Share：
Share this content in WeChat
X
[Chinese] [PDF] 625 1
• Clinical Article •
The value of susceptibility weighted imaging to differentiate the benign from malignant Bosniak ⅡF-Ⅲ renal cystic lesions
QIU Yuting  JIN Zixuan  WANG Tianchun  WANG Haitao  XU Qiang  SUN Jun  PAN Liang  DING Jiule  CHEN Jie  XING Wei 

Cite this article as: QIU Y T, JIN Z X, WANG T C, et al. The value of susceptibility weighted imaging to differentiate the benign from malignant Bosniak ⅡF-Ⅲ renal cystic lesions[J]. Chin J Magn Reson Imaging, 2025, 16(9): 112-117. DOI:10.12015/issn.1674-8034.2025.09.017.


[Abstract] Objective To evaluate the diagnostic performance of susceptibility-weighted imaging (SWI) in differentiating benign from malignant Bosniak ⅡF-Ⅲ renal cystic lesions.Materials and Methods This retrospective analysis included 38 Bosniak ⅡF-Ⅲ lesions including 17 benign, and 21 malignant cases with pathological confirmation. Two radiologists independently evaluated conventional magnetic resonance imaging (MRI) sequences (T1WI/T2WI) and SWI features through hemorrhagic foci, microvascular density, and ITSS area ratio. Statistical analysis incorporated Cohen's Kappa, Mann-Whitney U test, and binary logistic regression to develop a composite predictive model. Receiver operating characteristic (ROC) curve analysis was performed to compare the diagnostic performance of individual ITSS parameters and the combined predictor.Results Conventional MRI (T1WI/T2WI) signal characteristics showed no significant intergroup differences (P > 0.05). Substantial interobserver agreement was observed for dominant ITSS structures and ITSS area ratios (Kappa value of 0.72 and 0.74), with excellent agreement for the number of intratumoral hemorrhagic lesions and the number of intratumoral vessels (Kappa value of 0.90 and 0.84). Malignant lesions demonstrated significantly higher the number of intratumoral hemorrhagic lesions (P = 0.02), the number of intratumoral vessels (P < 0.01), and ITSS area ratio (P < 0.01). Compared to individual parameters, the composite predictive model achieved superior diagnostic performance [AUC = 0.943, 95% (confidence interval, CI): 0.877 to 1.000] in the number of intratumoral hemorrhagic lesions (AUC = 0.695, 95% CI: 0.520 to 0.869), the number of intratumoral vessels (AUC = 0.868, 95% CI: 0.757 to 0.980), and ITSS area ratio (AUC = 0.877, 95% CI: 0.771 to 0.983).Conclusions Comprehensive analysis of susceptibility signals on SWI provides valuable information for differentiating benign and malignant Bosniak ⅡF-Ⅲ renal cystic lesions, offering reliable imaging evidence for clinical decision-making.
[Keywords] renal cell carcinoma；complex renal cysts；magnetic resonance imaging；susceptibility-weighted imaging；Bosniak classification

QIU Yuting1, 2   JIN Zixuan1, 2   WANG Tianchun1, 2   WANG Haitao1, 2   XU Qiang3   SUN Jun1, 2   PAN Liang1, 2   DING Jiule1, 2   CHEN Jie1, 2   XING Wei1, 2*  

1 Department of Radiology, The Third Affiliated Hospital of Soochow University, Changzhou 213003, China

2 Changzhou Medical Center, Nanjing Medical University, Changzhou 213100, China

3 Department of Urology, Affiliated Hospital of Jiangsu University, Zhenjiang 212001, China

Corresponding author: XING W, E-mail: suzhxingwei@suda.edu.cn

Conflicts of interest   None.

Received  2025-03-03
Accepted  2025-08-25
DOI: 10.12015/issn.1674-8034.2025.09.017
Cite this article as: QIU Y T, JIN Z X, WANG T C, et al. The value of susceptibility weighted imaging to differentiate the benign from malignant Bosniak ⅡF-Ⅲ renal cystic lesions[J]. Chin J Magn Reson Imaging, 2025, 16(9): 112-117. DOI:10.12015/issn.1674-8034.2025.09.017.

[1]
MENSEL B, KÜHN J P, KRACHT F, et al. Prevalence of renal cysts and association with risk factors in a general population: an MRI-based study[J]. Abdom Radiol (NY), 2018, 43(11): 3068-3074. DOI: 10.1007/s00261-018-1565-5.
[2]
KANG H H, BAI X, WANG H Y. Interpretation for the Bosniak classification of cystic renal mass, version 2019[J]. Chin J Radiol, 2020, 54(8): 729-736. DOI: 10.3760/cma.j.cn112149-20200225-00252.
[3]
SILVERMAN S G, PEDROSA I, ELLIS J H, et al. Bosniak classification of cystic renal masses, version 2019: an update proposal and needs assessment[J]. Radiology, 2019, 292(2): 475-488. DOI: 10.1148/radiol.2019182646.
[4]
ZHENG S, YE X J, ZUO J, et al. Interpretation and reunderstanding of the updated pathological classification of renal tumors of World Health Organization in 2022[J]. Cancer Res Clin, 2023, 35(6): 401-407. DOI: 10.3760/cma.j.cn115355-20230504-00223.
[5]
SHEN L Y, YOON L, MULLANE P C, et al. World health organization 2022 classification update: radiologic and pathologic features of papillary renal cell carcinomas[J]. Acad Radiol, 2024, 31(8): 3257-3265. DOI: 10.1016/j.acra.2024.01.034.
[6]
CHEN H T, MA H, WANG Z J, et al. Laparoscopic partial nephrectomy for children with multilocular cystic renal neoplasm: a case report and literaturereview[J]. Chin J Urol, 2024, 45(3): 208-211. DOI: 10.3760/cma.j.cn112330-20230419-00132.
[7]
KANG H H, XIE W F, WANG H, et al. Multiparametric MRI-based machine learning models for the characterization of cystic renal masses compared to the Bosniak classification, version 2019: a multicenter study[J]. Acad Radiol, 2024, 31(8): 3223-3234. DOI: 10.1016/j.acra.2024.01.003.
[8]
PENG Y , LIN G W, LI S H, et al. Renal cystic lesions: CT and MRI diagnosis and differential diagnosis[J]. Journal of Practical Radiology, 2018, 34: 1401-1406, 1422. DOI: 10.3969/j.issn.1002-1671.2018.09.023.
[9]
ZHAO X, YAN Y, XIE W F, et al. Radiomics for differential diagnosis of Bosniak II-IV renal masses via CT imaging[J/OL]. BMC Cancer, 2024, 24(1): 1508 [2025-02-20]. https://pubmed.ncbi.nlm.nih.gov/39643905/. DOI: 10.1186/s12885-024-13283-6.
[10]
ZHANG Y C, YU S N, CHEN J, et al. Susceptibility weighted imaging in differentiating papillary from chromophobe renal cell carcinoma[J]. Chin J Magn Reson Imag, 2016, 7(12): 921-925. DOI: 10.12015/issn.1674-8034.2016.12.006.
[11]
WANG F, CAO D R. Opportunities and challenges of non-contrast-enhanced magnetic resonance imaging: Achievements and prospects over the past decade in China[J]. Chin J Magn Reson Imag, 2022, 13(10): 46-52, 60. DOI: 10.12015/issn.1674-8034.2022.10.006.
[12]
SUN J, PAN L, ZHA T T, et al. The role of MRI texture analysis based on susceptibility-weighted imaging in predicting Fuhrman grade of clear cell renal cell carcinoma[J]. Acta Radiol, 2021, 62(8): 1104-1111. DOI: 10.1177/0284185120951964.
[13]
CHEN J, SUN J, XING W, et al. Prediction of nuclear grade of clear cell renal cell carcinoma with MRI: intratumoral susceptibility signal intensity versus necrosis[J]. Acta Radiol, 2014, 55(3): 378-384. DOI: 10.1177/0284185113498076.
[14]
GENG Z J, WANG S T, MA L D, et al. Prediction of microvascular invasion in hepatocellular carcinoma patients with MRI radiomics based on susceptibility weighted imaging and T2-weighted imaging[J]. Radiol Med, 2024, 129(8): 1130-1142. DOI: 10.1007/s11547-024-01845-4.
[15]
EELEN G, TREPS L, LI X R, et al. Basic and therapeutic aspects of angiogenesis updated[J]. Circ Res, 2020, 127(2): 310-329. DOI: 10.1161/CIRCRESAHA.120.316851.
[16]
TIAN S F, LIU A L, LI Y, et al. The value of MR magnetic sensitive technology to identify the cystic renal cell carcinoma and complex renal cysts[J]. Chin J Magn Reson Imag, 2015, 6(10): 762-767. DOI: 10.3969/j.issn.1674-8034.2015.10.009.
[17]
BAI X, SUN S M, XU W, et al. MRI-based Bosniak classification of cystic renal masses, version 2019: interobserver agreement, impact of readers' experience, and diagnostic performance[J]. Radiology, 2020, 297(3): 597-605. DOI: 10.1148/radiol.2020200478.
[18]
BAI X, SUN S M, KANG H H, et al. Test-retest reliability analysis of MRI criteria in the 2019 Bosniak classification of cystic renal masses[J]. Chin J Radiol, 2022, 56(10): 1121-1128. DOI: 10.3760/cma.j.cn112149-20211013-00918.
[19]
BRANDI N, MOSCONI C, GIAMPALMA E, et al. Bosniak classification of cystic renal masses: looking back, looking forward[J]. Acad Radiol, 2024, 31(8): 3237-3247. DOI: 10.1016/j.acra.2023.12.019.
[20]
YU X, ZHANG L, LIU J Y, et al. Imaging evaluation of cystic renal masses:application of Bosniak classification system version 2019[J]. Journal of Practical Radiology2024, 40: 2010-2013. DOI: 10.3969/j.issn.1002-1671.2024.12.017.
[21]
SHANG X J, ZHONG Z P, LIN J K, et al. Value of machine learning algorithm model based on CT plain scan radiomics in diagnosis for cystic renal mass of high-grade Bosniak classification[J]. Chin Imag J Integr Tradit West Med, 2024, 22(6): 719-724. DOI: 10.3969/j.issn.1672-0512.2024.06.019.
[22]
MASINO F, EUSEBI L, BERTOLOTTO M, et al. Contrast-enhanced ultrasound in renal cystic lesions: an update[J]. J Med Ultrason (2001), 2024, 51(4): 635-647. DOI: 10.1007/s10396-024-01489-x.
[23]
ARITA Y, YOSHIDA S, KWEE T C, et al. Clinical utility of the Bosniak classification version 2019: Diagnostic value of adding magnetic resonance imaging to computed tomography examination[J/OL]. Eur J Radiol, 2022, 148: 110163 [2025-02-20]. https://www.sciencedirect.com/science/article/abs/pii/S0720048X22000134. DOI: 10.1016/j.ejrad.2022.110163
[24]
MÖLLER K, JENSSEN C, CORREAS J M, et al. CEUS Bosniak classification-time for differentiation and change in renal cyst surveillance[J/OL]. Cancers (Basel), 2023, 15(19): 4709 [2025-02-20]. https://www.mdpi.com/2072-6694/15/19/4709. DOI: 10.3390/cancers15194709.
[25]
LI A Q, LI S C, HU Y, et al. Bosniak classification of cystic renal masses, version 2019: Is it helpful to incorporate the diffusion weighted imaging characteristic of lesions into the guideline?[J/OL]. Front Oncol, 2022, 12: 1004690 [2025-2-20]. https://www.frontiersin.org/journals/oncology/articles/10.3389/fonc.2022.1004690/full. DOI: 10.3389/fonc.2022.1004690.
[26]
SHEN L Y, TSE J R, LEMIEUX S, et al. Risk of malignancy in T1-hyperintense Bosniak version 2019 class II and IIF cystic renal masses[J]. Abdom Radiol (NY), 2023, 48(8): 2636-2648. DOI: 10.1007/s00261-023-03955-5.
[27]
TANJI M, MINEHARU Y, SAKATA A, et al. High intratumoral susceptibility signal grade on susceptibility-weighted imaging: a risk factor for hemorrhage after stereotactic biopsy[J]. J Neurosurg, 2022, 138(1): 120-127. DOI: 10.3171/2022.4.JNS212505.
[28]
SCHOOTS I G, ZACCAI K, HUNINK M G, et al. Bosniak classification for complex renal cysts reevaluated: A systematic review[J]. J Urol, 2017, 198(1): 12-21. DOI: 10.1016/j.juro.2016.09.160.
[29]
LUOMALA L, RAUTIOLA J, JÄRVINEN P, et al. Active surveillance versus initial surgery in the long-term management of Bosniak IIF-IV cystic renal masses[J/OL]. Sci Rep, 2022, 12(1): 10184 [2025-02-20]. https://www.nature.com/articles/s41598-022-14056-6. DOI: 10.1038/s41598-022-14056-6.

PREV Efficacy study of diffusion spectrum imaging-based habitat imaging in differentiating heterogeneity between clear cell renal cell carcinoma and fat-poor angiomyolipoma
NEXT The value of intravoxel incoherent motion diffusion weighted imaging in the evaluation of bladder cancer grade and myometrial invasion
  


LINK


Tel & Fax: +8610-67113815    E-mail: editor@cjmri.cn