HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Abstract Full Text Submit a response Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Israel, G. M. Articles by Bosniak, M. A. Search for Related Content PubMed PubMed Citation Articles by Israel, G. M. Articles by Bosniak, M. A.

Calcification in Cystic Renal Masses: Is It Important in Diagnosis?¹

¹ From the Department of Radiology, New York University Medical Center, 560 First Ave, Suite HW 202, New York, NY 10016. From the 2001 RSNA scientific assembly. Received October 17, 2001; revision requested January 10, 2002; final revision received April 29; accepted April 30. Address correspondence to G.M.I. (e-mail: gary.israel@med.nyu.edu).

View larger version (153K): [in a new window]   Figure 1. Contrast material-enhanced transverse CT scan in a 73-year-old man with a category II cyst depicts a cystic lesion with an area of minimally thickened but smooth linear calcification (arrow) within a septum. No enhancement of associated tissues is present (calcification score: 2).

View larger version (144K): [in a new window]   Figure 2. Contrast-enhanced transverse CT scan in a 71-year-old man with a category II cyst depicts multiple but very thin calcified septa (arrows). No enhancement of associated tissues is present (calcification score: 1).

View larger version (134K): [in a new window]   Figure 3a. Images in a 51-year-old woman with a category IIF lesion. (a) Initial contrast-enhanced transverse CT scan demonstrates a complex calcified cystic mass (arrows) without enhancing components (calcification score: 3). The patient did not receive a full dose of intravenous contrast material because she had mild renal insufficiency, which accounts for the poor nephrogram. (b) On a nonenhanced transverse CT scan obtained nine years after a, the amount of calcification has increased but the lesion is unchanged in size (calcification score: 4).

View larger version (143K): [in a new window]   Figure 3b. Images in a 51-year-old woman with a category IIF lesion. (a) Initial contrast-enhanced transverse CT scan demonstrates a complex calcified cystic mass (arrows) without enhancing components (calcification score: 3). The patient did not receive a full dose of intravenous contrast material because she had mild renal insufficiency, which accounts for the poor nephrogram. (b) On a nonenhanced transverse CT scan obtained nine years after a, the amount of calcification has increased but the lesion is unchanged in size (calcification score: 4).

View larger version (165K): [in a new window]   Figure 4a. Images of a category IIF lesion in a 60-year-old man who was followed up for 17 years 4 months. (a) Contrast-enhanced transverse CT scan obtained in 1981 depicts a bilobular cystic renal mass (long arrows) with nodular calcification (short arrows) (calcification score: 2). No enhancing tissue is identifiable within the mass. (b) Unenhanced transverse CT scan obtained in 1998 reveals that calcification (arrows) has progressed within the mass (calcification score: 4). No enhancement was demonstrated on contrast-enhanced images (not shown).

View larger version (175K): [in a new window]   Figure 4b. Images of a category IIF lesion in a 60-year-old man who was followed up for 17 years 4 months. (a) Contrast-enhanced transverse CT scan obtained in 1981 depicts a bilobular cystic renal mass (long arrows) with nodular calcification (short arrows) (calcification score: 2). No enhancing tissue is identifiable within the mass. (b) Unenhanced transverse CT scan obtained in 1998 reveals that calcification (arrows) has progressed within the mass (calcification score: 4). No enhancement was demonstrated on contrast-enhanced images (not shown).

View larger version (146K): [in a new window]   Figure 5a. Images in a 72-year-old man with a category IIF lesion. (a) Contrast-enhanced transverse CT scan depicts a 2-cm mass (straight arrows) in the left kidney with thick mural calcification (curved arrows) (calcification score: 3). There are no enhancing soft-tissue components. A simple cyst (C) is present posteriorly. (b) A follow-up contrast-enhanced transverse CT scan obtained 4 years 10 months after a reveals that the mass is stable and is most consistent with a benign cyst.

View larger version (149K): [in a new window]   Figure 5b. Images in a 72-year-old man with a category IIF lesion. (a) Contrast-enhanced transverse CT scan depicts a 2-cm mass (straight arrows) in the left kidney with thick mural calcification (curved arrows) (calcification score: 3). There are no enhancing soft-tissue components. A simple cyst (C) is present posteriorly. (b) A follow-up contrast-enhanced transverse CT scan obtained 4 years 10 months after a reveals that the mass is stable and is most consistent with a benign cyst.

View larger version (131K): [in a new window]   Figure 6. Contrast-enhanced transverse CT scan in a 75-year-old woman with a category III lesion depicts a complex cystic lesion with thick mural calcification (straight arrows) and a thick, enhancing wall (curved arrow) (calcification score: 3). Nephrectomy was performed, and pathologic examination revealed a cystic renal cell carcinoma.

View larger version (164K): [in a new window]   Figure 7. Contrast-enhanced transverse CT scan in a 42-year-old woman with a category III lesion, fever, leukocytosis, right flank pain, and a history of urinary tract infection depicts an irregular cystic mass with a thick, enhancing wall (short arrows) and mural calcification (long arrow) (calcification score: 2). Because of the probability of infection, the lesion was aspirated, and pus was recovered. Catheter drainage was then instituted as treatment. The diminished quality of the nephrogram is due to a slow injection of a low dose of contrast material.

View larger version (150K): [in a new window]   Figure 8a. Images in a 55-year-old man with a category III lesion, a history of automobile trauma, and multiple inferior right rib fractures. (a) Contrast-enhanced transverse CT scan depicts a cystic lesion that extends from the lower pole of the right kidney. The lesion has a thick, enhancing wall (short arrows) and mural calcification (long arrow) (calcification score: 2). (b) Contrast-enhanced transverse CT scan obtained approximately 5 cm cephalad to a reveals that the lesion is immediately adjacent to a previously fractured rib (arrow). Because of the likelihood that this lesion was posttraumatic, the surgical approach was modified to exploratory. The lesion was resected, and a benign hemorrhagic cyst was diagnosed.

View larger version (157K): [in a new window]   Figure 8b. Images in a 55-year-old man with a category III lesion, a history of automobile trauma, and multiple inferior right rib fractures. (a) Contrast-enhanced transverse CT scan depicts a cystic lesion that extends from the lower pole of the right kidney. The lesion has a thick, enhancing wall (short arrows) and mural calcification (long arrow) (calcification score: 2). (b) Contrast-enhanced transverse CT scan obtained approximately 5 cm cephalad to a reveals that the lesion is immediately adjacent to a previously fractured rib (arrow). Because of the likelihood that this lesion was posttraumatic, the surgical approach was modified to exploratory. The lesion was resected, and a benign hemorrhagic cyst was diagnosed.

View larger version (156K): [in a new window]   Figure 9. Contrast-enhanced transverse CT scan in an 86-year-old woman with a category IV lesion depicts a complex cystic mass with mural calcification (long arrow), wall enhancement, and obvious enhancing soft-tissue components (short arrow) adjacent to the wall (calcification score: 3). At surgery, this lesion was revealed to be a cystic renal cell carcinoma.