The current radiological approach to renal cysts.

Abstract

The radiologic diagnosis of renal cysts (and their differentiation from renal neoplasms) has come a long way since the 1950s when the approach was surgical exploration, unless clinically contraindicated, for every renal mass detected using urography. Nephrotomography, renal angiography, and cyst puncture have contributed over the ensuing years to the differentiation of cyst from tumor. However, for the most part, sonography and CT (or a combination of these when necessary) have become the main diagnostic techniques for evaluating renal masses, and with their use we have never been more accurate, noninvasive, and relatively economically efficient. The more widespread use of CT has enabled serendipitous discovery of many small renal carcinomas, the removal of which should result in an improvement in the overall cure rate of patients with renal parenchymal neoplasms. On the other hand, we are also discovering many more cysts than we have previously. We must be on guard, therefore, against discovering lesions for which we are unable to establish a radiologic diagnosis of benignity, because this will only increase the need for exploratory surgery once again. It is thus imperative that imaging studies be performed with great care, that diagnoses be based on rigid criteria, and that more experience with difficult lesions be gained so that the proper approach to treatment will be determined. If we are able to accomplish this, then the present radiologic age can be remembered as a time when great advances in the evaluation of renal masses were made, with resultant improved patient management and cure of disease.