Role of the DWI and ADC value in complex renal cystic masses (Bosniak III and IV)

Kadhim, Mohammed Abd; Ahmed, Furqan Sabeeh

doi:10.52573/ipmj.2025.156148

	Role of the DWI and ADC value in complex renal cystic masses (Bosniak III and IV)
Iraqi Postgraduate Medical Journal
Volume 25, Issue 2, April 2026, Pages 168-174 PDF (3.66 M)
Document Type: Research Paper
DOI: 10.52573/ipmj.2025.156148
Authors
Mohammed Abd kadhim^* ¹; furqan sabeeh ahmed²
¹Iraqi board of medical specilization/ Medical collage/ Al-Nahrain &lrm;University.&lrm; Baghdad- Iraq&lrm;
²Radiology, Al-Imamian Al-Kadhimyian Medical City, Baghdad, Iraq.
Abstract
Background: Cystic renal masses are commonly encountered in clinical practice. Objective: To study the value of diffusion-weighted magnetic resonance imaging (DW-MRI) and ADC value for distinguishing benign and malignant complex renal cystic masses (Bosniak III and IV). Patients and methods: the study included 30 patients with complex renal cystic masses identified by computed tomography (CT) and ultrasound (U/S). there was 18 females and 12 males. The study was conducted in Al-Imamain Al-Kadhmain Medical City/ Baghdad from December 2022 to October 2023. The DWI and ADC were correlated with the histological finding (all patients have a histopathological diagnosis by surgical resection). Results: the patients’ ages ranged from (20-75) years, with mean±SD 56.87±7.07. Most malignant renal cystic masses show restricted diffusion and there was a significant relationship between diffusion restriction and diagnosis of malignant lesions P-value of 0.035. Most of Bosniak category IV were malignant (84.6%) in comparison to Bosniak category III where almost half of the cases (58.8%) were malignant. The ADC value for benign lesions ranged between (0.840–2.510 x10-3mm2/s) and for malignant lesions was (0.530–1.280 x10-3mm2/s) with stastically significant difference (P-value <0.001). The best ADC Cut off - value derived from the analysis was (0.925) with sensitivity and specificity of (88.89% and 90.48%) respectively (lower values were more indicative of malignancy, whereas values above this cut off value, suggested benign lesions). Conclusion: DWI MRI is highly sensitive and specific for the detection of malignant renal cystic masses. Most malignant renal cystic masses show restricted diffusion and lower ADC value of enhancing septa and solid nodules compared to benign cystic masses. The best cut-off point for ADC value to differentiate malignant from benign renal cystic masses was (0.925) with sensitivity and specificity of (88.89% and 90.48%) respectively. Keywords: complex renal cystic mass, Bosniak, Diffusion weighted magnetic imaging (DWI), ADC.
Keywords
complex renal cystic mass; Bosniak; Diffusion weighted magnetic imaging (DWI); ADC

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