Renal Mass Imaging Modalities: Does Body Mass Index (BMI) Matter?

In this supplementary commentary, we aim to expand upon the insights to provide further insight to the manuscript titled: Renal mass imaging modalities: does body mass index (BMI) matter? This manuscript showed that there was variability within imaging modality to accurately assess renal mass size in the setting of BMI.

Although BMI is not the best predictor of body habitus, especially in overly muscular with minimal body fat, it does quantify better than using weight or height alone. The distribution of fat between self-reported males and females can also be a confounder using this method. The extent and the density of retroperitoneal fat can differ in patients which can affect the measurements in all imaging modalities. Initially, we hypothesized that MRI would be the best predictor of mass size, however, there appear to be differences across the varying BMI. Most interestingly, CT with contrast, which is the gold standard to determine malignancy in the kidneys, had the worst predictor especially in BMI 3 and BMI 4 groups, overestimating approximately by 4mm. Overall, we predict that the use of CT to determine renal malignancy will stay the mainstay, however, caution should be used for those who are undergoing active surveillance. A consistent use of imaging modality should be used on those patients as each imaging modality has been shown to be variable with MRI overpredicting while ultrasound underpredicting respectively. As our sample population included a specific region, a component of inter-variability must be considered. As more personnel become involved in interpreting the radiological or pathological sample, the accuracy of the true difference is difficult to predict. Future studies including a national sample with randomized radiologist technologists, radiologists, and pathologists may have the greatest power, however, it may not be feasible. Overall, the study does show that there is disparity in estimated size with respect to BMI and caution should be used for those looking for accurate approximations.

Written by: Young Son,¹ Mark E Quiring,² Raeann M Dalton,³ Brian Thomas,³ Noah Davidson,⁴ Dayna DeVincentz,⁵ Collin Payne,⁶ Sahil H Parikh,³ Benjamin A Fink,³ Thomas Mueller,¹ Gordon Brown¹

Department of Urology, Jefferson Health New Jersey, Stratford, NJ
Texas College of Osteopathic Medicine, University of North Texas Health Science Center, Fort Worth, TX
School of Osteopathic Medicine, Rowan University, Stratford, NJ
Lake Erie College of Osteopathic Medicine, Erie, PA
College of Science and Mathematics, Rowan University, Glassboro, NJ
College of Osteopathic Medicine, Nova Southeastern University, Tampa Bay, FL

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