ARRS 2022 Abstracts

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E1811. Three-Step Approach to 2019 Bosniak Cystic Renal Mass Classification
Authors
  1. Dana Galvan; Department of Radiology, UNM Health Sciences Center
  2. Leila Nojaba; Department of Radiology, UNM Health Sciences Center
  3. Steven Eberhardt; Department of Radiology, UNM Health Sciences Center
  4. William Thompson; Department of Radiology, UNM Health Sciences Center
  5. Masoud Shiehmorteza; Department of Radiology, UNM Health Sciences Center
Background
A commonly encountered renal finding during daily radiological interpretations is a cystic renal mass. The 2019 Bosniak classification is currently used for appropriate characterization that helps guide further management of these lesions. Multiple characteristics must be taken into account when deciding a classification, such as wall thickness, number of septa, enhancement, and nodularity. Remembering the specific criteria for further characterization can be challenging. The need for a simplified approach to characterize all cystic renal masses will benefit both in-training and in-practice radiologists. A simplified approach will facilitate recognition of important characteristics for further classification, which will aid in recognition of Bosniak classification and help guide further management. Therefore, the purpose of this exhibit is to introduce a simple three-step approach to characterize all cystic renal masses to aid with consistent classification.

Educational Goals / Teaching Points
The educational goal of this exhibit is to explain the use of a simple three-step approach to characterize all cystic renal masses to aid with consistent classification. The exhibit will demonstrate the “magic 4” simplified rule for distinguishing nodularity, thickness, and septa. Lastly, a number of examples using the unique three-step approach will be used to demonstrate the classification of different Bosniak lesions such as 2F, 3, and 4.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
The simplified three step approach to classification of cystic renal masses will focus on specific imaging findings for further characterization. For each Bosniak classification, specific questions about the imaging findings will need to be answered to allow characterization as a Bosniak 2F, 3, or 4 renal cystic mass. Specific nodule findings will allow characterization as a Bosniak 4 mass, and the appearance of irregular wall/septa and their thickness will aid in the characterization of Bosniak 3 lesions. Imaging findings that need to be recognized for Bosniak 2F masses include number of septa and their thickness. The "magic 4" rule will further guide characterization of Bosniak cystic renal masses by focusing on identifying specific key imaging findings of the masses that involve a thickness of 4 mm and greater than or less than four septa.

Conclusion
Full comprehension and quick recall of the simplified three-step approach to the 2019 Bosniak classification is of significant importance to achieve the appropriate characterization and decide the management of renal cystic masses. The goal of this educational exhibit is to introduce and explain the simplified approach and reinforce its use through the selection of a variety of challenging renal cystic mass cases, which will facilitate the use and understanding of our three-step approach. At the end of the educational exhibit, both in-training and in-practice radiologists will feel confident in their ability to consistently classify cystic renal masses according to the 2019 Bosniak classification.