Novel Imaging Methods for Renal Mass Characterization: A Collaborative Review

• Published in: European urology 2022-05, Vol.81 (5), p.476-488
• Main Authors: Roussel, Eduard, Capitanio, Umberto, Kutikov, Alexander, Oosterwijk, Egbert, Pedrosa, Ivan, Rowe, Steven P., Gorin, Michael A.
• Format: Article
• Language: English
• Subjects: 99mTc-sestamibi; Artificial Intelligence; Carcinoma, Renal Cell - diagnostic imaging; Carcinoma, Renal Cell - pathology; Female; Girentuximab; Humans; Kidney cancer; Kidney Neoplasms - diagnostic imaging; Kidney Neoplasms - pathology; Machine learning; Magnetic Resonance Imaging; Male; Multiparametric magnetic resonance imaging; PET; Radiomics; Radiopharmaceuticals; Renal cell carcinoma; SPECT; Technetium Tc 99m Sestamibi; Virtual biopsy
• ISSN: 0302-2838; 1873-7560
• DOI: 10.1016/j.eururo.2022.01.040

Novel imaging tools, including multiparametric magnetic resonance imaging and molecular imaging techniques, are capable of noninvasively characterizing indeterminate renal masses. Pending validation and increased adoption, these tools can be combined with radiomics and artificial intelligence to provide a comprehensive virtual biopsy, ultimately allowing for risk-adapted tailored treatment approaches for patients. The incidental detection of localized renal masses has been rising steadily, but a significant proportion of these tumors are benign or indolent and, in most cases, do not require treatment. At the present time, a majority of patients with an incidentally detected renal tumor undergo treatment for the presumption of cancer, leading to a significant number of unnecessary surgical interventions that can result in complications including loss of renal function. Thus, there exists a clinical need for improved tools to aid in the pretreatment characterization of renal tumors to inform patient management. To systematically review the evidence on noninvasive, imaging-based tools for solid renal mass characterization. The MEDLINE database was systematically searched for relevant studies on novel imaging techniques and interpretative tools for the characterization of solid renal masses, published in the past 10 yr. Over the past decade, several novel imaging tools have offered promise for the improved characterization of indeterminate renal masses. Technologies of particular note include multiparametric magnetic resonance imaging of the kidney, molecular imaging with targeted radiopharmaceutical agents, and use of radiomics as well as artificial intelligence to enhance the interpretation of imaging studies. Among these, 99mTc-sestamibi single photon emission computed tomography/computed tomography (CT) for the identification of benign renal oncocytomas and hybrid oncocytic chromophobe tumors, and positron emission tomography/CT imaging with radiolabeled girentuximab for the identification of clear cell renal cell carcinoma, are likely to be closest to implementation in clinical practice. A number of novel imaging tools stand poised to aid in the noninvasive characterization of indeterminate renal masses. In the future, these tools may aid in patient management by providing a comprehensive virtual biopsy, complete with information on tumor histology, underlying molecular abnormalities, and ultimately disease prognosis. Not all renal tumors require treatmen