CECT - Renal Mass Reporting

SM-RMSP v2.0

Deterministic Reporting Engine

Enter imaging evidence only. Classifications automatically derived.

Evidence Admission → Validation → Knowledge → Classification → Governance → Report

Patient Context

Primary Evidence

Derived Knowledge

Output

Clinical Details

Manual Evidence

Indication

Incidentally detected mass

Hematuria

Flank pain

Known RCC Surveillance

Biopsy proven RCC

Comparison Study

Baseline Kidneys

Manual Evidence

Right Kidney

Length

cm

Cortex

mm

Cortical Scarring

Delayed Nephrogram / Excretion

Left Kidney

Length

cm

Cortex

mm

Cortical Scarring

Delayed Nephrogram / Excretion

Primary Tumor Evidence

Manual Evidence

Max Dimension (Radius)

cm

Side

Right

Left

Pole

Upper

Mid

Lower

Morphological Topology Drives RENAL Knowledge

% Exophytic Component

≥ 50% Exophytic

< 50% Exophytic

Entirely Endophytic

Distance to Collecting System / Sinus

≥ 7 mm

4.0 - 6.9 mm

≤ 4 mm (or Indenting)

Direct Invasion

Anterior / Posterior Orientation

Anterior

Posterior

Indeterminate / Neither

Relationship to Polar Lines

Entirely above upper or below lower polar line

Crosses a polar line

>50% across polar line / Interpolar / Crosses midline

Extrarenal Local Invasion Drives AJCC T-Stage

Perinephric fat invasion

Gerota fascia breach (T4)

Ipsilateral Adrenal invasion

Adjacent organ invasion (T4)

Collecting System

Manual Evidence

Morphology & Obstruction

Hydronephrosis

Absent

Mild

Mod/Severe

Displacement / Compression

UPJ Involvement

Urolithiasis (Stone Burden)

Select all present locations:

Upper pole calyces

Lower pole calyces

Renal pelvis

Ureteric

Arterial Anatomy (CTA)

Manual Evidence

Ipsilateral Artery Count

Single main renal artery

Dual renal arteries

Multiple (>2) arteries

Main Artery Diameter

mm

Accessory Polar Artery Present

Early Branching (< 2cm from ostium)

Hemodynamically significant stenosis

Venous Anatomy & Thrombus

Manual Evidence

Cranial Extent of Thrombus Drives Mayo Knowledge

Highest Anatomical Level

None / Pure Parenchymal

Confined to Segmental or Main Renal Vein

IVC - Infrahepatic (Below Hepatic Veins)

IVC - Retrohepatic (At/Above Hepatic Veins, Below Diaphragm)

IVC - Supradiaphragmatic / Right Atrium

Distance above ostium

cm

Needed for Mayo I vs II.

Max IVC Diameter

mm

Luminal Occlusion

%

IVC Wall Invasion Suspected

Bland Thrombus Cap

Regional Lymph Nodes

Manual Evidence

Regional Node Status

N0: No regional lymph node metastasis

N1: Regional lymph node metastasis present

NX: Regional nodes cannot be assessed

Largest Node Short Axis

mm

Central Necrosis Present

Distant Metastatic Survey

Manual Evidence

Distant Metastasis Status

M0: No distant metastasis

M1: Distant metastasis present

Select Sites:

Lung bases

Liver

Bones

Contralateral Adrenal

Peritoneum

Other

Deterministic Knowledge

Engine Computed

RENAL Nephrometry

Derived

--

Awaiting morphological evidence...

Evidence Sources (Rules Fired)

[R] Radius / Size -

[E] Exophytic % -

[N] Nearness to CS -

[A] Anterior/Posterior -

[L] Polar Lines -

AJCC 8th Stage

Derived

Stage -

cT- N- M-

Evidence Sources (Rules Fired)

T-Stage Base -

N-Stage Base -

M-Stage Base -

Surgical Dashboard

Engine Computed

Nephron Sparing

Awaiting

Venous Risk --

Vascular Complexity --

Clinical Stage --

Knowledge Bank

Clinical Reference

The Clinical Interface: Radiologist & Surgeon

The Radiologist's Role

The radiologist acts as the diagnostic cartographer. Rather than simply diagnosing a "renal mass," the goal is to provide a deterministic, anatomical roadmap. This means explicitly evaluating tumor morphology, mapping variant vascular anatomy, and precisely identifying the limits of local and systemic spread. Objective evidence gathering prevents downstream ambiguity.

What the Surgeon Needs

Surgeons use this evidence to make immediate, high-stakes decisions: Can this kidney be saved? (Nephron-Sparing Surgery vs. Radical Nephrectomy). They look for limiting factors: hilar proximity, collecting system invasion, complex multi-arterial supply, and venous thrombus extent. A clear, deterministic report dictates patient counseling and surgical approach.

RENAL Nephrometry Score

A structured system to quantify the complexity of renal tumors, primarily to assess the feasibility of partial nephrectomy.

Component	1 Point	2 Points	3 Points
(R)adius	≤ 4 cm	4.1 - 7 cm	> 7 cm
(E)xophytic/Endophytic	≥ 50% exophytic	< 50% exophytic	Entirely endophytic
(N)earness to collecting sys.	≥ 7 mm	4 - 6.9 mm	≤ 4 mm
(A)nterior/Posterior	Descriptive only (a = Anterior, p = Posterior, x = Neither)
(L)ocation (Polar lines)	Entirely above/below	Crosses polar line	> 50% across polar line / crosses midline

Low: 4-6 Moderate: 7-9 High: 10-12

Mayo IVC Thrombus Classification

• Level 0: Thrombus confined to renal vein (or segmental branches).
• Level I: Thrombus extends into IVC ≤ 2 cm above renal vein ostium.
• Level II: Thrombus extends into IVC > 2 cm above ostium, but below hepatic veins.
• Level III: Thrombus extends into intrahepatic IVC (at/above hepatic veins, below diaphragm).
• Level IV: Supradiaphragmatic extension (into right atrium).

AJCC 8th Ed. TNM Staging

T1/T2: Organ confined. T1 ≤ 7cm (T1a ≤ 4cm, T1b 4-7cm). T2 > 7cm (T2a 7-10cm, T2b > 10cm).

T3: Extends into major veins or perinephric/sinus fat, but NOT into ipsilateral adrenal or beyond Gerota's fascia.

T3a: Renal vein, segmental branches, or perinephric/sinus fat.
T3b: IVC below diaphragm.
T3c: IVC above diaphragm or right atrium.

T4: Invades beyond Gerota's fascia (including contiguous extension into ipsilateral adrenal gland).

Constitutional Governance

Patient & Study Identity

Indication and comparison established.

PENDING

Evidence Completeness

Morphology, vascular, nodes, and mets admitted.

PENDING

Deterministic Classification

RENAL, Mayo, and AJCC stages successfully resolved.

PENDING

0%

Admission Incomplete

Ready for Report Generation

The deterministic engine has evaluated all inputs. The final report will embed validated knowledge derived strictly from the admitted evidence.

Constitutional Validation Passed

Lineage Trace: Evidence (Manual) Knowledge (Rules) Classification (Derived) Report Output

Evidence Objects: 0 Knowledge Objects: 0 Derived Objects: 0

Conflicts: 0 Governance: ADMITTING

DSEA Pipeline

> Evidence admitted

> Re-evaluating rules...

> Governance revalidated

Action completed