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

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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.

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Abbreviations

BC:

Bosniak classification

BCv2019:

Bosniak classification version 2019

CRMs:

Cystic renal masses

CI:

Confidence interval

CT:

Computed tomography

ICC:

Intraclass correlation coefficient

IRA:

Inter-reader agreement

MRI:

Magnetic resonance imaging

RCC:

Renal cell carcinoma

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Acknowledgements

The authors of this research would like to express their gratitude to the Ministry of Education and the Deanship of Scientific Research, Najran University. They also thank the Kingdom of Saudi Arabia for its financial and technical support under code number NU/NRP/MRC/11/21.

Funding

This study has received funding from the Deanship of Scientific Research, Najran University, Kingdom of Saudi Arabia, grant number NU/NRP/MRC/11/21.

Author information

Authors and Affiliations

  1. Division of Radiology, Department of Internal Medicine, Medical College, Najran University, Najran, Kingdom of Saudi Arabia

    Yassir Edrees Almalki

  2. Department of Diagnostic Radiology, Faculty of Human Medicine, Zagazig University, Zagazig, Egypt

    Mohammad Abd Alkhalik Basha, Ahmed A. El-Hamid M. Abdalla, Hala Y. Yousef, Mohamed M. A. Zaitoun, Saeed Bakry Elsayed, Nader E. M. Mahmoud, Nader Ali Alayouty, Ahmad Abdullah Alnaggar, Sameh Saber, Ahmed Mohamed El-Maghraby, Amgad M. Elsheikh, Mohamed Hesham Saleh Saleh Radwan, Ahmed Gamil Ibrahim Abdelmegid & Maha Ibrahim Metwally

  3. Department of Diagnostic Radiology, Intervention and Molecular Imaging, Faculty of Human Medicine, Ain Shams University, Cairo, Egypt

    Rania Refaat & Susan Adil Ali

  4. Department of Radiology, College of Medicine, Qassim University, Buraidah, Kingdom of Saudi Arabia

    Sharifa Khalid Alduraibi

  5. Department of Diagnostic Radiology, Faculty of Human Medicine, Benha University, Benha, Egypt

    Sameh Abdelaziz Aly & Ahmed Shalan

  6. Department of Diagnostic Radiology, Faculty of Human Medicine, Port Said University, Port Said, Egypt

    Waleed S. Abo Shanab

  7. Department of Clinical Oncology, Faculty of Human Medicine, Zagazig University, Zagazig, Egypt

    Ahmed Ali Obaya & Shaimaa Farouk Abdelhai

  8. Department of Medical Oncology, Faculty of Human Medicine, Zagazig University, Zagazig, Egypt

    Shereen Elshorbagy

  9. Department of Urology, Faculty of Human Medicine, Al Azhar University, Cairo, Egypt

    Yasser M. Haggag

  10. Department of Diagnostic Radiology, Faculty of Human Medicine, Tanta University, Tanta, Egypt

    Hwaida M. Mokhtar

  11. Department of Clinical Oncology, Faculty of Human Medicine, Tanta University, Tanta, Egypt

    Nesreen M. Sabry

  12. Department of Diagnostic Radiology, National Institute of Urology and Nephrology, Cairo, Egypt

    Jehan Ibrahim Altohamy

  13. Department of Diagnostic Radiology, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt

    Rasha Taha Abouelkheir

  14. Department of Diagnostic Radiology, Faculty of Human Medicine, Helwan University, Cairo, Egypt

    Tawfik Omran

  15. Department of Internal Medicine, Katai Gabor Hospital, Karcag, Hungary

    Youssef H. Algazzar

Authors
  1. Yassir Edrees Almalki
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  2. Mohammad Abd Alkhalik Basha
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  3. Rania Refaat
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  28. Tawfik Omran
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  29. Ahmed Shalan
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  30. Youssef H. Algazzar
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  31. Maha Ibrahim Metwally
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Corresponding author

Correspondence to Mohammad Abd Alkhalik Basha.

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The scientific guarantor of this publication is Mohammad Abd Alkhalik Basha.

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The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.

Statistics and biometry

One of the authors has significant statistical expertise.

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Written informed consent was obtained from all subjects (patients) in this study.

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Institutional Review Board approval was obtained.

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  • prospective

  • diagnostic or prognostic study

  • multi-center study

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Almalki, Y.E., Basha, M.A.A., Refaat, R. et al. Bosniak classification version 2019: a prospective comparison of CT and MRI. Eur Radiol 33, 1286–1296 (2023). https://doi.org/10.1007/s00330-022-09044-3

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