Bosniak classification of renal cystic lesions
                    according to multidetector computed tomography findings

Renal cystic lesions are usually diagnosed in the radiologists' practice and therefore their characterization is crucial to determine the clinical approach to be adopted and prognosis. The Bosniak classification based on computed tomography findings has allowed for standardization and categorization of lesions in increasing order of malignancy (I, II, IIF, III and IV) in a simple and accurate way. The present iconographic essay developed with multidetector computed tomography images of selected cases from the archives of the authors' institution, is aimed at describing imaging findings that can help in the diagnosis of renal cysts.

Bosniak classification; Renal cysts; Multidetector computed tomography

Authorship

Christiana Maia Nobre Rocha de Miranda

PhD, MD, Titular Member of Colégio Brasileiro de Radiologia e Diagnóstico por Imagem (CBR), Coordinator for the Units of Computed Tomography and Magnetic Resonance Imaging, and Radiologist at the PET-CT Unit of Clínica de Medicina Nuclear e Radiologia de Maceió (MedRadiUS), Teacher of Radiology and Imaging Diagnosis at Universidade Federal de Alagoas (UFAL), Maceió, AL, BrazilPhD, MD, Titular Member of Colégio Brasileiro de Radiologia e Diagnóstico por Imagem (CBR), Coordinator for the Units of Computed Tomography and Magnetic Resonance Imaging, and Radiologist at the PET-CT Unit of Clínica de Medicina Nuclear e Radiologia de Maceió (MedRadiUS), Teacher of Radiology and Imaging Diagnosis at Universidade Federal de Alagoas (UFAL), Maceió, AL, BrazilBrazilMaceió, AL, BrazilPhD, MD, Titular Member of Colégio Brasileiro de Radiologia e Diagnóstico por Imagem (CBR), Coordinator for the Units of Computed Tomography and Magnetic Resonance Imaging, and Radiologist at the PET-CT Unit of Clínica de Medicina Nuclear e Radiologia de Maceió (MedRadiUS), Teacher of Radiology and Imaging Diagnosis at Universidade Federal de Alagoas (UFAL), Maceió, AL, Brazil

Carol Pontes de Miranda Maranhão

Titular Member of Colégio Brasileiro de Radiologia e Diagnóstico por Imagem (CBR), MD, Radiologist at the Units of Computed Tomography and Magnetic Resonance Imaging of Clínica de Medicina Nuclear e Radiologia de Maceió (MedRadiUS), Maceió, AL, BrazilTitular Member of Colégio Brasileiro de Radiologia e Diagnóstico por Imagem (CBR), MD, Radiologist at the Units of Computed Tomography and Magnetic Resonance Imaging of Clínica de Medicina Nuclear e Radiologia de Maceió (MedRadiUS), Maceió, AL, BrazilBrazilMaceió, AL, BrazilTitular Member of Colégio Brasileiro de Radiologia e Diagnóstico por Imagem (CBR), MD, Radiologist at the Units of Computed Tomography and Magnetic Resonance Imaging of Clínica de Medicina Nuclear e Radiologia de Maceió (MedRadiUS), Maceió, AL, Brazil

Carla Jotta Justo dos Santos

MD, Radiologist at the Units of Computed Tomography, Magnetic Resonance Imaging and PET-CT of Clínica de Medicina Nuclear e Radiologia de Maceió (Med-RadiUS), Maceió, AL, BrazilMD, Radiologist at the Units of Computed Tomography, Magnetic Resonance Imaging and PET-CT of Clínica de Medicina Nuclear e Radiologia de Maceió (Med-RadiUS), Maceió, AL, BrazilBrazilMaceió, AL, BrazilMD, Radiologist at the Units of Computed Tomography, Magnetic Resonance Imaging and PET-CT of Clínica de Medicina Nuclear e Radiologia de Maceió (Med-RadiUS), Maceió, AL, Brazil

Igor Gomes Padilha

Graduate Students (6th year), School of Medicine – Universidade Federal de Alagoas (UFAL), Maceió, AL, BrazilUniversidade Federal de Alagoas (UFAL)BrazilMaceió, AL, BrazilGraduate Students (6th year), School of Medicine – Universidade Federal de Alagoas (UFAL), Maceió, AL, Brazil

Lucas de Pádua Gomes de Farias

Milzi Sarmento da Rocha

Mailing Address: Dra. Christiana Maia Nobre Rocha de Miranda. Rua Hugo Corrêa Paes, 104, Farol. Maceió, AL, Brazil, 57050-730. E-mail: maiachristiana@globo.com

*
Study developed at Clínica de Medicina Nuclear e Radiologia de Maceió (Med-RadiUS), Maceió, AL, Brazil.

SCIMAGO INSTITUTIONS RANKINGS

Figures

Figures (9)

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Figure 1.
Bosniak category I. MDCT image, sagittal reconstruction demonstrating the presence of homogeneous cystic lesions with fluid attenuation, without calcifications, septations or enhancement after intravenous contrast injection. Simple cyst. Note the presence of a major lesion (arrow) located in the superior renal pole.

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Figure 2.
Bosniak category II. MDCT images, axial (A) and coronal (B) reconstructions demonstrating the presence of a cystic lesion with thin septation inside (arrow on A). Minimally complicated cyst.

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Figure 3.
Bosniak category II. MDCT images, coronal (A) and axial (B) reconstructions identifying a round-shaped, hyperattenuating lesion (64 UH density) measuring about 1.0 cm, possibly corresponding to a hemorrhagic cyst or to a cyst with high protein content (arrows). Minimally complicated cyst. Also, note the presence of simple cysts. Bosniak category I.

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Figure 4.
Bosniak category IIF. MDCT, coronal (A), axial (B) and sagittal (C) reconstructions demonstrating the presence of a right renal cystic lesion with parietal thickening (arrow on B) and a thin septum (arrow on C). Minimally complicated cyst requiring follow-up.

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Figure 5.
Bosniak category IIF. MDCT images, sagittal (A), axial (B) and coronal (C) reconstructions demonstrating the presence of a cystic lesion in the right kidney, with nodular, parietal calcifications. Minimally complicated cyst requiring follow-up.

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Figure 6.
Bosniak category III. MDCT images axial (A), coronal (B) and sagittal (C) reconstructions identifying a cystic lesion in the left kidney, with thin septum and septal calcifications (arrows on B). Indeterminate cyst.

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Figure 7.
Bosniak category III. MDCT images, axial (A,B,C,E) and coronal (D,B) demonstrating a hyperattenuating mass in the left kidney, with peripheral Gross calcifications (arrow on E). Indeterminate cyst.

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Figure 8.
Bosniak category IV. MDCT images, sagittal (A,D) and axial (B,C) reconstructions demonstrating a cystic lesion with gross and nodular parietal thickening.

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Figure 9.
Bosniak category IV. MDCT images, sagittal (A,B) and axial (C,D) reconstructions demonstrating lobulated cystic lesions with contrast-enhanced, thickened septa.

Figure 1. Bosniak category I. MDCT image, sagittal reconstruction demonstrating the presence of homogeneous cystic lesions with fluid attenuation, without calcifications, septations or enhancement after intravenous contrast injection. Simple cyst. Note the presence of a major lesion (arrow) located in the superior renal pole.

Figure 2. Bosniak category II. MDCT images, axial (A) and coronal (B) reconstructions demonstrating the presence of a cystic lesion with thin septation inside (arrow on A). Minimally complicated cyst.

Figure 3. Bosniak category II. MDCT images, coronal (A) and axial (B) reconstructions identifying a round-shaped, hyperattenuating lesion (64 UH density) measuring about 1.0 cm, possibly corresponding to a hemorrhagic cyst or to a cyst with high protein content (arrows). Minimally complicated cyst. Also, note the presence of simple cysts. Bosniak category I.

Figure 4. Bosniak category IIF. MDCT, coronal (A), axial (B) and sagittal (C) reconstructions demonstrating the presence of a right renal cystic lesion with parietal thickening (arrow on B) and a thin septum (arrow on C). Minimally complicated cyst requiring follow-up.

Figure 5. Bosniak category IIF. MDCT images, sagittal (A), axial (B) and coronal (C) reconstructions demonstrating the presence of a cystic lesion in the right kidney, with nodular, parietal calcifications. Minimally complicated cyst requiring follow-up.

Figure 6. Bosniak category III. MDCT images axial (A), coronal (B) and sagittal (C) reconstructions identifying a cystic lesion in the left kidney, with thin septum and septal calcifications (arrows on B). Indeterminate cyst.

Figure 7. Bosniak category III. MDCT images, axial (A,B,C,E) and coronal (D,B) demonstrating a hyperattenuating mass in the left kidney, with peripheral Gross calcifications (arrow on E). Indeterminate cyst.

Figure 8. Bosniak category IV. MDCT images, sagittal (A,D) and axial (B,C) reconstructions demonstrating a cystic lesion with gross and nodular parietal thickening.

Figure 9. Bosniak category IV. MDCT images, sagittal (A,B) and axial (C,D) reconstructions demonstrating lobulated cystic lesions with contrast-enhanced, thickened septa.

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