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Wednesday, June 19, 2013
Why order an MRI?
I am a 34 year old female. I recently had a CT scan because I have been having alot of pelvic/lower back pain. They found a cystic lesion in the renal area. I was then sent to get an MRI. In my research I have found that they can determine between a simple or complex cyst from a CT scan. My question is why they ordered an MRI? What else are they looking for??
There is a system of classifying renal cysts based on their "complexity." A simple cyst should look just like a round, thin-walled balloon filled with clear fluid. Such a cyst has a minimal chance of being (or ever becoming) malignant. A complex cyst may contain fluid that isn't completely clear, such as blood or degenerating tissue, and may be divided into compartments by walls or "septae." Specific cyst characteristics, such as their size, the thickness and smoothness/roughness of the septae, and the material contained within the cyst are used to predict the likelihood that a cyst is malignant (or may turn malignant).
Simple cysts and not-very-complex cysts can be watched and restudied after 3-6 months to see whether or not they change or grow. The more complex a cyst is, the better idea it is to have it surgically examined and removed. Although CT scans can demonstrate the features of a cyst well, MRIs are better, for instance at revealing the presence of septae and at showing how thick the septae are. Luckily these radiologic methods of determining the structure of cysts are quite accurate, because the vast majority of renal cysts are simple and benign -- so CT's and MRI's save many people from having to have surgery. May you be in this category!
Mildred Lam, MD
Associate Professor of Medicine
School of Medicine
Case Western Reserve University