Imaging of Pediatric Renal Cysts: An Update-AJR Expert Panel Narrative Review

Pediatric renal cysts can be isolated, hereditary, or related to acquired disease processes, and they may be congenital or develop over time. Given the heterogeneity of pediatric renal cysts, their increasing detection, and the absence of unified pediatric-specific guidelines, additional practical imaging-based recommendations are needed. This AJR Expert Panel Narrative Review seeks to address such gaps by providing guidance for radiologists in the evaluation of renal cysts, focusing on imaging characteristics, diagnostic considerations, and management recommendations. The authors comprise a multidisciplinary panel of pediatric radiologists, a pediatric nephrologist, and a pediatric urologist. This article addresses incidental and syndromic cystic renal disease, differentiation between benign and malignant cystic lesions, and the role of clinical history in guiding radiologic assessment. The roles of ultrasound (including contrast-enhanced ultrasound), CT, and MRI are presented, along with application of the modified Bosniak renal cyst classification in pediatric cases. Consideration is given to surveillance strategies, subspecialist referral pathways, and integration of societal guidelines. By highlighting current controversies and knowledge gaps, the article aims to clarify where agreement currently exists and where further research and multidisciplinary consensus are needed to achieve standardized evidence-based care for children with renal cystic disease.