Comparison of CT and MR Imaging of Cystic Renal Masses by Using the Bosniak Classification System

Authors

DOI:

https://doi.org/10.59667/sjoranm.v4i1.14

Keywords:

renal mass, Bosniak classification, comparison of CT and MRI, diagnostic value, intracystic septa, cystic wall thickening

Abstract

Purpose:
To compare the efficacy of computed tomography (CT) and magnetic resonance imaging (MRI) in evaluating cystic renal masses using the Bosniak classification system.
Materials and Methods:
Between January 2010 and December 2020, a total of 844 patients with suspected renal masses underwent total or partial nephrectomy at the Department of Urology, Heidelberg University Clinic. Among them, 123 patients presented with cystic renal masses. Out of this cohort, 15 patients underwent preoperative examinations using both MRI and CT within a 6-week timeframe. These examinations were retrospectively analyzed by two radiologists employing the Bosniak classification system. Each lesion was assessed based on CT images for lesion localization, volume, number, and thickness of septa/wall, calcification, presence of enhancing soft-tissue components, and lesion density. Pathologic correlation was available for all lesions.
Results:
Out of the 844 patients, 15 underwent both CT and MR imaging examinations (male-to-female ratio: 2.75, age range: 43-75 years; mean age: 60.5 years). Based on CT images, there were one category I, one category II, three category IIF, three category III, and seven category IV lesions. Findings based on CT and MR images were concordant in eleven (73.3%) renal lesions, while in 4 (26.7%) masses, differences were observed. In three (20%) cases, MR imaging revealed more septa/wall than CT, resulting in an upgrade of the classification at MR imaging. In one (6.7%) lesion, MR imaging showed no wall and/or septa thickness compared with CT, leading to a classification downgrade. MR imaging results led to a cyst classification upgrade in three masses (from category II to III, n=1; IIF to III, n=2) and downgrade in one lesion (from category IIF to II). Pathologically, 11 lesions (73.3%) were malignant (9 Cystic Clear cell carcinoma and 2 papillary renal cell carcinoma), while 4 lesions were renal cysts without malignancy.
Conclusion:
The majority of findings from both CT and MR imaging were similar in suspected cystic renal masses. MR imaging demonstrated additional septa/wall or septa/wall thickening, potentially upgrading lesions from borderline category IIF to III compared to CT. This distinction may contribute to improved case management. 

Author Biography

  • Gerd Nöldge, Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, University Hospital of Bern, University of Bern

    Founding Editor & Honorary Editor
    Switzerland & Germany
    Senior Consultant Radiology, University Hospitals Heidelberg & Bern

    Prof. Dr. med. Gerd Nöldge is a renowned German radiologist and pioneer in interventional radiology. As former Senior Consultant at Heidelberg University Hospital, he made groundbreaking contributions to gastrointestinal artery embolization, for which he received the inaugural Wilhelm Conrad Röntgen Prize in 1985. He played a key role in advancing kyphoplasty techniques for osteoporotic vertebral fractures, providing long-term evidence for the efficacy and stability of calcium phosphate cement in vertebral body augmentation.

    Prof. Nöldge has also significantly contributed to the clinical development and refinement of transjugular intrahepatic portosystemic shunt (TIPS) procedures, improving outcomes in patients with portal hypertension. His dedication to education and international collaboration has fostered enduring partnerships, including medical exchange programs with leading institutions in China.

    As Founding Editor of the Swiss Journal of Radiology and Nuclear Medicine, Prof. Nöldge played a decisive role in the establishment and early development of SJORANM. His appointment as Honorary Editor recognizes his founding contribution, his longstanding scientific commitment, and his lasting importance to the journal. 

    Former institutional affiliation: University Hospital Heidelberg – Diagnostic and Interventional Radiology
    Location: Heidelberg, Germany & Bern, Switzerland
    ROR: 013czdx64

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SJORANM article cover, Vol. 4 No. 1 (2024). Holographic symbolic illustration for article 16.

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Published

2024-01-31

Data Availability Statement

The data supporting the findings of this study are available from the corresponding author upon reasonable request, subject to applicable data protection requirements and institutional approval.

Issue

Vol. 4 No. 1 (2024)

Section

Research Articles

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Copyright (c) 2024 Keivan Daneshvar, Johannes Huber, Wolfram Andreas Bosbach, Nando Mertineit, Gerd Nöldge

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How to Cite

Daneshvar, K., Huber, J., Bosbach, W. A., Mertineit, N., & Nöldge, G. (2024). Comparison of CT and MR Imaging of Cystic Renal Masses by Using the Bosniak Classification System. Swiss Journal of Radiology and Nuclear Medicine, 4(1), 10-16. https://doi.org/10.59667/sjoranm.v4i1.14

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