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Contemporary update on imaging of cystic renal masses with histopathological correlation and emphasis on patient management.

Abstract：

:This article presents an updated review of cystic renal mass imaging. Most cystic renal masses encountered incidentally are benign and can be diagnosed confidently on imaging and require no follow-up. Hyperattenuating masses discovered at unenhanced or single-phase enhanced computed tomography (CT) measuring between 20-70 HU are indeterminate and can be further investigated first by using ultrasound and, then with multi-phase CT or magnetic resonance imaging (MRI); as the majority represent haemorrhagic/proteinaceous cysts (HPCs). Dual-energy CT may improve differentiation between HPCs and masses by suppressing unwanted pseudo-enhancement observed with conventional CT. HPCs can be diagnosed confidently when measuring >70 HU at unenhanced CT or showing markedly increased signal on T1-weighted imaging. Although the Bosniak criteria remains the reference standard for diagnosis and classification of cystic renal masses, histopathological classification and current management has evolved: multilocular cystic renal cell carcinoma (RCC) has been reclassified as a cystic renal neoplasm of low malignant potential, few Bosniak 2F cystic masses progress radiologically during follow-up; RCC with predominantly cystic components are less aggressive than solid RCC; and Bosniak III cystic masses behave non-aggressively. These advances have led to an increase in non-radical management or surveillance of cystic renal masses including Bosniak 3 lesions. Tubulocystic RCC is a newly described entity with distinct imaging characteristics, resembling a pancreatic serous microcystadenoma. Other benign cystic masses including: mixed epithelial stromal tumours (MEST) are now considered in the spectrum of cystic nephroma and angiomyolipoma (AML) with epithelial cysts (AMLEC) resemble a fat-poor AML with cystic components.

journal_name

Clin Radiol

journal_title

Clinical radiology

authors

Narayanasamy S,Krishna S,Prasad Shanbhogue AK,Flood TA,Sadoughi N,Sathiadoss P,Schieda N

doi

10.1016/j.crad.2018.09.003

subject

Has Abstract

pub_date

2019-02-01 00:00:00

pages

83-94

issue

eissn

0009-9260

issn

1365-229X

pii

S0009-9260(18)30537-3

journal_volume

pub_type

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Contemporary update on imaging of cystic renal masses with histopathological correlation and emphasis on patient management.