 2008; 28: 255-276
        • Pickhardt P.J.
        • Lonergan G.J.
        • Davis Jr., C.J.
        • et al.
        Infiltrative renal lesions: radiologic–pathologic correlation. Armed Forces Institute of Pathology.
        RadioGraphics. 2000; 20: 215-243
        • Cura M.
        • Elmerhi F.
        • Suri R.
        • et al.
        Vascular malformations and arteriovenous fistulas of the kidney.
        Acta Radiologica. 2010; 51: 144-149
        • Takahashi N.
        • Kawashima A.
        • Fletcher J.G.
        • et al.
        Renal involvement in patients with autoimmune pancreatitis: CT and MR imaging findings.
        Radiology. 2007; 242: 791-801
        • Martínez-de-Alegría A.
        • Baleato-González S.
        • García-Figueiras R.
        • et al.
        IgG4-related disease from head to toe.
        Radiographics. 2015; 35: 2007-2025
        • Barr R.G.
        • Peterson C.
        • Hindi A.
        Evaluation of indeterminate renal masses with contrast-enhanced US: a diagnostic performance study.
        Radiology. 2014; 271: 133-142
        • Park B.K.
        • Kim B.
        • Kim S.H.
        • et al.
        Assessment of cystic renal masses based on Bosniak classification: comparison of CT and contrast-enhanced US.
        Eur J Radiol. 2007; 61: 310-314
        • Ascenti G.
        • Mazziotti S.
        • Zimbaro G.
        • et al.
        Complex cystic renal masses: characterization with contrast-enhanced US.
        Radiology. 2007; 243: 158-165
        • Quaia E.
        • Bertolotto M.
        • Cioffi V.
        • et al.
        Comparison of contrast-enhanced sonography with unenhanced sonography and contrast-enhanced CT in the diagnosis of malignancy in complex cystic renal masses.
        Am J Roentgenol. 2008; 191: 1239-1249
        • Herts B.R.
        • Silverman S.G.
        • Hindman N.M.
        • et al.
        Management of the incidental renal mass on CT: a white paper of the ACR Incidental Findings Committee.
        JACR. 2018; 15: 264-273
        • Campbell S.C.
        • Novick A.C.
        • Belldegrun A.
        • et al.
        Guideline for management of the clinical T1 renal mass.
        J Clin Oncol. 2017; 35: 668-680
        • Finelli T.
        Partial nephrectomy is not the proven standard for stage T1b renal cell carcinoma.
        Can Urol Assoc J. 2012; 6: 131-133
        • Umbreit E.C.
        • Shimko M.S.
        • Childs M.A.
        • et al.
        Metastatic potential of a renal mass according to original tumour size at presentation.
        BJU Int. 2012; 109: 190-194
        • Alam R.
        • Patel H.D.
        • Riffon M.F.
        • et al.
        Intermediate-term outcomes from the DISSRM registry: a prospective analysis of active surveillance in patients with small renal masses.
        J Clin Oncol. 2017; 35: 430
        • Kunkle D.A.
        • Crispen P.L.
        • Chen D.Y.
        • et al.
        Enhancing renal masses with zero net growth during active surveillance.
        J Urol. 2007; 177: 849-854
        • Schoots I.G.
        • Zaccai K.
        • Hunink M.G.
        • et al.
        Bosniak classification for complex renal cysts reevaluated: a systematic review.
        J Urol. 2017; 198: 12-21
        • Lim C.S.
        • Schieda N.
        • Silverman S.G.
        Update on indications for percutaneous renal mass biopsy in the era of advanced CT and MRI.
        Am J Roentgenol. 2019; 212: 1187-1196
        • Meyer M.
        • Nelson R.C.
        • Vernuccio F.
        • et al.
        Virtual unenhanced images at dual-energy CT: influence on renal lesion characterization.
        Radiology. 2019; 291: 381-390
        • Mileto A.
        • Allen B.C.
        • Pietryga J.A.
        • et al.
        Characterization of incidental renal mass with dual-energy CT: diagnostic accuracy of effective atomic number maps for discriminating nonenhancing cysts from enhancing masses.
        Am J Roentgenol. 2017; 209: 221-230
        • Miskin N.
        • Qin L.
        • Matalon S.A.
        • et al.
        Stratification of cystic renal masses into benign and potentially malignant: applying machine learning to the bosniak classification.
        Abdom Radiol. 2020; 46: 311-318
        • Said D.
        • Hectors S.J.
        • Wilck E.
        • et al.
        Characterization of solid renal neoplasms using MRI-based quantitative radiomics features.
        Abdom Radiol. 2020; 25: 1
        • Kocak B.
        • Durmaz E.S.
        • Erdim C.
        • et al.
        Radiomics of renal masses: systematic review of reproducibility and validation strategies.
        Am J Roentgenol. 2020; 214: 129-136