Molecular Imaging Companion to KI-RADS for Renal Mass Risk Stratification

A molecular imaging companion to the Kidney Imaging Reporting and Data System (KI-RADS) is proposed, using 99mTc-sestamibi SPECT/CT and 89Zr-girentuximab PET/CT to generate a five-point Likert scale for aggressive histology risk in indeterminate renal masses.

• The companion KI-RADS uses a five-point Likert scale to translate molecular imaging findings into risk of aggressive histology.
• The best-characterized tracers are 99mTc-sestamibi (SPECT/CT) and 89Zr-girentuximab (PET/CT), both validated in prospective scan-and-resect trials.
• The framework is intended to complement MRI and biopsy, with future integration of AI.

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