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Hyperattenuating Renal Masses: Etiologies, Pathogenesis, and Imaging Evaluation¹

¹ From the Division of Abdominal Imaging and Intervention, Department of Radiology (S.G.S., K.J.M., K.T.), and Division of Cytology, Department of Pathology (E.S.C.), Brigham and Women’s Hospital, Harvard Medical School, 75 Francis St, Boston, MA 02115; and Department of Diagnostic Radiology, Keio University School of Medicine, Tokyo, Japan (M.J.). Recipient of a Certificate of Merit award for an education exhibit at the 2005 RSNA Annual Meeting. Received August 4, 2006; revision requested August 28 and received October 5; accepted October 10. S.G.S. is a consultant with Galil Medical, Yokneam, Israel, and with Siemens Medical Solutions, Forchheim, Germany; all remaining authors have no financial relationships to disclose. Address correspondence to S.G.S. (e-mail: sgsilverman{at}partners.org).

Some renal masses have higher attenuation than the surrounding renal parenchyma at computed tomography (CT). Their hyperattenuation is usually the result of proteinaceous fluid or densely packed cells. Most hyperattenuating renal masses are benign hemorrhagic or protein-aceous cysts. However, solid enhancing hyperattenuating renal masses may have malignant as well as benign causes. Possible malignant causes include renal cell carcinoma and lymphoma; benign causes include angiomyolipoma with minimal fat. It is important to identify the cause of a hyperattenuating renal mass so as to avoid unnecessary surgical resection or ablation. CT may be useful for diagnosing benign hyperattenuating renal cysts, hematomas, and vascular anomalies that appear masslike. However, some solid, enhancing, hyperattenuating masses cannot be diagnosed confidently with CT alone: Small ( 3-cm-diameter), homogeneously enhancing, hyperattenuating renal masses depicted on CT images may be either benign angiomyolipomas with minimal fat or renal cell carcinomas. Magnetic resonance (MR) imaging may be helpful for differentiating between angiomyolipomas with minimal fat and clear cell renal cell carcinomas; however, differentiation between angiomyolipomas with minimal fat and papillary renal cell carcinomas often is not possible on the basis of MR imaging. In such cases, a percutaneous biopsy may be useful for diagnosis. If the results of MR imaging and percutaneous biopsy are not definitive, surgery is warranted.

© RSNA, 2007

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