Israel Gary M, Bosniak Morton A
NYU Medical Center, Ste. HW 202, 560 First Ave., New York, NY 10016, USA.
AJR Am J Roentgenol. 2003 Sep;181(3):627-33. doi: 10.2214/ajr.181.3.1810627.
The purpose of this study is to show the use of follow-up CT studies in the management of moderately complex cystic lesions of the kidney (Bosniak category IIF).
The CT scans of 42 moderately complex cystic renal masses (Bosniak category IIF) with follow-up examinations for 2 years or greater or with pathology correlation (n = 3) were retrospectively analyzed by the authors in consensus. The complexity of each lesion was assessed on the basis of the number and appearance of the septa, wall thickness, interface with the kidney parenchyma, presence and amount of calcification, and contrast enhancement characteristics. Lesion size was measured in two dimensions. Follow-up examinations were evaluated for any interval change.
The average size of the lesions was 3.9 x 3.6 cm, and the average follow-up time was 5.8 years (range, 2 years-18 years 4 months; median, 5.0 years). Eighteen lesions had fewer than five septa, 16 lesions had between five and nine septa, and eight lesions had more than nine septa. In 39 lesions, the wall or septa or both were slightly thickened, and in a single lesion, the wall and septa were hairline thin. The two remaining lesions were of uniformly high attenuation and completely intrarenal. Forty-one lesions had a sharp interface with the kidney, whereas one had an indistinct interface. Twenty lesions contained calcium. Enhancement was not shown in any lesions except for minimal enhancement of smooth walls or septa of some lesions. Follow-up examinations showed that three lesions had developed more calcification, one lesion had increased in overall size but appeared less complex, and three lesions had decreased in size. In addition, two lesions had become more complex and developed thicker septa, and these lesions proved to be cystic neoplasms.
Follow-up CT studies are an effective way of managing patients with moderately complex cystic lesions of the kidney (Bosniak category IIF) because the absence of change supports benignity and progression indicates neoplasm.
本研究旨在展示随访CT检查在处理中度复杂肾囊性病变（博斯尼亚克IIF类）中的应用。
作者对42例中度复杂肾囊性肿块（博斯尼亚克IIF类）的CT扫描进行了回顾性分析，这些病例均有2年或更长时间的随访检查或病理对照（n = 3）。通过共识，对每个病变的复杂性进行评估，评估依据包括分隔的数量和形态、壁厚度、与肾实质的界面、钙化的存在及数量以及对比增强特征。在两个维度上测量病变大小。对随访检查评估有无任何间隔期变化。
病变的平均大小为3.9×3.6 cm，平均随访时间为5.8年（范围：2年至18年4个月；中位数为5.0年）。18个病变的分隔少于5个，16个病变的分隔在5至9个之间，8个病变的分隔多于9个。39个病变的壁或分隔或两者均轻度增厚，1个病变的壁和分隔呈细线状薄。其余2个病变呈均匀高密度且完全位于肾内。41个病变与肾的界面清晰，而1个病变的界面不清晰。20个病变含有钙化。除部分病变的光滑壁或分隔有轻微强化外，任何病变均未显示强化。随访检查显示，3个病变钙化增多，1个病变总体大小增加但复杂性降低，3个病变大小减小。此外，2个病变变得更复杂且分隔增厚，并被证实为囊性肿瘤。
随访CT检查是处理中度复杂肾囊性病变（博斯尼亚克IIF类）患者的有效方法，因为无变化支持良性，而进展则提示肿瘤。
