Department of Urology, Medical Faculty, Charles University, Charles University Hospital Plzen, E. Beneše 13, 305 99, Plzeň, Czech Republic.
Department of Pathology, Medical Faculty, Charles University, Charles University Hospital Plzen, Plzeň, Czech Republic.
World J Urol. 2018 Jun;36(6):905-911. doi: 10.1007/s00345-018-2176-z. Epub 2018 Jan 30.
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.
To determine the value of additional magnetic resonance imaging in CT-defined Bosniak IIF-III renal cystic lesions.
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.
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.
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.
CT 成像检查是肾囊性病变的标准检查方法，可确定 Bosniak 分类，进而决定进一步的治疗方案。由于 Bosniak II/IIF/III 类肾囊性病变可能存在肾细胞癌（RCC），因此在管理决策中可能需要额外的诊断方法。
确定 CT 定义的 Bosniak IIF-III 类肾囊性病变中附加磁共振成像的价值。
这是一项多中心回顾性研究，纳入了 2009 年至 2016 年间诊断为囊性肾病变的 46 例连续患者。纳入标准为：（1）CT 诊断为囊性肾Bosniak IIF-III 类病变，（2）随后进行 MRI 检查，（3）通过手术切除囊性肾肿块或随访获得明确的结果。
共纳入 46 例患者（35 例男性，11 例女性）。囊性病变的平均大小为 3.92cm（0.7-10cm）。根据 CT 结果，12 例（26.1%）和 34 例（73.9%）为 Bosniak IIF 和 III 类。31 例（67.4%）在 MRI 检查后重新分类 Bosniak 类别。27 例（58.7%）升级为更高类别，4 例（8.7%）降级为更低类别。因此，31 例中有 12 例（38.7%）患者的治疗管理发生显著改变，其中 8 例患者随后进行了手术。
与 CT 相比，MRI 研究可能减少 Bosniak IIF 类别的应用，这对相当一部分患者的治疗管理（手术与观察）有直接影响。
