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Congress: ECR25
Poster Number: C-14251
Type: Poster: EPOS Radiologist (educational)
DOI: 10.26044/ecr2025/C-14251
Authorblock: M. Maria, D. D. Susha; Bangalore/IN
Disclosures:
Minnu Maria: Nothing to disclose
Deepa Dayanandan Susha: Nothing to disclose
Keywords: Abdomen, Kidney, Oncology, CT, MR, Contrast agent-intravenous, Calcifications / Calculi, Cysts, Haemorrhage
Learning objectives This essay reviews the 2019 update of the Bosniak Classification for renal masses, highlighting key changes and providing imaging examples. It aims to enhance recognition of cystic renal masses and improve understanding and management through detailed radiological characteristics.
Read more Background The Bosniak Classification, introduced by Prof. Morton A. Bosniak in 1986, was updated in 2019 to improve the stratification of cystic renal masses based on imaging characteristics. This system assesses features like cystic or solid components, wall thickness, septation, and enhancement.While benign cysts are common, accurate classification is essential for predicting malignancy risk and guiding appropriate management, thereby preventing unnecessary interventions. The revised classification also incorporates MRI criteria for a comprehensive evaluation of indeterminate cystic masses, clarifying key imaging characteristics...
Read more Findings and procedure details Updated Terminology for Defining Walls and Septa in Cystic Renal MassesDetermination of number of septa : Few : 1-3 septa Many : 4 or more septa [fig 1] BOSNIAK II : Thin(2mm) and few septa BOSNIAK IIF : Many thin septa Determination of septa and wall thickness : Bosniak I: Smooth, thin, enhancing wall ≤ 2mm thickness, without septa. Bosniak II: Smooth, enhancing wall ≤ 2mm thickness, with 1-3 septa (each ≤ 2mm thick). Bosniak IIF: Smooth, minimally thickened wall or septa (3mm). Bosniak III: Any smoothly thickened wall or...
Read more Conclusion The Bosniak Classification effectively stratifies malignancy risk in renal cystic masses, with enhancing tissue volume as a key predictor. The 2019 update improves clarity, inter-rater agreement, and specificity, minimizing unnecessary treatments for benign lesions. This review helps radiologists grasp essential changes, enhancing clinical management of cystic renal masses. 
Read more References Schieda N, Davenport MS, Krishna S, Edney EA, Pedrosa I, Hindman N, et al. Bosniak classification of Cystic Renal Masses, version 2019: A pictorial guide to clinical use. RadioGraphics. 2021Apr16;41(3):814–28. Tse JR, Shen J, Yoon L, Kamaya A. Bosniak classification version 2019 of cystic renal masses assessed with MRI. American Journal of Roentgenology. 2020Aug;215(2):413–9. Silverman SG, Pedrosa I, Ellis JH, Hindman NM, Schieda N, Smith AD, et al. Bosniak classification of Cystic Renal Masses, version 2019: An update proposal and needs assessment....
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