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European Radiology
Published in: European Radiology 2/2023

13-08-2022 | Magnetic Resonance Imaging | Urogenital

Bosniak classification version 2019: a prospective comparison of CT and MRI

Authors: Yassir Edrees Almalki, Mohammad Abd Alkhalik Basha, Rania Refaat, Sharifa Khalid Alduraibi, Ahmed A. El-Hamid M. Abdalla, Hala Y. Yousef, Mohamed M. A. Zaitoun, Saeed Bakry Elsayed, Nader E. M. Mahmoud, Nader Ali Alayouty, Susan Adil Ali, Ahmad Abdullah Alnaggar, Sameh Saber, Ahmed Mohamed El-Maghraby, Amgad M. Elsheikh, Mohamed Hesham Saleh Saleh Radwan, Ahmed Gamil Ibrahim Abdelmegid, Sameh Abdelaziz Aly, Waleed S. Abo Shanab, Ahmed Ali Obaya, Shaimaa Farouk Abdelhai, Shereen Elshorbagy, Yasser M. Haggag, Hwaida M. Mokhtar, Nesreen M. Sabry, Jehan Ibrahim Altohamy, Rasha Taha Abouelkheir, Tawfik Omran, Ahmed Shalan, Youssef H. Algazzar, Maha Ibrahim Metwally

Published in: European Radiology | Issue 2/2023

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Abstract

Objective

To assess the diagnostic accuracy and agreement of CT and MRI in terms of the Bosniak classification version 2019 (BCv2019).

Materials and methods

A prospective multi-institutional study enrolled 63 patients with 67 complicated cystic renal masses (CRMs) discovered during ultrasound examination. All patients underwent CT and MRI scans and histopathology. Three radiologists independently assessed CRMs using BCv2019 and assigned Bosniak class to each CRM using CT and MRI. The final analysis included 60 histopathologically confirmed CRMs (41 were malignant and 19 were benign).

Results

Discordance between CT and MRI findings was noticed in 50% (30/60) CRMs when data were analyzed in terms of the Bosniak classes. Of these, 16 (53.3%) were malignant. Based on consensus reviewing, there was no difference in the sensitivity, specificity, and accuracy of the BCv2019 with MRI and BCv2019 with CT (87.8%; 95% CI = 73.8–95.9% versus 75.6%; 95% CI = 59.7–87.6%; p = 0.09, 84.2%; 95% CI = 60.4–96.6% versus 78.9%; 95% CI = 54.4–93.9%; p = 0.5, and 86.7%; 95% CI = 64.0–86.6% versus 76.7%; 95% CI = 75.4–94.1%; p = 0.1, respectively). The number and thickness of septa and the presence of enhanced nodules accounted for the majority of variations in Bosniak classes between CT and MRI. The inter-reader agreement (IRA) was substantial for determining the Bosniak class in CT and MRI (k = 0.66; 95% CI = 0.54–0.76, k = 0.62; 95% CI = 0.50–0.73, respectively). The inter-modality agreement of the BCv219 between CT and MRI was moderate (κ = 0.58).

Conclusion

In terms of BCv2019, CT and MRI are comparable in the classification of CRMs with no significant difference in diagnostic accuracy and reliability.

Key Points

• There is no significant difference in the sensitivity, specificity, and accuracy of the BCv2019 with MRI and BCv2019 with CT.
• The number of septa and their thickness and the presence of enhanced nodules accounted for the majority of variations in Bosniak classes between CT and MRI.
• The inter-reader agreement was substantial for determining the Bosniak class in CT and MRI and the inter-modality agreement of the BCv219 between CT and MRI was moderate.
Appendix
Available only for authorised users
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Metadata
Title
Bosniak classification version 2019: a prospective comparison of CT and MRI
Authors
Yassir Edrees Almalki
Mohammad Abd Alkhalik Basha
Rania Refaat
Sharifa Khalid Alduraibi
Ahmed A. El-Hamid M. Abdalla
Hala Y. Yousef
Mohamed M. A. Zaitoun
Saeed Bakry Elsayed
Nader E. M. Mahmoud
Nader Ali Alayouty
Susan Adil Ali
Ahmad Abdullah Alnaggar
Sameh Saber
Ahmed Mohamed El-Maghraby
Amgad M. Elsheikh
Mohamed Hesham Saleh Saleh Radwan
Ahmed Gamil Ibrahim Abdelmegid
Sameh Abdelaziz Aly
Waleed S. Abo Shanab
Ahmed Ali Obaya
Shaimaa Farouk Abdelhai
Shereen Elshorbagy
Yasser M. Haggag
Hwaida M. Mokhtar
Nesreen M. Sabry
Jehan Ibrahim Altohamy
Rasha Taha Abouelkheir
Tawfik Omran
Ahmed Shalan
Youssef H. Algazzar
Maha Ibrahim Metwally
Publication date
13-08-2022
Publisher
Springer Berlin Heidelberg
Published in
European Radiology / Issue 2/2023
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI
https://doi.org/10.1007/s00330-022-09044-3

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