Current Urology Reports

, Volume 12, Issue 1, pp 11–17

Contemporary Imaging of the Renal Mass



Renal masses increasingly are detected incidentally in asymptomatic individuals. Accurate characterization of these lesions is important for clinical management, planning intervention, and avoiding unnecessary procedures. Ultrasonography, computed tomography (CT), and magnetic resonance imaging (MRI) are the mainstays of renal mass detection and characterization. Ultrasonography is useful for distinguishing cystic from solid lesions and can detect lesion vascularity, especially with use of ultrasound contrast agents, but is less sensitive, less specific, and less reproducible than CT and MRI. CT, with and without intravenous contrast, is the primary imaging test for characterization and staging of renal lesions, and is utilized more often than MRI. Current multidetector CT technology provides near isotropic acquisition, with three-dimensional reformatting capabilities. Due to lack of exposure to iodinated contrast and ionizing radiation and superior soft tissue contrast, MRI is being increasingly utilized as a problem-solving tool for diagnosis, staging, and preoperative planning for renal malignancies. Future directions for imaging of primary renal neoplasm include accurate characterization of renal cell cancer subtype, assistance with treatment planning, and evaluation of treatment response.


Magnetic resonance imaging Computed tomography Ultrasonography Renal mass Renal cell carcinoma 


Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. 1.
    Bosniak MA: The small (less than or equal to 3.0 cm) renal parenchymal tumor: detection, diagnosis, and controversies. Radiology 1991, 179:307–317. (Published erratum appears in Radiology 1991, 181:289.)PubMedGoogle Scholar
  2. 2.
    Jayson M, Sanders H: Increased incidence of serendipitously discovered renal cell carcinoma. Urology 1998, 51:203–205.CrossRefPubMedGoogle Scholar
  3. 3.
    Frank I, Blute ML, Cheville JC, et al.: Solid renal tumors: an analysis of pathological features related to tumor size. J Urol 2003, 170:2217–2220.CrossRefPubMedGoogle Scholar
  4. 4.
    Zirinsky K, Auh YH, Rubenstein WA, et al.: CT of the hyperdense renal cyst: sonographic correlation. AJR Am J Roentgenol 1984, 143:151–156.PubMedGoogle Scholar
  5. 5.
    Jamis-Dow CA, Choyke PL, Jennings SB, et al.: Small (< or = 3-cm) renal masses: detection with CT versus US and pathologic correlation. Radiology 1996, 198:785–788.PubMedGoogle Scholar
  6. 6.
    Yamashita Y, Takahashi M, Watanabe O, et al.: Small renal cell carcinoma: pathologic and radiologic correlation. Radiology 1992, 184:493–498. (Published erratum appears in Radiology 1993, 189:925.)PubMedGoogle Scholar
  7. 7.
    Israel GM, Bosniak MA: How I do it: evaluating renal masses. Radiology 2005, 236:441–450.CrossRefPubMedGoogle Scholar
  8. 8.
    Park BK, Kim B, Kim SH, 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.CrossRefPubMedGoogle Scholar
  9. 9.
    Hélénon O, Correas JM, Balleyguier C, et al.: Ultrasound of renal tumors. Eur Radiol 2001, 11:1890–1901.CrossRefPubMedGoogle Scholar
  10. 10.
    Birnbaum BA, Hindman N, Lee J, et al.: Renal cyst pseudoenhancement: influence of multidetector CT reconstruction algorithm and scanner type in phantom model. Radiology 2007, 244:767–775.CrossRefPubMedGoogle Scholar
  11. 11.
    Vikram R, Ng CS, Tamboli P, et al.: Papillary Renal Cell Carcinoma: Radiologic-Pathologic Correlation and Spectrum of Disease. Radiographics 2009, 29:741–754.CrossRefPubMedGoogle Scholar
  12. 12.
    Fletcher JG, Takahashi N, Hartman R, et al.: Dual-energy and dual-source CT: is there a role in the abdomen and pelvis? Radiol Clin North Am 2009, 47:41–57.CrossRefPubMedGoogle Scholar
  13. 13.
    Graser A, Johnson TR, Bader M, et al.: Dual energy CT characterization of urinary calculi: initial in vitro and clinical experience. Invest Radiol 2008, 43:112–119.CrossRefPubMedGoogle Scholar
  14. 14.
    •• Graser A, Becker CR, Staehler M, et al.: Single-phase dual-energy CT allows for characterization of renal masses as benign or malignant. Invest Radiol 2010, 45:399–405. According to the authors, dual-energy CT allows accurate characterization of renal masses in a single phase acquisition while reducing patient radiation exposure by almost 50%. PubMedGoogle Scholar
  15. 15.
    Fazel R, Krumholz HM, Wang Y, et al.: Exposure to low-dose ionizing radiation from medical imaging procedures. N Engl J Med 2009, 361:849–857.CrossRefPubMedGoogle Scholar
  16. 16.
    Sadowski EA, Bennett LK, Chan MR, et al.: Nephrogenic systemic fibrosis: risk factors and incidence estimation. Radiology 2007, 243:148–157.CrossRefPubMedGoogle Scholar
  17. 17.
    Kuo P, Kanal E, Abu-Alfa AK, Cowper SE: Gadolinium-based MR contrast agents and nephrogenic systemic fibrosis. Radiology 2007, 242:647–649.CrossRefPubMedGoogle Scholar
  18. 18.
    Hecht EM, Israel GM, Krinsky GA, 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. Radiology 2004, 232:373–378.CrossRefPubMedGoogle Scholar
  19. 19.
    Israel GM, Hindman N, Bosniak MA: Evaluation of cystic renal masses: comparison of CT and MR imaging by using the Bosniak classification system. Radiology 2004, 231:365–371.CrossRefPubMedGoogle Scholar
  20. 20.
    Israel GM, Hindman N, Hecht E, Krinsky G: The use of opposed-phase chemical shift MRI in the diagnosis of renal angiomyolipomas. AJR Am J Roentgenol 2005, 184:1868–1872.PubMedGoogle Scholar
  21. 21.
    • Taouli B, Thakur RK, Mannelli L, et al.: Renal lesions: characterization with diffusion-weighted imaging versus contrast-enhanced MR imaging. Radiology 2009, 251:398–407. This articles shows that diffusion-weighted imaging can be used to characterize renal lesions; ADC values are significantly lower in renal malignancies than in benign lesions. CrossRefPubMedGoogle Scholar
  22. 22.
    Zhang J, Tehrani YM, Wang L, et al.: Renal masses: characterization with diffusion-weighted MR Imaging: a preliminary experience. Radiology 2008, 247:458–464.CrossRefPubMedGoogle Scholar
  23. 23.
    Rosenkrantz AB, Niver BE, Fitzgerald EF, et al.: Utility of the apparent diffusion coefficient for distinguishing clear cell renal cell carcinoma of low and high nuclear grade. AJR Am J Roentgenol 2010. doi:10.2214/AJR.10.4688.
  24. 24.
    • Sun MR, Ngo L, Genega EM, et al.: Renal cell carcinoma: dynamic contrast-enhanced MR imaging for differentiation of tumor subtypes—correlation with pathologic findings. Radiology 2009, 250:793–802. This article shows that different enhancement patterns on dynamic contrast-enhanced MRI allow for differentiation between clear cell, papillary, and chromophobe RCCs.CrossRefPubMedGoogle Scholar
  25. 25.
    Pedrosa I, Chou MT, Ngo L, et al.: MR classification of renal masses with pathologic correlation. Eur Radiol 2008, 18:365–375.CrossRefPubMedGoogle Scholar
  26. 26.
    Herts BR, Coll DM, Novick AC, et al.: Enhancement characteristics of papillary renal neoplasms revealed on triphasic helical CT of the kidneys. AJR Am J Roentgenol 2002, 178:367–372.PubMedGoogle Scholar
  27. 27.
    Kutikov A, Uzzo RG: The R.E.N.A.L. nephrometry score: a comprehensive standardized system for quantitating renal tumor size, location and depth. J Urol 2009, 182:844–853.CrossRefPubMedGoogle Scholar
  28. 28.
    Narumi Y, Hricak HT, Presti JC Jr, et al.: MR imaging evaluation of renal carcinoma. Abdom Imaging 1997, 22:216–225.CrossRefPubMedGoogle Scholar
  29. 29.
    Huch Böni RA, Debatin JF, Krestin GP: Contrast-enhanced MR imaging of the kidneys and adrenal glands. Magn Reson Imaging Clin N Am 1996, 4:101–131.Google Scholar
  30. 30.
    Sohn KM, Lee JM, Lee SY, et al.: Comparing MR imaging and CT in the staging of gastric carcinoma. AJR Am J Roentgenol 2000, 174:1551–1557 (Published erratum appears in AJR Am J Roentgenol 2000, 175:556.)PubMedGoogle Scholar
  31. 31.
    Kallman DA, King BF, Hattery RR, et al.: Renal vein and inferior vena cava tumor thrombus in renal cell carcinoma: CT, US, MRI and venacavography. J Computer Assist Tomogr 1992, 16:240–247.CrossRefGoogle Scholar
  32. 32.
    Choyke PL, Walther MM, Wagner JR, et al.: Renal cancer: preoperative evaluation with dual phase three-dimensional MR angiography. Radiology 1997, 205:767–771.PubMedGoogle Scholar
  33. 33.
    Majhail NS, Urbain JL, Albani JM, et al.: F-18 fluorodeoxyglucose positron emission tomography in the evaluation of distant metastases from renal cell carcinoma. J Clin Oncol 2003, 21:3995–4000.CrossRefPubMedGoogle Scholar
  34. 34.
    Chae EJ, Kim JK, Kim SH, et al.: Renal cell carcinoma: analysis of postoperative recurrence patterns. Radiology 2005, 234:189–196.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2010

Authors and Affiliations

  1. 1.Department of RadiologyNYU Langone Medical CenterNew YorkUSA

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