Common pitfalls in renal mass evaluation: a practical guide

Leão, Layra Ribeiro de Sousa; Mussi, Thais Caldara; Yamauchi, Fernando Ide; Baroni, Ronaldo Hueb

doi:10.1590/0100-3984.2018.0007

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Sumário

PICTORIAL ESSAYS • Radiol Bras 52 (4) • Jul-Aug 2019 • https://doi.org/10.1590/0100-3984.2018.0007 copy

Common pitfalls in renal mass evaluation: a practical guide

Armadilhas comuns na avaliação da massa renal: um guia prático

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

More than half of patients over 50 years of age have had at least one focal renal lesion detected as an incidental finding during an ultrasound, computed tomography, or magnetic resonance imaging examination. Although the majority of such lesions can be easily detected and correctly characterized, misdiagnoses may occur and are often related to methodological limitations, inappropriate imaging protocols, or misinterpretation. This pictorial essay provides recommendations on how to recognize benign and malignant renal processes that can be potentially missed or mischaracterized in imaging studies.

Keywords:
Kidney neoplasms/diagnostic imaging; Magnetic resonance imaging; Ultrasonography; Computed tomography

Parameter	Phase
Parameter	Unenhanced	Corticomedullary	Nephrographic	Excretory
Scan delay	Not applicable	Fixed, 40-60 s after contrast	Fixed, 80-100 s after contrast	Fixed, 5-7 min after contrast
		injection	injection	injection
Detector configuration	0.5 mm × 80 mm	0.5 mm × 80 mm	0.5 mm × 80 mm	0.5 mm × 80 mm
Reconstruction slice thickness	1 mm	2 mm	2 mm	3 mm

					Slice			Reconstruction
				FOV	thickness		TR/TE	slice thickness
Sequence	Imaging plane	Physiology	Volumetry	(cm)	(mm)	Matrix	(ms)	(mm)
AX T2-WI fat-suppressed	Axial	Respiratory-triggered	2D	34	6	-	79/283-14,000	1
DWI (b value = 0/50 s/mm²)	Axial	Respiratory-triggered	2D	34	6	224 × 256	1.0/13,332	1
DWI (b value = 400/800 s/mm²)	Axial	Respiratory-triggered	2D	34	6	224 × 256	15,485	1
Single-shot fast spin-echo T2WI	Coronal	Breath-hold	2D	38	5	256 × 224	120/minimum	1
T2WI	Axial	Breath-hold	2D	34	5	256 × 192	160/4100	1
Chemical shift (in-phase + out-of-phase) T1WI	Axial	Breath-hold	2D	34	03/08/19	256 × 192	Minimum- 4.2/6.2	1
Chemical shift (in-phase + out-of-phase) T1WI	Coronal	Breath-hold	2D	30	5	256 × 160	2.2; 4.5/230	1
Unenhanced T1WI fat-suppressed GRE	Axial + coronal	Breath-hold	3D	38	03/08/19	256 × 224	1.4/3.3	-
Post-gadolinium dynamic fat-suppressed GRE	Coronal + axial	Breath-hold	3D	38	3.8/3.4	256 × 224	1.9/4.4	-
	(delayed)				(delayed)

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[1] Correspondence: Dr. Fernando Ide Yamauchi. Hospital Israelita Albert Einstein - Departamento de Radiologia e Diagnóstico por Imagem. Avenida Albert Einstein, 627, Vila Leonor. São Paulo, SP, Brazil, 05652-900. Email: fernando.yamauchi@einstein.br.