Incidental Renal Lesions on Lumbar Spine MRI: Who Needs Follow-Up?

Nelson, Steve; Oettel, David J.; Lisanti, Christopher J.; Schwope, Ryan B.; Timpone, Vincent M.

doi:10.2214/ajr.18.20079

Cited by 11 publications

(7 citation statements)

References 15 publications

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“…The Bosniak Classification, version 2019 can be applied to more cystic masses imaged at CT, MRI, and to some extent US, with an expanded number of cystic masses that can be characterized as Bosniak II masses. Therefore, many previously "incompletely characterized" renal masses can now be classified as benign Bosniak II masses (1,(22)(23)(24)(25)(26)(27)(28). However, renal mass protocol CT and MRI remain a requirement for diagnosis of Bosniak III and IV masses.…”

Section: Imaging Techniques For Evaluation Of Cystic Renal Masses General Imaging Techniquementioning

confidence: 99%

Bosniak Classification of Cystic Renal Masses, Version 2019: A Pictorial Guide to Clinical Use

Schieda¹,

Davenport²,

Krishna³

et al. 2021

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Cystic renal masses are commonly encountered in clinical practice. In 2019, the Bosniak classification of cystic renal masses, originally developed for CT, underwent a major revision to incorporate MRI and is referred to as the Bosniak Classification, version 2019. The proposed changes attempt to (a) define renal masses (ie, cystic tumors with less than 25% enhancing tissue) to which the classification should be applied; (b) emphasize specificity for diagnosis of cystic renal cancers, thereby decreasing the number of benign and indolent cystic masses that are unnecessarily treated or imaged further; (c) improve interobserver agreement by defining imaging features, terms, and classes of cystic renal masses; (d) reduce variation in reported malignancy rates for each of the Bosniak classes; (e) incorporate MRI and to some extent US; and (f) be applicable to all cystic renal masses encountered in clinical practice, including those that had been considered indeterminate with the original classification. The authors instruct how, using CT, MRI, and to some extent US, the revised classification can be applied, with representative clinical examples and images. Practical tips, pitfalls to avoid, and decision tree rules are included to help radiologists and other physicians apply the Bosniak Classification, version 2019 and better manage cystic renal masses. An online resource and mobile application are also available for clinical assistance.

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Section: Imaging Techniques For Evaluation Of Cystic Renal Masses General Imaging Techniquementioning

confidence: 99%

Bosniak Classification of Cystic Renal Masses, Version 2019: A Pictorial Guide to Clinical Use

Schieda¹,

Davenport²,

Krishna³

et al. 2021

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“…At noncontrast CT, well-defined homogeneous masses from 29 to 20 HU (76-79) and well-defined homogeneous masses of 70 HU or greater (76,78,80) are highly likely to be benign cysts. At noncontrast MRI, well-defined homogeneous masses that are markedly hyperintense at T1-weighted noncontrast imaging (approximately 2.5 times the normal parenchymal signal intensity) also are likely to be benign cysts (81,82), and well-defined homogeneous masses that are similar in signal intensity to cerebrospinal fluid at T2-weighted imaging also are likely to be benign cysts (83). At portal venous phase CT, welldefined homogeneous masses of 40 HU or less also are likely to be benign cysts (84,85), but the optimal attenuation threshold is unclear; a threshold of 30 HU or lower appears to be safe (86).…”

Section: Recent Developments To Improve Characterization Of Cystic Renal Massesmentioning

confidence: 99%

“…HU at noncontrast CT (77-80); (b) homogeneous masses from 21 to 30 HU at portal venous phase CT (86); (c) homogeneous low-attenuation masses that are too small to characterize (11,75); (d) masses that are homogeneously markedly hyperintense (similar to cerebrospinal fluid) at T2-weighted MRI examinations performed without contrast material (83); and (e) masses that are homogeneously markedly hyperintense (approximately 2.5 times normal renal parenchymal signal intensity) at noncontrast T1-weighted MRI (81,82).…”

Section: Bosniak Iifmentioning

confidence: 99%

Bosniak Classification of Cystic Renal Masses, Version 2019: An Update Proposal and Needs Assessment

et al. 2019

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It has been more than 30 years since the Bosniak classification of cystic renal masses was first proposed (1). This CT-based classification was introduced in 1986 and originally divided cystic renal masses into one of four classes after exclusion of infectious, inflammatory, and vascular etiologies (Table 1) (1). Since then, refinements have reduced the number of benign masses in Bosniak class III (2-9). For example, Bosniak IIF (where the F is for follow-up) was added for cystic masses with many thin (or minimally thickened) septa with "perceived" enhancement, large (.3 cm) homogeneous nonenhancing hyperattenuating masses, and masses with thick or non-border-forming calcification.Bosniak summarized these changes in 2012 and contended that Bosniak I and II masses were "clearly benign," Bosniak IV masses were "clearly malignant," Bosniak IIF masses were "probably benign," and Bosniak III masses were "indeterminate" (approximately half were malignant and half were not) (9). These adaptations enabled radiologists and urologists to render specific management recommendations: Bosniak I and II masses have been ignored, Bosniak IIF masses have been followed, and Bosniak III and IV masses historically have been treated unless substantial comorbidities or limited life expectancy would warrant observation instead (10-12).

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“…36 With type II cystic lesions, the fat-saturated T1-weighted image shows homogenous high signal of content of the renal lesions. 46 The sequence plays an important role in determining the components of the cystic masses. 47 The different sequences of MRI can help characterize CRMs that cannot be determined by CT.…”

Section: Magnetic Resonance Imagingmentioning

confidence: 99%

“…The typical simple cysts, category I, show similar signals of fluid content as cerebrospinal fluid (CSF) on MRI sequences, which is regarded as a clear and homogenous low signal on the T1‐weighted sequence and high signal on the T2‐weighted sequence 36 . With type II cystic lesions, the fat‐saturated T1‐weighted image shows homogenous high signal of content of the renal lesions 46 . The sequence plays an important role in determining the components of the cystic masses 47 .…”

Section: Magnetic Resonance Imagingmentioning

confidence: 99%

Ultrasound, CT, and MR Imaging for Evaluation of Cystic Renal Masses

Zeng

et al. 2021

J of Ultrasound Medicine

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Cystic renal masses are often encountered during abdominal imaging. Although most of them are benign simple cysts, some cystic masses have malignant characteristics. The Bosniak classification system provides a useful way to classify cystic masses. The Bosniak classification is based on the results of a well‐established computed tomography protocol. Over the past 30 years, the classification system has been refined and improved. This paper reviews the literature on this topic and compares the advantages and disadvantages of different screening and classification methods. Patients will benefit from multimodal diagnosis for lesions that are difficult to classify after a single examination.

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Incidental Renal Lesions on Lumbar Spine MRI: Who Needs Follow-Up?

Cited by 11 publications

References 15 publications

Bosniak Classification of Cystic Renal Masses, Version 2019: A Pictorial Guide to Clinical Use

Bosniak Classification of Cystic Renal Masses, Version 2019: A Pictorial Guide to Clinical Use

Bosniak Classification of Cystic Renal Masses, Version 2019: An Update Proposal and Needs Assessment

Ultrasound, CT, and MR Imaging for Evaluation of Cystic Renal Masses

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