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Imaging assessment of renal masses

Cancer Imaging, Department of Radiology, Barts and the London NHS Trust, London EC1A 7ED, UK

Summary

• The majority of renal mass tumours are neoplastic, with infective and inflammatory comprising the smaller proportion.
  
• 70% of renal tumours are discovered incidentally, most commonly with ultrasound.
  
• Ultrasound not only characterises lesions as solid or cystic, but also evaluates key morphological features such as septations, wall nodules, calcifications and vascular flow.
  
• CT is the foundation of renal mass evaluation.
  
• Multidetector CT is used for staging and monitoring the response for treatment, including radiofrequency ablation.
  
• MRI is reserved for problem solving.
  

Contrast-enhanced computed tomography (CT) techniques are the foundations of renal mass evaluation. The main roles of the radiologist are to differentiate, where possible, between malignant and benign masses, to define the location and extent of spread of the lesion and to monitor and assess response to treatment. In this paper, we review the imaging characteristics of renal cell carcinoma, focusing on ultrasound, CT and MR imaging. We illustrate the need for clear anatomical evaluation for surgical planning, accurate staging and follow-up. We highlight the advantages and limitations of each imaging modality using specific examples, such as cystic renal mass lesions, angiomyolipomata, transitional cell carcinomas, hereditary renal cell carcinoma and follow-up after radiofrequency ablation of renal mass lesions.