Abstract
Now it is more than 30 years since we are using the Bosniak classification for cystic renal masses, which represents the scale for cancer probability using imaging features. First, we used ultrasound, then CT then MRI for characterization. Many studies were conducted try to characterize the lesions using the ADC values trying to reach solid values for characterization and subgrouping which we can use especially for indeterminate lesions and for benign lesions which are radiologically characterized as Bosniak III and IV and underwent unnecessary nephrectomies. Objectives: Retrospective evaluation the efficiency of DWI and ADC values in characterization of benign, indeterminate, and malignant renal masses using 3T MRI. Results: We found the ADC values of the benign cysts are significantly higher than malignant cysts (3.03 versus 2.35 10 mm/s), Median, P=0.0001 with sensitivity and specificity 84% and 92%, however still no definite cut off values for indeterminate lesions. Conclusion: MRI ADC values can be used for differentiation of benign and malignant lesions with high sensitivity and specificity however still no definite cut off values for radiologically indeterminate cystic renal masses.
Highlights
Cystic renal masses are commonly encountered in clinical practice
MRI ADC values can be used for differentiation of benign and malignant lesions with high sensitivity and specificity still no definite cut off values for radiologically indeterminate cystic renal masses
Benign cystic renal masses showed high significant values compared to malignant cysts were 3.03 x 10-3 mm2/s (0.75 × 10-3 mm2/s) 103 versus 1.9 (0.59) 103 mm2/s respectively, and higher to the normal renal parenchyma which was 2.09 x 10-3 at b value 1600 s/mm2, and these values are lower than the study done by Goya et al We assumed that our study have more population data than this limited cases study, and the results are similar to Inci etal with mean ADC value of 3.09 ± 0.14 103 mm2/s in benign renal cysts (Bosniak I) and close to study of Zhang et al who reported 3.269 ± 0.61 103 mm2/s for simple renal cysts
Summary
Cystic renal masses are commonly encountered in clinical practice. Improved resolution of imaging modalities has in part led to the improved ability to detect these abnormalities. The Bosniak criteria have stood the test of time as radiologists and urologists still primarily rely on these [1,2]. The conventional CT and MRI sequences cannot differentiate benign from malignant lesions in many cases. Studies have shown that 16%-33% of nephrectomies are performed on benign lesions [3]. There is a strong need for alternatives to gadolinium-enhanced sequences in patients at risk for nephrogenic systemic fibrosis (NSF) [4]
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