Abstract
available at http://www.ncbi.nlm.nih.gov/pubmed/26901011 Editorial Comment: This study examined 137 renal masses without fat. All masses were smaller than 4 cm. Patients were scanned during the noncontrast and nephrographic phases (many also underwent corticomedullary imaging). A total of 117 renal cell carcinomas and 20 benign lesions were included. Of the 117 malignant masses 9 (8%) did not reach the 15 HU enhancement threshold on nephrographic imaging and 14 (12%) did not reach the 20 HU threshold. Clear cell, papillary and chromophobe lesions were identified as the hypoenhancing masses. As we closely scrutinize small renal lesions, enhancement is an important indicator of whether a lesion is solid or cystic. Some solid renal cell carcinomas may be hypoenhancing and overlap in the range with renal cysts that may show some artifactual pseudoenhancement. Radiologists must review the morphology of the small hypoenhancing mass, review prior studies and consult the patient electronic radiology jacket to see if other imaging (ultrasound or magnetic resonance) may assist in differentiating the subtle solid hypoenhancing lesion from a simple cyst, complicated cyst or high attenuation cyst.
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