Clear cell renal cell carcinoma: identifying PTEN expression on multiphasic MDCT

Radiologist's Disease: Imaging for Renal Cancer

There is a clear benefit of imaging-based differentiation of small indeterminate masses to its subtypes of clear cell renal cell carcinoma (RCC), chromophobe RCC, papillary RCC, fat poor angiomyolipoma and oncocytoma because it helps determine the next step options for the patients. The work thus far in radiology has explored different parameters in computed tomography, MRI, and contrast-enhanced ultrasound with the discovery of many reliable imaging features that suggest certain tissue subtypes. Likert score-based risk stratification systems can help determine management, and new techniques such as perfusion, radiogenomics, single-photon emission tomography, and artificial intelligence can add to the imaging-based evaluation of indeterminate renal masses.

Image Interpretation: Practical Triage of Benign from Malignant Renal Masses

Indeterminate renal masses remain a diagnostic challenge for lesions not initially characterized as angiomyolipoma or Bosniak I/II cysts. Differential for indeterminate renal masses include oncocytoma, fat-poor angiomyolipoma, and clear cell, papillary, and chromophobe renal cell carcinoma. Qualitative and quantitative techniques using data derived from multiphase contrast-enhanced imaging have provided methods for specific differentiation and subtyping of indeterminate renal masses, with emerging applications such as radiocytogenetics. Early and accurate characterization of indeterminate renal masses by multiphase contrast-enhanced imaging will optimize triage of these lesions into surgical, ablative, and active surveillance treatment plans.