eMedicine Specialties > Radiology > Pediatrics
Multilocular Cystic Nephroma: Imaging
Updated: Apr 7, 2009
Radiography
Findings
On plain radiographs, cystic nephroma and cystic partially differentiated nephroblastoma (CPDN) cannot be distinguished, just as they cannot be distinguished by their gross anatomic appearances. However, in either type of multilocular cystic renal tumor, radiography does reveal displacement of the bowel and adjacent structures if the lesion is of sufficient size. Calcification, although uncommon, can be present and is defined as curvilinear and peripheral localizations.8
On excretory urography, the kidneys function normally with multilocular cystic renal tumors. Because the mass is rarely suspected on the basis of the clinical findings, excretory urography reveals nonspecific stretching, displacement, extension of the tumor to the renal pelvis, and attenuation of the renal collecting system by the mass. Delayed or absent excretion is also demonstrated.
Degree of Confidence
A general nonspecific renal tumor can be identified by using radiography, with some degree of confidence. However, the use of radiography to diagnose multilocular cystic nephroma specifically results in a low degree of confidence. On plain radiographs, multilocular cystic renal tumor appears similar to other renal tumors because plain radiography cannot be used to differentiate between cystic and solid lesions.
False Positives/Negatives
The occurrence of false-positive and false-negative results is high because plain radiography cannot be used to differentiate between specific structures, and the study has low precision in the diagnosis of these tumors.
Computed Tomography
Multilocular cystic nephroma. CT shows a normal right kidney and an enlarged left kidney with a large well-defined mass, with several hypoattenuating cysts. No enhancement or septation is noted.
Multilocular cystic nephroma. CT shows a normal right kidney and an enlarged left kidney with a large well-defined mass, with several cysts with hypoattenuation. No enhancement or septation is noted. Perfusion can be seen crossing the midline on part of the remaining left kidney.
Multilocular cystic nephroma. CT shows a normal right kidney and an enlarged left kidney with a large well-defined mass, with several cysts with hypoattenuation. No enhancement or septation is noted. Perfusion is seen crossing the midline on part of the remaining left kidney, with some signs of dilatation of the collecting system.
Multilocular cystic nephroma. CT shows a normal right kidney and an enlarged left kidney with a large well-defined mass, with several cysts with hypoattenuation. No enhancement or septation is noted. Perfusion is seen crossing the midline on part of the remaining left kidney, with some signs of dilatation of the collecting system.
Multilocular cystic nephroma. CT shows a large multilocular cystic nephroma involving the right kidney and crossing the midline.
Multilocular cystic nephroma. CT shows a large multilocular cystic nephroma involving the right kidney and crossing the midline.
Findings
CT findings are dependent on the size of the cyst and the amount of stromal tissue. In most cases, the mass is identified with the following CT findings9 :
- Well-defined margins
- Multicystic architecture
- Enhancing septa
- Herniation into the renal collecting system
Cystic spaces are not enhancing and demonstrate CT numbers slightly higher than those of water. In some cases, the entire mass or portions of the mass may appear solid because of smaller closely spaced cysts.
Degree of Confidence
CT results in a high degree of confidence in the diagnosis of multilocular cystic nephroma. CT images define the structures of lesions on the kidneys well.
False Positives/Negatives
False-positive and false-negative rates are low because of the accuracy of the method.
Magnetic Resonance Imaging
Multilocular cystic nephroma. Axial MRI shows a large multilocular cystic nephroma involving the right kidney and crossing the midline.
Multilocular cystic nephroma. Axial MRI shows a large multilocular cystic nephroma involving the right kidney and crossing the midline.
Multilocular cystic nephroma. Sagittal MRI shows a large multilocular cystic nephroma involving the right kidney.
Findings
- MRI demonstrates the low signal intensity of the tumor capsule.
- Observations of nonenhanced MRIs have shown encapsulated masses with dividing septa between cystic spaces.
- Kettritz et al6 found the following:
- On T1-weighted sequences, signal intensity varies from low to very high and from low to intermediate.
- T2-weighted sequencing resulted in low signal intensity in the tumor capsule and the intermediate septations.
- The signal intensity of the cysts was high in all cases.
- Variable signal intensity from the cyst contents is attributed to differing concentrations of old hemorrhage and protein.
Degree of Confidence
MRI results in a high degree of confidence in the diagnosis of multilocular cystic nephroma. MRI images define the structures of lesions on the kidneys well.
False Positives/Negatives
False-positive and false-negative rates are low because of the accuracy of the method.
Ultrasonography
Multilocular cystic nephroma. Sonograms show a normal right kidney and, within an enlarged left kidney, multiple anechoic cystic changes separated by hyperechoic septa.
Multilocular cystic nephroma. Sonogram shows multiple anechoic cystic changes separated by hyperechoic septa within an enlarged left kidney.
Multilocular cystic nephroma. Sonogram shows multiple anechoic cystic changes separated by hyperechoic septa within an enlarged left kidney.
Multilocular cystic nephroma. Color Doppler sonogram shows multiple anechoic cystic changes separated by hyperechoic septa within an enlarged left kidney without Doppler flow.
Multilocular cystic nephroma. Color Doppler sonogram shows multiple anechoic cystic changes separated by hyperechoic septa within an enlarged left kidney without Doppler flow.
Findings
Results of US depend on the amount of stroma and the size of the loculi.10
- The appearance of multilocular cystic renal tumor includes multiple anechoic spaces separated by hyperechoic septa. This pattern is similar to that of multilocular cystic nephroma; however, if the loculi are small, the tumor mimics an echogenic solid mass.
- In most patients, the renal origin of the mass can be confirmed by identifying a beak or claw of normal renal parenchyma around the periphery of a well-defined mass, by the splaying or displacement of the renal collecting system, and by synchronous motion of the mass and kidney with respiratory excursion.
- Color Doppler US can also be used to evaluate tumors and can provide a noninvasive assessment of lesion vascularity. This is possible because of the Doppler-shifted signals of abnormally high velocity emitted by low-resistance neovascularity in some neoplasms.
Degree of Confidence
US can be used with a high degree of confidence. A diagnosis can be made with high precision because sonograms clearly depict the structure of the lesions.
False Positives/Negatives
False-positive and false-negative rates are low because of the accuracy of the method.
Nuclear Imaging
Findings
Scintigraphy of the kidneys can be performed. Scintigrams demonstrate a defect corresponding to the renal mass.
Degree of Confidence
Nuclear medicine studies result in a low degree of confidence in the diagnosis of multilocular cystic nephroma specifically. Although a general nonspecific renal mass can be identified, details cannot be differentiated.
False Positives/Negatives
The lack of precision results in high false-positive and false-negative rates because of the inaccuracy of the method.
Angiography
Findings
On angiographic examination, multilocular cystic renal tumors usually appear hypovascular, although they may also be avascular or hypervascular. Angiography may reveal features that are not specific for differential diagnosis. Magnetic resonance angiography may help if a preoperative evaluation of the vascular anatomy is needed.
Degree of Confidence
Angiography results in a high degree of confidence. The structures of lesions on the kidneys are well differentiated with this method, which results in a precise diagnosis.
False Positives/Negatives
Angiography has low false-positive and false-negative rates because of the accuracy of the method.
More on Multilocular Cystic Nephroma |
| Overview: Multilocular Cystic Nephroma |
 Imaging: Multilocular Cystic Nephroma |
| Multimedia: Multilocular Cystic Nephroma |
| References |
| Further Reading |
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References
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Stamatiou K, Polizois K, Kollaitis G, Dahanis S, Zafeiropoulos G, Leventis C, et al. Cystic nephroma: a case report and review of the literature. Cases J. Oct 23 2008;1(1):267. [Medline].
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Further Reading
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Keywords
multilocular cystic nephroma, multilocular cystic renal tumor, cystic nephroma, cystic partially differentiated nephroblastoma, CPDN, multilocular cystic renal tumor, benign multilocular cystic nephroma, polycystic nephroblastoma, differentiated nephroblastoma, well-differentiated polycystic Wilms tumor, benign cystic differentiated nephroblastoma, cystic partially differentiated nephroblastoma
