单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,肾脏囊性占位,2013-11,肾脏囊性占位2013-11,1,Introduction,Ignore,Follow or Excise,Radiological Interpretation,Calcification,Hyperdense or High signal,Septations,Enhancement,Multiloculated,Nodularity,Wall thickening,Role of Biopsy,Dr Bosniaks opinion,Bosniak Classification of Renal Cystic Disease,IntroductionIgnore,Follow or,2,Renal cysts are commonly encountered lesions in daily radiological practice.Usually these are simple benign cysts,but they can become complicated in case of hemorrhage,infection and ischemia.When this occurs it can be difficult to differentiate these complicated cysts from cystic renal cell carcinomas(10%of all renal cell carcinomas)Since the only treatment for renal cell carcinoma is surgery or ablation,we need to recognize these cystic renal cell carcinomas.Imaging is a reliable means for differentiating benign from malignant cystic lesions.,Renal cysts are commonly encou,3,Even on gross examination a cystic renal cell carcinoma(left)may be indistinguishable from a complicated cyst(right),Even on gross examination a cy,4,Ignore,Follow or Excise,Renal cysts can be classified according to the Bosniak classification depending on their features.Type Icysts are simple cysts.Type IIare the minimally complicated cysts.Type I and II can be ignored.Type II Fare probably benign,but need to be followed.Type III and IVboth are surgical lesions.Type IV is inevitably malignant and in the type III group about 80-90%turn out to be malignant as well.,In our communication with the clinicians it is important,that we explain the significance of our findings and the meaning of the classification in terms of:Ignore(type I and II),Follow(type IIF)or Excise(type III and IV).So in this lecture we will only talk about Ignore,Follow or Excise.For those who want to see the original Bosniak classification,look at the table which is presented at the end of the lecture.,Ignore,Follow or Excise,5,肾脏囊性占位ppt课件,6,Radiological Interpretation,Although the final differentiation of cystic renal masses is based upon histologic diagnosis,there are imaging findings that tell you that a cyst is not a simple cyst and whether it is probably benign or malignant.,The following imaging features indicate that a cyst is NOT simple:-Calcification-Hyperdense/high signal-Septations-Multiple locules-Enhancement-Nodularity/wall thickening,Radiological Interpretation,7,Differentiation is based upon histologic diagnosis,but Imaging is a reliable means for differentiating benign from malignant cystic lesions,Differentiation is based upon,8,The table on the left summarises these imaging features together with the management consequences:Ignore,Follow or Excise.,When we look at these imaging features,we have to realise,that the most worrisome portion of a cystic mass should be used in deciding appropriate management.So when the findings are discordant either within one examination or using different radiological examinations,the lesion should be managed based upon the most aggressive imaging findings.,When we look at the table on the left,we can say that we are pretty good with the first 3 parameters(calcification,hyperdens and septations),because we are correct in about 95%of the cases.The other four are even more easy,because when you have any of these(enhancement,multiloculated,nodularity or wall thickening),the lesion is almost always a surgical lesion.,Regarding follow up,there are no rules at the moment.One could do a follow up at 6 months and if the lesion is stable then double the follow up time.,We will now discuss all these imaging features in detail.,The table on the left summaris,9,肾脏囊性占位ppt课件,10,Calcification,The most important thing is a good description of the type of calcifications.We can ignore small amounts of calcification that are smooth,septal or if it is milk of calcium,which moves to the lowest point with positional changes.We have to make sure,that no enhancement(=All lesions that show enhancement and lesions with wall thickening or nodularity of the wall outside the calcifications should be excised.We can follow lesions with thick or nodular calcification without any enhancement.,CalcificationThe most importa,11,肾脏囊性占位ppt课件,12,Benign calcifications:small punctate and milk of calcium.Ignore,On the left we see a cystic lesion.There is a small punctate calcification that we can ignore.On the bottom of the cyst there is a layer of calcium typical for milk of calcium.This is also a benign calcification that we can ignore.,Benign calcifications:small p,13,LEFT:NECT with a smooth linear calcification and nodular calcification.RIGHT:Enhanced CT shows enhancement.Excise,On the left a patient with nefrolithiasis.There is also a cystic lesion with linear and nodular calcification.If there were only these linear calcifications we could ignore the lesion.In case of nodular calcification we can follow it,if there is no enhancement.In this case however we see enhancement,so this lesion has to be excised