Do all non-calcified echogenic renal lesions found on ultrasound need further evaluation with CT?

Abstract

From the surprisingly limited evidence available in the literature, it must be concluded that all non-calcified echogenic renal lesions detected with ultrasound need a CT to rule out an RCC.

Sonographically Identified Echogenic Renal Masses Up to 1 cm in Size Are So Rarely Malignant They Can Be Safely Ignored

“…In summary, the results of this study strongly suggest that a small echogenic renal mass up to 1 cm in size that is incidentally discovered sonographically has such a low prevalence of malignancy, current or future, that it can be ignored if it fulfills the following study criteria: (1) there is no history of malignancy or presence of a known mass elsewhere that might be malignant; (2) more than 50% of the mass is echogenic by visual estimation; (3) the mass is intracortical, visually extending less than 50% from the cortex either peripherally or into the renal sinus; (4) the maximum diameter can be measured in 3 orthogonal planes on axial and longitudinal sections; and (5) the patient is an adult.…”

Ten uncommon and unusual variants of renal angiomyolipoma (AML): radiologic–pathologic correlation

“…9,10 Large (>1 cm) echogenic renal cortical nodules can be further characterized with CT to confirm the presence of intratumoural fat. 5,9 The management of small (<1 cm) echogenic renal cortical nodules varies and is controversial. 5 A meta-analysis on the topic concluded that, based on limited evidence, all incidental echogenic cortical nodules should be further characterized with CT. 9 CT is limited for the detection of fat within small (<1 cm) nodules because of inaccurate placement of region of interest (ROI) measurements and volume averaging of voxels containing renal parenchyma and fat.…”

“…5,9 The management of small (<1 cm) echogenic renal cortical nodules varies and is controversial. 5 A meta-analysis on the topic concluded that, based on limited evidence, all incidental echogenic cortical nodules should be further characterized with CT. 9 CT is limited for the detection of fat within small (<1 cm) nodules because of inaccurate placement of region of interest (ROI) measurements and volume averaging of voxels containing renal parenchyma and fat. 5 Thin-section CT 6 can increase the diagnostic yield ( Fig 3); however, for very small nodules CT is frequently non-diagnostic even when pixel analysis is performed.…”

Angiomyolipoma (AML) without visible fat: Ultrasound, CT and MR imaging features with pathological correlation

“…Analyses were performed by the same blinded radiologist. For US, echogenicity of the AML was assessed with respect to adjacent renal CP (as described previously [26,27]) as hypoechoic (echogenicity<CP), isoechoic (echogenicity similar to CP), or hyperechoic (echogenicity>CP).…”