{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T12:58:45Z","timestamp":1790686725208,"version":"4.1.0"},"reference-count":14,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T00:00:00Z","timestamp":1790640000000},"content-version":"vor","delay-in-days":271,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,1,1]],"date-time":"2026-01-01T00:00:00Z","timestamp":1767225600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Case Reports in Nephrology"],"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Clear cell renal cell carcinoma (ccRCC) is the most common histological subtype of malignant renal neoplasms, with an increasing incidence in Western countries. Early diagnosis is a critical determinant of prognosis, as advanced\u2010stage disease with metastatic dissemination entails a significantly reduced median survival. Characterizing complex cystic renal lesions presents a recognized diagnostic challenge on noncontrast computed tomography (CT), which often leads to underestimation and missed diagnoses. Artificial intelligence (AI) applied to diagnostic imaging is emerging as a supplementary decision\u2010support tool, but its integration must be critically evaluated to understand its potential to reduce diagnostic errors as well as its limitations.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Case Presentation<\/jats:title>\n                    <jats:p>We report the case of a 73\u2010year\u2010old male physician with a history of myocardial infarction who presented with left flank pain. An initial noncontrast CT of the urinary tract on January 15 revealed a 37\u2010mm left upper\u2010pole renal cyst and a 5\u2010mm suspected calculus. The cyst was characterized as simple, and the report offered only a generic follow\u2010up recommendation. Over the next 4\u2009months, the patient\u2019s persistent pain was attributed entirely to presumed ureteric stone disease, leading to a ureteroscopy and ureteral stent placement, without characterizing the known renal cyst with contrast. On June 5 (5\u2009months after the initial CT), a contrast\u2010enhanced CT revealed a 6\u2010cm heterogeneous, exophytic left renal mass. Subsequent staging confirmed pulmonary and cerebral metastases from ccRCC. The patient died in mid\u2010August, 7\u2009months after the initial CT. Retrospective re\u2010evaluation of the baseline CT images, both by a senior radiologist and through an AI platform, confirmed that the lesion already exhibited features suspicious for neoplasia at the time of the first scan, warranting further investigation with contrast\u2010enhanced CT or magnetic resonance imaging in accordance with international guidelines. Simulated retrospective analysis via a web\u2010based AI platform not only flagged the mass as suspicious but also generated several critical errors (e.g., hallucinating contrast enhancement on the unenhanced scan, mislocalizing the mass to the mid\u2010to\u2010lower pole, and claiming it was \u201cnew\u201d without comparison data).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>This case demonstrates how a complex cystic renal lesion may be underestimated in the absence of contrast medium and an adequate level of clinical\u2013radiological suspicion. Re\u2010evaluation by AI produced a result consistent with that of the expert radiologist, suggesting that systematic integration of AI tools into the radiological workflow could contribute to reducing diagnostic errors, particularly in settings where interobserver variability represents a clinically significant risk factor. AI can act as an effective supplementary decision\u2010support tool to reduce perceptual errors; clinicians and radiologists must remain highly vigilant regarding AI\u2010generated factual inconsistencies. Proper adherence to imaging guidelines and the use of contrast medium remain paramount.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1155\/crin\/5359978","type":"journal-article","created":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T12:23:48Z","timestamp":1790684628000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Missed Diagnosis of Clear Cell Renal Cell Carcinoma on Noncontrast Computed Tomography: The Potential Role of Artificial Intelligence in Reducing Radiological Diagnostic Error"],"prefix":"10.1155","volume":"2026","author":[{"ORCID":"https:\/\/orcid.org\/0009-0008-3750-5164","authenticated-orcid":false,"given":"Fabio Massimo","family":"Abenavoli","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4046-2122","authenticated-orcid":false,"given":"Omar","family":"Tujjar","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrea","family":"Alfonso","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,9,29]]},"reference":[{"key":"e_1_2_9_1_2","doi-asserted-by":"publisher","DOI":"10.1038\/nrdp.2017.9"},{"key":"e_1_2_9_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.eururo.2018.08.036"},{"key":"e_1_2_9_3_2","doi-asserted-by":"publisher","DOI":"10.6004\/jnccn.2022.0001"},{"key":"e_1_2_9_4_2","doi-asserted-by":"publisher","DOI":"10.1148\/radiol.11111595"},{"key":"e_1_2_9_5_2","doi-asserted-by":"publisher","DOI":"10.1148\/radiol.2019182646"},{"key":"e_1_2_9_6_2","doi-asserted-by":"publisher","DOI":"10.1038\/s41568-018-0016-5"},{"key":"e_1_2_9_7_2","doi-asserted-by":"publisher","DOI":"10.1038\/s41591-021-01614-0"},{"key":"e_1_2_9_8_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jclinepi.2017.04.026"},{"key":"e_1_2_9_9_2","doi-asserted-by":"publisher","DOI":"10.1148\/rg.2015150023"},{"key":"e_1_2_9_10_2","first-page":"e577","article-title":"Interpersonal Variability of the Bosniak Classification for Complex Renal Cysts","volume":"185","author":"Weibl P.","year":"2011","journal-title":"The Journal of Urology"},{"key":"e_1_2_9_11_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.eururo.2022.03.006"},{"key":"e_1_2_9_12_2","doi-asserted-by":"crossref","DOI":"10.25259\/JCIS_160_2024","article-title":"Computed Tomography and Magnetic Resonance Imaging Characteristics of Renal Cell Carcinoma: Differences Between Subtypes and Clinical Evaluation","volume":"15","author":"Baytok A.","year":"2025","journal-title":"Journal of Clinical Imaging Science"},{"key":"e_1_2_9_13_2","doi-asserted-by":"publisher","DOI":"10.1038\/s41591-018-0300-7"},{"key":"e_1_2_9_14_2","first-page":"4797","article-title":"Diagnostic Accuracy of Deep Learning-based CT Analysis for Cystic and Solid Renal Lesions: A Systematic Review","volume":"33","author":"Uhlig J.","year":"2023","journal-title":"European Radiology"}],"container-title":["Case Reports in Nephrology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1155\/crin\/5359978","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1155\/crin\/5359978","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1155\/crin\/5359978","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T12:23:49Z","timestamp":1790684629000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1155\/crin\/5359978"}},"subtitle":[],"editor":[{"given":"Poorani","family":"Gurumallesh Prabu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2026,1]]},"references-count":14,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2026,1]]}},"alternative-id":["10.1155\/crin\/5359978"],"URL":"https:\/\/doi.org\/10.1155\/crin\/5359978","archive":["Portico"],"relation":{},"ISSN":["2090-6641","2090-665X"],"issn-type":[{"value":"2090-6641","type":"print"},{"value":"2090-665X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,1]]},"assertion":[{"value":"2026-06-14","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-09-09","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-09-29","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"5359978"}}