Validation of the updated Bosniak classification (2019) in pathologically confirmed CT-categorised cysts.

INTRODUCTION: The updated Bosniak classification in 2019 (v2019) addresses vague imaging terms and revises the criteria with the intent to categorise a higher proportion of cysts in lower-risk groups and reduce benign cyst resections. The aim of the present study was to compare the diagnostic accuracy and inter-observer agreement rate of the original (v2005) and updated classifications (v2019). METHOD: Resected/biopsied cysts were categorised according to Bosniak classifications (v2005 and v2019) and the diagnostic accuracy was assessed with reference to histopathological analysis. The inter-observer agreement of v2005 and v2019 was determined. RESULTS: The malignancy rate of the cohort was 83.6% (51/61). Using v2019, a higher proportion of malignant cysts were categorised as Bosniak ≥ III (88.2% vs 84.3%) and a significantly higher percentage were categorised as Bosniak IV (68.9% vs 47.1%; p = 0.049) in comparison to v2005. v2019 would have resulted in less benign cyst resections (13.5% vs 15.7%). Calcified versus non-calcified cysts had lower rates of malignancy (57.1% vs 91.5%; RR,0.62; p = 0.002). The inter-observer agreement of v2005 was higher than that of v2019 (kappa, 0.70 vs kappa, 0.43). DISCUSSION: The updated classification improves the categorisation of malignant cysts and reduces benign cyst resection. The low inter-observer agreement remains a challenge to the updated classification system.

Representation of visual numerosity information during working memory in humans: An fMRI decoding study.

Both animal and human studies on numerosity have shown the importance of the parietal cortex for numerosity processing. However, most studies have focused on the perceptual processing of numerosity. Still, it is unclear how and where numerosity information is coded when this information is retained during a working memory delay phase. Such temporal storage could be realized by the same structures as perceptual processes, or be transformed to a more abstract representation, potentially involving prefrontal regions. FMRI decoding studies allow the identification of brain areas that exhibit multi-voxel activation patterns specific to the content of working memory. Here, we used an assumption-free searchlight-decoding approach to test where numerosity-specific codes can be found during a 12 s retention period. Participants (n = 24) performed a retro-cue delayed match-to-sample task, in which numerosity information was presented as visual dot arrays. We found mnemonic numerosity-specific activation in the right lateral portion of the intraparietal sulcus; an area well-known for perceptual processing of numerosity. The applied retro-cue design dissociated working memory delay activity from perceptual processes and showed that the intraparietal sulcus also maintained working memory representation independent of perception.