From the Department of Radiology (I.P., J.A.C.), Department of Urology (I.P., J.A.C.), and Advanced Imaging Research Center (I.P.), University of Texas Southwestern, 5323 Harry Hines Blvd, Clements Imaging Bldg, Ste 2202, MC 9085, Dallas, TX 75390.
Radiology. 2022 Feb;302(2):256-269. doi: 10.1148/radiol.210034. Epub 2021 Dec 14.
The widespread use of cross-sectional imaging has led to a continuous increase in the number of incidentally detected indeterminate renal masses. Frequently, these clinical scenarios involve an older patient with comorbidities and a small renal mass (≤4 cm). Despite aggressive treatment in early stages of the disease, a clear positive effect in reducing kidney cancer-specific mortality is lacking, indicating that many renal cancers exhibit an indolent oncologic behavior. Furthermore, in general, one in five small renal masses is histologically benign and may not benefit from aggressive treatment. Although active surveillance is increasingly recognized as a management option for some patients, the absence of reliable clinical and imaging predictive biologic markers of aggressiveness can contribute to patient anxiety and limit its use in clinical practice. A standardized approach to the image interpretation of solid renal masses has not been broadly implemented. The clear cell likelihood score (ccLS) derived from multiparametric MRI is useful in noninvasively identifying the clear cell subtype, the most common and aggressive form of kidney cancer. Herein, a review of the ccLS is presented, including a step-by-step guide for image interpretation and additional guidance for its implementation in clinical practice.
横断面成像的广泛应用导致偶然发现的不确定肾肿块数量不断增加。这些临床情况通常涉及患有合并症和小肾肿块（≤4 厘米）的老年患者。尽管在疾病早期积极治疗，但缺乏明确的积极效果来降低肾癌特异性死亡率，这表明许多肾癌表现出惰性的肿瘤行为。此外，一般来说，五个小肾肿块中有一个组织学上是良性的，可能不需要积极治疗。尽管主动监测越来越被认为是一些患者的治疗选择，但缺乏可靠的临床和影像学预测生物侵袭性标志物可能导致患者焦虑，并限制其在临床实践中的应用。对实体肾肿块的图像解释尚未广泛采用标准化方法。多参数 MRI 得出的透明细胞可能性评分（ccLS）有助于无创性识别透明细胞亚型，这是最常见和侵袭性最强的肾癌。本文回顾了 ccLS，包括图像解释的分步指南和在临床实践中实施的额外指导。
