Department of Radiology, University Hospital of South Manchester, Southmoor Road, Wythenshawe, Manchester M23 9LT, UK.
Clin Radiol. 2011 Dec;66(12):1129-39. doi: 10.1016/j.crad.2011.07.044. Epub 2011 Aug 17.
Incidental renal masses are common findings on cross-sectional imaging. Most will be readily identified as simple cysts, but with an inexorable rise in abdominal imaging, [particularly computed tomography (CT)], coupled with a rise in the incidence of renal cancer, the likelihood of detecting a malignant mass is increasing. This review informs the radiologist which lesions can be safely ignored, which will require further imaging for accurate categorization, and which require referral for consideration of treatment. For the small proportion of lesions that are indeterminate, careful attention to imaging technique, and the use of unenhanced and contrast-enhanced CT or magnetic resonance imaging (MRI) in all but a few specific instances will accurately characterize such lesions. The figures have been chosen to illustrate specific imaging features of common renal lesions. Management options for malignant, or presumed malignant, renal masses include active surveillance, percutaneous ablation, laparoscopic or open, partial or total nephrectomy. Biopsy has a role in determining the nature of masses that remain indeterminate on cross-sectional imaging, prior to definitive treatment. Common pitfalls in assessing incidental renal lesions are emphasized; some of these are due to sub-optimal imaging techniques and others to errors in interpretation.
偶然发现的肾脏肿块是横断面成像的常见表现。大多数肿块很容易被识别为单纯性囊肿，但随着腹部成像（特别是计算机断层扫描（CT））的不断增加，以及肾癌发病率的上升，检测到恶性肿块的可能性也在增加。这篇综述告知放射科医生哪些病变可以安全忽略，哪些需要进一步成像以进行准确分类，哪些需要转介以考虑治疗。对于一小部分不确定的病变，仔细注意成像技术，并在极少数特定情况下使用未增强和增强 CT 或磁共振成像（MRI），将准确地描述这些病变。这些图像是为了说明常见肾脏病变的特定成像特征。恶性或疑似恶性肾脏肿块的治疗选择包括主动监测、经皮消融、腹腔镜或开放手术、部分或全部肾切除术。活检在确定横断面成像仍不确定的肿块的性质方面具有一定作用，可在明确治疗前进行。强调了在评估偶然发现的肾脏病变时常见的陷阱；其中一些是由于成像技术不佳，而另一些则是由于解释错误。
