Evaluation of cystic renal masses: comparison of CT and MR imaging by using the Bosniak classification system.
OBJECTIVE
To compare computed tomography (CT) and magnetic resonance (MR) imaging in the evaluation of cystic renal masses by using the Bosniak classification system.


METHODS
Images of 69 renal masses in 59 patients (38 men, 21 women; mean age, 60.4 years; range, 30-86 years), who had undergone both CT and MR imaging examinations within 1 year (average, 60.5 days; range, 0-356 days), were retrospectively analyzed by two radiologists in consensus. For each lesion, images were compared for thickness of wall and septa, number of septa, and presence of enhancement. Each mass was categorized (Bosniak classification) first on CT images and then on MR images, and results were compared. Pathologic correlation was available in 25 lesions.


RESULTS
On CT images, there were 15 category I, 16 category II, 10 category IIF, 19 category III, and nine category IV lesions. Findings on CT and MR images were similar in 56 (81%) lesions; in 13 (19%) lesions, there were differences. In eight (12%) lesions, MR imaging depicted more septa than did CT, which resulted in an upgrade of the classification at MR imaging in two cases. In seven (10%) lesions, MR imaging depicted increased wall and/or septa thickness compared with CT, resulting in a classification upgrade in six cases. Three lesions had both increased numbers of septa and thickening of the wall and/or septa. In two (3%) lesions, enhancement characteristics at CT and MR imaging were different. One of these lesions also had an increased number of septa. Overall, MR imaging results led to a cyst classification upgrade of seven lesions, from category II to IIF (n = 2), IIF to III (n = 3), or III to IV (n = 2). Pathologic correlation in 25 lesions revealed 20 malignant and five benign lesions.


CONCLUSIONS
CT and MR imaging findings were similar in the majority of cystic renal masses. In some cases, however, MR images may depict additional septa, thickening of the wall and/or septa, or enhancement, which may lead to an upgraded Bosniak cyst classification and can affect case management.
Israel
Gary M
GM
Department of Radiology, NYU Medical Center, 560 First Ave, Suite HW 202, New York, NY 10016, USA. gary.israel@med.nyu.edu
Hindman
Nicole
N
Bosniak
Morton A
MA
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D052177:Kidney Diseases, Cystic / Q000145:classification* / Q000175:diagnosis* / Q000473:pathology; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed