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Magnetic resonance imaging as an adjunct diagnostic tool in computed tomography defined Bosniak IIF–III renal cysts: a multicenter study

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Abstract

Introduction

CT imaging is the standard examination for renal cystic lesions and defines the Bosniak category, which dictates further management. Given that Bosniak II/IIF/III renal cystic lesions can potentially harbor renal cell carcinoma (RCC), additional diagnostic modalities may be required in management decision making.

Aim

To determine the value of additional magnetic resonance imaging in CT-defined Bosniak IIF–III renal cystic lesions.

Materials and methods

This a multicenter retrospective study of 46 consecutive patients, diagnosed with cystic renal lesions between 2009 and 2016. The inclusion criteria were: (1) cystic renal lesion classified as Bosniak IIF–III on CT, (2) a subsequent MRI examination, and (3) documented outcome via surgery for cystic renal mass or follow-up.

Results

46 patients (35 males, 11 females) were included. The mean size of the cystic lesion was 3.92 cm (0.7–10 cm). According to the CT findings, Bosniak IIF and III were found in 12 (26.1%) and 34 (73.9%) cases. Reclassification of Bosniak category was done after MRI examination in 31 cases (67.4%). An upgrade rate of 58.7% (27 cases) to a higher category was made, while the downgrade rate to a lower category was achieved in 4 cases (8.7%). As a result, significant therapeutic management change was made in 12/31 patients (38.7%), of whom 8 underwent subsequent surgery.

Conclusion

MRI study may reduce the use of Bosniak IIF category (in comparison with CT), which has a direct impact on therapeutic management (surgery vs. surveillance) in a significant proportion of patients.

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References

  1. McGuire BB, Fitzpatrick JM (2010) The diagnosis and management of complex renal cysts. Curr Opin Urol 20:349–354

    Article  PubMed  Google Scholar 

  2. Pitra T, Procházková K, Trávníček I et al. (2016) Cystické tumory ledvin. In. Klinická urológia, 79

  3. Bosniak MA (1997) Diagnosis and management of patients with complicated cystic lesions of the kidney. AJR Am J Roentgenol 169:819–821

    Article  PubMed  CAS  Google Scholar 

  4. Bosniak MA (1997) The use of the Bosniak classification system for renal cysts and cystic tumors. J Urol 157:1852–1853

    Article  PubMed  CAS  Google Scholar 

  5. Curry NS, Cochran ST, Bissada NK (2000) Cystic renal masses: accurate Bosniak classification requires adequate renal CT. AJR Am J Roentgenol 175:339–342

    Article  PubMed  CAS  Google Scholar 

  6. Israel GM, Hindman N, Bosniak MA (2004) Evaluation of cystic renal masses: comparison of CT and MR imaging by using the Bosniak classification system. Radiology 231:365–371

    Article  PubMed  Google Scholar 

  7. Moch H, Cubilla AL, Humphrey PA et al (2016) The 2016 WHO classification of tumours of the urinary system and male genital organs-part a: renal, penile, and testicular tumours. Eur Urol 70:93–105

    Article  PubMed  Google Scholar 

  8. Lopez-Beltran A, Scarpelli M, Montironi R, Kirkali Z (2006) 2004 WHO classification of the renal tumors of the adults. Eur Urol 49:798–805

    Article  PubMed  Google Scholar 

  9. Ascenti G, Mazziotti S, Zimbaro G et al (2007) Complex cystic renal masses: characterization with contrast-enhanced US. Radiology 243:158–165

    Article  PubMed  Google Scholar 

  10. Bosniak MA (1986) The current radiological approach to renal cysts. Radiology 158:1–10

    Article  PubMed  CAS  Google Scholar 

  11. Bosniak MA (1993) Problems in the radiologic diagnosis of renal parenchymal tumors. Urol Clin North Am 20:217–230

    PubMed  CAS  Google Scholar 

  12. Israel GM, Bosniak MA (2003) Follow-up CT of moderately complex cystic lesions of the kidney (Bosniak category IIF). AJR Am J Roentgenol 181:627–633

    Article  PubMed  Google Scholar 

  13. Israel GM, Bosniak MA (2005) An update of the Bosniak renal cyst classification system. Urology 66:484–488

    Article  PubMed  Google Scholar 

  14. Israel GM, Bosniak MA (2003) Calcification in cystic renal masses: is it important in diagnosis? Radiology 226:47–52

    Article  PubMed  Google Scholar 

  15. Smith AD, Remer EM, Cox KL et al (2012) Bosniak category IIF and III cystic renal lesions: outcomes and associations. Radiology 262:152–160

    Article  PubMed  Google Scholar 

  16. Weibl P, Hora M, Kollarik B et al (2015) Management, pathology and outcomes of Bosniak category IIF and III cystic renal lesions. World J Urol 33:295–300

    Article  PubMed  Google Scholar 

  17. Ferreira AM, Reis RB, Kajiwara PP et al (2016) MRI evaluation of complex renal cysts using the Bosniak classification: a comparison to CT. Abdom Radiol 41:2011–2019

    Article  Google Scholar 

  18. Hartman DS, Choyke PL, Hartman MS (2004) From the RSNA refresher courses: a practical approach to the cystic renal mass. Radiographics 24(Suppl 1):S101–115

    Article  PubMed  Google Scholar 

  19. Hora M, Hes O, Michal M et al (2005) Extensively cystic renal neoplasms in adults (Bosniak classification II or III)–possible “common” histological diagnoses: multilocular cystic renal cell carcinoma, cystic nephroma, and mixed epithelial and stromal tumor of the kidney. Int Urol Nephrol 37:743–750

    Article  PubMed  Google Scholar 

  20. Weibl P, Hora M, Kollarik B et al (2017) A practical guide and decision-making protocol forthe management of complex renal cystic masses. Arab J Urol 15:115–122

    Article  PubMed  PubMed Central  Google Scholar 

  21. Nikken JJ, Krestin GP (2007) MRI of the kidney-state of the art. Eur Radiol 17:2780–2793

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  22. Lei Y, Wang H, Li HF et al (2015) Diagnostic significance of diffusion-weighted MRI in renal cancer. Biomed Res Int 2015:172165

    PubMed  PubMed Central  Google Scholar 

  23. Gilet AG, Kang SK, Kim D, Chandarana H (2012) Advanced renal mass imaging: diffusion and perfusion MRI. Curr Urol Rep 13:93–98

    Article  PubMed  Google Scholar 

  24. Balyemez F, Aslan A, Inan I et al (2017) Diffusion-weighted magnetic resonance imaging in cystic renal masses. Can Urol Assoc J 11:E8–E14

    Article  PubMed  PubMed Central  Google Scholar 

  25. Maki DD, Birnbaum BA, Chakraborty DP et al (1999) Renal cyst pseudoenhancement: beam-hardening effects on CT numbers. Radiology 213:468–472

    Article  PubMed  CAS  Google Scholar 

  26. Weibl P, Klatte T, Kollarik B et al (2011) Interpersonal variability and present diagnostic dilemmas in Bosniak classification system. Scand J Urol Nephrol 45:239–244

    Article  PubMed  Google Scholar 

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Acknowledgements

This work was supported by MH CZ – DRO, the Charles University Research Fund (project number Q39), by the National Sustainability Program I (NPU I) Nr. LO1503 provided by the Ministry of Education Youth and Sports of the Czech Republic.

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Authors and Affiliations

  1. Department of Urology, Medical Faculty, Charles University, Charles University Hospital Plzen, E. Beneše 13, 305 99, Plzeň, Czech Republic

    Tomas Pitra, Ivan Travnicek, Kristyna Prochazkova & Milan Hora

  2. Department of Pathology, Medical Faculty, Charles University, Charles University Hospital Plzen, Plzeň, Czech Republic

    Kristyna Pivovarcikova & Ondrej Hes

  3. Department of Radiology, Medical Faculty, Charles University, Charles University Hospital Plzen, Plzeň, Czech Republic

    Radek Tupy & Tana Barakova

  4. Department of Pathology, Faculty of Medicine, University of British Columbia, Royal Columbian Hospital, Vancouver, BC, Canada

    Reza Alaghehbandan

  5. Department of Urology, Medical University of Vienna, Vienna, Austria

    Tobias Klatte

  6. Department of Urology, Jagiellonian University Medical College, Kraków, Poland

    Piotr Chlosta

Authors
  1. Tomas Pitra
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  2. Kristyna Pivovarcikova
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  3. Radek Tupy
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  4. Reza Alaghehbandan
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  5. Tana Barakova
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  6. Ivan Travnicek
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  7. Kristyna Prochazkova
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  8. Tobias Klatte
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  9. Piotr Chlosta
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  10. Ondrej Hes
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  11. Milan Hora
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Contributions

TP, project development, Manuscript writing, Data collection or management, Data analysis; KP, Manuscript writing/editing; RT and RA, Data analysis, Manuscript editing; TB, Data analysis; IT, KP and PC, Data collection or management; TK, Data collection or management, Manuscript editing; OH and MH, Manuscript editing.

Corresponding author

Correspondence to Tomas Pitra.

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The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Retrospective study

For this type of study formal consent is not required.

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Cite this article

Pitra, T., Pivovarcikova, K., Tupy, R. et al. Magnetic resonance imaging as an adjunct diagnostic tool in computed tomography defined Bosniak IIF–III renal cysts: a multicenter study. World J Urol 36, 905–911 (2018). https://doi.org/10.1007/s00345-018-2176-z

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  • DOI: https://doi.org/10.1007/s00345-018-2176-z

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