Heilbrun Marta E, Remer Erick M, Casalino David D, Beland Michael D, Bishoff Jay T, Blaufox M Donald, Coursey Courtney A, Goldfarb Stanley, Harvin Howard J, Nikolaidis Paul, Preminger Glenn M, Raman Steven S, Sahni Anik, Vikram Raghunandan, Weinfeld Robert M
University of Utah, Salt Lake City, Utah.
Cleveland Clinic, Cleveland, Ohio.
J Am Coll Radiol. 2015 Apr;12(4):333-41. doi: 10.1016/j.jacr.2014.12.012.
Renal masses are increasingly detected in asymptomatic individuals as incidental findings. An indeterminate renal mass is one that cannot be diagnosed confidently as benign or malignant at the time it is discovered. CT, ultrasonography, and MRI of renal masses with fast-scan techniques and intravenous (IV) contrast are the mainstays of evaluation. Dual-energy CT, contrast-enhanced ultrasonography, PET/CT, and percutaneous biopsy are all technologies that are gaining traction in the characterization of the indeterminate renal mass. In cases in which IV contrast cannot be used, whether because of IV contrast allergy or renal insufficiency, renal mass classification with CT is markedly limited. In the absence of IV contrast, ultrasonography, MRI, and biopsy have some advantages. Owing to the low malignant and metastatic potential of small renal cell carcinomas (≤4 cm in diameter), active surveillance is additionally emerging as a diagnostic strategy for patients who have high surgical risk or limited life expectancy. The ACR Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed every 3 years by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of current medical literature from peer-reviewed journals and application by the panel of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures. In those instances in which evidence is lacking or not definitive, expert opinion may be used to recommend imaging or treatment.
肾脏肿块在无症状个体中越来越多地作为偶然发现被检测出来。不确定的肾脏肿块是指在发现时无法可靠地诊断为良性或恶性的肿块。采用快速扫描技术并静脉注射（IV）造影剂的肾脏肿块CT、超声和MRI是评估的主要手段。双能CT、造影增强超声、PET/CT和经皮活检都是在不确定肾脏肿块的特征描述方面越来越受到关注的技术。在无法使用IV造影剂的情况下，无论是由于IV造影剂过敏还是肾功能不全，CT对肾脏肿块的分类都明显受限。在没有IV造影剂的情况下，超声、MRI和活检具有一些优势。由于小肾癌（直径≤4cm）的恶性和转移潜能较低，对于手术风险高或预期寿命有限的患者，主动监测也正在成为一种诊断策略。美国放射学会适宜性标准是针对特定临床情况的循证指南，由多学科专家小组每3年进行一次审查。指南的制定和审查包括对同行评审期刊上的当前医学文献进行广泛分析，并由专家小组应用成熟的共识方法（改良德尔菲法）对成像和治疗程序的适宜性进行评分。在缺乏证据或证据不明确的情况下，可采用专家意见来推荐成像或治疗方法。
