ACR Appropriateness Criteria® Indeterminate Renal Mass

Expert Panel on Urologic Imaging; Zhen J Wang; Paul Nikolaidis; Gaurav Khatri; Vikram S Dogra; Dhakshinamoorthy Ganeshan; Stanley Goldfarb; John L Gore; Rajan T Gupta; Robert P Hartman; Marta E Heilbrun; Andrej Lyshchik; Andrei S Purysko; Stephen J Savage; Andrew D Smith; Darcy J Wolfman; Jade J Wong-You-Cheong; Mark E Lockhart

doi:10.1016/j.jacr.2020.09.010

ACR Appropriateness Criteria® Indeterminate Renal Mass

J Am Coll Radiol. 2020 Nov;17(11S):S415-S428. doi: 10.1016/j.jacr.2020.09.010.

Authors

Expert Panel on Urologic Imaging; Zhen J Wang¹, Paul Nikolaidis², Gaurav Khatri³, Vikram S Dogra⁴, Dhakshinamoorthy Ganeshan⁵, Stanley Goldfarb⁶, John L Gore⁷, Rajan T Gupta⁸, Robert P Hartman⁹, Marta E Heilbrun¹⁰, Andrej Lyshchik¹¹, Andrei S Purysko¹², Stephen J Savage¹³, Andrew D Smith¹⁴, Darcy J Wolfman¹⁵, Jade J Wong-You-Cheong¹⁶, Mark E Lockhart¹⁷

Affiliations

¹ University of California San Francisco School of Medicine, San Francisco, California. Electronic address: [email protected].
² Panel Chair, Northwestern University, Chicago, Illinois.
³ Panel Vice-Chair, UT Southwestern Medical Center, Dallas, Texas.
⁴ University of Rochester Medical Center, Rochester, New York.
⁵ The University of Texas MD Anderson Cancer Center, Houston, Texas.
⁶ University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania; American Society of Nephrology.
⁷ University of Washington, Seattle, Washington; American Urological Association.
⁸ Duke University Medical Center, Durham, North Carolina.
⁹ Mayo Clinic, Rochester, Minnesota.
¹⁰ Emory University School of Medicine, Atlanta, Georgia.
¹¹ Thomas Jefferson University Hospital, Philadelphia, Pennsylvania.
¹² Cleveland Clinic, Cleveland, Ohio.
¹³ Medical University of South Carolina, Charleston, South Carolina; American Urological Association.
¹⁴ University of Alabama at Birmingham, Birmingham, Alabama.
¹⁵ Johns Hopkins University School of Medicine, Washington, District of Columbia.
¹⁶ University of Maryland School of Medicine, Baltimore, Maryland.
¹⁷ Specialty Chair, University of Alabama at Birmingham, Birmingham, Alabama.

PMID: 33153554
DOI: 10.1016/j.jacr.2020.09.010

Abstract

Renal masses are increasingly detected in asymptomatic individuals as incidental findings. CT and MRI with intravenous contrast and a dedicated multiphase protocol are the mainstays of evaluation for indeterminate renal masses. A single-phase postcontrast dual-energy CT can be useful when a dedicated multiphase renal protocol CT is not available. Contrast-enhanced ultrasound with microbubble agents is a useful alternative for characterizing renal masses, especially for patients in whom iodinated CT contrast or gadolinium-based MRI contrast is contraindicated. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.

Keywords: AUC; Appropriate Use Criteria; Appropriateness Criteria; Indeterminate renal mass; Kidney neoplasm; Renal cell carcinoma; Renal tumor; Small renal mass.

Publication types

Practice Guideline

MeSH terms

Evidence-Based Medicine*
Humans
Magnetic Resonance Imaging
Societies, Medical*
United States