Böbrek Tümörlerinde Radyolojik Görüntüleme
Özet
Radyolojik görüntüleme, böbrek kitlelerinin saptanması, karakterizasyonu ve evrelenmesinde temel bir rol oynar. Kesitsel görüntüleme yöntemlerinin yaygınlaşmasıyla birlikte tesadüfen saptanan renal lezyonların sıklığı belirgin şekilde artmıştır. Böbrek kitlesi tespit edildiğinde ilk adım, lezyonun kistik mi yoksa solid mi olduğunun belirlenmesidir. Kistik lezyonlar, Bosniak sınıflandırması (2019 versiyonu) kullanılarak malignite riskine göre I–IV kategorilerine ayrılır; bu sınıflama için BT veya MR renal kitle protokolleri kullanılır. Renal lezyonların çoğu kistik olmakla birlikte, solid kitlelerin büyük kısmı malign karakterlidir ve bu grubun yaklaşık %90’ını renal hücreli karsinomlar (RCC) oluşturur. Berrak hücreli RHK en sık görülen alt tip olup, onu papiller ve kromofob tipler izler. Benign solid kitleler arasında anjiyomiyolipom (AML) ve onkositom yer alır; bunlar radyolojik olarak RHK’yı taklit edebilir. Ultrasonografi (US) ucuz, ulaşılabilir ve radyasyon içermeyen bir yöntem olmakla birlikte, tanı ve alt tip ayrımında kontrastlı BT altın standarttır. Multiparametrik MR, hem morfolojik hem de fonksiyonel bilgi sağlar ve özellikle iyot kontrast kontrendikasyonu olan olgularda tercih edilir. MR, vasküler invazyon, perinefrik yağ tutulumu ve tümör psödokapsül bütünlüğü gibi prognostik parametreleri değerlendirmede etkilidir. Doğru radyolojik tanı, uygun tedavi planlaması, evreleme ve takip sürecinin yönlendirilmesi açısından büyük önem taşır.
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