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Imaging renal masses and staging renal tumours

Department of Radiology, University Hospital South Manchester, Manchester M23 9LT, UK

• Cystic renal masses are characterized using the widely adopted Bosniak classification, which allows management decisions to be made.
  
• Multidetector computerized tomography (MDCT), magnetic resonance and contrast-enhanced ultrasound are all valuable tools that allow the characterization of complex cystic and indeterminate renal masses.
  
• The TNM classification is most widely adopted for staging renal cell carcinomas.
  
• MDCT is the main modality for staging renal tumours.
  

Renal masses with a range of appearances, from entirely cystic to solid, are commonly encountered in adult radiological practice. Characterization of more complex cystic masses is a challenge, to which the now considerably refined Bosniak classification has been applied. Benign tumours of the kidney include angiomyolipomas and oncocytomas. Prior to surgery, it is not always possible to confidently define a lesion as benign, although features such as focal fat are important. Renal cell carcinomas (RCCs) account for approximately 90% of all malignant renal masses. The incidence of diagnoses of RCC is increasing, in part as a consequence of the exponential increase in cross-sectional imaging. This has resulted in the identification of many incidental tumours, which overall are of an earlier stage. Here, we review the epidemiology and presentation of renal masses and the relevance of radiological staging and various surgical options. The TNM staging classification is described in its most recently revised form, with discussion of the challenges this presents to cross-sectional imaging. Brief mention is made of the role of guided needle biopsy and radiofrequency ablation in the management of RCC.