Apparent Diffusion Coefficient Value of Diffusion-Weighted Imaging for Hepatocellular Carcinoma: Correlation with the Histologic Differentiation and the Expression of Vascular Endothelial Growth Factor

허숙희,정용연,신상수,김진웅,임효순,이재혁,고양석,조철균,강형근 대한영상의학회 2010 Korean Journal of Radiology Vol.11 No.3

Objective: To evaluate whether the histopathological differentiation and the expression of vascular endothelial growth factor (VEGF) of hepatocellular carcinoma (HCC) do show correlation with the apparent diffusion coefficient (ADC) value on diffusion-weighted imaging (DWI). Materials and Methods: Twenty-seven HCCs from 27 patients who had undergone preoperative liver MRI (1.5T) and surgical resection were retrospectively reviewed. DWI was obtained with a single-shot, echo-planar imaging sequence in the axial plane (b values: 0 and 1,000 sec/mm2). On DWIs, the ADC value of the HCCs was measured by one radiologist, who was kept ‘blinded’ to the histological findings. Histopathologically, the differentiation was classified into well (n = 9), moderate (n = 9) and poor (n = 9). The expression of VEGF was semiquantitatively graded as grade 0 (n = 8), grade 1 (n = 9) and grade 2 (n = 10). We analyzed whether the histopathological differentiation and the expression of VEGF of the HCC showed correlation with the ADC value on DWI. Results: The mean ADC value of the poorly-differentiated HCCs (0.9 ± 0.13× 10-3 mm2/s) was lower than those of the well-differentiated HCCs (1.2 ± 0.22× 10-3 mm2/s) (p = 0.031) and moderately-differentiated HCCs (1.1 ± 0.01×10-3 mm2/s) (p = 0.013). There was a significant correlation between the differentiation and the ADC value of the HCCs (r = -0.51, p = 0.012). The mean ADC of the HCCs with a VEGF expression grade of 0, 1 and 2 was 1.1 ± 0.17, 1.1 ± 0.21 and 1.1 ± 0.18×10-3 mm2/s, respectively. The VEGF expression did not show correlation with the ADC value of the HCCs (r = 0.07, p = 0.74). Conclusion: The histopathological differentiation of HCC shows inverse correlation with the ADC value. Therefore, DWI with ADC measurement may be a valuable tool for noninvasively predicting the differentiation of HCC. Objective: To evaluate whether the histopathological differentiation and the expression of vascular endothelial growth factor (VEGF) of hepatocellular carcinoma (HCC) do show correlation with the apparent diffusion coefficient (ADC) value on diffusion-weighted imaging (DWI). Materials and Methods: Twenty-seven HCCs from 27 patients who had undergone preoperative liver MRI (1.5T) and surgical resection were retrospectively reviewed. DWI was obtained with a single-shot, echo-planar imaging sequence in the axial plane (b values: 0 and 1,000 sec/mm2). On DWIs, the ADC value of the HCCs was measured by one radiologist, who was kept ‘blinded’ to the histological findings. Histopathologically, the differentiation was classified into well (n = 9), moderate (n = 9) and poor (n = 9). The expression of VEGF was semiquantitatively graded as grade 0 (n = 8), grade 1 (n = 9) and grade 2 (n = 10). We analyzed whether the histopathological differentiation and the expression of VEGF of the HCC showed correlation with the ADC value on DWI. Results: The mean ADC value of the poorly-differentiated HCCs (0.9 ± 0.13× 10-3 mm2/s) was lower than those of the well-differentiated HCCs (1.2 ± 0.22× 10-3 mm2/s) (p = 0.031) and moderately-differentiated HCCs (1.1 ± 0.01×10-3 mm2/s) (p = 0.013). There was a significant correlation between the differentiation and the ADC value of the HCCs (r = -0.51, p = 0.012). The mean ADC of the HCCs with a VEGF expression grade of 0, 1 and 2 was 1.1 ± 0.17, 1.1 ± 0.21 and 1.1 ± 0.18×10-3 mm2/s, respectively. The VEGF expression did not show correlation with the ADC value of the HCCs (r = 0.07, p = 0.74). Conclusion: The histopathological differentiation of HCC shows inverse correlation with the ADC value. Therefore, DWI with ADC measurement may be a valuable tool for noninvasively predicting the differentiation of HCC.

난소 낭성 종양에서 확산강조 자기공명영상을 이용한 현성 확산계수의 유용성

허숙희,정용연,송상국,김진웅,서정진,김형중,정광우,박진균,강형근 대한영상의학회 2005 대한영상의학회지 Vol.52 No.3

Purpose: To evaluate the usefulness of apparent diffusion coefficient (ADC) values using diffusion-weighted magnetic resonance imaging (DWI) in patients with ovarian cystic tumors. Materials and Methods: During past 12 months, we studied 30 patients who were clinically suspected of having ovarian cystic tumors and who underwent DWI using a 1.5 T MR unit. Eight patients with small cystic ovarian lesions of less than 3 cm in diameter and insufficient DWI were excluded from the calculation of the ADC values. The remaining twenty-six cystic ovarian lesions in 22 patients were classified into four groups; ovarian cysts, cystadenomas, other benign tumors, and malignant tumors. DWI was obtained using single-shot spin echo planar imaging and two gradient steps (b values of 0, 800 sec/mm2). The ADC values were measured using regions-of-interest (ROI) in the cystic components of the DWI located in the same section as the T2- weighted image and away from the septation and solid components. Results: The mean ADC values were 0.196±0.105×10-3 mm2/sec in the ovarian cysts, 1.312±1.064×10-3 mm2/sec in the cystadenomas, 0.274±0.124×10-3 mm2/sec in the other benign tumors, and 1.011±0.080×10-3 mm2/sec in the malignant tumors. The differences in the ADC values between the ovarian cysts and cystadenomas, the ovarian cysts and malignant tumors, the cystadenomas and other benign tumors, and the other benign tumors and malignant tumors were statistically significant (p < 0.01). There was no statistically significant difference in the ADC values between the ovarian cysts and other benign tumors, or between the cystadenomas and malignant tumors (p > 0.05). Conclusion: The calculated ADC values using DWI should be helpful in the differential diagnosis of cystic ovarian tumors. 목적: 난소의 낭성 병변에서 확산강조 자기공명영상의 현성 확산계수 값을 구하고 유용성을 알아보고자 하였다. 대상과 방법: 최근 1년간 난소 종양이 의심되어 1.5 T MR 기기를 사용하여 확산 강조 영상을 얻은 30명 중에서, 낭성 병변의 직경이 3 cm이하로 작은 경우와 신호강도가 너무 적어 적절한 확산 강조 영상을 얻지 못해 현성 확산계수 값을 측정할 수 없었던 8명을 제외하였다. 난소 병변은 22명의 환자에서 총 26예로 낭종, 낭선종, 낭선종을 제외한 기타 양성 종양 및 악성 종양의 네 군으로 분류하였다. 확산 강조 영상은 single-shot echo planar imaging기법으로 확산 강조 경사 자기의 세기 b0와 b1을 각각 0 sec/mm2와 800 sec/mm2로 하여 얻었다. 현성 확산계수 값은 T2 강조 영상에서 종양의 낭성 병변을 확인한 후, 동일한 횡단면의 확산 강조 영상에서 관심 영역을 25 pixel로 정하고 격막이나 고형 성분을 피해 5회 측정하여 평균값을 구하였다. 결과: 현성 확산계수 값의 평균은 낭종, 낭선종, 기타 양성 종양, 악성 종양이 각각 0.196± 0.105×10-3 mm2/sec, 1.312±1.064×10-3 mm2/sec, 0.274±0.124×10-3 mm2/sec, 1.011± 1.080×10-3 mm2/sec이었다. 현성 확산계수 값은 낭종과 낭선종, 낭종과 악성 종양, 낭선종과 기타 양성 종양 상호간에 유의한 차이가 있었다(p<0.01). 그리고 기타 양성 종양과 악성 종양 간의 현성 확산계수 값의 상호간에 유의한 차이가 있었다(p<0.01). 그러나 낭종과 기타양성 종양, 낭선종과 악성 종양의 각각의 현성 확산계수 값은 상호간의 차이가 유의하지 않았다(p>0.05). 결론: 난소 종양의 낭성 병변에서 확산강조 자기공명영상을 이용하여 측정한 현성 확산계수 값은 난소종양의 감별진단에 도움을 줄 수 있을 것으로 생각된다.

Pre-Treatment Diffusion-Weighted MR Imaging for Predicting Tumor Recurrence in Uterine Cervical Cancer Treated with Concurrent Chemoradiation: Value of Histogram Analysis of Apparent Diffusion Coefficients

허숙희,신상수,김진웅,임효순,정용연,강우대,김석모,강형근 대한영상의학회 2013 Korean Journal of Radiology Vol.14 No.4

Objective: To evaluate the value of apparent diffusion coefficient (ADC) histogram analysis for predicting tumor recurrence in patients with uterine cervical cancer treated with chemoradiation therapy (CRT). Materials and Methods: Our institutional review board approved this retrospective study and waived informed consent from each patient. Forty-two patients (mean age, 56 ± 14 years) with biopsy-proven uterine cervical squamous cell carcinoma who underwent both pre-treatment pelvic magnetic resonance imaging with a 3.0 T magnetic resonance scanner and concurrent CRT were included. All patients were followed-up for more than 6 months (mean, 36.4 ± 11.9 months; range 9.0-52.8 months) after completion of CRT. Baseline ADC parameters (mean ADC, 25th percentile, 50th percentile, and 75th percentile ADC values) of tumors were calculated and compared between the recurrence and no recurrence groups. Results: In the recurrence group, the mean ADC and 75th percentile ADC values of tumors were significantly higher than those of the no recurrence group (p = 0.043 and p = 0.008, respectively). In multivariate analysis, the 75th percentile ADC value of tumors was a significant predictor for tumor recurrence (p = 0.009; hazard ratio, 1.319). When the cut-off value of the 75th percentile ADC (0.936 x 10-3 mm2/sec) was used, the overall recurrence free survival rate above the cut-off value was significantly lower than that below the cut-off value (51.9% vs. 91.7%, p = 0.003, log-rank test). Conclusion: Pre-CRT ADC histogram analysis may serve as a biomarker for predicting tumor recurrence in patients with uterine cervical cancer treated with CRT.

신경베체트병의 확산강조 자기공명영상: 초기 및 추적 검사

허숙희,서정진,김형중,장남규,신상수,정용연,정광우,강형근 대한영상의학회 2005 대한영상의학회지 Vol.53 No.3

목적: 신경베체트병의 진단과 추적 검사에서 확산강조 자기공명영상을 시행하고 현성확산계수 값을 측정하여 이의 유용성에 대해 알아 보고자 한다. 대상과 방법: 신경베체트병으로 진단된 6명을 대상으로 후향적으로 분석하였다. 6명 환자 모두에서 초기 및 추적 자기공명영상을 시행하였고 이중 4명에서 초기 및 추적 확산강조 자기공명영상을 얻었으며 나머지 2명의 환자는 초기 확산강조 자기공명영상을 얻었다. 확산강조 자기공명영상은 1.5 T MR기기를 이용하여 multi-shot echo planar imaging 기법으로 확산강조 경사자계세기(b value) b0와 b1을 각각 0 sec/mm2, 1000 sec/mm2으로하여 획득하였다. 현성확산계수 값과 현성확산계수 지도는 상용화된 software를 이용하여 얻었다. 자기공명영상에서 병변의 위치를 확인하고 확산강조영상에서 병변의 신호강도를 관찰하였다. 초기 확산강조영상에서 병변부위와 정상부위에서 측정한 각각의 현성확산계수 값을 비교하였으며 추적 확산강조영상에서 병변부위의 현성확산계수 값의 변화를 분석하였다. 결과: 초기 확산강조영상에서 6예중 4예에서 등신호강도를, 2예에서 고신호강도를 보였다. 현성확산계수 값은 등신호강도를 보인 4예중 3예와 고신호강도를 보인 2예에서 정상부위와 비교하여 높은 값을 보였으며 이는 통계적으로 유의하였다(p<0.05). 추적 확산강조 자기공명영상을 시행한 4예중 3예에서 현성확산계수 값이 감소하여 정상부위와 비슷한 값을 보였다. 결론: 신경베체트 환자에서 초기 및 추적 검사에서 확산강조영상을 시행하고 현성확산계수 값을 측정함으로써 신경베체트병의 병태 생리를 규명하고 다른 질환과의 감별에 도움을 줄 수 있을 것으로 생각된다. Purpose: To assess the usefulness of diffusion-weighted MR imaging (DWI) and apparent diffusion coefficient (ADC) in the initial and follow-up studies of patients with neuro-Behcet's disease. Materials and Methods: Six patients diagnosed with neuro-Behcet's disease were the subjects of this study. Initial and follow-up MR imaging were obtained in all six patients. Initial and follow-up DWI were also obtained in four of the six patients, with only an initial DWI in the other two. The DWI were obtained using multi-shot echo planar imaging, on a 1.5T MR unit, with two gradient steps (b values of 0, 1000 sec/mm2). The ADC value and ADC maps were obtained using commercial software. The locations and signal intensities of the lesions were analyzed on conventional MRI and DWI, respectively. The ADC values of the lesions were calculated on the initial and follow-up DWI, and compared those of lesions in the normal contralateral regions. Results: The initial DWI showed iso-signal intensities in four of the six patients, with high signal intensities in the other two. In five of the six patients, including three of the four that showed isosignal intensities and the two that showed high signal intensities on the initial DWI, the ADC values of the involved lesions were higher than those of the normal contralateral regions. In three of four that showed isosignal intensities, the ADC values of the lesions were decreased and normalized on the follow-up DWI. Conclusion: Obtaining DWI and ADC values in patients with neuro-Behcet's disease may be helpful in the understanding of pathophysiology and differential diagnosis of this disease.

Solitary Small Hepatic Angiosarcoma: Initial and Follow-up Imaging Findings

허숙희,정용연,신상수,Tae Woong Chung,강형근 대한영상의학회 2007 Korean Journal of Radiology Vol.8 No.2

We report an uncommon case of solitary, small hepatic angiosarcoma that was initially considered as a hemangioma. We present the imaging findings, with an emphasis on the initial and follow-up CT and MR findings, as well as report on the more suggestive findings of angiosarcoma than those of a hemangioma.

가토의 급성 뇌경색에서 관류 및 확산강조 자기공명영상

허숙희,임남열,정광우,윤웅,김윤현,정용연,정태웅,김정,박진균,강형근,서정진,Heo Suk-Hee,Yim Nam-Yeol,Jeong Gwang-Woo,Yoon Woong,Kim Yun-Hyeon,Jeong Young-Yeon,Chung Tae-Woong,Kim Jeong,Park Jin-Gyoon,Kang Heoung-Keun,Seo Jeong-Jin 대한자기공명의과학회 2003 Investigative Magnetic Resonance Imaging Vol.7 No.2

목적 : 가토 모델을 이용한 급성 허혈성 뇌경색에서 확산강조 자기공명영상과 관류자기공명영상의 유용성에 대해 알아보고자 하였다. 대상 및 방법 : 여섯 마리의 순계 가토의 경동맥에 히스토아크릴글루와 리피오돌 및 텅스텐 파우더를 동맥내 주입하여 뇌경색을 유발한 후 1시간 내에 고식적인 T1 및 T2 강조영상, 그리고 확산강조 자기공명영상과 관류자기공명영상을 획득하였다. 관류자기공명영상은 측내실 수준과 대뇌기저핵의 1cm 상방에서 각각 얻었고, 이 영상을 특수 영상 소프트웨어로 후처리하여 뇌혈류 용적 , 뇌혈류양 및 평균 조영제 통과시간을 포함한 관류 영상을 획득하였다. 뇌경색 부위는 각각의 관류 지도와 확산강조 자기공명영상으로 평가하였다. 뇌경색 부위와 반대편 정상 부위에서 조영제 평균 통과시간 차이를 측정하였다. 결과 : 모든 가토에서 T2 강조영상상 비정상 신호강도는 없었으나 확산강조 자기공명영상에서 고신호강도의 뇌경색 병변을 확인할 수 있었다. 상대적 뇌혈류용적, 뇌혈류양 및 평균 조영제 통과시간을 포함한 관류자기공명영상에서 모두 관류 결손을 인지할 수 있었다. 뇌혈류양과 평균 조영제 통과시간 지도에서 관류결손지역으로 나타난 면적의 비교는 6예 중 4예에서 평균 조영제 통과시간 지도가 뇌혈류양 지도보다 면적이 크게 나왔으며, 2예는 같았다. 평균 조영제 통과시간 지도의 관류결손 면적이 뇌혈류양 지도보다 작게 나온 경우는 없었다. 또한 뇌혈류양 지도에서 병변의 면적은 확산강조 자기공명영상에서의 병변의 면적보다 3예에서 넓게 나타났고, 3예에서 같게 나타났다. 평균 조영제 통과시간 지도에서 병변의 면적은 확산강조 자기공명영상에서의 병변의 면적보다 모두 크게 나타났다. 평균 조영제 통과시간 지도에서 병변의 면적이 뇌혈류양 지도에서 병변의 면적보다 크면서 확산강조 자기공명영상에서와 같은 경우가 3예, 뇌혈류양 지도에서 병변의 면적이 확산강조 자기공명영상에서와 같으며 평균 조영제 통과시간 지도에서 병변의 면적보다 작은 경우가 3예, 그리고 평균 조영제 통과시간 지도에서 병변의 면적이 뇌혈류양 지도의 병변의 면적보다 크면서 확산강조 자기공명영상에서의 면적이 가장 적은 경우가 1예 있었다. 결론 : 확산강조 자기공명영상과 관류자기공명영상은 가토에서 초급성 뇌경색을 진단하고 뇌혈류 역학상태를 평가하는데 유용한 기법이라고 생각된다. Purpose : The present study was undertaken to evaluate the usefulness of cerebral diffusion (DWI) and perfusion MR imaging (PWI) in rabbit models with hyperacute cerebral ischemic infarction. Materials and Methods : Experimental cerebral infarction were induced by direct injection of mixture of Histoacryl glue, lipiodol, and tungsten powder into the internal cerebral artery of 6 New-Zealand white rabbits, and they underwent conventional T1 and T2 weighted MR imaging, DWI, and PWI within 1 hour after the occlusion of internal cerebral artery. The PWI scan for each rabbit was obtained at the level of lateral ventricle and 1cm cranial to the basal ganglia. By postprocessing using special imaging software, perfusion images including cerebral blood volume (CBV), cerebral blood flow (CBF), and mean transit time (MTT) maps were obtained. The detection of infarcted lesion were evaluated on both perfusion maps and DWI. MTT difference time were measured in the perfusion defect lesion and symmetric contralateral normal cerebral hemisphere. Results : In all rabbits, there was no abnormal signal intensity on T2WI. But on DWI, abnormal high signal intensity, suggesting cerebral infarction, were detected in all rabbits. PWI (rCBV, CBF and MTT map) also showed perfusion defect in all rabbits. In four rabbits, the calculated square of perfusion defect in MTT map is larger than that of CBF map and in two rabbits, the calculated size of perfusion defect in MTT map and CBF map is same. Any rabbits do not show larger perfusion defect on CBF map than MTT map. In comparison between CBF map and DWI, 3 rabbits show larger square of lesion on CBF map than on DWI. The others shows same square of lesion on both technique. The size of lesion shown in 6 MTT map were larger than DWI. In three cases, the size of lesion shown in CBF map is equal to DWI. But these were smaller than MTT map. The calculated square of lesion in CBF map, equal to that of DWI and smaller than MTT map was three. And in one case, the calculated square of perfusion defect in MTT map was largest, and that of DWI was smallest. Conclusion : DWI and PWI may be useful in diagnosing hyperacute cerebral ischemic infarction and in e-valuating the cerebral hemodynamics in the rabbits.

京畿道岸地域 貝類中의 重金屬含量에 關한 硏究

허숙희,고영수 漢陽大學校 韓國生活科學硏究所 1992 韓國 生活 科學 硏究 Vol.- No.10

本 硏究에서는 경기도 연안지역에 棲息하는 貝類의 중금속오염 실태를 파악하기 위하여 강화, 반월, 소래, 인천의 4個 地域에서 바지락, 꼬막, 동죽, 피조개, 모시조개등 5種의 試料를 採取하여 ICP法으로 카드뮴, 납, 아연, 망간 및 구리의 含量을 測定하여 比較 考察하였다. 그 結果 카드뮴은 0.03∼0.25ppm의 범위였으며, 강화의 꼬막이 0.25ppm으로 가장 높았고 인천과 소래의 모시조개가 0.03ppm으로 가장 낮았다. 납은 0.39∼1.01ppm의 범위였으며, 인천의 동죽이 1.01ppm으로 가장 높았고 소래의 꼬막이 0.39ppm으로 가장 낮았다. 아연은 4.91∼10.54ppm의 범위에 있었고, 인천의 모시조개가 10.54ppm으로 가장 높았고 강화의 꼬막이 4.91ppm으로 가장 낮았다. 망간은 0.89∼13.79ppm의 범위에 있었고 인천의 동죽이 13.79ppm으로 가장 높았고 강화의 바지락이 0.89ppm으로 가장 낮았다. 그리고 구리는 검출되지 않았다. 이상의 結果로 볼 때 이들 조개류의 오염의 정도는 크게 문제시되지 않을 것으로 생각된다. This study was performed to investigate the content of heavy metal in shellfishes. The area of samples collection were In Cheon, Kang Wha, Ban Wol, So Rae in Kyungki coast. The kinds of sample were short necked calm(Tapes philippinarum), ark shell (Anadara granosa bisenesis), surf clam(Mactra veneriformis), chest shell (Anadara broughtonii) and corb shell(Paphia philippinarum). The contents of cadmium, copper, lead, zinc, and manganese are determined by ICP (Plasma Scan 710 Labtest Co). The mean of the heavy metal concentration in shellfishes are as follows : The highest value of cadmium was 0.25 ppm in Anadara granosa bisenesis at Kang Wha, and the lowest value of cadmium was 0.03 ppm in Paphia philippinarum at In Cheon and So Rae. The highest value of lead was 1.01 ppm in Mactra veneriformis at In Cheon, and the lowest value of lead was 0.39 ppm in Anadara granosa bisensis at So Rae. The highest value of zinc was 10.54 ppm in Paphia philippinarum at In Cheon, and the lowest value of zinc was 4.91 ppm Anadara granosa bisenesis at Kang Wha. The highest value of manganese was 13.79 ppm in Martra veneriformis at In Cheon, and the lowest value of mangnese was 0.89 ppm in Tapes philippinarum at Kang Wha, Copper was not detected. According to the results the content of heavy metal of shellfishes in Kyungki coast were agreed with the other data of study in this field.

凋落

허숙희 덕성여자대학 1973 운현 Vol.4 No.1

Hepatic Arterial Phase on Gadoxetic Acid-Enhanced Liver MR Imaging: A Randomized Comparison of 0.5 mL/s and 1 mL/s Injection Rates

김성모,허숙희,김진웅,임효순,신상수,정용연,강형근 대한영상의학회 2014 Korean Journal of Radiology Vol.15 No.5

Objective: To compare gadoxetic acid injection rates of 0.5 mL/s and 1 mL/s for hepatic arterial-phase magnetic resonance (MR) imaging. Materials and Methods: In this prospective study, 101 consecutive patients with suspected focal liver lesions were included and randomly divided into two groups. Each group underwent dynamic liver MR imaging using a 3.0-T scanner after an intravenous injection of gadoxetic acid at rates of either 0.5 mL/s (n = 50) or 1 mL/s (n = 51). Arterial phase images were analyzed after blinding the injection rates. The signal-to-noise ratios (SNRs) of the liver, aorta, portal vein, hepatic vein, spleen, and pancreas were measured. The contrast-to-noise ratios (CNRs) of the hepatocellular carcinomas (HCC) were calculated. Finally, two experienced radiologists were independently asked to identify, if any, HCCs in the liver on the images and score the image quality in terms of the presence of artifacts and the proper enhancement of the liver, aorta, portal vein, hepatic vein, hepatic artery, spleen, pancreas, and kidney. Results: The SNRs were not significantly different between the groups (p = 0.233–0.965). The CNRs of the HCCs were not significantly different (p = 0.597). The sensitivity for HCC detection and the image quality scores were not significantly different between the two injection rates (p = 0.082–1.000). Conclusion: Image quality and sensitivity for hepatic HCCs of arterial-phase gadoxetic acid-enhanced MR were not significantly improved by reducing the contrast injection rate to 0.5 mL/s compared with 1 mL/s.

신장 낭성 종괴의 영상 진단 및 관리: 2019년 Bosniak Classification 개정안 소개

나유경,허숙희,신상수,정용연 대한영상의학회 2019 대한영상의학회지 Vol.80 No.6

Cystic renal masses are commonly encountered in daily clinical practice. Improvements in the resolution of imaging modalities have led to an improved ability to detect cystic renal masses. It is important for radiologists to recognize and appropriately characterize cystic renal masses. Since 1986, the Bosniak classification system has been widely accepted for the evaluation of cystic renal masses, portions of which have been revised in 2019. Although the Bosniak classification system cannot fully differentiate aggressive lesions from indolent lesions, the system may help improve the specificity of detection for higher-risk classes for malignancy, increase the proportion of masses that are surveilled or ignored rather than resected, and select optimal management strategies. 낭성 신장 종괴는 영상 검사의 빈도와 해상도의 증가로 인해 일상적인 임상 상황에서 흔하게발견된다. 따라서 영상의학과 의사는 낭성 신장 종괴를 잘 인지하고 적절하게 분석하여 악성도의 위험을 예측할 수 있어야 한다. 1986년 이래로 낭성 신장 종괴의 평가에는 전 세계적으로 Bosniak 분류 시스템이 널리 이용되어 왔으며 일부 내용이 2019년에 개정되었다. Bosniak 분류는 병변의 공격성을 예측하기는 어렵지만, 악성 위험을 계층화하여 수술적 제거보다는 추가 검사가 필요 없거나 추적 관찰로도 충분한 종괴의 진단을 늘리고, 또한 적절한 치료방침을 선택하는데 도움을 준다.