title: ACR Appropriateness Criteria indeterminate renal mass.
abstract: Renal masses are increasingly detected in asymptomatic individuals as incidental findings. An indeterminate renal mass is one that cannot be diagnosed confidently as benign or malignant at the time it is discovered. CT, ultrasonography, and MRI of renal masses with fast-scan techniques and intravenous (IV) contrast are the mainstays of evaluation. Dual-energy CT, contrast-enhanced ultrasonography, PET/CT, and percutaneous biopsy are all technologies that are gaining traction in the characterization of the indeterminate renal mass. In cases in which IV contrast cannot be used, whether because of IV contrast allergy or renal insufficiency, renal mass classification with CT is markedly limited. In the absence of IV contrast, ultrasonography, MRI, and biopsy have some advantages. Owing to the low malignant and metastatic potential of small renal cell carcinomas (≤4 cm in diameter), active surveillance is additionally emerging as a diagnostic strategy for patients who have high surgical risk or limited life expectancy. The ACR Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed every 3 years by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of current medical literature from peer-reviewed journals and application by the panel of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures. In those instances in which evidence is lacking or not definitive, expert opinion may be used to recommend imaging or treatment.
authors.affiliation: University of Utah, Salt Lake City, Utah. Electronic address: marta.heilbrun@hsc.utah.edu.
authors.forename: Marta E
authors.initials: ME
authors.lastname: Heilbrun
authors.affiliation: Cleveland Clinic, Cleveland, Ohio.
authors.forename: Erick M
authors.initials: EM
authors.lastname: Remer
authors.affiliation: Northwestern University, Chicago, Illinois.
authors.forename: David D
authors.initials: DD
authors.lastname: Casalino
authors.affiliation: Rhode Island Hospital, Providence, Rhode Island.
authors.forename: Michael D
authors.initials: MD
authors.lastname: Beland
authors.affiliation: Intermountain Urological Institute, Murray, Utah.
authors.forename: Jay T
authors.initials: JT
authors.lastname: Bishoff
authors.affiliation: Albert Einstein College of Medicine, Bronx, New York.
authors.forename: M Donald
authors.initials: MD
authors.lastname: Blaufox
authors.affiliation: Emory University Hospital, Atlanta, Georgia.
authors.forename: Courtney A
authors.initials: CA
authors.lastname: Coursey
authors.affiliation: University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania.
authors.forename: Stanley
authors.initials: S
authors.lastname: Goldfarb
authors.affiliation: Scottsdale Medical Imaging, Scottsdale, Arizona.
authors.forename: Howard J
authors.initials: HJ
authors.lastname: Harvin
authors.affiliation: Northwestern University, Chicago, Illinois.
authors.forename: Paul
authors.initials: P
authors.lastname: Nikolaidis
authors.affiliation: Duke University Medical Center, Durham, North Carolina.
authors.forename: Glenn M
authors.initials: GM
authors.lastname: Preminger
authors.affiliation: Universty of California Los Angeles Medical Center, Los Angeles, California.
authors.forename: Steven S
authors.initials: SS
authors.lastname: Raman
authors.affiliation: Brigham & Women's Hospital, Boston, Massachusetts.
authors.forename: Anik
authors.initials: A
authors.lastname: Sahni
authors.affiliation: University of Texas MD Anderson Cancer Center, Houston, Texas.
authors.forename: Raghunandan
authors.initials: R
authors.lastname: Vikram
authors.affiliation: Oakland University William Beaumont School of Medicine, Troy, Michigan.
authors.forename: Robert M
authors.initials: RM
authors.lastname: Weinfeld
mesh_terms: D003937:Diagnosis, Differential; D003952:Diagnostic Imaging / Q000592:standards*; D052177:Kidney Diseases, Cystic / Q000175:diagnosis*; D007680:Kidney Neoplasms / Q000175:diagnosis*; D017410:Practice Guidelines as Topic; D011871:Radiology / Q000592:standards*; D014481:United States
keywords: Appropriateness Criteria; diagnostic imaging; renal cell carcinoma; renal cyst; renal mass