Classification de Bosniak Mode d`emploi – Limites et CAT O…
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1. Hb susceptibilit magn tique Rehaussement masqu Valeur du T2 h t rog n it de signal Int r t soustraction seq dynamique Confrontation IRM TDM T G T1 fat sak Gd nan Ac map un Subtr Se83 Sp89 DW Se71 Sp91 Subtr DW Se87 Sp92 7 Confiance diag T1 hyperintense renal lesions characterization with diffusion W MRI vs contrast enhanced MRI Kim S et al Radiology 2009 H maturie lombalgies recen Scanner une phase Diag kyste dense Precision LE Precision LU Oo O L sions de type en surveillance active Esp rance de vie r duite Risque n phronique et comorbidit s Surveillance IRM Meilleure confiance diagnostique reclassement en IV susceptible de modifier la pris en charge gt T From ISRAEL GM et al Radiology 2004 Boorjian SA S al he evolving management of small renal masses Curr Oncol Bp 2009 e unkle DA et al Excise ablate or observe the small renal mass dilemma a meta analysis and review J Urol 2008 Classification de Bosniak Mode d emplol O Helenon S Merran et coll Je m assure que la l sion entre dans le champ Je m assure d une technique CT ad quate Je maitrise mes outils d analyse Bosniak Je surveille les IIF apres confirmation IRM J utilise echo et l IRM lorsque tous les crit res ne sont pas reunis lesions indeterminees Echographie ciblee micr2. Dystrophie kystique localisee z Tum encapsulee z des maladies kystiques hereditaires Unilateral focal ou diffus rein de taille normal Groupe de kystes non encapsule gt Surveillance Les kystes infracm inclassables Les tres petites l sions lt 10mm Densit postcontraste ind termin e Population generale adulte Microkyste hautement prob stop Surtout si densit spontan e hydrique Fen tre troite gt hypodense cortex 15UH 5 yen sun Bosniak MA Radiology 19 E w Curry NS AJR 1995 T Ma s Born factor Les kystes Infracm inclassables Les tres petites l sions lt 10mm Population risque de CCR CCR traite ou synchrone CCR familiaux VHL BHD papillaires surveillance active microlesion non chir OU IRM T2w FSE ou SSFSE avec fatsat E m K 3 Kyste dense atypique Diag diff CCR solide papillaire rehauss neg 6 s Echographie cibl e contraste IRM signal caract ristique 2 3 des cas aaa 1 33 72 mear 2014 3417 99 ar T LL 7 one 4200mm mE oy 20 68 Zone 31 96 mmt Js cart type 23 08 an May 27 83 Scart type 17 99 E Zona 30 36 mrt Phenomene beam hardening 0 maximum Forte prob si hydrique avt inj un Diag diff CCR solide papillaire Echographie cibl e contraste Am Zone 76 09 mm MW R N H L A I I Zone 171 39 mm Moy 6
3. 8 00 Ecart type 14 78 lage 17 122 Les masses kystiques inclassables Type lt Ill gt avec rehaussement n gatif Scanner Type Ill rehaussement ou douteux Conduite tenir Echo de contraste cibl e IRM S q dyn Gd fatsat Si Gd reclassement en III chir Les masses kystiques inclassables Type lt Ill gt avec rehaussement n gatif s Scanner Type Ill rehaussement ou douteux Conduite tenir Echo de contraste cibl e IRM S q dyn Gd fatsat Si Gd reclassement en III chir er NETTE Les masses kystiques mal classees Lesions IIF sousclassees Category Septa Wall No of Septa CAT devant un IIF CT Imaging CT Imaging CT Imaging Outcome IRM USC en valuation Hairline Minima 3 year stabil Reclassement Med Ds en Ill ou IV chirurgicaux line Hairine Malignant JE zZ d om k A 7 er gt P From ISRAEL GM HINDMAN N BOSNIAK MA Evaluation of cystic renal masses comparison of CT and MR imaging by using the Bosniak classification system Radiology 2004 nh NS x RAN CTT EAN AG RONA w 9 EAL d Wenn b WAN u WAWAN w vel i vL Ka L W L F K LA wt r in ait i K d DT a Et FR E Y sr We K ft Ce tu Les masses kystiques mal classees L sions sousclass es en IRM s Limites de l IRM Tum Kyst h morragiques hypersignaux T1 D gradation de l
4. Classification de Bosniak Mode d emploi Limites et CAT O H l non S Merran et coll s Situation fr quemment rencontr e Kystes 50 apres 50 ans CCR kystiques 10 D couverte fortuite sur scanner IRM abdominale L outil systeme de Bosniak 1986 1997 v2 BOSNIAK MA The current radiologic approach to renal cysts Radiology 1986 La classification TDM de Morton Bosniak 1 Il Ill IV BOSNIAK MA Diagnosis and management of patients with complicated cystic lesions of the kidney AJR 1997 Introduction de la cat gorie IIF Follow up Certains criteres tres subjectifs Litterature parfois discordante Variabilite inter observateurs Ne resout pas ttes les situations rencontrees The Bosniak Renal Cyst Classification 25 Years Later Radiology March 2012 e past 25 years there have been continuous advances in the diagnosis of disease throughout the body owing to ie introduction of new technology and the experience ined with its use However the imaging and evaluation complicated cystic lesions o k remains a difficult problem The classification of rena tic lesions suggested 25 years ago now referred to as the ion remai rti RadioGraphics 2008 EDUCATION EXHIBIT F Pitfalls in Renal Mass Evaluation and How to Avoid Them Gary M Israel MD Morton A Bosniak MD Bosniak Category IIF and Ill Cystic Renal Lesions Outcomes and Associations Radiology January 2012 5 z E E CME FEATURE Andrew D
5. Smith MD 2 G ee i urpose o evaluate cl n cal outcomes pathologic subtypes met Erick M Remer MD aes ae yi astatic disease rate and clinica features associated witl f f malignancy in Bosniak category IIF and Ill cystic ren Michael L Lieber MS lesions Tumeurs kystiques cat IIF Ill et IV e Carcinome conventionnel 80 CCR Formes kystiques 25 Uni ou multiloculaire e Carcinome kystique multiloculaire a c claires e Carcinome papillaire 15 CCR Forme pseudokystiques unilocul 30 e Nephrome kystique lt 1 Tumeur benigne multiloculaire Paroi fibreuse epith aplati A r h raed Pr d gt E Simple ou remani infection h morragie Kis Cortical ou m dullaire Lymphangiectasie Origine parenchymateuse e Masses supracm origine epitheliale nephron Lesions d origine urotheliale diverticule Origine infectieuse et parasitaire abces chronique Contexte urologique aigu h morragie traumatisme RR kystique localis e Evenement LEP lt Dystrophie kystique localisee Ne pas classer Mais surveiller Lesion kystique non encapsulee S approprier et maitriser The Bosniak Renal Cyst Classification System des criteres reproductibles Category Criteria and Management ategor IF fen F indicates need tor follow up Trfaging lesions are more complex cysts that cannot be neatly clas sified as categor
6. ategory these lesions are generally well marginated they are thought to be benign but need follow up to prove their benignity by showing stability 46 Cystic masses with thickened irreqular or smooth walls or septa and in which measurable enhancement is present these masses need surgical intervention in most cases as neoplasm cannot be excluded this category includes enhancine nieh attenuation lesions OTS complicated hemorrhagic or infected cysts multilocular cystic nephroma and attenuation cy sts that are completely in cystic neoplasms these lesions need histologic diagnosis as even gross arenal and gt observation by the urologist at surgery or the pathologist at gross pathologic Zn Quantifying the be of the septa ag evaluation is frequently indeterminate Category wall that would place a lesion in category IF Clearly malignant cystic masses that can have all of the criteria of category Ill burt masses and is also not possible However any thickness To also contain distinct enhancing soft tissue components independent of the wall ae s er or septa these masses are clearly malignant and need to be removed nign or mal thin would upgrade a lesion from category I Perceived enhancement refers to enhancement of hairline thin or minimally thickened walls or irregular we Vo category IF In our series 39 of the 42 le septa that can be visually appreciated when comparing unenhanced and contrast enhanced CT hancement sions contamed e her
7. hirurgicaux I Il et IIF Scanner coupes lt 3mm et phase nephrogr Efficacit n 116 n 42 et CAT Cat et Il 100 benin STOP Cat IIF 5 malin CCR Suivi 5A Cat Ill 50 60 malin CCR Chirurgie Cat IV 100 malin CCR Chirurgie CURRY N Cystic renal masses accurate Bosniak classification requires adequat renal CT AJR 2000 ISRAEL GM BOSNIAK MA Follow up CT of moderately complex cystic lesions of the kidney Bosniak category IIF AJR 2003 Type Echogr diagnostique dans la majorite des cas ae ie simples Parol non Visible Signal hydrique lt 15UH Variation pre post AUH lt 10UH Type ll Type Il hyperdense Kyste finement cloisonn aval Type D gt 50UH Kyste finement calcifie Petit kyste hyperdense sscapsulaire Hemorragie ancienne gt Riche en prot ines lt Lait gt calcique ver 1 Cloisons nombreuses hairline thin gt gt 2 Paroi visible millimetrique non mesurable Rehaussement faible perceptible ku vr 1 Epaisse calcification sans rehaussement Kystes hyperdenses gros gt 3cm ou intraparenchymateux Type Ill Uniloculaire Paroi paisse r guli re Rehaussement Type III Multiloculaire Paroi epaisse et cloisons Rehaussement multiloculaire Rehaussement IRM Cat III multiloc Chir prevue Votre avis et attitude
8. obulles D IRM T1 T2 Diff Gd dynamique fatsat Les masses kystiques inclassables et mal classees par CT Indications de l cho cibl e et de l IRM Microlesion infraCM terrain risque s Variation D ind termin e A 10 20UH Densit spontan e ind termin e 20 50UH s Paroi paisse rehaussement n gatif Masse de type IIF sousclassees Masses de type Ill sousclassees si surv active
9. septum or wall that images side by side and on subtracted MR imaging datasets This enhancement occurs in Category gs slightly thicker than hairline thin Tt is this hairline thin or smooth minimally thickened septa walls and therefore cannot be measured or quantified The authors believe tiny capillaries supply blood and contrast material to these septa walls which are appreciated because of higher doses of intravenous contrast material and ISRAEL GM BOSNIAK MA Follow up CT of moderately complex cystic lesions of the kidney Bosniak category IIF AJR 2003 ISRAEL GM HINDMAN N BOSNIAK MA Evaluation of cystic renal masses comparison of CT and MR imaging by using the Bosniak classification Radiology 2004 ISRAEL GM BOSNIAK MA How I do it Evaluating renal masses Radiology 2005 Outils diagnostiques Les densit s et leurs variations Densit spontan e lt hydrique gt lt 20H 15H et moins Rehaussement n gatif AUH lt 10H positif AUH gt 15H 20H et plus ind ter AUH 10 20H Outils diagnostiques La paroi Normale inframm Non visible interface Epaisse Non mesurable lt 1mm M Mesurable gt 1mm Reguliere et uniforme Irreguliere nodulaire Rehaussement Perceptible vs marque Les calcifications Fines ou paisses R guli re vs irr gul Classification de Bosniak Objectif Separer les lt kystes gt supracm chirurgicaux cat Ill et IV des non c
10. y II or II lesions These cysts may contain an increased number of hairline thin septa or have minimal but smooth thickening of the wall or septa The wall and or septa may contain calcifications which may be thick and Modular WICITOUT OTTS TOOT Like category Il cysts these lesions may demonstrate minimal perceived en hancement of a hairline thin smooth septum or wall however there are no enhancing soft tissue components Non A benign simple cyst with a hairline thin wall that does not contain septa calcifications or solid components It has water attenuation and does not enhance no intervention is needed A Denon cysoe lesen dt Pay Conta a lew Ia e II septa IM weten perceived not measurable enhancement may be appreciated fine calcification or a short segment of slightly thickened calcification may be present in the wall or septa uniformly high attenuating lesions lt 3 cm that are sharply marginated and do not enhance are included in this group no intervention is peeded Cysts may contain multiple hairline thin septa perceived not measurable enhancement of a hairline thin smooth septum or wall can be identified there may be minimal thickening of wall or septa which may contain calcification That may De Mick and nodular OUT no Measurable Contrast enhancement IS present 45 there are no enhancing soft tissue components totally intrarenal nonenhancing high attenuating renal lesions gt 3 cm are also included in this c
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