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Applicability of Bosniak 2019 for renal mass classification on portal venous phase at the era of spectral CT imaging using rapid kV-switching dual-energy CT

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Abstract

Objectives

To evaluate the applicability of Bosniak 2019 criteria on a monophasic portal venous phase using rapid kilovoltage-switching DECT (rsDECT).

Materials and methods

One hundred twenty-seven renal masses assessed on rsDECT were included, classified according to Bosniak 2019 classification using MRI as the reference standard. Using the portal venous phase, virtual monochromatic images at 40, 50, and 77 keV; virtual unenhanced (VUE) images; and iodine map images were reconstructed. Changes in attenuation values between VUE and 40 keV, 50 keV, and 77 keV measurements were computed and respectively defined as ∆HU40keV, ∆HU50keV, and ∆HU77keV. The values of ∆HU40keV, ∆HU50keV, and ∆HU77keV thresholds providing the optimal diagnostic performance for the detection of internal enhancement were determined using Youden index.

Results

Population study included 25 solid renal masses (25/127, 20%) and 102 cystic renal masses (102/127, 80%). To differentiate solid to cystic masses, the specificity of the predefined 20 HU threshold reached 88% (95%CI: 82, 93) using ∆HU77keV and 21% (95%CI: 15, 28) using ∆HU40keV. The estimated optimal threshold of attenuation change was 19 HU on ∆HU77keV, 69 HU on ∆HU50eV, and 111 HU on ∆HU40eV. The rsDECT classification was highly similar to that of MRI for solid renal masses (23/25, 92%) and for Bosniak 1 masses (62/66, 94%). However, 2 hyperattenuating Bosniak 2 renal masses (2/26, 8%) were classified as solid renal masses on rsDECT.

Conclusion

DECT is a promising tool for Bosniak classification particularly to differentiate solid from Bosniak I-II cyst. However, known enhancement thresholds must be adapted especially to the energy level of virtual monochromatic reconstructions.

Clinical statement

DECT is a promising tool for Bosniak classification; however, known enhancement thresholds must be adapted according to the types of reconstructions used and especially to the energy level of virtual monochromatic reconstructions.

Key Points

• To differentiate solid to cystic renal masses, predefined 20 HU threshold had a poor specificity using 40 keV virtual monochromatic images.

• Most of Bosniak 1 masses according to MRI were also classified as Bosniak 1 on rapid kV-switching dual-energy CT (rsDECT).

• Bosniak 2 hyperattenuating renal cysts mimicked solid lesion on rsDECT.

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Abbreviations

DECT:

Dual-energy CT

rsDECT:

Rapid kilovoltage-switching dual-energy CT

TUE:

True unenhanced

VMI:

Virtual monochromatic image

VUE:

Virtual unenhanced

References

  1. Herts BR, Silverman SG, Hindman NM et al (2018) Management of the incidental renal mass on CT: a white paper of the ACR Incidental Findings Committee. J Am Coll Radiol 15:264–273. https://doi.org/10.1016/j.jacr.2017.04.028

    Article  PubMed  Google Scholar 

  2. Hélénon O, Crosnier A, Verkarre V et al (2018) Simple and complex renal cysts in adults: classification system for renal cystic masses. Diagn Interv Imaging 99:189–218. https://doi.org/10.1016/j.diii.2017.10.005

    Article  PubMed  Google Scholar 

  3. Schieda N, Davenport MS, Krishna S et al (2022) Bosniak classification of cystic renal masses, version 2019: a pictorial guide to clinical use. Radiographics 42:E33. https://doi.org/10.1148/rg.219016

    Article  PubMed  Google Scholar 

  4. Silverman SG, Pedrosa I, Ellis JH et al (2019) Bosniak classification of cystic renal masses, version 2019: an update proposal and needs assessment. Radiology 292:475–488. https://doi.org/10.1148/radiol.2019182646

    Article  PubMed  Google Scholar 

  5. McGrath TA, Shoeib A, Davenport MS et al (2021) Evaluation of class II cystic renal masses proposed in Bosniak classification version 2019: a systematic review of supporting evidence. Abdom Radiol (NY) 46:4888–4897. https://doi.org/10.1007/s00261-021-03180-y

    Article  PubMed  Google Scholar 

  6. Corwin MT, Altinmakas E, Asch D et al (2021) Clinical importance of incidental homogeneous renal masses that measure 10–40 mm and 21–39 HU at portal venous phase CT: a 12-institution retrospective cohort study. AJR Am J Roentgenol 217:135–140. https://doi.org/10.2214/AJR.20.24245

    Article  PubMed  Google Scholar 

  7. Lestra T, Mulé S, Millet I et al (2016) Applications of dual energy computed tomography in abdominal imaging. Diagn Interv Imaging 97:593–603. https://doi.org/10.1016/j.diii.2015.11.018

    Article  CAS  PubMed  Google Scholar 

  8. P R, A P, F K, et al (2020) Update on multienergy CT: physics, principles, and applications. Radiographics 40. https://doi.org/10.1148/rg.2020200038

  9. Lennartz S, Hokamp NG, Kambadakone A (2022) Dual-energy CT of the abdomen: radiology in training. Radiology 212914. https://doi.org/10.1148/radiol.212914

  10. Bellini D, Panvini N, Laghi A, et al (2019) Systematic review and meta-analysis investigating the diagnostic yield of dual-energy CT for renal mass assessment. AJR Am J Roentgenol 1–10. https://doi.org/10.2214/AJR.18.20625

  11. Pourvaziri A, Parakh A, Mojtahed A et al (2019) Diagnostic performance of dual-energy CT and subtraction CT for renal lesion detection and characterization. Eur Radiol 29:6559–6570. https://doi.org/10.1007/s00330-019-06224-6

    Article  PubMed  Google Scholar 

  12. Salameh J-P, McInnes MDF, McGrath TA et al (2019) Diagnostic accuracy of dual-energy CT for evaluation of renal masses: systematic review and meta-analysis. AJR Am J Roentgenol 212:W100–W105. https://doi.org/10.2214/AJR.18.20527

    Article  PubMed  Google Scholar 

  13. Jamali S, Michoux N, Coche E, Dragean CA (2019) Virtual unenhanced phase with spectral dual-energy CT: is it an alternative to conventional true unenhanced phase for abdominal tissues? Diagn Interv Imaging 100:503–511. https://doi.org/10.1016/j.diii.2019.04.007

    Article  CAS  PubMed  Google Scholar 

  14. Xiao JM, Hippe DS, Zecevic M et al (2021) Virtual unenhanced dual-energy CT images obtained with a multimaterial decomposition algorithm: diagnostic value for renal mass and urinary stone evaluation. Radiology 298:611–619. https://doi.org/10.1148/radiol.2021192448

    Article  PubMed  Google Scholar 

  15. Meyer M, Nelson RC, Vernuccio F et al (2019) Virtual unenhanced images at dual-energy CT: influence on renal lesion characterization. Radiology 291:381–390. https://doi.org/10.1148/radiol.2019181100

    Article  PubMed  Google Scholar 

  16. Cao J, Lennartz S, Pisuchpen N et al (2022) Renal lesion characterization by dual-layer dual-energy CT: comparison of virtual and true unenhanced images. AJR Am J Roentgenol. https://doi.org/10.2214/AJR.21.27272

    Article  PubMed  PubMed Central  Google Scholar 

  17. Mastrodicasa D, Willemink MJ, Madhuripan N et al (2021) Diagnostic performance of single-phase dual-energy CT to differentiate vascular and nonvascular incidental renal lesions on portal venous phase: comparison with CT. Eur Radiol 31:9600–9611. https://doi.org/10.1007/s00330-021-08097-0

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  18. Pedrosa I, Cadeddu JA (2022) How we do it: managing the indeterminate renal mass with the MRI clear cell likelihood score. Radiology 302:256–269. https://doi.org/10.1148/radiol.210034

    Article  PubMed  Google Scholar 

  19. Mendonca PRS, Lamb P, Sahani DV (2014) A flexible method for multi-material decomposition of dual-energy CT images. IEEE Trans Med Imaging 33:99–116. https://doi.org/10.1109/TMI.2013.2281719

    Article  PubMed  Google Scholar 

  20. Marin D, Davis D, Roy Choudhury K et al (2017) Characterization of small focal renal lesions: diagnostic accuracy with single-phase contrast-enhanced dual-energy CT with material attenuation analysis compared with conventional attenuation measurements. Radiology 284:737–747. https://doi.org/10.1148/radiol.2017161872

    Article  PubMed  Google Scholar 

  21. Moleesaide A, Maneegarn A, Kaewlai R, Thiravit S (2022) Virtual monochromatic spectral attenuation curve analysis for evaluation of incidentally detected small renal lesions using rapid kilovoltage-switching dual-energy computed tomography. Abdom Radiol (NY). https://doi.org/10.1007/s00261-022-03634-x

    Article  PubMed  Google Scholar 

  22. Ho LM, Marin D, Neville AM et al (2012) Characterization of adrenal nodules with dual-energy CT: can virtual unenhanced attenuation values replace true unenhanced attenuation values? AJR Am J Roentgenol 198:840–845. https://doi.org/10.2214/AJR.11.7316

    Article  PubMed  Google Scholar 

  23. Lacroix M, Mulé S, Herin E et al (2020) Virtual unenhanced imaging of the liver derived from 160-mm rapid-switching dual-energy CT (rsDECT): comparison of the accuracy of attenuation values and solid liver lesion conspicuity with native unenhanced images. Eur J Radiol 133:109387. https://doi.org/10.1016/j.ejrad.2020.109387

    Article  PubMed  Google Scholar 

  24. Parakh A, Lennartz S, An C et al (2021) Dual-energy CT images: pearls and pitfalls. Radiographics 41:98–119. https://doi.org/10.1148/rg.2021200102

    Article  PubMed  Google Scholar 

  25. Benveniste AP, de Castro FS, Broering G et al (2017) Potential application of dual-energy CT in gynecologic cancer: initial experience. AJR Am J Roentgenol 208:695–705. https://doi.org/10.2214/AJR.16.16227

    Article  PubMed  Google Scholar 

  26. Almalki YE, Basha MAA, Refaat R et al (2022) Bosniak classification version 2019: a prospective comparison of CT and MRI. Eur Radiol. https://doi.org/10.1007/s00330-022-09044-3

    Article  PubMed  Google Scholar 

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Funding

The authors state that this work has not received any funding.

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Authors and Affiliations

  1. Department of Radiology, APHP, HU Henri Mondor, Creteil, Val-de-Marne, France

    Edouard Reizine, Maxime Blain, Lorenzo Pescatori, Benjamin Longère, Wafa Boughamni, Mohamed Bouanane, Sébastien Mulé & Alain Luciani

  2. Faculté de Médecine, Université Paris Est Creteil, 94010, Creteil, France

    Edouard Reizine, Maxime Blain, Sébastien Mulé & Alain Luciani

  3. INSERM Unit U 955, Equipe 18, 94010, Creteil, France

    Edouard Reizine, Sébastien Mulé & Alain Luciani

  4. Imagerie Médicale, CHU Henri Mondor, 51 Avenue du Marechal de Lattre de Tassigny, 94010, Créteil, France

    Edouard Reizine

  5. University Lille, U1011 – European Genomic Institute for Diabetes, 59000, Lille, France

    Benjamin Longère

  6. INSERM U1011, 59000, Lille, France

    Benjamin Longère

  7. Department of Cardiovascular Radiology, CHU Lille, 59000, Lille, France

    Benjamin Longère

  8. Institut Pasteur Lille, 59000, Lille, France

    Benjamin Longère

  9. Department of Urology, APHP, HU Henri Mondor, Créteil, France

    Alexandre Ingels

Authors
  1. Edouard Reizine
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Correspondence to Edouard Reizine.

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Guarantor

The scientific guarantor of this publication is Alain Luciani.

Conflict of interest

Sébastien Mulé is a member of the European Radiology Editorial Board. They have not taken part in the review or selection process of this article.

The other authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.

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Reizine, E., Blain, M., Pescatori, L. et al. Applicability of Bosniak 2019 for renal mass classification on portal venous phase at the era of spectral CT imaging using rapid kV-switching dual-energy CT. Eur Radiol 34, 1816–1824 (2024). https://doi.org/10.1007/s00330-023-10145-w

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