IMPROVING IMAGING DIAGNOSIS OF RENAL MASS LESIONS

Abstract

Renal mass lesions are increasingly detected in daily clinical practice because ultrasonography, computed tomography, and magnetic resonance imaging are now widely used for abdominal evaluation. The main diagnostic challenge is not only detecting a renal lesion, but also accurately distinguishing benign from malignant masses, characterizing cystic versus solid lesions, defining local extent, and guiding further management. Contemporary imaging relies on a stepwise pathway in which ultrasound often serves as the first-line modality, while multiphasic contrast-enhanced CT remains the principal method for characterization and staging; MRI is particularly valuable when CT findings are equivocal or iodinated contrast is undesirable. Diagnostic performance can be improved through standardized imaging protocols, multiphasic enhancement assessment, consistent use of Bosniak 2019 criteria for cystic masses, careful integration of clinical data, and selective use of renal mass biopsy. Emerging tools such as contrast-enhanced ultrasound, radiomics, machine learning, and molecular imaging with sestamibi SPECT/CT or PSMA PET/CT may further refine noninvasive diagnosis. Although these innovations are promising, most remain adjuncts rather than replacements for conventional cross-sectional imaging. A structured multimodal strategy offers the best opportunity to improve accuracy, reduce unnecessary surgery, and optimize patient-specific management. (ACSearch)