Renal Clear Cell Likelihood Score (ccLS)

Used in prediction of likelihood of clear cell renal cell carcinoma, the most common renal cancer

ccLS
Does the lesion have macroscopic fat**?
** If a small amount of macroscopic fat is suspected (which may not be considered sufficient to confidently diagnose AML), exclude that portion of the lesion from the assessment on the remaining questions.
How much of the lesion shows enhancement?

This lesion is favored to be an angiomyolipoma (AML) and therefore is not eligible for ccLS.

This lesion is considered a cystic mass and is not eligible for ccLS algorithm. Instead, it should be evaluated using the Bosniak classification.

 

MRI-based Bosniak Classification:

What is the scan's protocol?
Which one best describes the lesion?
Does the lesion have any of the following features?
Does the lesion have any enhancing nodule(s)*?
*Enhancing Nodule: ≥4 mm convex protrusion with obtuse margins, or a convex protrusion of any size that has acute margins
What kind of septa does the lesion have?
How are the lesion's walls?
Is the lesion nonenhancing and heterogenously hyperintense at T1w fat sat imaging?
Is the lesion's intensity homogenous and similar to CSF on T2w imaging?
Does the lesion have any calcifications?

Bosniak classification does not apply to this lesion.

Recommendation: Renal mass CT or MRI

Bosniak classification does not apply to renal masses.

Bosniak II

Recommendation: No follow-up is needed

Bosniak IV

Recommendation: Urology consult

Bosniak III

Recommendation: Urology Consult

Bosniak II

Recommendation: No follow-up

Bosniak IIF

Recommendation: Re-image every six months twice, then every one year for four times (total follow-up of 5 years)

Bosniak I

Recommendation:
No follow-up
How is the lesion's T2 signal intensity compared to cortex?
How is the lesion's enhancement during the corticomedullary compared to the cortex?

Enhancement

%
%

%
Does the lesion have microscopic fat?

Microscopic fat

This lesion has microscopic fat.
This lesion does not have unequivocal microscopic fat.

Calculated score is ccLS 1

Calculated score is ccLS 3

Calculated score is ccLS 3

What is the arterial-to-delayed enhancement ratio (ADER§)?
§ ADER = the difference between signal intensity in the corticomedullary phase and precontrast images and divided that difference by the difference in signal intensity on delayed phase and precontrast images
Is the lesion homogeneous and/or shows marked restriction on DWI?

Calculated score is ccLS 2

Calculated score is ccLS 2

Calculated score is ccLS 4

Is Segmental Enhancement Inversion (SEI) present?

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