T1 Hyperintense Cystic Renal Masses in Bosniak v.2019: MR Subtraction Imaging for Enhancing Interobserver Agreement and Diagnostic Performance

Motivation: T1 hyperintensity can affect the assessment of cystic renal masses (CRMs), and MR subtraction imaging may be helpful. Goal(s): To investigate whether MR subtraction imaging can improve interobserver agreement and diagnostic performance in evaluating T1 hyperintense CRMs. Approach: A single-center retrospective study. Results: The over interobserver agreement substantially improved with subtraction (weighted Κ = 0.62 vs 0.48, P = .004). Higher interobserver agreement (weighted Κ = 0.61 vs 0.44, P = .002) and diagnostic performance (sensitivity, 86.7% vs 77.8%, P = .002; specificity, 84.3% vs 74.5%, P = .004; AUC, 0.855 vs 0.761, P = .017) were noted for junior radiologist with subtraction. Impact: MR subtraction imaging proves to be a valuable adjunct tool in evaluating T1 hyperintense CRMs, particularly for less experienced readers. This may enhance more consistent application of the Bosniak v.2019 and optimize patient clinical decisions.