Top

Published in:

01-12-2020 | Computed Tomography | Educational Review

CT and MR imaging of cystic renal lesions

Authors: Francesco Agnello, Domenico Albano, Giuseppe Micci, Giuseppe Di Buono, Antonino Agrusa, Giuseppe Salvaggio, Salvatore Pardo, Gianvincenzo Sparacia, Tommaso Vincenzo Bartolotta, Massimo Midiri, Roberto Lagalla, Massimo Galia

Published in: Insights into Imaging | Issue 1/2020

Abstract

Cystic renal lesions are a common incidental finding on routinely imaging examinations. Although a benign simple cyst is usually easy to recognize, the same is not true for complex and multifocal cystic renal lesions, whose differential diagnosis includes both neoplastic and non-neoplastic conditions. In this review, we will show a series of cases in order to provide tips to identify benign cysts and differentiate them from malignant ones.

Hartman DS, Choyke PL, Hartman MS (2004) From the RSNA refresher courses: a practical approach to the cystic renal mass. Radiographics 24(Suppl 1):S101–S115 PMID: 15486234PubMedCrossRef

Hélénon O, Crosnier A, Verkarre V, Merran S, Méjean A, Correas JM (2018) Simple and complex renal cysts in adults: classification system for renal cystic masses. Diagn Interv Imaging 99(4):189–218. https://doi.org/10.1016/j.diii.2017.10.005 PMID: 29482969CrossRefPubMed

Park BK, Kim B, Kim SH, Ko K, Lee HM, Choi HY (2007) Assessment of cystic renal masses based on Bosniak classification: comparison of CT and contrast-enhanced US. Eur J Radiol 61(2):310–314 PMID: 17097844PubMedCrossRef

Ascenti G, Mazziotti S, Zimbaro G et al (2007) Complex cystic renal masses: characterization with contrast-enhanced US. Radiology 243(1):158–165 PMID: 17392251PubMedCrossRef

Corvino A, Catalano O, Corvino F, Sandomenico F, Petrillo A (2017) Diagnostic performance and confidence of contrast-enhanced ultrasound in the differential diagnosis of cystic and cysticlike liver lesions. AJR Am J Roentgenol 209(3):W119–W127. https://doi.org/10.2214/AJR.16.17062 CrossRefPubMed

Corvino A, Catalano O, Setola SV, Sandomenico F, Corvino F, Petrillo A (2015) Contrast-enhanced ultrasound in the characterization of complex cystic focal liver lesions. Ultrasound Med Biol 41(5):1301–1310. https://doi.org/10.1016/j.ultrasmedbio.2014.12.667 CrossRefPubMed

Corvino A, Sandomenico F, Setola SV, Corvino F, Tafuri D, Catalano O (2019) Morphological and dynamic evaluation of complex cystic focal liver lesions by contrast-enhanced ultrasound: current state of the art. J Ultrasound 22(3):251–259. https://doi.org/10.1007/s40477-019-00385-2 CrossRefPubMedPubMedCentral

Quaia E, Bertolotto M, Cioffi V et al (2008) Comparison of contrast-enhanced sonography with unenhanced sonography and contrast-enhanced CT in the diagnosis of malignancy in complex cystic renal masses. AJR Am J Roentgenol 191(4):1239–1249. https://doi.org/10.2214/AJR.07.3546 PubMedCrossRef

Johnson PT, Horton KM, Fishman EK (2010) Optimizing detectability of renal pathology with MDCT: protocols, pearls, and pitfalls. AJR Am J Roentgenol 194(4):1001–1012. 20308503. https://doi.org/10.2214/AJR.09.3049 CrossRefPubMed

10.

Israel GM, Bosniak MA (2005) How I do it: evaluating renal masses. Radiology 236(2):441–450 PMID: 16040900PubMedCrossRef

11.

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):365–371 PMID: 15128983PubMedCrossRef

12.

Terada N, Arai Y, Kinukawa N, Terai A (2008) The 10-year natural history of simple renal cysts. Urology 71(1):7–11. https://doi.org/10.1016/j.urology.2007.07.075 PMID: 18242354CrossRefPubMed

13.

Carrim ZI, Murchison JT (2003) The prevalence of simple renal and hepatic cysts detected by spiral computed tomography. Clin Radiol 58(8):626–629 PMID: 12887956PubMedCrossRef

14.

Bosniak MA (1986) The current radiological approach to renal cysts. Radiology 158(1):1–10 PMID: 3510019PubMedCrossRef

15.

Bosniak MA (1997) The use of the Bosniak classification system for renal cysts and cystic tumors. J Urol 157(5):1852–1853 PMID: 9112545PubMedCrossRef

16.

Balci NC, Semelka RC, Patt RH et al (1999) Complex renal cysts: findings on MR imaging. AJR Am J Roentgenol 172(6):1495–1500 PMID: 10350279PubMedCrossRef

17.

Israel GM, Bosniak MA (2005) An update of the Bosniak renal cyst classification system. Urology 66(3):484–488 PMID: 16140062PubMedCrossRef

18.

Benjaminov O, Atri M, O'Malley M, Lobo K, Tomlinson G (2006) Enhancing component on CT to predict malignancy in cystic renal masses and interobserver agreement of different CT features. AJR Am J Roentgenol 186(3):665–672 PMID: 16498093PubMedCrossRef

19.

Galia M, Albano D, Bruno A et al (2017) Imaging features of solid renal masses. Br J Radiol 90(1077):20170077. https://doi.org/10.1259/bjr.20170077 PMID: 28590813PubMedPubMedCentralCrossRef

20.

Mileto A, Allen BC, Pietryga JA et al (2017) Characterization of incidental renal mass with dual-energy CT: diagnostic accuracy of effective atomic number maps for discriminating nonenhancing cysts from enhancing masses. AJR Am J Roentgenol 209(4):W221–W230. https://doi.org/10.2214/AJR.16.17325 PMID: 28705069PubMedCrossRef

21.

Fananapazir G, Lamba R, Lewis B, Corwin MT, Naderi S, Troppmann C (2015) Utility of MRI in the characterization of indeterminate small renal lesions previously seen on screening CT scans of potential renal donor patients. AJR Am J Roentgenol 205(2):325–330. https://doi.org/10.2214/AJR.14.13956 PMID: 26204282CrossRefPubMed

22.

Israel GM, Bosniak MA (2003) Calcification in cystic renal masses: is it important in diagnosis? Radiology 226(1):47–52 PMID: 12511667PubMedCrossRef

23.

Baert L, Steg A (1977) Is the diverticulum of the distal and collecting tubules a preliminary stage of the simple cyst in the adult? J Urol 118(5):707–710 PMID: 410950PubMedCrossRef

24.

Davarpanah AH, Spektor M, Mathur M, Israel GM (2016) Homogeneous T1 Hyperintense renal lesions with smooth borders: is contrast-enhanced MR imaging needed? Radiology 281(1):326. https://doi.org/10.1148/radiol.2016164032 PMID:27643777CrossRefPubMed

25.

Silverman SG, Israel GM, Herts BR, Richie JP (2008) Management of the incidental renal mass. Radiology 249(1):16–31. https://doi.org/10.1148/radiol.2491070783 PMID: 18796665CrossRefPubMed

26.

Bosniak MA (1993) Problems in the radiologic diagnosis of renal parenchymal tumors. Urol Clin North Am 20(2):217–230PubMed

27.

Bosniak MA (1997) Diagnosis and management of patients with complicated cystic lesions of the kidney. AJR Am J Roentgenol 169(3):819–821PubMedCrossRef

28.

Smith AD, Remer EM, Cox KL et al (2012) Bosniak category IIF and III cystic renal lesions: outcomes and associations. Radiology 262(1):152–160. https://doi.org/10.1148/radiol.11110888 PMID: 22106359PubMedCrossRef

29.

Hindman NM, Hecht EM, Bosniak MA (2014) Follow-up for Bosniak category 2F cystic renal lesions. Radiology 272(3):757–766. https://doi.org/10.1148/radiol.14122908 PMID: 24766033CrossRefPubMed

30.

O'Malley RL, Godoy G, Hecht EM, Stifelman MD, Taneja SS (2009) Bosniak category IIF designation and surgery for complex renal cysts. J Urol. 182(3):1091–1095. https://doi.org/10.1016/j.juro.2009.05.046 PMID: 19616809CrossRefPubMed

31.

Bosniak MA (2012) The Bosniak renal cyst classification: 25 years later. Radiology 262(3):781–785. https://doi.org/10.1148/radiol.11111595 PMID: 22357882CrossRefPubMed

32.

Wood CG 3rd, Stromberg LJ 3rd, Harmath CB et al (2015) CT and MR imaging for evaluation of cystic renal lesions and diseases. Radiographics 35(1):125–141. https://doi.org/10.1148/rg.351130016 PMID: 25590393PubMedCrossRef

33.

Winters BR, Gore JL, Holt SK, Harper JD, Lin DW, Wright JL (2015) Cystic renal cell carcinoma carries an excellent prognosis regardless of tumor size. Urol Oncol 33(12):505.e9–505.13. https://doi.org/10.1016/j.urolonc.2015.07.017 PMID: 26319351CrossRef

34.

Hartman DS, Davis CJ Jr, Johns T, Goldman SM (1986) Cystic renal cell carcinoma. Urology 28(2):145–153 PMID: 3739121PubMedCrossRef

35.

Moch H (2010) Cystic renal tumors: new entities and novel concepts. Adv Anat Pathol 17(3):209–214. https://doi.org/10.1097/PAP.0b013e3181d98c9d PMID:20418675CrossRefPubMed

36.

Moch H, Cubilla AL, Humphrey PA, Reuter VE, Ulbright TM (2016) The 2016 WHO Classification of tumours of the urinary system and male genital organs-part a: renal, penile, and testicular tumours. Eur Urol 70(1):93–105. https://doi.org/10.1016/j.eururo.2016.02.029 PMID: 26935559CrossRefPubMed

37.

Jhaveri K, Gupta P, Elmi A et al (2013) Cystic renal cell carcinomas: do they grow, metastasize, or recur? AJR Am J Roentgenol 201(2):W292–W296. https://doi.org/10.2214/AJR.12.9414 PMID: 23883243PubMedCrossRef

38.

Meilstrup JW, Mosher TJ, Dhadha RS, Hartman DS (1995) Other renal tumors. Semin Roentgenol 30:168–184PubMedCrossRef

39.

Bracken RB, Chica G, Johncon DE, Luna M (1979) Secondary renal neoplasms: an autopsy study. South Med J 72:806–807PubMedCrossRef

40.

Abrams H, Spira R, Goldstein M (1950) Metastases in carcinoma: analysis of 1000 autopsied cases. Cancer 3:74–85PubMedCrossRef

41.

Klinger ME (1951) Secondary tumors of the genitourinary tract. J Urol 65:144–153PubMedCrossRef

42.

Patel U, Ramachandran N, Halls J, Parthipun A, Slide C (2011) Synchronous renal masses in patients with a nonrenal malignancy: incidence of metastasis to the kidney versus primary renal neoplasia and differentiating features on CT. AJR Am J Roentgenol 197(4):W680–W686. https://doi.org/10.2214/AJR.11.6518 PMID: 21940540CrossRefPubMed

43.

Choyke PL, White EM, Zeman RK, Jaffe MH, Clark LR (1987) Renal metastases: clinicopathologic and radiologic correlation. Radiology 162(2):359–363 PMID: 3797648PubMedCrossRef

44.

Fan G, Xie YU, Pei X et al (2015) Renal metastasis from cervical carcinoma presenting as a renal cyst: a case report. Oncol Lett 10(5):2761–2764PubMedPubMedCentralCrossRef

45.

Moslemi MK (2010) Mixed epithelial and stromal tumor of the kidney or adult mesoblastic nephroma: an update. Urol J 7(3):141–147 PMID: 20845287PubMed

46.

Lane BR, Campbell SC, Remer EM et al (2008) Adult cystic nephroma and mixed epithelial and stromal tumor of the kidney: clinical, radiographic, and pathologic characteristics. Urology 71:1142–1148PubMedCrossRef

47.

Goyal A, Sharma R, Bhalla AS, Gamanagatti S, Seth A (2013) Diffusion-weighted MRI in inflammatory renal lesions: all that glitters is not RCC! Eur Radiol 23(1):272–279. https://doi.org/10.1007/s00330-012-2577-0 PMID:22797980CrossRefPubMed

48.

Kawashima A, Sandler CM, Goldman SM (2000) Imaging in acute renal infection. BJU Int 86(Suppl 1):70–79 PMID: 10961277PubMed

49.

Papanicolaou N, Pfister RC (1996) Acute renal infections. Radiol Clin North Am 34(5):965–995 PMID: 8784392PubMed

50.

Katabathina VS, Kota G, Dasyam AK, Shanbhogue AK, Prasad SR (2010) Adult renal cystic disease: a genetic, biological, and developmental primer. Radiographics 30(6):1509–1523. https://doi.org/10.1148/rg.306105513 PMID: 21071372CrossRefPubMed

51.

Gabow PA (1993) Autosomal dominant polycystic kidney disease. N Engl J Med 329(5):332–342 PMID: 8321262PubMedCrossRef

52.

Choyke PL (2000) Acquired cystic kidney disease. Eur Radiol 10(11):1716–1721 PMID: 11097395PubMedCrossRef

53.

Grantham JJ, Torres VE, Chapman AB et al (2006) Volume progression in polycystic kidney disease. N Engl J Med 354(20):2122–2130 PMID: 16707749PubMedCrossRef

54.

Chauveau D, Fakhouri F, Grünfeld JP (2000) Liver involvement in autosomal-dominant polycystic kidney disease: therapeutic dilemma. J Am Soc Nephrol. 11(9):1767–1775 Review. PubMed PMID: 10966503PubMed

55.

Tickoo SK, de Peralta-Venturina MN, Harik LR et al (2006) Spectrum of epithelial neoplasms in end-stage renal disease: an experience from 66 tumor-bearing kidneys with emphasis on histologic patterns distinct from those in sporadic adult renal neoplasia. Am J Surg Pathol 30(2):141–153 PMID: 16434887PubMedCrossRef

56.

Pei Y, Obaji J, Dupuis A et al (2009) Unified criteria for ultrasonographic diagnosis of ADPKD. J Am Soc Nephrol 20(1):205–212. https://doi.org/10.1681/ASN.2008050507 PubMedCrossRef

57.

Markowitz GS, Radhakrishnan J, Kambham N, Valeri AM, Hines WH, D'Agati VD (2000) Lithium nephrotoxicity: a progressive combined glomerular and tubulointerstitial nephropathy. J Am Soc Nephrol 11(8):1439–1448 PMID: 10906157PubMed

58.

Farres MT, Ronco P, Saadoun D et al (2003) Chronic lithium nephropathy: MR imaging for diagnosis. Radiology 229(2):570–574 PMID: 14595154PubMedCrossRef

59.

Slywotzky CM, Bosniak MA (2001) Localized cystic disease of the kidney. AJR Am J Roentgenol 176(4):843–849 PMID: 11264061PubMedCrossRef

Title: CT and MR imaging of cystic renal lesions
Authors: Francesco Agnello
Domenico Albano
Giuseppe Micci
Giuseppe Di Buono
Antonino Agrusa
Giuseppe Salvaggio
Salvatore Pardo
Gianvincenzo Sparacia
Tommaso Vincenzo Bartolotta
Massimo Midiri
Roberto Lagalla
Massimo Galia
Publication date: 01-12-2020
Publisher: Springer Berlin Heidelberg
Keywords: Computed Tomography
Kidney Cancer
Renal Abscess
Kidney Cancer
Computed Tomography
Kidney Cancer
Published in: Insights into Imaging / Issue 1/2020
Electronic ISSN: 1869-4101
DOI: https://doi.org/10.1186/s13244-019-0826-3

Keynote webinar | Spotlight on medication adherence

Springer Medicine

CT and MR imaging of cystic renal lesions

Abstract

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Please log in to get access to this content

Other articles of this Issue 1/2020

Multimodality imaging features of desmoid tumors: a head-to-toe spectrum

Tumor in the veins: an abdominal perspective with an emphasis on CT and MR imaging

Predictive value of a false-negative focused abdominal sonography for trauma (FAST) result in patients with confirmed traumatic abdominal injury

MRI of rectal cancer—relevant anatomy and staging key points

Early experiences of radiographers in Ireland during the COVID-19 crisis

Radiology imaging management in an Italian cancer center (IRST IRCCS) during the COVID-19 pandemic