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Open Access 01-10-2011 | Pictorial Review

Assessment and characterisation of common renal masses with CT and MRI

Authors: Leo Pallwein-Prettner, Daniel Flöry, Claus Raphael Rotter, Kurt Pogner, Gerhard Syré, Claudia Fellner, Ferdinand Frauscher, Friedrich Aigner, Frens Steffen Krause, Franz Fellner

Published in: Insights into Imaging | Issue 5/2011

Abstract

Objective

Owing to the widespread use of abdominal imaging studies the detection rate of solid renal masses has increased, and an accurate characterisation of imaging features of renal masses has become more essential for case management.

Method and results

MR imaging (MRI) and computed tomography (CT) are frequently used modalities for detection and differentiation of renal masses. This article gives a review of imaging characteristics of benign and malignant renal masses, discussing their appearance in CT and MR imaging. Advanced MR techniques like diffusion-weighted imaging and apparent diffusion coefficient (ADC) mapping, which have shown promising results in the differentiation between benign and malignant renal lesions, will be introduced.

Conclusion

MRI and CT are useful in the characterisation and estimation of the prognosis for renal masses.

Srougi V, Kato RB, Salvatore FA, Ayres PP, Dall'Oglio MF, Srougi M (2009) Incidence of benign lesions according to tumor size in solid renal masses. Int Braz J Urol 35(4):427–431PubMedCrossRef

Coulam CH, Sheafor DH, Leder RA, Paulson EK, DeLong DM, Nelson RC (2000) Evaluation of pseudoenhancement of renal cysts during contrast-enhanced CT. AJR Am J Roentgenol 174(2):493–498PubMedCrossRef

Tada S, Yamagishi J, Kobayashi H, Hata Y, Kobari T (1983) The incidence of simple renal cyst by computed tomography. Clin Radiol 34:437–439PubMedCrossRef

Pahernik S, Ziegler S, Roos F, Melchior SW, Thüroff JW (2007) Small renal tumors: correlation of clinical and pathological features with tumor size. J Urol 178:414–417, discussion 416-417PubMedCrossRef

Jemal A, Siegel R, Ward E, Hao Y, Xu J, Murray T et al (2008) Cancer statistics, 2008. CA Cancer J Clin 58:71–96PubMedCrossRef

Chow WH, Devesa SS, Warren JL, Fraumeni JF Jr (1999) Rising incidence of renal cell cancer in the United States. JAMA 281:1628–1631PubMedCrossRef

D'Antonio A, Caleo A, Caleo O, Addesso M, Boscaino A (2010) Hepatocellular carcinoma metastatic to the kidney mimicking renal oncocytoma. Hepatobiliary Pancreat Dis Int 9(5):550–552PubMed

Kovacs G, Akhtar M, Beckwith BJ et al (1997) The Heidelberg classification of renal cell tumours. J Pathol 183:131–133PubMedCrossRef

Motzer RJ, Bacik J, Mariani T, Russo P, Mazumdar M, Reuter V (2002) Treatment outcome and survival associated with metastatic renal cell carcinoma of non-clear-cell histology. J Clin Oncol 20:2376–2381PubMedCrossRef

10.

Choh NA, Jehangir M, Choh SA (2010) Renal replacement lipomatosis: a rare type of renal pseudotumor. Indian J Nephrol 20(2):92–93PubMedPubMedCentralCrossRef

11.

Tarhan F, Gül AE, Karadayi N, Kuyumcuoğlu U (2004) Inflammatory pseudotumor of the kidney: a case report. Int Urol Nephrol 36(2):137–140PubMedCrossRef

12.

Joffe SA, Servaes S, Okon S, Horowitz M (2003) Multi-detector row CT urography in the evaluation of hematuria. Radiographics 23(6):1441–1455PubMedCrossRef

13.

Zhang J, Pedrosa I, Rofsky NM (2003) MR techniques for renal imaging. Radiol Clin North Am 41:877–907PubMedCrossRef

14.

Silverman SG, Leyendecker JR, Amis ES Jr (2009) What is the current role of CT urography and MR urography in the evaluation of the urinary tract? Radiology 250(2):309–323PubMedCrossRef

15.

Nikken JJ, Krestin GP (2007) MRI of the kidney – state of the art. Eur Radiol 17:2780–2793, ReviewPubMedPubMedCentralCrossRef

16.

Al-Okaili RN, Krejza J, Wang S, Woo JH, Melhem ER (2006) Advanced MR imaging techniques in the diagnosis of intraaxial brain tumors in adults. Radiographics 26(Suppl 1):S173–S189PubMedCrossRef

17.

Zhang J, Tehrani YM, Wang L, Ishill NM, Schwartz LH, Hricak H (2008) Renal masses: characterization with diffusion-weighted MR imaging—a preliminary experience. Radiology 247(2):458–464PubMedCrossRef

18.

Sandrasegaran K, Sundaram CP, Ramaswamy R, Akisik FM, Rydberg MP, Lin C, Aisen AM (2010) Usefulness of diffusion-weighted imaging in the evaluation of renal masses. AJR Am J Roentgenol 194(2):438–445PubMedCrossRef

19.

Gill IS, Aron M, Gervais DA, Jewett MAS (2010) Small renal mass. N Engl J Med 362:624–634PubMedCrossRef

20.

Kreft BP, Müller-Miny H, Sommer T, Steudel A, Vahlensieck M, Novak D, Müller BG, Schild HH (1997) Diagnostic value of MR imaging in comparison to CT in the detection and differential diagnosis of renal masses: ROC analysis. Eur Radiol 7(4):542–547PubMedCrossRef

21.

Frank I, Blute ML, Cheville JC, Lohse CM, Weaver AL, Zincke H (2003) Solid renal tumors: an analysis of pathological features related to tumor size. J Urol 170:2217–2220PubMedCrossRef

22.

Chawla SN, Crispen PL, Hanlon AL, Greenberg RE, Chen DY, Uzzo RG (2006) The natural history of observed enhancing renal masses: meta-analysis and review of the world literature. J Urol 175:425–431PubMedCrossRef

23.

Klatte T, Patard JJ, de Martino M et al (2008) Tumor size does not predict risk of metastatic disease or prognosis of small renal cell carcinomas. J Urol 179:1719–1726PubMedCrossRef

24.

Remzi M, Ozsoy M, Klingler HC et al (2006) Are small renal tumors harmless? Analysis of histopathological features according to tumors 4 cm or less in diameter. J Urol 176:896–899PubMedCrossRef

25.

Schurich M, Pallwein L, Steiner H, Mallouhi A, zur Nedden D, Frauscher F (2005) The role of Multiphasic Helical CT in estimation of type of renal cell carcinoma: an approach based on standardized morphological and enhancement parameters (abstract for poster presentation LPH06-04) In: Radiological Society of North America scientific assembly and annual meeting program. Oak Brook, IL. Available at http://rsna2005.rsna.org/rsna2005/V2005/conference/event_display.cfm?em_id=4419040

26.

Siu W, Hafez KS, Johnston WK III, Wolf JS Jr (2007) Growth rates of renal cell carcinoma and oncocytoma under surveillance are similar. Urol Oncol 25:115–119PubMedCrossRef

27.

Kunkle DA, Crispen PL, Chen DYT, Greenberg RE, Uzzo RG (2007) Enhancing renal masses with zero net growth during active surveillance. J Urol 177:849–854PubMedCrossRef

28.

Silverman SG, Israel GM, Herts BR, Richie JP (2008) Management of the incidental renal mass. Radiology 249:16–31PubMedCrossRef

29.

Kim JK, Kim SH, Jang YJ et al (2008) Renal angiomyolipoma with minimal fat: differentiation from other neoplasms at double-echo chemical shift FLASH MR imaging. Radiology 239:174–180CrossRef

30.

Israel GM, Bosniak MA (2008) Pitfalls in renal mass evaluation and how to avoid them. Radiographics 28(5):1325–1338, ReviewPubMedCrossRef

31.

Outwater EK, Bhatia M, Siegelman ES, Burke MA, Mitchell DG (1997) Lipid in renal clear cell carcinoma: detection on opposed-phase gradient-echo MR images. Radiology 205:103–107PubMedCrossRef

32.

Pedrosa I, Sun MR, Spencer M, Genega EM, Olumi AF, Dewolf WC, Rofsky NM (2008) MR imaging of renal masses: correlation with findings at surgery and pathologic analysis. Radiographics 28:985–1003PubMedCrossRef

33.

Wagner BJ (1997) The kidney: radiologic-pathologic correlation. Magn Reson Imaging Clin N Am 5:13–28PubMed

34.

Israel GM, Hindman N, Bosniak MA (2004) Evaluation of cystic renal masses: comparison of CT and MR imaging by using the Bosniak classification system. Radiology 231(2):365–371PubMedCrossRef

35.

Koga S, Nishikido M, Inuzuka S, Sakamoto I, Hayashi T, Hayashi K, Saito Y, Kanetake H (2000) An evaluation of Bosniak's radiological classification of cystic renal masses. BJU Int 86(6):607–609PubMedCrossRef

36.

Xu HX (2009) Contrast-enhanced ultrasound: the evolving applications. World J Radiol 31(1):15–24CrossRef

37.

Novara G, Martignoni G, Artibani W, Ficarra V (2007) Grading systems in renal cell carcinoma. J Urol 177:430–436PubMedCrossRef

38.

Cheville JC, Lohse CM, Zincke H, Weaver AL, Blute ML (2003) Comparisons of outcome and prognostic features among histologic subtypes of renal cell carcinoma. Am J Surg Pathol 27:612–624PubMedCrossRef

39.

Ruppert-Kohlmayr AJ, Uggowitzer M, Meissnitzer T, Ruppert G (2004) Differentiation of renal clear cell carcinoma and renal papillary carcinoma using quantitative CT enhancement parameters. AJR Am J Roentgenol 183:1387–1391PubMedCrossRef

40.

Roy C, Sauer B, Lindner V, Lang H, Saussine C, Jacqmin D (2007) MR imaging of papillary renal neoplasms: potential application for characterization of small renal masses. Eur Radiol 17:193–200PubMedCrossRef

41.

Yoshimitsu K, Kakihara D, Irie H et al (2006) Papillary renal carcinoma: diagnostic approach by chemical shift gradient-echo and echo-planar MR imaging. J Magn Reson Imaging 23:339–344PubMedCrossRef

42.

Vikram R, Sandler CM, Ng CS (2009) Imaging and staging of transitional cell carcinoma: part 2, upper urinary tract. AJR Am J Roentgenol 192(6):1488–14893, ReviewPubMedCrossRef

43.

Pickhardt PJ, Lonergan GJ, Davis CJ Jr, Kashitani N, Wagner BJ (2000) From the archives of the AFIP: infiltrative renal lesions—radiologic-pathologic correlation. Radiographics 20:215–243PubMedCrossRef

44.

Hulnick DH, Bosniak MA (1986) “Faceless kidney”: CT sign of renal duplicity. J Comput Assist Tomogr 10:771–772PubMedCrossRef

45.

Sheth S, Ali S, Fishman E (2006) Imaging of renal lymphoma: patterns of disease with pathologic correlation. Radiographics 26(4):1151–1168, ReviewPubMedCrossRef

46.

Urban BA, Fishman EK (2000) Renal lymphoma: CT patterns with emphasis on helical CT. Radiographics 20:197–212PubMedCrossRef

47.

Semelka RC, Kelekis NL, Burdeny DA, Mitchell DG, Brown JJ, Siegelman ES (1996) Renal lymphoma: demonstration by MR imaging. AJR Am J Roentgenol 166:823–827PubMedCrossRef

48.

Pinggera GM, Peschel R, Buttazzoni A, Mitterberger M, Friedrich A, Pallwein L (2009) A possible case of primary renal lymphoma: a case report. Cases J 2:6233PubMedPubMedCentralCrossRef

49.

Simpfendorfer C, Herts BR, Motta-Ramirez GA, Lockwood DS, Zhou M, Leiber M, Remer EM (2009) Angiomyolipoma with minimal fat on MDCT: can counts of negative-attenuation pixels aid diagnosis? AJR Am J Roentgenol 192(2):438–443PubMedCrossRef

50.

Israel GM, Hindman N, Hecht E, Krinsky G (2005) The use of opposed-phase chemical shift MRI in the diagnosis of renal angiomyolipomas. AJR Am J Roentgenol 184:1868–1872PubMedCrossRef

51.

Burdeny DA, Semelka RC, Kelekis NL, Reinhold C, Ascher SM (1997) Small (<1.5 cm) angiomyolipomas of the kidney: characterization by the combined use of in-phase and fat-attenuated MR techniques. Magn Reson Imaging 15:141–145PubMedCrossRef

52.

Harmon WJ, King BF, Lieber MM (1996) Renal oncocytoma: magnetic resonance imaging characteristics. J Urol 155:863–867PubMedCrossRef

53.

Verswijvel G, Oyen R, Van Poppel H, Roskams T (2000) Xanthogranulomatous pyelonephritis: MRI findings in the diffuse and the focal type. Eur Radiol 10:586–589PubMedCrossRef

54.

Craig WD, Wagner BJ, Travis MD (2008) Pyelonephritis: radiologic-pathologic review. Radiographics 28(1):255–277, quiz 327-328. ReviewPubMedCrossRef

55.

Jeong JY, Kim SH, Lee HJ, Sim JS (2002) Atypical low-signal-intensity renal parenchyma: causes and patterns. Radiographics 22(4):833–846, ReviewPubMedCrossRef

56.

Wang R, Li AY, Wood DP Jr (2011) The role of percutaneous renal biopsy in the management of small renal masses. Curr Urol Rep 12(1):18–23PubMedCrossRef

57.

Sofikerim M, Tatlisen A, Canoz O, Tokat F, Demirtas A, Mavili E (2010) What is the role of percutaneous needle core biopsy in diagnosis of renal masses? Urology 76(3):614–618PubMedCrossRef

58.

Volpe A, Terrone C, Scarpa RM (2009) The current role of percutaneous needle biopsies of renal tumours. Arch Ital Urol Androl 81(2):107–112, ReviewPubMed

Title: Assessment and characterisation of common renal masses with CT and MRI
Authors: Leo Pallwein-Prettner
Daniel Flöry
Claus Raphael Rotter
Kurt Pogner
Gerhard Syré
Claudia Fellner
Ferdinand Frauscher
Friedrich Aigner
Frens Steffen Krause
Franz Fellner
Publication date: 01-10-2011
Publisher: Springer Berlin Heidelberg
Published in: Insights into Imaging / Issue 5/2011
Electronic ISSN: 1869-4101
DOI: https://doi.org/10.1007/s13244-011-0116-1

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Assessment and characterisation of common renal masses with CT and MRI

Abstract

Objective

Method and results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Objective

Method and results

Conclusion

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